Doctors Without Boundaries

Feb 4, 2009

This afternoon, I drove the Galloper up to the guesthouse with Caro and Trish in the car. All of us were sweaty and tired from a full clinic day at Carrefour where we saw patients of all ages, with a variety of complaints. Some were clearly exhibiting “vitamin seeking behavior,” others were hospital-worthy, and a lot of others in-between. One gentleman came in temporal wasting, a history of fevers for a month, and a chronic cough that worried me for acute active TB. The clinic had offered its usual hum of activity as we sorted through complaints, attempted to triage the sickest of the bunch, and educate with the help of Haitian nurses and translators.

As we approached the guesthouse, the usual crowd of vendors along the sidewalk had swelled and spilled into the street. One of the men pulled away from the crowd and rushed to the galloper's window, “Doctor Kim, we need your help!” Oh boy. So we three doctors emerged from the car looking quite serious, wondering what kind of situation awaited us in the heart of the mass of people. Heart attack? Hit and run? The crowd parted like the red sea to reveal a young man sitting on a chair looking quite uncomfortable. “He fell,” the crowd told us, “at 9am.” Hmm, since it was past 2pm, clearly the boy had been suffering for a while now. When asking how he fell, we heard both “while walking” and “from 3 stories.” Regardless, all he was complaining of was a knee injury, and he didn't appear to be bloodied, so our worries of full-body trauma were eased a bit. We all hovered over the knee in question to examine the site of pain. We discovered with a bit of shock a badly deformed joint. Clearly something was out of line as a bulky mass jutted out from the side of the knee. Dislocation? Compound fracture? Not as much swelling as we’d expect. Palpating around, the boy seemed very uncomfortable and jumped when we poked on the part seemingly out of place, tossing his head back in a full-body moan. I had to fight down a bubbling hot lava of frustration and anger. Why hadn’t anyone taken this boy to the hospital already? Why did they think it was a better idea to wait HOURS for the doctors to arrive?

Our attempts at getting more history into the accident went unrewarded. But the most important piece was “no no, his knee did NOT look like that before the fall.” The young man was a son of one of the vendors, although his parent wasn’t part of the history giving. So we relied on the information of helpful neighbors and put our heads together working on a plan of “attack” so to speak. We three doctors decided that we’d try to get the knee aligned better, put a brace on and take him to the nearest hospital for x-rays.

Trish crawled onto the young man’s lap and sat down bracing him. Caro and I positioned ourselves on either side of the man’s leg and took hold. “PUUUUUULLL” we chanted together and used our bodies to put traction on the leg attempting to relocate the tibia to a more suitable, stable position distal to the femur. “AAAAAAAAHHHHHHH” our patient screamed and wiggled. Nothing, not a budge. One more time, Puuuuuuuuuuuuuull. Caro and I did our best, beads of sweat forming newly on our foreheads. But the accident was old enough that all the muscles were in true spasm and the nothing was budging. Keep in mind we were doing our heroic intervention to a swelling crowd of Haitian on-lookers truly fascinated by the street-side entertainment. Better than an episode Rescue 911.

Noting that no curb-side relocation was in our stars today, we dosed our patient with pain meds, apologized for the torture, fashioned a brace out of a cardboard box and string, eased the young man into the Galloper and drove him to the nearest, “Doctors Without Borders” hospital for assessment.

Leaving him to the care of the doctors there, we left feeling pretty good about our efforts. Our relocation attempt wasn’t successful, but we gave it a good effort. And the adrenaline of doing a sidewalk trauma evaluation was a nice high for the afternoon. Slapping each other’s backs and joking about where else we could seek out lads and damsels in distress, we headed back to the guesthouse. Trish pointed out another future patient as she observed a man leaning a metal ladder against some power lines. But today was not our day to do CPR and electrical burn treatment. He seemed to have a shock-proof body.

When we got back to the guesthouse, we were greeted like heros. “OH thank you for helping, doctors.” We finally ran into the father of the boy who had just arrived and heard the story. He thanked us profusely for helping his son. And with the crowds dispersed, the father felt he could elaborate on the history. Apparently his son, as a 5-year-old boy, had a brick wall fall on his leg which fractured it badly. His son, as a child, underwent surgery to realign the bones. The second surgery recommended was too expensive for the family to afford, so the boy grew into a man with a chronically unstable knee. Hmmmm. So "falling" while walking was a common predicament his son got into, and it always caused him significant pain. This perked a few questions. We asked about the shape of his knee, describing what we saw on the street. “Yah, its been that way since he was a boy. We should have gotten the surgery, but just couldn’t afford it at the time.” Right.

Sure enough, a couple of hours later our patient was back at the guest house sporting a new ace bandage wrapped around the still-disfigured knee and toting his x-rays. He thanked us so much for our help (the torture???) and let us examine the films. Sure enough, the bones were all in tact, just bowed out in an angle that caused the impressive misalignment we noted curb-side.

We always say in medicine the diagnosis 90% of the time can come from the history alone. And TIMING of the history is everything.

So our afternoon adventure served to illustrate, once again, the challenges of cross-cultural, cross-language work and the ridiculous situations you get yourself tangled up in. Good thing we all have a healthy sense of humor and found it all quite hysterical. Trish, Caro and I decided we’d form a new international organization, specializing in foreign traveling physicians coming in and providing various interventions in health. We’d dub our new organization, “Doctors Without Boundries,” and would tote the slogan, “We tackle your chronic problems in a traumatic way.”

So we ended up not being the heroes of the moment, but students of another funny Haitian moment. Ah Haiti, keeps us humble, keeps us honest, and as always, keeps us entertained. Thank God for a patient Haitian population who seems to tolerate our invasion. I’m grateful our Haitian friends recognize that we are here with best intentions, even if the miraculous work we attempt to do ends up looking more like a comedy of errors.