Republic, everything changed in an instant. The process of completing the largest medical center paved road transitioned to dirt, the relative and hospital in the area which will provide state-of- cleanliness of our surroundings took a turn for the the-art care in a region which is completely lacking worse and the poverty was palpable in everything in even the basic aspects of patient management. we saw, heard and smelled. Before the earthquake The local clinic is run primarily by an American hit in January 2010,Haiti already was in bad shape. Nurse, Emily Bartelheimer from Snohomish, That tragic event knocked the breath out of this Washington. My goal was to teach her basic deeply impoverished country. Not only did people compounding skills which would have to deal with their financial situation, now they allow her to broaden the scope of had the additional stress of having lost their the treatment options for her homes and most importantly, members of their patients. In this area, Emily is not family. It was a bad situation which turned just the nurse, she also has to act hopelessly tragic. as the doctor and pharmacist. She T h e D a n i t a s C h i l d r e n o r p h a n a g e is all that these patients have and, (www.danitaschildren.com) was what brought me I speak the truth when I say she is to this area. Founder, Danita Estrella, previously tremendous at what she does. served as a translator and had visited Haiti from I came to Haiti prepared to work with mostly cases Florida on a day-trip more than 12 years ago. She involving children who were unable to swallow was so moved by what she saw that she returned traditional oral medications; but, I soon found out home, sold all that she had and single-handedly that this is not a problem in this region. Children are opened a small orphanage in a rented house with taught at an early age to swallow pills with ease. I a handful of children.Today the orphanage houses soon found out that there were three main issues more than 120 children and provides everything that patients needed help with: wound care, that they need. In addition to the orphanage, the infection and compounding for special needs organization also runs a school for 500 students children. I will present two cases that I worked on and a clinic which sees approximately 40 patients during my stay. in a four-hour work period. They also are in the Case #1 – Wound Care My very first case involved L.S., a 17-year-old male who presented with three wounds on his knee, leg and chin.The patient had suffered with these wounds for approximately three years and the infection had reached a point where it had eaten through the cartilage of his knee and resulted in a severe decrease in mobility. L.S. and his family were extremely poor and at times he would walk miles with crutches just to visit the clinic every Monday, Wednesday and Friday for dressing changes. Although multiple treatments and even surgery were performed, the infection seemed to progressively get worse. Realizing that we were traveling back to the United States, Nurse Emily decided to collect three wound cultures which were sent for processing upon our arrival.The bacteria was identified in two days (this would have taken up to two months in Haiti) and we were able to come up with a compounded treatment option for the patient. The therapy included a six-week course of oral ciprofloxacin along with the two following topical treatments: • Misoprostol 0.0024%/Lidocaine 1%/Metronidazole 2% Polyox Adhesive powder • Ciprofloxacin 2% in 20% Poloxamer Gel I A C P C U S T O M Rx C O N N E C T I O N I A C P R X . O R G 5
Custom Rx Connection August 2012
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