He was an older gentleman that was chilling under a shade hut fashioned at an intersection where people can sit, watch traffic, play dominoes, sell d'lau, or whatever they want. I was doing the survey thing and trying to find an occupied house for my pen to point to #WhenRandomizationIsntRandom. Like most people, this gentleman mistook me for a doctor and asked to speak with me. Not a problem. I like standing still under the hot sun #Sarcasm. He awkwardly maneuvers his arms and cane around, gesturing to me, that something was going on with something above his waist. It wasn't very clear. So I got the translation.
"He's complaining about pain in his shoulder." Me too buddy. Can't shake it #HillsachsLesions. "How long has it been going on?" I ask. "He thinks thirty years." Uh huh. I'm gonna go out on a limb and say that I can't fix this problem today. Again, he's trying to move his arm and can't. My powers of observation combined with my inability to keep my mouth shut force me to ask the question, "Did something hit your arm a long time ago, like a car collision, moto wreck, the ground from a fall?" Even looking at his arm I could tell that the anatomy wasn't appropriate. Something was amiss. "I got hit with a machete."
Damn. And he did too. His scar extended from the middle of his back, over his shoulder, towards the front of his chest (as you can see). This scar was well-healed. His shoulder joint was destroyed. I moved his wrist and could feel the grinding with my other hand. This man had dealt with a massive blow with a machete, somehow survived surefire exsanguination, and then dealt with a non-functioning dominant shoulder for much of his adult life. #WhatDidHeDoToProvokeTheAttack I really wanted to ask the story behind the assault, but unlike most of the time I've been down here I held my tongue.
I had him come to one of our morning clinics and Angie loaded him up with Tylenol and Ibuprofen. Unbeknownst to me at the time of meeting him, he was from the mountains. He had walked five hours the morning of clinic to get there. He moved about six inches with each step. We gave him money for a moto, but the last time we saw him he was plugging his way up the hill on his own two feet.While violence is certainly something to be concerned about in Haiti, I would think it pales in comparison to the number of trauma patients generated by their crazy transportation system. Although, I did see a guy get his face cut with a knife at the market last Wednesday #Carazy #WasItWorthTheExtraFiveGourdes?
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We've had a few patients come in that were victims of moto accidents. The first CHW patient was a little boy who suffered a burn on most of his lower leg at the hands of a moto exhaust. A couple weeks ago we had a mother and father bring in a little girl who had had the moto fall over on its side while she was sitting on it. She landed on her wrist and the moto landed on her leg. Without imaging we couldn't diagnose much. But everything seemed structurally in tact. Unfortunately for us, it was the middle of the week so we couldn't send her to one hospital that only had xray on Monday and Friday and the Health Center downtown's xray machine was broken. We didn't even have an ultrasound to work with. So I fashioned a rudimentary splint for her wrist to hopefully prevent avascular necrosis. And then I fashioned an even crappier splint for her lower leg just to give her some support. Come to find out, the father was the driver of the moto and he hurt himself too. His leg wasn't spared. Everything looked fine and we gave them both some tylenol. The next day we sent the CHWs to check on her. Apparently the parents thought deep-tissue massage of her lower extremity would help her heal...She was in agony. We decided to use some of our casting supplies to make sure that didn't happen again. Now I just need to find some cast cutters to get the damn thing off...And now her dad is super psyched to drive me if I need a moto ride #FriendsWithBenefits.
And as luck would have it there was a moto accident that occurred within the hour that I returned from Port au Prince from dropping Angie off at the airport. Mike and Chris weren't set to arrive till the next day. We had given the translators the day off. And I was all alone at Mission Matana. So why wouldn't there be a moto wreck? It looked nasty. The young male had fallen off the back of the moto as it was cruising down the road. Some of his skin felt compelled to stay on the ground. The rocks that help "hold the road together" thought it nice to give him something to remember them by.
His left leg was covered with superficial scrapes. His right shin had a deep gash exposing some tissue beneath the skin. His right ankle and foot didn't have much skin over it and somehow he'd received a thick cut slicing over the bony landmark. #GottaCoverBasics #ABCs #CSpine.
I tell the girls living at the compound with me to grab a lot of d'lau. This is gonna take a while. I start cleaning and while I'm doing so (without anything more than tylenol for pain btw) I'm trying to convince him to just go to the hospital where he can be checked out by someone with more equipment. He wasn't having it. I irrigated #IfOnlyTheFieldsWereAsWellIrrigated #MountainsBeyondDeserts. Everything was dirty. I was convinced I was looking at bone mainly because I'm paranoid. I was nowhere near bone. Two of the cuts were gonna need to be closed with suture. I numbed him up and then bandaged the other minor scrapes before stitching. It's been a while. I won't lie. But it came together nicely. And, surprisingly enough, he has come back for his dressing changes every two days like we asked. He may be one of five patients who come back for follow up like requested. His wound is healing very nicely.
Trauma pervades the culture in Haiti. Jobs are risky. Safety precautions are minimal. Equipment is on its last leg. Traffic is horrendous. Night is pitch black. And violence pervades a culture teeming with voodoo priests, uneducated adolescents who idolize the hip hop culture, and former militants. Nobody seems to be spared. I've spoken with an evangelical group who has been doing missions in Haiti since the 80's. The gentleman I spent most of my time talking with has more stories than the Bible. Fortunately he's still alive to tell them. Too many of his stories included, "and then there was a gun in my face" or "I hope you're prepared to die tonight."
While I have not had an experience quite like these I have encountered some resistance to my being here. Some people don't trust my intentions. Some people think I'm objectifying them. Some people want me to leave. And encountering an apple of this sort can really spoil your taste for apples of all kind #WonderIfHaitiansWouldResentBeingReferredToAsApples. Haiti comes with some extreme highs and extreme lows to say the least. Some days it's hard to find the energy to get up and get to work, but somewhere out there is an apple that is ready to be tended to.
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