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.