May 4--via Michael Wayman from Norton

A man came to our hosts' home late last night with complaint of nausea, vomitting, and epigastic pain. Dr. Crafton assessed him. He vomitted once so we gave him phenergan and instructed him to see us in the clinic tomorrow. He met us at the clinic door. Dr. Crafton performed a detailed assessment and found the 19 year-old boy to have an abdomen that required surgery. We gave IV fliuds and IV antibiotics to him. April, the clinic leader found a man to take our patient to Port au Prince to the Unisersity of Miami hospital operating there. The ambulance was a 1980 Suburban with a hood that was secured with jute twine. No ACLS crew was available, of course. We were informed that had he gone to a Haitian hospital they may have refused to treat him. Later that evening one of the locals informed us that our patient died. No known details as of yet. At the same time this morning Dr. Crafton and I delivered a 6 pound 12 ounce baby boy. We received a call this morning, prior to arriving at the clinic, stating that a woman in labor was coming. So we rushed over there. Her water broke upon arrival and contractions ensued. Dr. Crafton blurted out "game on." About 15 minutes later there was a baby boy. We were giving the mother IV fluids while massaging her uterus. It took about 45 minutes to deliver the placenta. We had to be quite creative with our limited resources. The delivery was not sterile. There was no water and no electricity. We sterilized our instruments with alcohol gel and Dr. Crafton stitched the perineum with 2.0 vicryl. Not the preferred choice. We observed the mother and baby for 3 hours and they were released. Susan and I walked the two home. Susan carried the baby while the mother walked ahead of us. The mother seemed disinterested in the recent events. We escorted her back to a tin shack, which was serving as her home. The events were very sad indeed but they do the best they can under the circumstances in which they find themselves. Now, that I am writing this blog a woman shows up at the gait with a febrile infant who is also experiencing rectal bleeding. I ran back to the clinic to retrieve Tylenol and flagyl. We also gave the mother some Pedialyte for the infant and told her to come to the clinic in the morning. This is quite commonplace here because there are no emergency rooms and no immediate care centers. Several patients today had malaria. There was a boy for whom Dr. Crafton, Jean, and I made a house call. Dr. Crafton suspected malaria and tuberculosis. We treated him with IV fluids, chloroquine, cipro, phenergan, and Pedialyte. Again, he was instructed to see us in the clinic tomorrow. A very busy and fruitful day.