Thursday, September 15, 2011

El Salvador, part 2- Patients

Seeing the patients in El Salvador was an intense experience.

There was the three day old baby with a dislocated shoulder.
There was the young man with some kind of growth problem whose radius bone stuck out an inch or so past his humerus in his elbow and his left knee bent the wrong direction.
There was a girl with bone tumors, a girl with bowed legs from Rickets, a baby with club feet, a man with shattered bones in both his legs. These people we could help.
But for every surgery performed I'm sure there were dozens more who needed help. It was completely overwhelming at times.
There were people who needed prosthetic hips or knees, which we didn't have.
There were children who would need surgery in a year or two years instead of right now because their bones needed to grow more.
There was the young girl with little turned in feet who couldn't get an operation because the skin on her feet was too fragile and the risk of infection too great.
We had our big clinic day on Sunday but throughout the week as word spread more people would come and knock on the OR doors or wait in the preop waiting area just for the possibility of being seen. Our schedule was completely booked but the surgeons still managed to find time to see the extra patients. When a worried mother shows up at the OR doors and begs you to look at her child's feet you look at her child's feet, even if you're completely booked and pulling 18 hour days. You just do it.

There was one young girl, about 15 years old, who had surgery on both her legs (for bone tumors). She was in pain and she was also very anxious the first day after surgery so we gave her some Valium and Tylenol with Codeine. The next day she felt better so the PT decided to get her up to walk. She started feeling dizzy so I asked her (with the help of a translator, of course) if she had been drinking water. She said she hadn't. I gestured to her three quarters empty water bottle and encouraged her to drink it. She said okay she would but still looked... doubtful or something. The translator pulled me aside and said "I just realized something-- I think the patients have to pay for their water. She probably doesn't have any more so she's conserving it."
OH MY GOD it it stuff like this that just makes me want to lie down on the ground and weep or start handing out money or SOMETHING I don't know. It was 95 degrees and the patient rooms were 6 to 8 beds with people lying drenched in sweat, fanning their faces and swatting the flies away.
We went downstairs and brought the girl four icy cold bottles of water from our stash in the OR area.

There was a little girl who came to our clinic day wearing a party dress. Her hip joint was frozen. It might look in this photo like she is standing up straight but I can assure you she is not.
Do me a favor, would you? Stand up and bend one hip joint 90 degrees. Now try to walk. It was a little different for this girl because she was a child so her locked bent leg didn't have as far to reach as a full adult leg, but basically she walked with her rear end sticking out and her spine all curved. And a very determined look on her sweet little face. This little girl and her mother had been brought to our clinic by an El Salvadorian missionary who was working to bring people from "very far away" so they could get medical care. I never learned exactly how far they had come, but the little girl had been born on an island somewhere so I suspect it was far.
After the surgery the little girl was put in a cast that went up her whole leg all the way to her waist (a Spica cast, it is called, but I couldn't find a good link). She was discharged from the hospital two days later (after her pain was under control and to make sure she didn't have any surgery complications) and her mother had a lot of questions. I told the mother I would go get the surgeon and he would come talk to her. When I returned with the surgeon, the little girl was wearing another party dress.
Her mother had gotten her dressed up to see the doctor.

There was a little girl who had suffered from Rickets and had bowed femur bones as a result. The surgeons straightened her bones out and put her in casts. When I saw her up in the post op pediatric ward she had tears streaming down her face, she was in so much pain.
It might look like she's smiling in this pic, but she definitely had tears in her eyes.
We found out from the nurses that she had received only Ibuprofen the night before so I gave her a dose of my new best friend, Tylenol with Codeine, then and came back throughout the day for subsequent doses. "Of course she's in pain," my dad told me when I updated him about this patient. "She had major surgery on both femurs. Imagine having a toothache in both your legs."
Oh, I see. MISERY.
Because she was in so much pain, the surgeons came to her room and split her cast (sawed up both sides of her legs and wrapped the casts with bandages so they weren't so tight) and then when she was still in severe pain they took her back to the OR and recasted her. She felt MUCH better after the recasting.
Sitting up and smiling and ready to go home.

We couldn't help everyone but we helped those we could.
That little footsie? Belongs to the girl in the photo below:
She couldn't walk before. And now she will.