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Stories from the field

Page history last edited by ResearchFammed 13 years, 11 months ago

HISTOIRE DE TERRAIN - STORIES FROM THE FIELD

 

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From a resident in Haiti, under the auspices of the Humanitarian Studies Initiative, McGill Department of Family Medicine International Division.

 

22 February 2010

So I thought I'd at least send a quick update to let people know I am alive and really having fun. I work 12 hour or plus per day, running the Triage/Emergency department. Complaints range from typical stuff we see at home (headache, back pain, heartburn), to truck/helicopter loads of post-op amputees and fractures. I have also been doing a makeshift Orthopedic clinic out of the ER because truck loads of people are arriving to have casts removed and Xrays, now that we are almost 6 weeks out. The sound of my cast cutter really draws a crowd! It's quite sad because it seems most people with closed fractures were quickly thrown into casts immediately after the earthquake. Xrays are showing badly healed displaced fractures that need operations. Everyone thinks were are taking them to the OR to amputate. Luckily we haven't yet.

We have also seen A LOT of critically ill children since arriving. They must have known we were coming because apparently there weren't many previously.

Yesterday, I ran a code on a 6 month old baby in the Triage area. This is essentially a medium size event tent (think white, graduation ceremony style), with 15 patient cots low to the ground. The child arrived in a truck and was carried in, unresponsive, severe respiratory distress, and hypovolemic shock. I ended up putting in an IO, then a femoral line (actually an 22 gauge IV) and intubated the child while kneeling in the dirt, with about 20 people watching. We rushed the baby across the border to a hospital on the Dominican Republic side. There we were going to airlift to the capital that had ventilators. We bagged the child for 40 minutes in the back of a pick up truck over VERY bumpy roads. The baby took a bad turn part way into the trip and I ended up starting compressions because his heart stopped in the Dominican hospital (again 20 people watching). We gave 2 rounds of epi and got the heart back (the whole time hoping the helicopter was on its way). The helicopter was not on its way :( That's all I'll say about that story.

There have been happier stories, of critically ill children whose lives we've saved. This is pretty amazing considering we are working under tents in the dirt in a giant field (kind of MASH style but bigger). One 3 month old presented post-seizure and in hypovolemic shock. IO, IV fluids and a course of ceftriaxone later the baby is at home with mom. A 2 month came in with severe respiratory distress due to pneumonia. Oxygen saturation was 83%. Things got so bad we almost intubated. 5 days later the baby is off oxygen and is going home tomorrow. I also had a 15 year old present with signs of ruptured appendicitis. Luckily an Ecuadorian general surgeon had arrived the day before. He was taken to the OR within hours and 2 days later is living in the camp with his family.

So lots of great experiences and procedures. I even act as the nurse, spiking IV lines, prepping lines, putting in IVs and giving IV meds.

Tonight I'm on-call from 1-7AM so I'd better get some sleep. It's too hot to sleep post-call because it gets up to 35 degrees quickly so I'll just keep working.

I think of you all often,

Jennifer Turnbull

Pediatric Emergency Medicine fellow

 


Here's one perspective from Andy Rooney on the practice of medicine in an overly specialized system, entitled "We Need More Family Doctors"

 

http://www.cbsnews.com/video/watch/?id=6430975n&tag=contentMain;contentAux

April 24 2010

 

There's a lot in the newspapers these days about health care reform but I think they ought to be more specific and talk about something we all need: one all-purpose doctor.

 

There's just no doubt we have an acute shortage of what we used to call "family physicians."

 

We need more medical schools that graduate doctors who specialize in everything and nothing - the whole body, not just one part of it.

 

The practice of medicine has become too specialized, I think. Several years ago I had surgery on my right wrist. The doctor was very good. Two years later my left hand started to hurt so I went back to the doctor but I found out he only worked on right wrists. I mean, you talk about specializing.

 

We all need a doctor who'd give us a complete physical check-up for everything - kidney stones, cancer, lung problems, eyesight, even our hearing. They're all part of our one body.

 

A good friend of mine whose wife had a hip replacement was having trouble with a knee he hurt years ago, and he decided he might need a knee replacement.

 

I asked if he was going to his wife's orthopedic surgeon.

 

"No" my friend said in a way that suggested I was dumb for asking.

 

"He doesn't do knees!!!"

 

Well, pardon me.

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