Saturday 12 and Sunday 13 November 2011

On Saturday Robyn took us to a beautiful unspoilt beach called “Chouchou Bay” at 2 hours drive west of Cap Haitien. Although the distance was only about 50-60 kms it took us about 2 hours to get there because the road was pretty bad at times resembling more a riverbed than something for cars to drive on. The country side was spectacular with green mountains hugged by clouds, rivers and small settlements along the road. Once we left the main road the traffic was made up mainly of the odd motorcycle taxi loaded literally to the “gunnels”. You wouldn’t believe it but the Haitiens can fit the following on a motorcycle: 1 driver, 3 adult passengers, 1 baby and a 100kg bag of rice on the handle bars!!! Then imagine a road like a riverbed and you have the picture: the drivers are very skilled and must have a great sense of balance. Once we got to the beach we were amazed but the beauty of the place. A sandy and sheltered bay with clear water surrounded by trees and not a soul in sight apart from some local fishermen. After a picnic lunch it was time for a swim and the water was just perfect!

A local fisherman was weaving a net and he was so skillful with his hands it was a pleasure watching him: he told us that it takes him 2 weeks to finish a whole net! Another one played the guitar and the local children and Robyn started to sing and dance. We had a wonderful time and I hope that this place stays as it is and escapes development for the tourist industry!!!

Sunday was a day of rest and I had my weekly swim in the swimming pool at the Roi Christophe Hotel where we also had a nice brunch.

Monday 14 November 2011

The weekend at the hospital was busy for the orthopaedic department following a “taptap” accident about 2 hours out of town. Taptaps are the local taxis which basically are pick up trucks transporting people between cities and normally when fully loaded have 20 people on board. One of them came of the road and hit a rock face causing half a dozen of seriously injured passengers. So the orthopaedic ward was pretty full this morning during the ward round: 1 severe head injury, 1 patient with a dislocated hip and 2 wrist fractures of which one was dislocated and open, 1 fracture dislocation of the hip, 1 forearm fracture and some more minor injuries. The head injury patient is unconscious and lying on the ward and the family asked me to have a look at him. He has a severe head injury without any skull fracture and no other bone fractures. His neck and spine are clinically normal and he really needs a CT scan which is not available here. So the only thing we can do is to monitor him clinically and hope that he will wake up and recover the motor function of his limbs. Here in Haiti if you have a head injury you either die or you recover spontaneously because there are only a couple of neurosurgeons in Port au Prince. The patient with both wrist fractures and hip dislocation had his wrists redudec and plastered and his hip reduced under sedation. He was sitting in his hospital bed pretty happy.this morning. The other patient had a posterior fracture dislocation of the hip whichwe reuced under general anaesthetic today but the hip was very unstable and we had to put here into skeletal traction as a result. She will have to remain in traction for 6 weeks to allow the acetabular fracture to heal and the hip to become stable. Ideally she would require surgery in the form of fixation of the posterior wall but logistically I am not sure whether that is possible here.

The outpatient clinic was busy today with fractures from the weekend and follow ups. One 8 year old boy presented with a contracture of his middle, ring and little fingers as a result of an electrical burn 6 months ago. He climbed on the roof of a house and touch some live wires. He has skin contractures from burns and will require Z plasties and skin grafts to allow him to straighten his fingers again. Hopefully I can do his surgery before I leave at the end of the month.

At the moment we have 15 plus patients waiting for surgery and very little theatre time.

The orthopaedic residents told me that it is very difficult to get the anaesthetists motivated to do orthopaedic cases. They were saying that they have to beg them on their knees and probably whisper sweet things into their ears etc. I told the 2 residents that I have a perfect solution for the problem: I suggested to them that they marry anaesthetists and then their wives would be able to provide anaesthetic services for the orthopaedic department. They laughed and thought it was very funny! Well here in Haiti you have to think laterally at every level!