Friday: Last day in the OR and a fruitful one!

After a week that seems to have been both long and short at times the last two cases are entering the ORs. It has been a pleasantly productive day with both ORs at our disposal, with a brief gynae case in room 1 in the morning for the local team. 6 cases today the final tally.

If there was a theme today it was neglect. First case was a skin graft to the abdomen. The unfortunate patient had suffered a perforated diverticulum which was left until it formed an enterocutaneous fistula. Not the sort of pathology you see in Canada, but people here can be very stoical about their health issues

The abdomen was successfully covered and we handed the reins to the gynaecologists. In room 2 a tibia was nailed followed by another challenging case. 

This is the left knee of a 31 year old farmer. He was walking on this for 8 months!! His leg on that side had telescoped 4 inches shorter. Unfortunately a functional knee was not possible and it had to be disimpacted and fused, stable but still shorter.

The redoubtable Taylor mans the C-Arm

Last case in room 2 a k-wire of an elbow. Plastics/Ortho joint exercise: Marti scrubbed in to help, another example of the good team work which has characterised this mission.

Next door in 1 the recently comatose diabetic patient with a gangrenous foot has finally agreed to an amputation! Anaemic and still haemodynamically precarious an interesting end to our clinical time here!

 

Some examples of the random chaos of the anaesthesia supplies. Drugs are of various origins and vintages. Supply boxes usually have what it says on the outside, but again in various size and state of repair. A word to the wise is to have located everything you could possibly need for your case beforenyou start because you will surely be unable to locate it in time of crisis! My surgical colleagues have found similar issues with instrument sets etc, almost none of which seem to be fully stocked. 

I discovered also it was simple things like syringes and catheter mounts that were in short supply, for the surgeons towels and C-Arm covers.

I would say things are much better than before and the OR runs as smoothly as possible under the leadership of Miss Michelle Barjon, who rules with a rod of iron and a heart of gold. There is however a need for better inventory control, in fact any kind of inventory, which would help in pre-mission planning and would save a lot of time exploring cupboards and shelves on arrival.

Meanwhile today has seen some unrest on the streets of Port au prince and we have heard police helicopters all day. Hopefully there will be no rioting to keep us from team dinner tonight!!

Hope to have an entry with pictures and stories from elsewhere in the hospital up in the next day or two. So if any of my readers on the team can oblige please do so!

Ok last patient dropped off, narcotics returned to pharmacy and I am in my shorts relaxing. Tomorrow we will be Nova Scotia bound with lots of stories and memories!

Thursday: Running to stand still...

Sometimes on these missions your carefully organised day does not go according to plan. Orthopaedics had 3 cases, Plastics had two cases and as of writing (4pm) we have managed to do one of our plastic cases!  Problem was local neurosurgeon had booked a craniotomy for chronic subdural in the room with fluoroscopy which delayed ortho, and in the other room local surgeons had cases booked also. There were also staffing issues locally with only one Haitian Anaesthesia staff on, so we were persuaded to provide coverage! 

In an attempt to be productive we agreed to start with one of our cases at 730, a skin graft on a 5 month old with spina bifida and a broken down meningocoele repair. Neither Kwesi nor I are paediatric in our regular practice but agreed to the do the case jointly.

Managed to get started close to 830! All went well though and the little patient was lively and comfortable on reaching PACU.

Then it was time to be helpful and between us we looked after the craniotomy which became more and more involved and didn't finish, after a 9am start, to around 3 pm. While we were in there next door an emergency PEG tube was booked for a 2kg neonate with oesophageal atresia. Kwesi lent a hand for the induction.

Yes the patients are getting smaller.

Which means we finally get to start Ortho at 4pm! We aren't planning on being ambitious and are only doing 2 cases. First a 92 year old with a combined hip screw/IM nail for a femoral fracture sustained chasing cattle, so as you can appreciate he is fairly healthy, give or take some uncontrolled hypertension. Lastly a second incision/drainage of the man with the infected joints we did earlier in the week, which we hope to do next door once the local team finishes doing a multiply cancelled hernia.

We are all getting pretty fatigued. Its like a whole week in the trauma room. Kim was out of action yesterday with the flu/chest infection that has been going through the group, and Dave Amirault is only feeling better today.

All looking forward to a pleasant meal tonight: hopefully at the Visa Lodge. The UN has not impressed with surly service, early closure and worse of all the disappearance of chicken fajitas from the menu!

No chicken fajitas!!

Relaxing in the Tropicana Lounge on Wednesday night

From last night: Kwesi enjoys a Juicy Burger after a late night in the OR

Jill at work in the PACU

OK time to get these cases done, we still have plenty to do tomorrow!

Wednesday: A busy day at the office

I'm not just the team social media intern! Full day of operating for us today. Got started with an above knee amputation under spinal in a sick diabetic. Then came an elbow reconstruction for an 8 week old Monteggia fracture which was a challenge.

But eventually Dave Johnston was victorious! What was to have been our last case followed, a Moore's for a frail elderly lady with a fractured hip. Again challenging as not all the relevant instruments were present but once more after some improvisation all was well.

Dave Amirault, Keith Neufield and two Haitian residents work on the Moore's.

Unfortunately our night is not over: nasty dogbite has to be sorted by Marti LeBlanc. Poor woman has sustained a radial fracture as well as damage to the thumb. At this rate dinner will be a late take out brought back from the UN!

Tomorrow Kwesi and I turn into a Paediatric Anaesthetist as we have a 3 month old  Spina Bifida patient for a skin graft and have been roped into doing a revision colostomy in a 2 and a half year old as the Haitian staff will be tied up with a chronic subdural. Maybe we will get to do some Ortho cases after!

Anaesthesia viewpoint

Rest day: a Haitian history lesson, some R & R then back to reality

Today, Tuesday, the Broken Earth team gets the day off. This time unlike my previous visit we got the chance to see around Port au Prince albeit with an ever present Police escort

First stop on the tour, after driving by the Porsche dealership(!), was a look at some traditional Haitian gingerbread house architecture.

Then it was off to downtown Port au Prince where we saw the main square with it's statue of Petion.

We made a swift exit when we started to attract a crowd then headed off to have a look at some of the rest of the city.

Ruins of the Presidential Palace

This monument was built by Bertrand Aristide to commemorate 200 years since the liberation of the Haitian slaves.

This is the Haitian Unknown Soldier monument. In this case it memorialises an unknown rebel slave (note the shackles) who was beheaded by the French. It was erected by Papa Doc Duvalier which is why the plaque was damaged during unrest. In the background of the last picture you can see some enthusiastic art vendors and of course our bodyguards.

Next stop was the National Museum. Originally envisaged as a mausoleum a la Pantheon in Paris for Papa Doc et al it was repurposed as a museum. The tomb in the centre holds the remains of Toussaint L'Ouverture, Petion, DeSallines and Henri Christophe the founding fathers of Haiti. No photos allowed sadly. This gave us a harsh history lesson: from the torture and annihilation of the natives by Christopher Columbus and his men, through the brutality of the slave trade, the slave rebellion and its aftermath all the way to the present. Fascinating selection of artefacts from the anchor of the Santa Maria, heavy shackles all the way to Papa Doc's stethoscope and gold plated carbine! This certainly put the country's present economic and political struggles in context. Evidence of which we could see as we left : riot police were assembling for the afternoons demonstrations!

Then we drove through some of the areas worse hit by the earthquake. In the pictures you can see the Cathedral, which has displaced people living outside in tents. We then headed to the sketchiest neighbourhood I have ever been in to see some remarkable art at a gallery/atelier.

The artist Eugene uses a lot of real human skulls in his art: he says they were easy to find in the rubble after the earthquake. This was very dark art reflecting the chaos of the earthquake and the vodoun roots of Haiti. There was also an exhibit of photos by a French photographer Mosel who was first on the seen immediately after the quake struck. Very disturbing and very moving.

Off to the stately Hotel Olaffson for lunch and refreshment before a trip to the orphanage which was both sad and uplifting. As you can see the kids had a great time playing with the team. These children range from the truly abandoned to those whose parents cannot cope. Several have challenging medical needs and the Ortho boys were asked for an opinion on one who had bad arthrogryposis. Once again we were reminded of how good we have it at home and I am thankful to be able to provide my children with more than they need!

Last stop after a long but enlightening day was the Visa Lodge and a swim and supper. Pool heavily chlorinated so it turned some of the blondes in our party green!

Refreshed we returned to Bernard Mevs and were brought back to reality by the ambulances and heavily armed cops in the courtyard: one of the police had been shot 5 times, thankfully missing anything vital. A reminder of how dangerous this country still is.

As I update this on Wednesday we have plenty of work to keep us occupied starting with an above knee amputation. More soon!