Tuesday, September 27, 2011

Today is Tuesday and I am all caught up :)

Wow, finally caught up on the blogging. Well, as I am typing this I am attempting to post my previous blogs that I spent some time on this morning getting caught up with. So today was an interesting day. We had our usual morning meeting at 730 then made our rounds. One of our patients that has been here for about two weeks already is a young 20 year-old woman with osteomyelitis that caused a pathologic fracture of her hip as well as formed a huge soft tissue tumor that encompasses her proximal thigh and the pelvis. For those of you who don’t know much about osteosarcoma, it’s bad news. As I have mentioned before, if chemo and radiation therapy exist in Haiti, it is extremely expensive and difficult for most everyone to get. In addition, due to the size of her tumor and it’s involvement of the soft tissues, she would basically need an amputation of her leg with a hemi-pelvectomy to have any chance of survival. Until yesterday, she didn’t know that this was what she had. We had been slowly broaching the subject over the past week, letting her know that it’s possibly a tumor and would likely involve major surgery. Yesterday, she was finally told details of her disease. 

So other than following her in rounds for the past 1.5 weeks, I became more directly involved in her care today. She was diagnosed with “a vaginal infection” upon arrival at the hospital and had started treatment by one of the local medicine doctors which included augmentin, azithromycin, and nystatin cream. Not surprisingly, her “vaginal infection” had not improved after over a week of treatment with this regimen. I was asked my the long-term volunteer nurse, Lynn if I would be willing to do a speculum vaginal exam on her to try and determine what she has and what would be best to treat it with since she had not had any symptom improvement. My treatment of the woman with breast cancer and bone mets and vaginitis had apparently proven my “expertise” as a gynecologist. Well, at least amongst our group here, I am probably the one with the most up-to-date knowledge and experience of gynecological issues (thank you HCMC Ob/Gyn rotation!). So, on my ortho humanitarian aid trip, I found myself performing a speculum exam on this 20 year-old female in a large ward with minimal privacy. I asked her more specific questions about the types of symptoms she was having (which I won’t detail here) and found out that she had been raped as a child and had never had a speculum exam before. To make matters even more difficult, she could not lay down due to her hip fracture. I was not the most successful in the exam, but I was able to see enough and hear enough history to determine that her current regimen was definitely not appropriate and started her on a more appropriate empiric treatment for her symptoms.

Another of the day’s highlights was my first experience of real Haitian coffee. Now I’m hoping this doesn’t end up giving me uncomfortable GI symptoms, but even if it does, it may have been worth it. Haitian coffee is not just straight black coffee...it’s mixed with other things and almost takes like the best mocha you have ever had except for less sweet and more of a kick. If you have ever had New Orleans coffee, it is a similar experience in that it is not what you would necessarily expect when ordering coffee but turns out to be a delightful surprise. I already knew Haitian coffee was good as I have bought beans on several previous trips and also discovered the immense pleasure of drinking Rebo coffee at the airport prior to departure on our last trip here. Their version of the frappaccino should be enough to send all coffee-lovers on a pilgrimage to Haiti. 

After being a gynecologist and drinking some delicious coffee, I joined the team in the OR for some cases. Since we have two surgeons and two anesthetists, we were able to run cases simultaneously (ones that needed a ventilator in one room and ones that could go with just a spinal in the other) and finished 4 cases by 4 pm. We should have had one more, but the patient had car trouble and was not able to make it in for his surgery. All in all, it was a great second day of our second week and it looks like we may be headed to the Auberge again tonight. This time for some fried plantains and of course, more Prestige.

ps...I tried to upload photos but it takes way too long on this internet connection so I will add photos later (either when the connection is better or when I get back to the US)

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