Day 9 - it's ok to wear boxer shorts when you operate

Wow - the patients keep coming. They are setting up more and more tents and there never seems to be enough room. The last I heard, we have about 200 patients.
The last couple of days, some I.T. guys from Harvard have been here trying to help set up a system of banding/identifying patients and keeping track of their tent location. Because of overcrowding, there was also a decision made that each patient could have one "attendant" to stay with them in the tent - to help them eat, bathe, etc...Most of the patients have now been officially "banded" and their one attendant (who is usually a family member or friend) was given a special blue band to show that they could stay in the camp 24/7 and eat the meals and use all of the services. Needless to say, the blue bands have become highly sought after. They're being tracked in an i-touch application so we just have to know their first or last name to track them down in this ever growing sea of tents. It has been very helpful.
One of my patients is a 20 year old named Vanessa. She has an external pelvic fixator for a fracture, plus various other injuries. She's been feeling poorly the last couple of days and I knew something was up when she was moaning and crying this evening - she has never complained once about pain or anything else. She had a high fever, and the doc and I had her transported out of her tent to triage to be able to examine her more thoroughly and figure out what was going on. After several hours, there is high suspicion that she might have malaria. There was word that the Ecuador team can do a malaria blood smear, so we're hoping that's true. Anyway, I felt so bad for her - I can't even imagine how horrible she already feels with her injuries - and then malaria.
The Operation Smile team is the hardest working team I have ever worked with. The surgery crew was operating yesterday and it was 93 degrees in their makeshift O.R. . They have air conditioners set up, but they're no match for the Haitian mid-day sun. The plastic surgeon had to change his scrubs several times during one case because they were dripping wet, and finally resorted to just being in his boxers under his surgical gown.
The nurses out in the tents - which includes me - have kind of gotten a system down to see all our patients and get the dressing changes, meds, etc.. done before noon. . We try and get as much done as possible before 11am when the searing heat starts.
We continue to see long term complications starting to emerge. We have many patients with DVT's, which I think I mentioned in an earlier blog. We've been treating them with Lovenox twice a day, and also giving it prophylactically to the immobile patients. Now, because of a Lovenox shortage, we're now only able to treat the known DVT patients, and hope the other immobile patients don't develop one.
I have a great translator named Carlyle. He has been with me almost everyday. Today, while translating in triage, he became very teary eyed and upset after hearing one of the new patients tell her what had happened to her. She was a 14 year old who had already had surgery to remove her left eye, in addition to many facial fractures. She had spent 3 days waiting under cement rubble to be rescued and was taken to somewhere (?) in Port-au-Prince to have surgery. She was then transferred somewhere else - she couldn't tell us exactly where - and then finally to us. She had no idea where her family was, or even if they were alive. She was so traumatized, and it was just heart wrenching to listen to her tell the story. Carlyle and I both cried. We took all her phone numbers and are attempting to locate some family for her. I hope there is a happy ending.