The ward round this morning was very relaxed and there was a lot of Haitian humour and bursts of laughing. There was one admission last night and guess what: a motorcycle accident. The patient suffered a heel fracture and a posterior hip dislocation on the same side. This is the 4th hip dislocation I have seen over the last 4 weeks and probable double the number of femoral fractures. The hip dislocation was reduced by the resident last night and the patient sitting up in his bed very happy. Then we saw a 12 year old boy with an angulated proximal femoral fracture in a long leg plaster slab unreduced with obvious angulation of the proximal thigh. The junior resident was told off in no terms that this was not an appropriate way of treating femoral fractures and he looked very sheepish indeed. The other patients were all fine including a little boy with osteomyelitis of the femur who looked very happy this morning.
We then went to the medical ward to look at a patient with a spontaneous compression fracture of the thoracic spine with a history of convulsions, improving paraparesis and a mild fever. He had been improving on antibiotics and I thought that the most likely diagnosis ,by exclusion, was osteomyelitis. However you never know here in Haiti!
The outpatient clinic was steady today with the usual interesting patients. There was a young child with congenital elevation of the scapula (Sprengel’s shoulder), an elderly man with a non union of the humerus and a complex intra articular fracture of the proximal tibia treated in a long leg plaster and Mammon, the plaster technician reduced a Colles fracture without anaesthetic: he likes to play doctor!
Finally I saw the sad case of a young man who was involved in an altercation in the Dominican Republic which ended up him loosing his arm from a single very sharp machete blow. He put his arm in front of his face to protect himself but the machete sliced through his forearm including bone resulting in a surgical guillotine amputation. In New Zealand this would have been a perfect indication for a reimplantation with a number of surgical teams reattaching the amputated arm. However in this part of the world this is not possible and this young man is now one handed which is a significant disability. The residents told me that these machete incidents are very common in the Dominican Republic were the Haitian are treated very badly. There is in fact a lot of animosity between the 2 countries. I said to the residents if the Dominican machetes are that sharp we should send our theatre instruments there for sharpening as they are all dead blunt!
To finish off the day I helped one of the residents to drain a chronic osteomyelitis of the humerus and then it was time to go home.
Yesterday I have been contacted by the Baptist Convention Hospital regarding a patient with a C6C7 dislocation and spinal cord injury who is somewhere in the centre of Haiti and I have been asked to see whether I can stabilise his neck here at Justinien Hospital before I leave next week. I said that I am happy to help if they can get the patient here over the weekend. We shall see what happens.
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