Visit to the citadelle and my last week in Haiti

Last weekend we went to visit the famous citadelle built by Roi Christophe, the king of the first independent black government of Haiti, to defend his country against the French and Napoleon in particular. This well preserved fortress is situated on top of a 900 meter high mountain which dominates the northern plain around Cap Haitien and was linked to a whole series of other forts along the coast line. The construction is an engineering master piece built around 1804-06. Apparently 20.000 people died during the construction and all the building materials had to be carried up the hill by human labour. The fortress was fitted with over 300 canons some of which are well preserved and beautifully decorated with french and english symbols. The view from the top was breathtaking and although we had to walk uphill for about 45 minutes in the intense tropical heat once on top it was nice and cool:the inside was naturally air conditioned and we really enjoyed the cool air!!!At the bottom of the hill was the ruined palace called "Sans Souci" where Roi Christophe lived with his wife and 2 children as well as his many servants. He eventually committed suicide but his burial place remains unknown to this day.

I have been very busy at the hospital over the last week teaching the residents and operating on the many acutes who present everyday. Cap Haitien is the capital of the compound tibia fractures. The reason is the many motorbikes circulating here in a chaotic traffic: the bikes are real tibia crackers!!! I have been able to achieve some changes in the management of the fractures and I am pleased with that. However I am concerned that the residents will go back to their old habits particularly if the orthopaedic surgeon in charge at the hospital is not endorsing what I have been teaching.

There are also many spinal injuries here mainly as a result of people falling from trees trying to collect certain fruits.Two days ago I was shown a patient who had fallen from a tree and was paraplegic. He was lying on the floor in the emergency department and when I enquired why he was not in a bed I was told that he had fallen out of bed. There was this poor chap lying in his own urine and nobody cared about him. I asked the residents whether they had a spinal board but they said there was none. However after a short period of time one of them turned up with exactly what was needed. This gave me the opportunity to teach the doctors how to lift a patient with a spinal injury safely and we all carried him to the surgical ward. The treatment for these patients is basically inexistant and they are left lying in bed with very little active management. The problem here is that the nurses only give injections and sit around in their impeccably white uniforms and matching white stockings doing very little. They don't want to get their uniform dirty and as a result it is the house surgeons who have to do all the dressings and even take charge of the pressure sore prevention. Yesterday I operated on this patient with a T9-T10 fracture dislocation using an old Hartshill rectangle I brought with me and fortunately they had some wires which I could use. The hospital was on generator power and as a result the airconditioner didn't work so it was hot like hell!! In addition there were about 10-12 doctors wanting to watch the operation which further contributed to the heat. I was dripping with perspiration after about an hour and had to have a change of clothes. Also in the tropics your hands sweat profusely when wearing surgical gloves and the sweat accumulates during the operation and when things start to overflow you have to put on a new pair. Anyway I got through the operation OK and the patient is doing well although I suspect that his paraplegia is permanent. I will try to get him into a spinal unit run by the Baptist church on the outskirts of Cap Haitien for his ongoing care. There is a great need for an orthopaedic surgeon with spinal expertise and I hope that in the future I will be able to teach some basic spinal surgery to one of the residents.

Tomorrow is my last day at the hospital and everybody wants me to come back next year which is very encouraging. I have also given the residents a small research project and I will set up a website so that I can do some distance teaching and provide them with teaching materials. I however think that yearly visits are required to teach them new surgical skills and help them to get access to better orthopaedic equipment and trauma implants. But one thing they desperately need is somebody who can fix their image intensifier for intraoperative Xray imaging so that they can treat the fractures by closed methods. This will also allow the surgeons to get post operative films which currently are difficult to obtain as the patients have to pay for them and they are not cheap in Haitien terms. Without post operative films they residents don't get any feedback on how they are performing and they will not be able to learn.

Finally I want to talk briefly about the Haitien food. I have been looked after very well by Robyn and Bernadette who has been cooking for us. Breakfast is quite substantial and normally has fresh food like papaya ( my favourite), pineapple, mango, grapefruit, and banana as well as cornflakes, yoghurt, toast, jam, peanut butter and eggs. And then there is the fantastic Haitien coffee! I will miss this when I have to return to my bowl of cornflakes and milk! Evening meals normally have meat or fish, bean sauce, fried plantain babanas, igname or sweet potatoes and salad. The meat here is mainly goat which is delicious and the other day I had "tete de cabri" which is goat's head and it was delicious. However I was not brave enough to eat the eyes! There is also very good 'free range chicken', pork and beef. I love their fresh juices and they have lemon, orange, grapefruit, orange etc. I certainly haven't lost any weight despite all the water which has gone through my sweat glands over the last 3 and a half weeks.

Well this is my last blog and on Friday I will head back to the Dominican Republic to fly to Auckland via Miama and LA. I can't imagine what it will feel like experiencing a temperature difference of over 30 degrees Celsius. I might have to buy an extra woollen jersey in Auckland!

I hope you enjoyed my blog and many thanks to those of you who left comments. I enjoyed reading them!

So it is au revoir from Haiti and I guess I will have to turn up at work next Monday.

The weekend: beach, church and Roi Christophe hotel

Saturdays are reserved for local excursions and everybody is looking forward to that day. There are very nice beaches around Cap Haitien but the problem is the access. The roads are bad and often the only way to get there is by boat.

The other problem is the pollution. As soon as there is human presence the sea is being used as a giant waste disposal system. Here in Cap Haitien the beaches are littered with millions of plastic bottles and domestic rubbish. When it rains the streets are transformed into raging rivers and all the rubbish is flushed out to sea. All the city sewers also drain into the sea. There are no water treatment plants as far as I can tell and the pollution here in the city is anenormous problem. as soon as one drives to the rural areas where the population concentration is less it looks relatively clean and there is less rubbish in the streets.

So we went toa small fishing village called Labadie, at an hours drive west of CapHaitien over a rather rutted road.The beach of Labadie is famous the large cruise ships as the water is very deep allowing them to get very close to shore. The beach has now been fencedoffand canonly be used by the tourists who get off the boat for the day to enjoy watersports. Haitiens are not allowed in and as a result we decided that this was true apartheid and that we would get a local boat to go to Labadie village situated in the next bay.

As soon as we arrived we saw most of the villagers gathered around a TV in the village square watching the Argentina Germany game. All the Bresil supporters were yhoping for Argentina to loose and they had a ball!!!. The end of the game was followed by great celebrations and even a mock funeral with a coffin carried through the streets.

We found a nice beach next to an old lodge restored by its owners and run as a bed and breakfast. Inside there were beautiful old pieces of Haitien furniture as well as a number of antiques. A great place to stay for the weekend and relax. The swimin the sea, in fact the Atlantic ocean rather than the Caribbean sea as I first thought, was pleasant but not very refreshing as the water was rather warm: it felt like being in a bath at home.

After our swim we had a small picnic followed by a walk through the picturesque village. We saw people cleaning fish caught the same day and came across a very odd looking specimen which turned out to be a puffer fish. Now this brought back some memories from 30 years ago when I was studying tropical medicine in France.: we learned about poisonous tropical fish and one of them was the puffer fish. We asked the locals but they said it was safe to eat.

A lot of the locals dive to catch fish using a spear gun but seem to get only small fish. They also catch crayfish, octopus, and what they call 'conch' here which is a large shell fish which has a beautiful shell which is sold to the tourists. Unfortunately there are no fisheries regulations here and the locals take everything irrespective of size.We bougth some crayfish and crabs to take home and some of it is in my lunchbox today.

Sunday starts very early with a church service at 6am. The Haitiens dress up in their best clothes for church. Ladies in beautifully colored dresses and hats which in NZ would be worn for weddings or goingtothe races. gentlemen wear suits, collar and tie despite the intenseheat. I wore a white shirt and tie last Sunday but dropped the tie this timefor personal comfort reasons!
The church service is attended by 2-3000 people which are crammed like sardines in a tin. The service is in Creole and French and takes 2-3 hours. I had to address the congregation in French last Sunday but this time I was off the hook. They have many choirs here and Haitiens love singing. The sermonisnormally very long and the minister sometimesgets very passionate about things and starts shouting and gesticulating letting out some strange high pitched sounds.It is all very entertaining although I don't follow Creole very well yet. I understand some words and occasionally I follow parts of the sermon. They have communion once a month which means the service takes an extra hour. You wouldn't believe it but they manage to serve bread and wine to over 2000people! Amazing really.

After church our routineis to go to the local Roi Christophe hotel which is like a green oasis in the centreof town.We have a nice breakfast there with local fruit like pineapple, mango, papaya followedby eggs and a big glass of freshly squeezed juice. The other attraction is that the hotel has wirelessinternet. Sowe allgetourlaptopsout and do our emails, check whats happening in NZ and I often use this time to write my blog. The hotel was built last century and has been restored nicely keeping the old features including a number of antiques. It is a peaceful haven in the middle of the dusty and dirty streets of the city. The largeoldtress in the garden provide the shade and coolness we enjoy and the day is spent there relaxing and using the pool!!!

After having dinner we return home refreshed for another week's work.

Finally I want to give you a brief account of the heat here in Haiti. Most days the temperature is around 33-35 degrees Celsius with a humidity of around 80% andat night it drops to30-31 degrees. This means that you sweat continously and your clothes stick to your skin permanently including whatever you wear at night. It feels like being in a sauna with your clothes on! There is no air conditioning at the hospital except in the 2 operating theatres. At home we use fans which are left on at night to cool things down. During the day I drinkabout 3-4 litresof fluids and as soon as I finish a bottle of water half of it has already come back out through my sweat glands.

Here in Haiti its drink or die!!

Miss Ro Mother Theresa of Cap Haitien

I want to dedicate this post to a very special person without whom our stay in Haiti would not have been possible: you guessed right it is Robyn. I have been here just over 10 days and have observed her in action and I also know that she operates invisibly in the background to make things happen miraculously. She has an endless circle of friends here in Cap Haitien but also across Haiti and having the right contacts here is so important. She speaks the local Creole language which immediately opens doors and hearts.

We were in Port au Prince last weekend having lunch when a person approached her remembering her from so many years ago. Then we had the routine which kicks in when Robyn meets old friends: big hug, kissess, excitment, jumping up and down, followed by a long chat. You walk around Cap Haitien with Robyn and she knows so many people that you have to stop every couple of 100 meters for a chat.It is wonderful to see how she relates to the Haitiens.

She is an amazing person who has spent her whole life serving others and in the process has helped so many people here in a spiritual and material sense. She is so generous of her time and the words no and impossible are not part of her vocabulary. Robyn is full of energy but some days she overstretcches herself and we have to tell her to slow down and rest.

Robyn's skills are exceptional and I will try to describe them although I know the list is endless. She is a manager, organiser, accountant, travel agent, catering manager, automatic cash machine, interpreter, cook, driver, personal assistant to the team, call centre, coach, counsellor, nurse, mother to Enoch and many others, guide, patient advocate etc.

She is an exceptional person who has achieved so much in this country and iI believe she deserves more recognition for what she has done and continues doing here. Haiti needs an great army of Robyn like soldiers to get this country back on its rails and achieve the social changes which will lift Haiti out of this mess. I guess it will take generations to achieve any visible changes and it is the seeds planted by Robyn which will grow into great big trees bearing the fruits of her labour.

I would like to take this opportunity to thank Robyn for all she has done for the team and to express my appreciation for her constant care about our material and spiritual needs.

Thank you for everything Robyn!