A case of the Mondays

The working week began in earnest today with plenty of work in the OR. Started with a removal of a wire from an elbow, then an ankle fixation. An orthopaedic scouting mission to the General was thwarted when Dr Johnston became unwell. Fortunately there is no shortage of medical help and after some IV rehydration, Gravol and some rest he made a swift recovery.

Charmaine and Noreen wait for lunch. Worth waiting for too: meatballs, rice, creole sauce and beans. The Haitian cuisine is certainly good here.

What do you do if you don't have the right tool in your set to remove an external fixator? Why simply use the nearest monkey wrench!! Improvisation is the key here that's for sure. The fixator was in to hold a tibia in a policeman who sustained a gun shot wound. As the designated centre for treating the police here we have an appreciation of how violent and dangerous their job is. Once again reminding us of how it would not be a good idea to go for an evening stroll around Delmas!

Good day for teaching mind you: that's Hippolyte a Haitian Orthopaedic resident scrubbed in with Dave to fix an 8 week old fractured ankle.With an intermittently functioning imager it was certainly a learning experience for all!! 

Meanwhile next door Kwesi is teaching Regional Anaesthesia to the local staff Judith, and a PGY3 Haitian Anaesthesia resident Alain Bien Amie. We discovered to our considerable joy that there was a state of the art Sonosite machine with linear and curved probes, good for us and our blocks and good for the ER guys if they want to scan any bellies.

Kwesi being a great teacher and mentor as always.

All in all a successful day with 6 cases being done in the OR. Tomorrow we get to be tourists and get the historical tour of Port au Prince but my orthopaedic colleagues have found another 8 cases to get our teeth into from Wednesday onwards! Tonight the UN and their delicious fajjitas, we have earned them for sure!

The mission gets underway!

No restful Sunday for Team Broken Earth! After breakfast the surgeons managed to find 3 deserving candidates: a broken ankle, a closed reduction of a humerus and drainage of an elbow and knee due to a mysterious condition. First case, first awkward airway but ketamine and an LMA saved the day! While underway we heard about another patient who had fallen from a roof breaking both forearms,one open, and sustaining a significant head injury! Brief pause for very tasty chicken, rice and beans then back to the OR! Unfortunately our cunning plan for a quick MUA and plaster of the humerus was foiled and the surgeons had to open and plate! With the urgency of the open wrist looming we had to cancel the ankle until tomorrow. Marty gave him a Power Bar and some water and he was understanding!

 Then it was onto bilateral wrists  which was Jodi Coles first ortho scrub with a wee bonus facial laceration. 2 teams again to expedite our pool time and supper! And this cunning plan was also foiled by a deep intraoral laceration being discovered on extubation. Kwesi nobly volunteered to stay and I am finishing this with the rest of the team at the Visa Lodge!

Very neighbourly ORs: the window between them is kept open because A/C only works in one of them!

Time for a swim while our dinner is prepared. Will update you all tomorrow!

Broken Earth January 2015

So we have arrived again in Hopital Bernard Mevs.  Fairly smooth trip. This time our briefing was not interrupted by unexpected trauma so everyone was able to make it to the Visa Lodge. Some of the team took the opportunity for a dip while waiting patiently for the delicious food which eventually came!

A few beers and rums brought the team closer together so as is traditional we are going to the roof to chill out before the real challenge begins tomorrow!

Final thoughts

Being back to work seems a little surreal. Our return journey on Saturday passed in a blur. Free wireless in Port au Prince but had to pay at Miami!! 5 security checkpoints, 3 immigration posts and 2 sets of customs later we were in Halifax! Smooth and punctual flights, except in and out of Pearson which was a tad bumpy . We even had a couple of team meals and beers along the way, so it felt a lot more pleasant than the drag it could have been.

Now that the dust has settled I think we can say for sure that it was a positive experience. I saw things I would not see here in Halifax, both good and bad. I saw a 14 year old bleed out from a gunshot wound for lack of blood and blood products, but I also saw good teamwork save the day and the patients under challenging circumstances. The surgeries we did undoubtedly changed the patients' lives for the better and will allow them to contribute positively to the future of this fascinating, troubled country.

There is plenty of work still to do at Bernard Mevs. There is a need for better organisation and inventory in the ORs. Better biomedical support would enable the anesthesia machines and monitors to work properly and would allow more challenging cases to be done there. The hospital badly needs a better ultrasound machine for the ER and OR. Plenty of things to target in future missions and fundraising.

Would I do it again? Absolutely! I think I speak for most of my colleagues when I say I look forward to going back.

I would like to thank Chad Coles and Dave Amirault and of course Marc Butler for making all this happen. Finally I would like to thank my wife and children for their love and support: nightly Face Time conversations kept me calm and grounded, I love you all!

Until the next time then.....

Haitian miscellany

Team broken earth headquarters

Luxury accommodation: I am at the back on the bottom

Traditional Haitian tombs

Sugar cane

Bustling market

Site of future Olympic stadium

Suicidal Tap-Tap overtaking us

Classroom at Martinette school

Shanty town: many who fled PAP after earthquake live here, mass grave of c240000 is over the hill.

We will not forget you Haiti!

Last night

It has been both quick week and a long one and either way it is at an end. Today was an interesting day. 8 of us went to Tytoo gardens orphanage while the ortho guys went to the medical school to teach.

The orphanage visit was very interesting and we concluded that in future visits a deployment to their community clinic would be productive. We returned to Bernard Mevs to find a contingent of Brazilian UN troops lined up outside in fullbody armour toting automatic weapons. Not sure 

what they were up to apart from posturing - a show of force I guess since it seems MINUSTAH doesn't do an awful lot to make life any safer round here.

While we were away Nick the super ER resident donated blood since the one patient in the hospital with A neg blood needed a transfusion! Another example of how members of the team have stepped up during our brief tour of duty!

That being said we headed to their logistic base since we all like the burritos and generous rum measures for our final Haitian team dinner. We had no sooner finished dinner and were kicking back when one of the EMTs from Bernard Mevs walked in and said an anesthesiologist was needed. Not sure how this happened since we were all supposed to be done at 7 and there are five Haitian anesthesiologists. Nevertheless Heather took one for the team and went back with him while the rest of us stayed. A good night was had by all who stayed, fact we managed to drink the UN dry of rum!!

Now we are all gathered on the roof,listening to a carefully curated playlist and enjoying some well deserved refreshment, a happy cohesive team content to have completed a mission under challenging conditions. At the very least I have managed to acquire a voodoo doll! It has been a positive experience for us all, a we we're chance to work with other disciplines we do. It work with in our regular life. We will certainly never forget this unique experience and I for one look forward to coming back. The rain is now falling and we are seeking shelter. Will update the blog as we return to Nova Scotia.

Visit to Tytoo gardens part two : the pictures

On the road to the orphanage

Someone is tired

Little ones at play

How could you say no to that face?

They are all huggers!

Food aid: part of the Elderly outreach programme

The school the charity built

Well equipped playground

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