Our room was hot like an oven! I could not sleep at all. The cool air outside was so pleasant that I decided to get up. I would rather be a victim of mosquitos outdoor than a baked potato indoor!
I sat on the chair on the balcony, let the moonlight soak me. Lake Azuei was sparkling with silver in the distance. What a wonderful time being alone in the quietness, when everyone was sleeping, even the dogs did not bark and cats did not meow. My thoughts and imagination were set free.
The dawn came, and the village awoke. Smoke was rising from a chimney, and roosters were crowing. Doctor Yu got up, joined me at the balcony, we both sat speechlessly, enjoying this beautiful morning. Soon, Dr. Shu also joined us. The sky started changing colors, as if God the greatest artist was painting with orange, red, yellow and blue on this magnificent canvas. What a marvelous art work displayed just before our eyes! We were struck with awe! We bowed down to pray together.
Doctor Yu was concerned about my sleep deprivation. I smiled and said, “God is my strength and help, don’t worry, today you will see God’s protection in me.”Our first patient was a 31-year-old engineer. His symptom was getting worse. His just got engaged and was planning to get marry in the next few months. He was concerned that the operation might impair his ability to have children. Dr. Jolius assured him, so did I. Of course, With his excellent surgical skills, Dr. Shu would make sure the operation would not affect the patient’s fertility.
This patient held a BS degree (Bachelor Degree of Science) from a university in engineering. He had the highest degree among all our patients. Some of our patients could not even read or write, even for consent they used thumb print for the signature. Obviously, this patient was the exception. I was curious and inquired about his family background. It turned out that his parents were not wealthy. He worked hard to save for his education. He had seven brothers and sisters. Five of them also graduated from colleges.
He could speak three foreign languages: English, French and Spanish. He spoke English fluently. He was a Christian too. He accepted the Lord Jesus as his savior when he was 18 years old. Even though his work schedule was busy, he managed to go to church on Sundays and participated in Bible studies on Friday nights. He was a grateful and joyful person, handsome and smart too. I joked that he was my boyfriend for the day, making everyone in the operation room laugh.
The second patient was the only patient wearing a mask. He had some coughs a week ago, with subjective fever for one day. He didn’t have a thermometer, was not sure what his temperature was. He had been coughing frequently since then. Apart from this, he had no other symptoms, such as fatigue, loss of taste and smell, or difficulty breathing.
Could he have COVID 19? Since there was no PCR test available at the surgical center, we could not rule out the possibility. He had some rales in the right lower lung, and occasionally some wheezing on auscultation. Breath sound in other areas were clear. Blood oxygen saturation was 97%. His symptoms and vital signs indicated acute bronchitis.
During coronavirus pandemic in the United States, we would assume all patients with respiratory symptoms as potential COVID -19 patients unless proven otherwise. All elective surgeries would be postponed in our hospital until the patients’ sars-cov-2 PCR tests came back negative. Should I cancel the case? This was a tough call. If I cancelled the case, he might not have another chance of being cured from hydrocele for a long time. If I decided to proceed with the surgery, and if he was actually an asymptomatic virus carrier, then our surgical team, the surgical center staffs, other patients and family members would be exposed to the highly contagious virus. We did not have adequate PPE (personal protective equipment) besides our N95 mask, surgical gown, and gloves. I surely did not want our team members going back home with COVID-19!
I spoke to Dr. Shu and other physicians regarding the decision. After careful consideration, we agreed that the patient might just be experiencing symptoms of bronchitis, and the case should not be cancelled. But just in case, we took some precautions. Each of us wore N95 and eye goggles. All other non-essential personnel would stay out of the operation room. The patient should be isolated from other patients in PACU.
But there was no negative pressure isolation room! There was only one PACU with all the patients. The very minimum we could do was to put him at the far end of PACU, and used a room separator to separate him from the rest of the patients and gave him a good N95 to wear. But not surprisingly, when I brought the next patient into PACU two hours later, the room separator was removed. If this patient had had coronavirus infection, it would inevitably infect other patients and all people near him.
Fortunately, we did not have any symptom for the next few days.
It seemed that the infection rate of COVID-19 in Haiti was much lower than that in the United States. There were multiple factors. Insufficient testing of coronavirus would be one. Yet the death rate was very low, suggesting the infection might not be that high. Due to Haiti’s hot weather all year round, the Haitians had their windows and doors open, which facilitated the air circulation, thus decreased the concentration of the virus load. In fact, their windows were some bricks made in patterns, there were no glasses or other material to close the windows, so their windows were open-type. Mass communication was another factor. Half of Haiti’s population live in mountainous areas, the density of crowd was relatively low. People usually stayed in same places; this decreased the transmission of the virus among the people.
Note: So far, there are 10,963 confirmed COVID-19 patients in Haiti, the death toll was 240, and the mortality rate was 2.19% (as of 1/20/2021).
Based on our assessment of Haiti’s coronavirus infection, we thought it would be safe to travel to Haiti as long as we wore N95 masks, used sanitizers, washed hands frequently, and kept social distancing.
Our third patient was a pastor. He was also a part-time driver. He was a very grateful person. Every time he answered a question, he would give thanks.
Our fourth patient was the oldest of all our patients, 96 years old! The average life span for Haitians was about 60 years. Initially we could not believe his age, but once he got on his feet to walk to the OR, we could see the effect of aging. He had bilateral hydroceles and right inguinal hernia. Performing hydrocelectomy was not difficult, but repairing his inguinal hernia was not easy, since it was large, and some of the intestines had adhesions.
I gave 12.5 mg of bupivacaine for spinal anesthesia, which reached the T4 level dermatome. During hydrocelectomy, the patient was comfortable. During inguinal hernia repair, the patient felt nauseated. Small dose of ketamine was given iv. Soon the patient developed delirium. Dr. Shu injected some local anesthetic to his groin and finished the operation quickly.
Dr. Shu’s specialty was cosmetic surgery and office procedures. Repairing such complicate inguinal hernia was a challenge. Dr. Peterson, the director of surgery at the center, kindly participated in the operation and repaired the hernia together. It was nice to see physicians from different country and training background to work harmonically.
Keeping patient’s information in private is paramount in the United States. But in Haiti, patient privacy was not treated as important as in the US. Due to limited working space in pre-op and PACU, the other people could overhear our interview of the patients.
Venessa was our OR nurse. She was young and beautiful, and we all liked her. We wanted to say “I love you” in Creole. It sounds like “Meow, meow, meow”. So, we said “Vanessa, meow, meow, meow.” Were we speaking cat’s language? It was so funny!
Though we took our duties seriously, yet we were not solemn all the time. We liked jokes too, and there were lots of happy moments.
I anaesthetized 6 patients today, and our team performed 11 operations. The day started at 8:45 am and finished at 9 pm. I was awake the whole time, didn’t even feel tired. God surely was my strength.
This was our fourth day in Haiti.
