Broken Earth : My trips to Haiti with a team from Halifax: Snowflakes and gunshots : the mission concludes

The snowflakes in Halifax on our return were a subtle reminder of how far away Haiti is from us both geographically and culturally. All in all a very successful mission but there is still much to be done.

Our last day was a busy one, like the others. In the OR we had 2 cases to finish off the trip: a hemiarthroplasty for a hip fracture and a washout of a gunshot wound. The latter was in a friend of the Chief Medical Officer here at HBM. He was sitting in his car in Petionville when a couple of guys opened fire. He ducked, a bullet hit his shoulder and he floored it out of there. Just random violence and a reminder of how dangerous life still is here, even in the so-called good part of town, the part that gets coverage of its gourmet food in in-flight magazines!

The rest of the team were supposed to be heading out to a resort for the delayed field trip but that had to change due to rumours of possible disturbances in the wake of post-election controversy. Instead it was off to the pool at Visa Lodge for R & R instead. I couldn't go due to an unfortunately timed bout of gastroenteritis! Spent most of the rest of Friday in my bunk or rehydrating. Poor Darrell our hardworking paramedic got sick to with a nasty febrile illness. Not sure what he has and guesses from us range from influenza to Chinkungunya, or maybe some new zombie virus!! Decided his new nickname should be 'Patient Zero'! Poor guy is supposed to be working on Sunday!!

The team had fun in the sun and returned for some Christmas festivities, as the last night coincided with several of the parties back home. Karaoke continued into the wee hours. At least I was spared a hangover the next morning!!

The return journey was uneventful if long: started at 630 local with the bus taking us to the airport until 1130 wheels down at Halifax. Plenty of time in Miami and Philadelphia airports for some final bonding time with the team. Everyone was glad to be home even if the chill in the air was brutal after a week in 30 degree heat.

As I said there is still much to be done. Over the last few days everyone has been sorting through bags of equipment and other donations that piled high which highlights one problem going forward and one that afflicts many such projects: well meaning but useless donations! There was a lot of stuff sent that wasn't needed eg IV cannulae of which they have abundant supplies and David McCartney uncovered a lot of vintage ortho plates and screws that no-one would ever think of using in 2016! Going forward there needs to be a more structured approach to needs assessment pre-mission rather than everyone piling extra stuff in their bags because 'it might come in handy'. Sadly it often does not and ends up gathering dust in storage, hiding things that are needed.

In the OR and ER when the whole TBE could work from staff to junior things ran harmoniously but in areas where it was only nursing, paramedical and resident staff from us such as PICU and ICU there were occasionally communication breakdowns and a tendency fro the Haitian staff to shrink into the background rather than get involved. To build sustainability there is a need for better integration and skill sharing. I would certainly have liked the chance to work with and share ideas with the local anaesthesia staff but they were occupied in other ORs and at present there are no anaesthesia residents around. I think we as Team Broken Earth need a more formalised 'five year plan' for education that involves all with the Haitian staff being brought to the fore.

Overall though I feel optimistic. The infrastructure has changed by leaps and bounds since I first came. See below for pictures of the new ICU which looks like it could be in any teaching hospital in North America. I look forward to returning and watch this vision for change continue to grow and improve the health of the people of Haiti. I hope the future of the country becomes more stable and that other countries continue to support their efforts to advance the quality of life of their people. After a troubled history they are surprisingly, and inspirationally, resilient: friendly positive and hardworking.