In her latest instalment from the front line of the Haiti relief effort, Fi Stephenson talks about training student nurses and establishing routines.
So much has happened recently, I don’t know where to start, but here is a potted version.
Team C have now been and gone. Leanne and Hatti did a great job in helping to teach the student nurses with me. The students, all 14 of them, had pitched up from Port Au Prince as their nursing school was closed following the earthquake. They really deserve some credit for wanting to continue their studies.
They were like sponges and seemed to really enjoy learning from us all. When they left after three weeks I got the medical director and head nurse to present each student with a Certificate of Study in Spinal Care Theory & Practice that I had created. The MD gave a speech in the middle of the ward so that the patients could be part of the ceremony. The students were thrilled to each have a personally signed piece of memorabilia!
Some of the patients have now returned to Milo and have had spinal fixations by an American team of spinal specialists. What an amazing prospect for them! Many put their trust in God and pray for the time when they will be able to get up and walk again. How can anyone shatter that hope and dream? Reality is unlike anything we could imagine. With no infrastructure to help paraplegics and quadriplegics in Haiti, their future is certainly not as clear as it is for someone in the same position in the western world. These patients at least though have the chance of some sort of a future as their spines will be stronger and their future of pain and further spinal damage should be less.
The three friends (Les Amis) were first up for consideration for spinal fixation. Young women in their twenties and thirties with incomplete paraplegia. Eve, a former nurse is not able to have this yet though as she sustained an enormous grade 4 pressure ulcer. She was offered a skin graft and wound closure but she refused. She said she had been injured and scarred enough and declined the operation even though we said it would enable her to rehabilitate more quickly. I guess she could not see her wound - or feel it - so had no real idea of the extent of her (totally preventable) tissue breakdown.
Her daily routine will continue to be 2 hourly turns; left lateral, right lateral, prone. No sitting and no supine position for months and months. What a prospect. She said she was in Gods hands and did not want to take any further risks to her health or feel any further pain. So her friends were transferred with another young woman, which left her alone. This was the first time the friends had been apart since the 12th of January. She cried and prayed, and cried and prayed some more.
To cut a long story short, they did get their operations and returned to our unit on day 3 post op by helicopter. The reunion was a really joyous occasion for everyone. The three friends and their families were united again!
Whilst they had been away, our new unit was finished and the patients were moved by stretcher to their new hospital beds with proper hospital mattresses, bedside lockers, air conditioning, freshly painted walls and a new floor! I had taken photos of the new ward and had shown the families and patients their new ‘home’, and gave them the opportunity to choose their beds. Eve wanted to be close to the door and I asked her to choose the beds for her friends. There was so much excitement amongst the families and staff during the move! Big smiles and laughter! Everyone felt truly energized. The visiting teams of doctors just could not believe it! They were so complimentary about the unit and many said it was like walking in to a western ward again and in complete contrast to the haitian medical environment. All I can say is that a lot of work was involved by an amazing team of people, both Haitian and English (here and in the UK), and it really is lovely to see all our efforts put into practice! It genuinely is a good feeling to know that we are making a difference here. Of course there are teething problems to anything new and we have certainly had them. There will be more in the future, but at the end of the day, everyone is trying to do their best - given the circumstances.
Edward has a C5 and C6 injury which has left him as a tetraplegic. He can move his upper arms a little and can breath by himself but that is about it. He has lovely eyes, a wonderful smile and a great sense of humor. And is aged 27 years. His mother and sister look after him and have been with him throughout his journey. He is now in a Halo and almost got to go to Germany for spinal surgery. It got to Diplomatic Level and the plan was for him to fly in an ICU plane all the way there. Like all things relating to Haiti, nothing is set in stone.
The patient transfer criteria changed and he now did not meet that criteria. Damn. His journey is not over, but the dilemma is; what can be done - if anything? The surgery he would need is so complex and certainly not something to be done in Haiti. His prognosis is not a good one. Edward has the bed with the best view of the ward so that he has things to look at in whatever position he is in. His paraplegic room mate, Daniel, a mathematics professor, has become good friends with Edward and they keep each others spirits up. He has witnessed many of the issues facing Edward and it must be hard for him to see his friend and family go through it all.
On a lighter note, it is lovely to see the patients settling into a comfortable routine here. Meals are now served at regular times (phew - what a battle that was!). They know when dressings are changed, catheters are changed or bags emptied. They know to ask if they have not had their body position changed for a while. Every night they have a prayer meeting and sing hymns together. It is a very moving environment to say the least.
So now I have the prospect of rest and recuperation for me, after 2 months here in Haiti. To be honest I have mixed feelings about this. I think it is because I feel guilty that I can go somewhere to rest and recuperate. These people can’t. But I know that I need it so that I can re-charge my batteries and come back again. I know that it is going to be a culture shock too. Watch this space!