Our last day in Mirebalais

The students taking the course post test

Taking the post test

We started the day like any other, with yoga at 6:30 by the pool for 45 - 60 minutes followed by showers then breakfast.  Breakfast has been fruit, usually papaya and mango, crepes, ham and cheese omelettes, bread and coffee.  Our two transport vehicles (2 SUVs) arrive around 8 am to take us to the hospital.  Part of the team went upstairs to set up for the last lectures and part of the team went to the ER to check on the patients we put on NIV yesterday.  After ensuring they were doing well, we made our way to a bay where the ER docs were doing a quick assessment of a 7 year old that was kicked in the abdomen by a horse two days ago.  He will go to the OR to resect a perforated jejunum.  He is awake but quiet, just watching all the docs around him with wide eyes.  He doesn't look afraid. 

The ED docs doing their assessment guided by Amy, a visiting physician from Minnesota, now studying in New York City.

We then make our way to the ICU to check on our vented patient.  Sadly, he passed away last night evidently suffering from a tension pneumo.  The team is devastated.  But, as in the states, death is a part of what we do and we can't dwell on it, so we reorient, thoughtfully, and move on to our next task.  After readying more vents and delivering them to the ED, we returned to the ICU where Mario was called (Mario is called several times a day to do this and that.  He can and he does!) to troubleshoot the vent.  The 7 year old is back from the OR, hypotensive.  Thankfully we set one of the vents up yesterday in PEDS mode so it's ready to go but like at Cottage,sometimes the outlets don't work!  Or maybe it was a dead cord?  Miraculously Mario and I put our heads together and set the vent up for the 7 year old.  Mario texted Justin Werth in SB and he agreed, the settings were appropriate.  Victory!  

Mario and Kaina working on the 7 year old after surgery 

Diane organizing the lectures, coordinating the course.  She has coordinated the schedule and materials, the equipment and skills stations.  Diane and Dr. Fried made this course possible here in Haiti.  It took much planning and organization for us to be here.  

Maggie is a star.  She not only keeps the team organized, ensuring we are fed, transported everywhere  and all around happy campers but she has also jumped right in there to retrieve stored ventilators and ventilator parts from BioMed.  She put all the components together, cleaned them up and tested them to ready them for use in the ED.  The ED docs were ecstatic to get them.  As one of them explained, "We LOVE Bipap!"  There's a poster on the administration walls of a study done on heart failure.  Of 938 patients admitted, 300 had heart failure.  For some reason, heart failure is a huge problem here.  They need a cardiologist here.  

Yesterday Mario was asked to assess a young man with flash pulmonary edema in the ED.  He was retracting and tripoding, desperate for help with wide eyes, struggling to breathe.  Another older female patient was also suffering from heart failure and Cameron, the visiting ED physician was faced with a decision of which one to put on NIV with their single LTV.  Mario explained that their ICU vent also had a noninvasive mode so Mario quickly put both patients on BIPAP.  This morning both patients are still in the ED but both are off BIPAP on O2, looking much better.  

The R2s at the airway skills station taught by Jason and Mario.  Despite the awesome smile from the gentleman at the head of the bed, Jason stopped him and told him not to ever take his eyes off the vocal chords.  Jason asked him to manually ventilate the patient for two minutes until his hands were sore, then reintubate the patient.  Lesson learned! 

Our new RCP, Maggie readying one of 12 brand new LTV transport vents that we found in BioMed.  These vents are identical to the ventilator we use on the Pediatric transport rig at Cottage.  It's an excellent vent.  12 were just sitting in BioMed which is a hot, dust filled room near the front of the hospital.  We found two ICU vents in partial disarray as if they are being used for parts.