Tranquil Tuesday

Confined to barracks today due to the more volatile than usual political situation. However the sun is shining and we are allowed on the roof. Considering the alternative is snow in Halifax we can't really complain.

We all chilled in the sun, playing some Bocce ball. Michelle wasn't happy with the quality of the balls so went and made some with plaster! Marc and Katy even managed to get a rooftop workout in. A ball game of 'Foursquare" was prematurely ended when the ball was lost over the edge.

Just when the ennui was beginning to set in we had the opportunity to go to the OR to sort out our gunshot wound. Good case: patient spoke excellent English and his biggest fear was how much this was going to cost him! We reassured him that it was all covered. Our First world moans about poor wifi and water pressure put squarely into perspective! He did very well. Once I managed to solve a couple of technical issues ie no oxygen or anaesthetic gas(!)  Brandon and I got him induced, The Daves explored his peroneal nerve and plated his tibial plateau. Tourniquet troubles however: we ended up using machine number 3 a 70s throwback if ever I saw it. Yours truly managed to get it to work.

Then it was off to MINUSTAH for supper, minus a few of the group as there was a code blue in PICU. Had a very welcome bacon cheeseburger with spicy fries and a substantial measure of rum with barely enough room in the glass for coke!

Just another manic Monday

Day 3: Monday

Written over breakfast on Tuesday by the way. This is supposed to be our day off but due to the ongoing political situation we are currently confined to the compound. Hopefully we might get onto the roof for some sun and fresh air later. No water pressure at present either so definitely another day in paradise!!

We had our first official full day in the OR yesterday and it was certainly productive. First case was a complex trimalleolar ankle fracture, then an exploration of a nasty wrist injury due to a grinder. Not as soft tissue as first expected, as well as tendon damage there was crushed bone, so that was not a quick case. To round things off a fractured tibia/fibula which was 3 weeks old. This would have been a challenging case at the Halifax Infirmary and it certainly was far from straightforward here. Took a few hours to get everything lined up and nailed but the result looks perfect. Again it shows what can be done with more limited resources when you have skilled surgeons and a good nursing team! Haitian Ortho residents were able to scrub in for the cases too so even during the challenges David McCartney and Michelle Arakgi were able to impart some knowledge!

Back to our quarters where we discovered that the presidential election results were due. Given the inflammatory situation, with supporters of one party threatening to set Port au Prince on fire if they lost, it  was decided no trip out for supper! Instead a large pizza order was delivered from Visa Lodge which fed us well. Managed to amuse ourselves for the evening chatting, playing and getting to know the other members of the team. Some serious games of Cribbage went on: who knew Michelle , Marc and Katy were such card sharks?? We are all able to laugh together: Darrell the legendary paramedic being one of the entertainers of the group- he can even juggle and do magic!

As seems to be a recurring theme in my career as a reluctant paediatric anaesthetist I ended up in PICU getting an arterial stab on a newborn with an omphalocoele getting surgery today. Ultrasound was available but I ended up drawing on my dormant paeds skills and used the Force to do it by touch! The great thing about this trip is always the cross-discipline cooperation. Everyone helps everyone else: ER docs in the ICU and recovery, RT everywhere it seems for example.

I stayed up to find out the election result on twitter and to my surprise there was a winner: Jovenel Moise a former banana farmer from the PHTK ( Haiti Bald Headed Party!) and the anointed successor of former Pres Martelly. His platform was make Haiti great again by growing more bananas on the deforested land!  Already there are accusations of corruption and mentions of Trump! As to the disgruntled Fanmi Lavalas party ( Aristide's party and the party of the shot PM from my earlier entry)who threatened to set the streets on fire- their candidate came in fourth!

At the time of writing Port au Prince is peaceful and in all probability only minor demonstrations and celebrations are likely. Still confined to barracks though, no city tour for the group. I am sure we will find something to occupy ourselves. Might get into the OR later to explore a gunshot wound in an unfortunate gentleman who got shot 3 days ago. He was dropped off in a mattress in the back of a Tap-Tap taxi which made a colourful if unsafe ambulance alternative.

Anyway I hear the water is back on so a shower and a shave are beckoning. Will keep everyone updated. Marc Butler in his new found role as Cruise Entertainment Director is looking for balloons and a cable to connect his laptop to the TV so we will no doubt be kept amused!

Day 2: another pleasant Haitian Sunday

 

Writing this over breakfast on Monday. The Haitian porridge is almost worth the trip alone, sweet and spicy, just the thing to get us started on today's casualties!

Finally got into the OR yesterday for more routine stuff. While Kim, Karen and Katy sorted through a mountain of supplies I went to look after a breast reconstruction with the departing plastics team from LA. I was able to relieve one of the local staff to go and do a cleft palate case on a 15 day old, figured it wasn't the time for me to start having a go at neonatal anaesthesia.

Lunch was a welcome feast of local Creole cuisine before we got into the OR to get a couple of cases done. First up was a little old lady, 61 but she looked about 100, with a flexion contracture after a fall and a femur fracture. Got it straightened out so she will be a lot more mobile.

Next was an elbow fracture, young guy had a rock thrown at him which given the current political climate is not surprising. Thought it all went very smoothly but as is the way with these things it wasn't! Decided to stop breathing in recovery. Not ideal as the cubicles are tiny, dominated by a big oxygen tank and the suction only worked if you held the tubing in one hand and used the suction in the other! He came round but preferred coughing to breathing and unfortunately developed negative pressure pulmonary oedema! Needed diuresed and an overnight stay. Just goes to show there is no such thing as routine anaesthesia!

Just as we all got ready for supper the heavens opened and there was a torrential tropical downpour. Nearly caused an international incident at the Travotel restaurant as they didn't have many tables and a lot of patrons looked on jealously as they set up a big banquet table for our second group. Then it was back to the quarters for Cards against Humanity where the surprisingly filthy mind of Katy Van Vulpen triumphed - and she looks so sweet and innocent too!!

Air conditioning broke down during the night and all hell was breaking out in ICU and Paeds ICU with cardiac arrests and neonatal deaths. Lot of tired faces at breakfast this morning but the Ortho OR team and I are relatively refreshed and ready to go!

The mission begins:pizza and gunfights

Yesterday was a long day for us all. Started for me when my alarm went off at 230 for a 4am airport rendezvous. 12 hours and 3 flights later we arrived in Port au Prince and headed to the hospital. 

Bernard Mevs has undergone some changes and the volunteer accommodation has certainly improve. No need for mosquito nets now that it is fully enclosed and air conditioned. We claimed our bunks ( only 4 to a room now!) and headed to Visa Lodge for dinner.

We managed to inadvertently order an excess of pizzas which are now in our fridge (another innovation!). Had just enjoyed a few slices and a beer when we got a call that a gunshot was coming in and could anaesthesia and ortho come back...

Got back and got as organised as we could and waited for the patients to arrive. Turned out one was a former PM and was the victim of an attempted assassination! he was fortunate in that it was very superficial and just required debridement and closure in the OR. Would have liked the chance to get prepared in the OR but managed to make it work and he did well. Was very glad to have the expert assistance of Brandon Dsouza,a respiratory therapist who I think will be invaluable this trip as I am solo.

An innocent bystander wasn't so lucky. the other casualty was caught in the crossfire and got shot in the head. He got intubated on arrival and currently sits this morning on a ventilator. No CT scan but plain films show no bullet in the head. Neurosurgery wants to watch and wait. 2 died on the scene, which was near the Tytoo Orphanage, so that is a trip which wont be happening this time.

After getting to bed around midnight I slept like a log and am now enjoying some coffee. Thankfully not much on the agenda for today. Going to see if I can tidy up my end of the OR while Dave Amirault goes in search of patients. Doesn't look as if there will be a lack of them!