Hello All,
Sixth night shift in a row. I think its six, anyway...... I am taking a water break right now to try and stay hydrated. The 'staff lounge' here at Cite Soleil CTC is an old railroad car. It has bunk beds built into it, and has a cooler and some chairs. The beds are in here in the event we must stay longer at the site than planned.
Rain has just started and sounds neat on the tin roof of the rail car. I expect it will bring the mosquitos out later so will fish out some more bug spray. Hearing thunder is a bit of a novelty at this time of year, for a Canadian anyway. :)
Slept not too badly last night but am still really struggling with fatigue. Only 930 here and I am already nodding. Oh oh.
Managed to drop a big metal part of a truck door closure on my thumb tonite when retrieving blankets. Looks like I might have a blood blister forming under the nail. Fun fun fun. Shouldn't be a problem finding someone to have a look at it anyway if need be, ha ha ha.
Apparently there are 20 new people coming in tomorrow. That's good news as we have some going home as well. We had heard that some folk who were scheduled to come had been cancelled and I have to say I was a little worried. Some of the people on this shift have worked 9 in a row...... Yikes.
So I guess I am half way through this mission trip, as by the calendar I start on my way home a week tomorrow. Probably a week would have been enough, the heat and long shifts are wearing me down a bit.
The rain is coming down so hard and there are a few (*very* recently discovered!) holes in the triage tent. We are trying to clean it up now and have all the IV cath packages spread out on a blue pad to dry. Think maybe triage will have to relocate to the main tent again. I don't mind that, is nicer to be closer to the rest of the team and help if needed. Even though I am a major type A personality, running triage by myself (second night now) scares the hell out of me. Cholera patients all still look very very sick to me - I have not yet learned discernment between circling the drain and almost circling the drain - at any rate, they all look very sick to me, and until they have their big bolus of fluid DONE, I cannot convince myself they are alright.
For the medicos out there, the fluid resuscitation phase which is done in triage, is as follows:
Lactated ringers solution. Rapid bolus as follows:
Men-
2 litres in 30 mins, and then
2 litres over 2.5 hours
Women-
1.5 litres in 30 mins, and then
1.5 litres over 2.5 hours
Peds (14 and under)-
30 ml/kg/hr over 30 mins, and then
30 ml/kg/hr over 2.5 hours
Infants-
15 ml/kg/hr over 60 mins and then
15 ml/kg/hr over 5 hours
After the intial bolus amount, the patient is taken to the ward rooms and given a bed. It takes an average of 3 days to be treated for cholera. The fluid needs of the patients can be truly enormous. Each bag of RL hung is numbered sequentially. It is not unusual at all to see someone on bag 50 or 60 in the men's ward (Have heard upwards of 80 litres....!!). No kidding. When the bouts of diarrhea and vomitting are occurring, a single epiosode can excrete up to 1.5 litres, quite explosively. We learn 2 things from this: 1) as much fluid as you can possibly give, as fast as you can give it isn't always enough, and 2)around cholera patients you must be very watchful and always know where the buckets are. Nuff said about that.
That's probably enough blether for now. I will write later on the international flavour of Team Cite Nights!
Pray that I get a day off soon... because I really could use one. Still really enjoying the experience, but dragging it a little lol!
Michelle
