day 5

Things are a little different here. There is no middle class - only the people with nothing, people with money, and the people who had money but lost everything in the quake (and are now more people who have nothing). There is nothing like "homeowners insurance" here, so if your house got destroyed in the quake, you have nothing.

We met many of these people when we (Claire, Nia, and I) went to visit one of the tent cities. Before the quake, this had been a sort of shanty-town, but all the roofs came off of the houses during the quake. Claire grew up here, and her best friend (who still lives here) donated all the tarps that make up the new roofs of the tent city. These people have no health care, and they have no way to get to a medical center like Medishare. No clean water, many high risk pregnancies, bacterial vaginosis, just a few of the problems we're seeing. We played with the kids and heard many of the stories.

The stories we hear break your heart - like the 17 year old who was trying to help a friend out of a building during the quake. He was holding his friends hand, trying to pull him to safety, when the wall collapsed, crushing his friend to death and amputating his hand. He says the pain where his hand was is bad, but the pain of watching his friend die is worse.

And the patients we see - especially the kids - they rip at your heartstrings.

Back at the hospital, I saw a girl with sickle cell with a Potassium of 9... Should be about 3-5, and I've never seen someone alive over a 7. I don't really understand the patho-phys of how sickle cell makes that possible, all I know is I saw the fear in the pediatricians eyes when I said we had no kayexalate (binds and removes potassium from blood). We tore through the supply tent (which is less than organized), nothing. I started tearing up - I know the kid with encephalitis is going to go anytime, not another one.

So what do you do with a sickle cell kid with a potassium level of 9 when you can't find any kayexalate? Yeah, Drug Info questions from Haiti can be a little rough... Well, my plan was to give her candy, shoot her full of glucose and insulin (to push some into the cells), then start her on IV fluids and furosemide to push some out through the kidneys.

The pediatrician thought it sounded better than any ideas she'd come up with, and we followed my treatment plan... And I'm happy to say the patient is still with us 2 days later :-)

Once again, I have so many more stories to share, but not the time to write it all down.

Short version: I'm safe, alive and well, and trying to keep my patients the same!

~PJ