This was our second trip to Boudon today. The drive seemed shorter this time. The village feels to rural and so isolated even though you can see the not-so-modern urban sprawl of Port-au-Prince just about 20 or so miles away, as the crow flies. Yet, this village is so remote and might as well be in the isolated interior of Africa.
Today, though, we couldn't see Port-au-Prince. We were high up in the clouds all day covered in a mist with only short periods of sunshine that showered my sun-burned skin with painful radiation to the point that I felt like hiding under one of the very few trees in this grassy step into the mountain side.
This was clearly an inclimate day for the villagers sine they were all bundled up until late in the afternoon, shivering and collectively complaining of the cold. To us, however, it was the most comfortable weather so far.
We weren't expecting to see too many people, or at least as many as we had in Boudon yesterday, but actually ended up see about twice as many. Some were very sick.
First was a young girl,maybe about 10 whose eyes were not just blood shot but the sclera was in fact completely red. I didn't treat or examine this girl, that was Darla, I just took her vitals. She had been trampled yesterday in a mass panic that really speaks to the terror that is just beneath the surface of every Haitian's psyche following the January 2010 earthquake.
I first caught word of this incident yesterday. I'm amazed by how fast rumours spread through such a remote area. While seeing patients yesterday, one woman I was getting medical history from became very distracted as I heard wales echoing throughout the vast mountain side. She didn't yet know what had happened but somehow knew something was bad.
I asked on of the interpreters and he told me that the villagers were frantic about a school that had collapsed an killed everyone inside. The hysteria was growing rapidly since this was a school that many parents in the area trucked their kids off to and I knew that the only thing we could do was get some reliable information instead of the unreliable mountain "corry" or an exaggerated rumour that is so common a phenomena that even Haitians have a creole name for it.
I asked Dr. Sorg to make a phone call to the mission to find out what really happened. Rob Baker, while driving back from dropping our team off in Boudon, had actually witnessed the event. He saw kids and parents scurrying out of a school carrying children who appeared injured. What had happened is two very big water trucks involved in the road construction had passed by the school and made the whole two-story brick and mortar building shake causing the kids to run for the exits with the bigger kids trampling the smaller ones in the stair way and in the bottle neck while going out the door. There was no real damage to the building, but, as a result, over 20 kids were treated and released from the Fermathe Mission Hospital with concussions and soft-tissue injuries. This girl with the bright red sclera was one of those who was trampled. She'll be ok according to our doctors, but she did take a beating.
Second was a young woman who had just recently had a c-section in which her baby had died. She was at home near Boudon and was too sick to go to the distant Fermathe hospital. She was number 75 in line to see the doctor and we were on number 39. Her husband walked her to the front of the line. We were short one interpreter today, so I was on my own doing crowd control with Abby taking vitals while the ever increasing crowd of people became a vocally perturbed by the apparent crowding in line.
I advised the husband that she'd have to wait in line, completely unaware of her medical issues as we had yet to even begin her intake. When he got upset with me I called an interpreter over who was doing another job to help me. He explained that this was a prior arrangement from yesterday and assured me that this had been cleared with Dr. Sorg, who was a couple hundred feet away in a tarp covered shack treating patients. I allowed the man to then take his wife to see the doctor and Abby kept her head down (wisely) while the crowd grew upset now with me. They were pointing their fingers at me and scowling at me. I got a very uneasy feeling and asked a couple interpreters to explain to the restless crown why she was permitted to skip ahead in line. The interpreters all shrugged at my predicament and made it clear that they didn't want to deal with the angry crowd either.
I appealed to Johnny, Darla's interpreter for the day, who seemed inpatient wit my silly request and ran up to the crown and asked them collectively if they were upset with me (the apparent equivalent to "you gotta problem? Good!") And every one smiled and said no. The second Johnny disappeared from view, the scowls began again and I again started to get that uneasy "oh crap" feeling paramedics who work in urban areas know well. I returned to the treatment shack and stressed to Dr. Sorg that I felt we were reaching a critical mass and someone needed to finally explain to everyone why this woman was allowed to go in front.
Dr. Sorg returned to the crowd and apparently realised the direction the mood was heading and implored one of the interpreters, I forget which, to explain the circumstances. The collective tempers cooled and everyone was left smiling. I was left scratching my head, but didn't have the time to process it before our next serious patient was thrust into the mix.
A tiny 28 year old girl sat down at our triage table out in the drizzle and rain. Her pulse was thready and fast. Her blood pressure was critically low. She was 5 months pregnant, hadn't eaten or had anything to drink for some time, possibly due to chronic nausea.
In a country where infant mortality rate is already higher than anywhere else in the Western Hemisphere, I considered my resources, which are few, we had to be slightly more aggressive in treating this patient. I had an interpreter explain to her that she was very sick (which she already knew) and that the abdominal cramps, dizziness and near syncope was indicative of need of some "special medicine". I carried her down the hill (she weighed MATBE 90 pounds) to our temporary pharmacy and started an IV. With 1 litre of Normal saline, almost all of her complaints were resolved except that she kept saying that she still wouldn't be able to eat because her throat was sore. We gave her some antibiotics, ranitidine and prenatal vitamins and I sought out so family to explain that she needed as much nourishment that they could muster to keep her and the baby alive.
After these, every other experience today seems mundane. The mist is lower in the valley now and I can actually feel it coming in my open window. I'll leave it open. I think its helping my dust-plaqued lungs.
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