Day two from Cange: wound care in the wards

Joceyln Guerrier, shown receiving a dressing change, was injured when her house collapsed during the earthquake.

After the earthquake, the hospital complex in Cange was inundated with people suffering from fractures, crushed limbs, spine and pelvic injuries and deep cuts and abrasions. Now, almost two months later, the wards are still home to patients with wounds that are slowly healing—and require attentive care so they don’t turn more serious.

Monday morning began with wound care rounds. Nurses Cassandra Mombrun and Pat Lisle assisted Dr. John Meara as they took off old bandages, cleaned and dressed wounds, and looked for signs of infection. One dressing change was for Jocelyn Guerrier, a 28-year-old woman with a fractured leg and a deep gash wound on her calf, who’s lived here since the day after the earthquake. She was washing clothes on her balcony when she felt the house shake. She tried to run outside but didn’t make it in time, and the house collapsed on top of her. A car transported her to Cange, where she’s been ever since. Although her house was completely destroyed, her family stayed safe during the disaster.

With her husband by her side, the doctors and nurses cleaned her wound, which was healing successfully. But there’s a need to stay vigilant. Sepsis—a potentially fatal condition where the body is quickly overwhelmed by infection—is a very real threat here. “In this type of environment, infections can spread easily and wounds need to be assessed on a daily basis,” says Mombrun.

There are unique challenges when you’re caring for patients after a natural disaster. Although the hospital is slowly returning to its normal caseload, it’s busier than usual, and patients are still housed in the two non-clinical spaces that were converted into wards. Visiting medical teams rotate almost every week, and patient handoffs must be coordinated so clinicians know the important clinical details about their new patients. Maintaining a high state of cleanliness is tricky. On top of all this, many patients have nutritional deficiencies, which can impede wound healing and recovery.

Anesthesiologist Michael Angel monitors a surgical patient.

Some wounds that are too large or too painful to clean by the bedside require general anesthesia. Today, Children’s clinicians, in conjunction with their Haitian colleagues, performed six “I and D’s” —irrigation and debridement procedures—where wounds are cleaned and dead tissue, which is a medium for continuing infection, is removed. The last patient of the day, a 35-year-old man with an open tibial fracture, was a good example of what’s at stake with wound care. Since his bone was exposed, he was at risk of developing osteomyelitis, an infection of the bone. “When that happens in the United States, it can be difficult to treat. In Haiti, it’s practically impossible,” says anesthesiologist Craig McClain. “He will possibly need an amputation, and in a country without disability benefits and social security, if he can’t work and provide for himself and his family, it could have devastating consequences.”