Dlo Twa

Water can be the source of so much joy all while it can be the source of so much strife.  Yesterday we ran through our second trauma in as many days.  A six-year-old girl had fallen into the river and was pulled out after an unknown amount of time.  She was carried into our clinic floppy.  Her eyes were shut and his muscles relaxed.  It became #GoTime.  I grabbed her and set her on our exam table.  She was groaning and tachypneic.  Rachel and I rolled her on her side to see if we could discern breath sounds.  Crackles all along the right side, but she was moving air.  Rachel got vitals while I checked for neurologic status.  Her eyes were closed and she was sluggish to open them for pain.  She had sounds coming from her mouth, but would not respond to questions or use words.  I pinched her arm.  Nothing.  I pinched the skin over her ribs.  Nothing.  I pinched her leg.  Maybe a muscle response.  GCS is not good.  “She needs to be intubated.  If only we had a pulse ox to see how she is oxygenating.”  PERRL.  Heart sounds are good.  No signs of trauma from the fall.

Our interpreters are fiendishly translating four different women giving their accounts of the events, yet none of them witnessed it.  We continue to stimulate her by firmly rubbing her sternum and speaking to her.  Slowly we see more life coming out of her.  Her eyes open with more purpose.  She mutters a few words.  Eventually we get her to give us a ‘thumbs up’ with each thumb.  She’s sleepy, but appears to be improving without intervention.

We call Dr. Buresh for guidance as we tell Guirlene to work on getting a tap tap to take her to the hospital #TwoInTwoDays.  I give him the 30 second presentation and ask his opinion.  We don’t have oxygen.  We can’t ventilate her.  We can’t even monitor her.  She needs broad spectrum, IV antibiotics, which we do not have.  Her lungs sound full of water and she’s doing a pretty terrible job of replacing the water with air on her own.  He reminds us to maintain her c-spine because of the unknown fall history. 

Guirlene reports that no taptaps are available.  Mahalia volunteers her car.  I drive it around so we can load and go.  We log roll her and slide her onto the folding chair just like before.  I think I need to patent this.  We take her out to the car and carefully load her into the backseat.  Rachel rides alongside her to maintain c-spine.  Thankfully the girl continues to improve clinically and even flashes a smile.  I navigate the SUV out the gate through the throng of community members that had followed the child over.  I head down the road.  Potholes are the least of my concern.  Large ravines have been carved through the dirt road from the storms.  Maintaining c-spine precautions won’t be easy.  I cringe with every bump and turn, but the girl is a trooper.

We arrive at the local hospital and I take John in to find a collar for our patient.  The nurse immediately diverts us to the doctor who is in the back administering an IV injection.  She finishes up and quickly says she can’t speak English.  #JohnToTheRescue.  I explain that we need a collar to protect our patient’s neck.  She tells the nurse to call for the Cuban doctor on call.  The front exam table is vacated so John and I head back out to bring in the girl.  I crawl through the back seat and push her out the other side so Rachel can maintain c-spine.  We get her onto the exam table as the Cuban doctor walks into the “ER”. 

He starts speaking… in Spanish.  #RachelToTheRescue.  She’s been trying to speak Spanish this entire trip and now she finally gets her shot.  She shines.  We tell the doctor that the little girl was brought to us after falling into the river from an unknown height and was submerged for an unknown time.  She was somnolent when she was brought to us, but has slowly improved.  Her lungs sound crappy on the right side.  And we’ve been doing our best to maintain c-spine precautions. 

They accept the transfer.  However they also do not have any breathing assistance machines or xrays.  She’ll have to be sent to another hospital.  They notify the ambulance drivers while the Cuban physician places an IV.  The Haitian physician begins writing transfer papers.  We wait for her to be loaded into the back of the ambulance and are even hit up to help pay for gas.  But, we had every confidence that the little girl was going to make it to St. Damien’s http://saintdamienhospital.nph.org/ and not incur a single cost for her treatment.