I arrived in Cap Haitien yesterday after a 5 hour drive which was, in Haitien terms, uneventful although the border crossing was interesting. All was done through a middle man who takes away your passport and gets all the formalities done for a small fee. The Haitien immigration office was situated inside a container and everything was handwritten into a book, left hand side when you enter and right hand side when you leave. How they track people entering and leaving the country is anybody's guess.

Once in Cap Haitien I caught up with the other members of the team including Ross Pettigrew and everybody was happy to read the Otago Daily Times from last Saturday which I had slipped into my luggage. The we had a little farewell lunch for Dale one of the of physiotherapist who was finishing her stint here and in the evening we were invited for dinner at one of the local hotels. Most of us had goat stew and the meat was very tender and tasty.

I am staying with Ross in a private house which at the moment hasn't got any running water as the pump is broken. So we have to get the water from a well in front of the house and the shower is very simple:you stand in a baby bath, poor water over yourself using a container and the water is recycled and used to flush the toilet. That's it very simple and nothing can go wrong.

I had a reasonable night sleep under my mosquito net and luckily there was no power cut which meant that the fans were going all night yeah! This morning after we all had the great haitien breakfast in the form of spaghetti and then we were off to the hospital to meetthe membres of the orthopaedic department.

The only orthopod Dr Pierre Louis is a very nice man of my age (actually he was born in December 1952 just a week before myself) and we found him watching soccer in the operating theatre (the attached photo shows the TV and the arial is a used diathermy cord!!!). He showed me around the orthopaedic outpatient clinic where he introduced me to his registrars who currently are 2 first year trainees. After that we went on a ward round and saw only fractures: mainly tibias, including a nasty open pilon fracture, but also an elderly lady with a neck of femur fracture and some kids with upper and lower limb fractures.

The wards are very crowded without sense of hygiene: no hand washing facilities, no gloves, the windows have no glass ( shutters only) and open onto a central courtyard with flies on soaked dressings etc. There are a number of cases who require surgery and my challenge for tomorrow is to help the residents with an operating list as Dr Pierre Louis is away. I have no idea what implants they have but one thing I know is that the image intensifier parked in the corridor is not working. So all the internal fixations will have to be done open in an environment where the infection risk is very high. Well we shall see how things go but I will have to think out of the square, think Haitien and constantly remind myself that things are different here.

I spend a short period of time with Ross in the general surgery clinic and then attended some sort of medical round mainly for residents and nurses. Ross was asked to give a talk and he spoke about his research from 30 years ago with myself acting as simultaneous translater.

In the afternoon there is nothing happening at the hospital apart for the occasional emergency case and we normally go home at 2.00pm. This timetable would be a great opportunity for me to learn to play golf if only there was a golf course.

This gives you an idea of the local circumstances and our challenge is to find a way for us to contribute for the benefit of the local doctors and patients. We will certainly not be able to significantly change the system which basically lacks all the basic infrastructure and administrative organisation. If only we could send some of our managers here as they would be very useful in establishing basic organisational structures.

However every little step counts and when they are added up in the end I hope that we will be able to make some lasting contribution.