Sunday, February 27, 2011

TRAVELER'S THOUGHTS - St. Vincent's Clinic

Dr. Eric with a representative of the Japanese NGO
that built St. Vincent's temporary clinic

Observations and thoughts from a Critical Care House Physician

(While we usually write our posts from the perspective of our group as a whole, this one was written by our doctor, Eric. We felt it was best to keep this in his voice, since he is the medical professional and has the knowledge and background to comment on the clinic and medical facilities at St. Vincent’s.)

At first glance, the clinic building itself impressed me. It is a very simple, versatile structure that could be adapted to many purposes as the needs of St. Vincent’s change over time.
(I wonder how hard these buildings get used during normal years, but would suspect this facility should last as long or longer than most other temporary structures. I wonder how the roof will fare during hurricane season. Tom, no doubt, would have a better understanding of this.)

It was refreshing to see that each clinic room had a window that opens into the hall and to the outside, allowing some natural light and a bit of ventilation. All rooms had electric lights and fans overhead as well as more electrical outlets than expected. In addition, there was a toilet and sink with running water at the end of the hall. Considering the destruction of the much of the city's infrastructure, this was an unexpected bonus.

It is hard to say how these rooms could be best utilized. Without having seen the clinic in operation, I suspect it functions reasonably well. Each clinic room is basically a blank slate at present. Most had some type of simple furniture, depending on the nature of the clinic being held; however, other furniture and equipment would improve how well each clinic operates.

The Club Foot Room

Take for instance the Club Foot Room (which might be more appropriately labeled the Cast Room). It is perfectly functional with minimal furnishings: a table, 2 chairs and a bucket of water for dipping the casting fabric. Couple these simple items with skilled hands to apply the cast and the clinic can serve its’ purpose. Small additions like a lockable cabinet or cart to hold the various casting materials (i.e. soft wraps, pads, cast cutter and cast removal pry tool) would make the room more efficient. None of these items were in the room, so I suspect they are stored somewhere else or are brought in each time a medical team arrives. The addition of an adjustable height stool for the technician applying the cast would also be beneficial.

There are similar needs in all the rooms. Most have a place for patients to sit or lie and a place for the physician to sit. However, there was not a dedicated place for general examinations and few privacy barriers for disrobing. There appeared to be no easy setup for iodine, bandages, suture and gauze to treat common cuts and scrapes. Again, small additions like shelves or cabinets could benefit the clinic doctors seeing patients at St. Vincent’s.

I did not get a sense as to how the medical charts and records were or should be handled. There was no initial receiving desk or charting area. There was no dedicated space for medical records.

While there is an interior hallway with a row of chairs for those waiting to be seen, space is tight. A busy clinic day could easily overwhelm the limited interior seating. Also, I doubt if a wheelchair could make it down the hallway with these chairs in place. (I wonder if a fixed rood over the part of the courtyard adjacent to the clinics main door could cover a temporary receiving desk/table and become an additional waiting area protected from the hot Haitian sun.)

The Eye Clinic

The room that was my biggest mystery was the Eye Clinic. I am not sure if any of the equipment was functioning. The opthalmoscope was plugged in but would not turn on. The large box of interchangeable glass lenses (that help determine what correction is needed) were a jumbled pile in a closed case. I could not ascertain whether either of the eye care machines in the exam room worked. The vision charts were on the floor partially behind the exam table and did not seem accessible for use. There were multiple boxes of eyeglasses with their corrections written on the front of the wrapping of each pair. I suspect this room likely has the greatest need for technological improvement.

One of the brace crafters (left), Dr. Eric (center) and
Mr. Alexis (Headmaster at St. Vincent's school)

The brace shop, which will soon move to another location and be replaced by a dental clinic and expanded pharmacy, was fascinating. The craftsmen’s ability to manufacture braces with the limited equipment that survived the quake was impressive to say the least. The men, (I believe most or all of which are hearing impaired), are presently limited to one working drill press, a grinder, and a manual metal cutting tool (similar to a large paper cutter). With these and other simple hand tools and well-worn anvils, they are able to produce leg braces and prosthesis for lower extremities. I get the feeling that the manufacture of prosthesis are limited by the shop’s access to martificial feet and the high quality metal spacers that connect the prosthetic foot with the stump cover.

One of St. Vincent's custom prosthesis

One of the workers showing off his leg

The prosthesis they showed us were tremendous! Each was skillfully made and quite impressive.

Dr. Eric learning how the braces are made

The men also make external metal braces that attach with leather straps to thigh and calf. Each brace is made from long metal pieces with hinge pins crafted from cut nails formed into rivets. Their resourcefulness was indeed impressive. (The repurposing and recycling movement has been well-embraced in this shop!)

The oven

Unfortunately, they are no longer able to make synthetic braces and prosthetics due to the lack of sufficient electrical power. The industrial oven needed to manipulate and cure the synthetics sits empty because it requires 220 current that is not available at the temporary clinic. Hopefully there will be a large enough generator to power the oven at the permanent location. Otherwise, a very useful piece of equipment will continue to sit and gather dust.

When the brace shop moves to its permanent location, quite a bit of space will be available in the clinic. A portion of this space is allocated for a dental clinic while the rest will allow the pharmacy to be expanded.

We came across no dental equipment that had been salvaged from the previous location. I failed to ask Father Saldoni if any had been recovered.

In the expanded pharmacy, I envision sturdy open shelves for the larger cases of donated meds, a compounding area (covered lab bench), a records table/cabinet, hopefully a rework of the present shelves which house the easily accessible meds, and cabinets for the more fragile meds (injectable) could fit in this larger space. Hopefully this vision for a more efficient use of space will be taken into consideration.

While my observations about the clinic may seem negative, they are not. I am impressed that there is a clinic; that there are multiple exam rooms, that there is a functioning restroom. It was very clean, well maintained and fairly well lit. Each exam room could function if staffed with skilled professionals. However, there are definitely improvements that could be made to make the spaces function better until the permanent facility is built.

Thoughts from The Red Thread Promise: We wonder when building of the permanent structure on St. Vincent's larger property (the one destroyed in the quake) will commence. To our knowledge, the Haitian government is still in the process of creating it’s first set of building codes, something that has not existed to date. Until those codes are complete and published, no new construction can begin. The good news is that the architectural plans are being developed as we speak. In fact, Tom, from The Red Thread’s team, is working with St. Vincent’s Haitian and American architects to maximize the potential for the new facility.

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