One FP's moment in the surgical sun

It was another bone-rattling bus ride in Haiti. The potholes in the dusty road were so big that they resembled dinosaur-slaying meteorite strikes. As we drove along, children would run after the bus smiling, waving, and yelling "Blan! Blan!"-their word for foreigner-in hopes that we would throw them candy.

We were there to offer far more. The 20-odd passengers on the bus, hailing from all over North America, constituted a mobile medical clinic intent on relieving pain and suffering in this impoverished Caribbean country. We had all signed up to serve under the umbrella of Mission to Haiti, an organization based in Miami. Our part of the group included my wife, Pam, who's a registered nurse; my daughter, Lizzie, then 14; and John Hester, a nurse and dental technician whom I met at a free health center in Raleigh, NC. Little did I know that John would later become my surgical assistant and scrub nurse.

This particular day, our destination was Nan Palmiste, a tidy village of thatched huts, pastel-colored stucco homes, and manicured thicket fences. As a local pastor directed us to a parking spot, we caught a glimpse of our patients: Several hundred Haitian men, women, and children, all in their Sunday best, milled about next to a small school building.

Within an hour, we were examining patients, dispensing medicine, extracting teeth, and wiping down children with scabicide. The low-pitched din of human chatter filled the air, punctuated by the baas, oinks, and clucks from our curious animal neighbors. Every so often, we were bathed by a Caribbean breeze.

The relative calm was suddenly broken by the sound of panic. People gasped as a path opened up through the crowd. A worried man was running toward us, cradling a crying girl in his arms. Her eyes were wide open in terror, and the mud on her school uniform indicated a recent accident. As they came closer, I could make out a bloodied leg and, to my shock, a dangling, lifeless foot.

The story rushed back and forth through our interpreter. The girl's name was Veronique, and she was 8 years old. She had fallen off her bike onto a trash pile containing old sheet metal. As I examined the wound, my heart sank. A deep, jagged oblique laceration split open the back of her ankle all the way to the heel, completely severing her Achilles' tendon and exposing the distal tibia. The gash was filled with dirt and debris.

"Oh my God," I said, shuddering. "What am I going to do with this mess?"

Ordinarily in remote Haitian villages, wounds like this would be packed with mud, crudely bandaged, and left to their own fate. Sometimes a voodoo priestess would offer chants and potions. The wounded usually would lose the foot, and perhaps the leg. Tetanus and overwhelming sepsis were possible. These poor villagers had no local doctors, no transportation to a hospital in Port-Au-Prince, the capital city, and no money for treatment even if they got there.

John Hester and I thought hard and fast. I had a tattered, olive-green Boy Scout knapsack filled with autoclaved surgical instruments, donated suture material, sterile gloves, and drapes. Our group's makeshift pharmacy had bottles of irrigation saline and all the antibiotics and pain meds we would need. And John could raid the dental supplies for syringes of lidocaine.

The next issue was the surgeon-me. Although my residency training in family medicine was top notch, my experience in Achilles' tendon repair was limited to assisting on two or three operations. I hesitated for a moment, remembering the adage, "First, do no harm." But the procedure was pretty straightforward, and I had faith in my suturing skills. Besides, other options for this youngster were bleak at best. I looked up from the knapsack to John. "Let's do this," I said. John smiled and nodded.