First real workday at Leogane Hospital
A few procedures were added to our day’s schedule, including an urgent C-section for a pre-eclampsia indication that gave birth to a set of twins, we also performed numerous wound debridements and about a dozen conservative fracture treatments. Almost all injuries were open wounds or fractures dating from the earthquake. Some injuries were already been taken care of in urgency, but sometimes in an inappropriate manner, which resulted in the need for secondary treatment or even surgery.
The day in the OR started around 8:00 am and usually ended between 6:00 and 7:00 pm. We made our round of hopsitalized patients around 7:00 pm, and after having solved the daily issues, we planned the procedures scheduled for the next day. Our day ended with dinner in the company of all the other residents in the camp around 8:00–10:00 pm. Nighttime gatherings were privileged moments, because they not only gave us a chance to unwind and relax, but they also gave us the opportunity to organize the following day and spend some time exchanging our stories of the day with the ones that spent it outside of the hospital (mobile clinics, distribution teams, expeditions and teams giving help to the population on the field).
We had about 10 vehicles. We were under a tight surveillance when we needed to leave the hospital, because there were risks for us to be mugged, kidnapped...
It’s easy to assess the workload and conditions under which we had to work. Even though we had all the supplies needed for basic surgery, we were missing simple things like cast’s saws, power tools for external fixators, staplers for skin grafts, etc... There were no x-ray unit, and the only facility available with one was located at a 10-minute car ride in the Canadian military hospital just outside Leogane.
We treated about 30 cases per day in our surgical ward. The simplest cases (debridements, casts, tractions and wound dressing changes) were performed on exam tables in the middle of the ward. The more complex cases, in need of a "sterile" environment, were handled inside the OR, separated from the surgical ward by a tarp and equipped with a surgical table and basic anesthetic supplies. Most anesthesia were induced by epidural or use of Ketamin for most of our "general anesthesia".
The simple organization of the surgical ward allowed two surgeons to go from one table to another to perform our respective procedures. Five Haitian nurses and two MSF OT scrub-nurses assisted us. Extra helpers were in charge of bringing the patients to the OR and cleaning the tables after each procedure.
This first day has set the tone for my mission, and I realized that it will be difficult, frustrating at times, but undeniably gratifying...
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