Saturday 5 and Sunday 6 November 2011
After a leisurely breakfast we went to the hospital to have a look at the new Intensive Care Unit build by the Israeli Government. We were particularly interested in the lightweight modular building material which has been used for this construction. The unit is brand new and has already suffered water damage as a result of a leaking roof problem. We were able to see the water on the floor ourselves after a night of heavy rain. Quite a number of ceiling panels were water damaged in a building which was finished 4 months ago. This does not sound good for the future of the building and the electronic equipment inside. As this building material has been imported from overseas nobody knows how to fix the leaks: the lesson here is that you should use local building materials which can be repaired by local workers! When we looked at the building from the outside it was clear to our unprofessional eyes that the pitch of the roof was too small: Haitien rain is not like in New Zealand and when it rains here the skies open and it pours heavily for short periods of time transforming the streets into raging rivers. In the afternoon, whilst on our way to the market, we were caught out by the rain and had to take shelter in front of a shop for 1 hour to wait for the rain to stop and the waters to recede. As a result of the rain the temperature has dropped and I am now able to sleep without a fan going all night. Hurray!
Sunday started with a 3.5 hour church service which was interrupted by another downpour of rain as all the windows had to be closed. As it was the first Sunday of the month communion was served to 2000 people a truly amazing organizational challenge handled superbly by the church staff. After that I had my weekly swim in my private swimming pool deserted by Haitien and ‘Blancs’ i.e. Whites alike!
The rest of the day was catching up on emails and reading.
Monday 7 November 2011
The day at the hospital started with the registrar presentations followed by the ward round. The amputee from last week was doing well and so was the young boy with TB of the knee whose antituberculous treatment has been started and his pain is much better now that he is in a plaster. There was only one admission over the weekend in the form of a femoral shaft fracture from a motorcycle accident of course.
Outpatient clinic today was cut short by the fact that the only Xray machine had broken down. When I asked the registrars what normally happens in such a case they told me that some times this means no Xrays for a few days, weeks, or months! Well we could be in for a few challenges.
However I saw a middle aged lady with a marked , almost 75 degrees, deformity of the forearm after a fracture of the radius and ulna 4 months prior. The radius was plated but the plate removed prematurely for unknown reasons. After that a young man was brought to the clinic from ED wit a hand injury. He was assaulted with a machete following an argument over a cow! He lost most of his thumb unfortunately and the only thing I could do was showing the medical student how the clean the wound and stitch up the skin under local anaesthetic. Finally a mother brought her 5 day old baby boy with severe congenital malformations of both lower limbs. On the right side he had a complete absence of the tibia with agenesis ( non formation ) of the knee joint and the fibula attached to the back of the thigh. The foot was turned upside down and associated with an absence of the big toe. On the other side he had a partial absence of the tibia ( missing the distal third) and a clubfoot type deformity with a very small big toe and unstable ankle. I have seen such a case in New Zealand a couple of years ago and based on this I know that this boy will require an amputation through the knee on the right side and a reconstruction of the ankle and foot on the left. This surgery will not be able to be done before the age of 1 because of anaesthetic reasons. In the meantime I will splint the left leg to correct part of the deformity to prevent things from getting worse over the next 12 months. I wonder what the future holds for this young boy in Haiti where there is significant discrimination against people with physical disabilities.
After a leisurely breakfast we went to the hospital to have a look at the new Intensive Care Unit build by the Israeli Government. We were particularly interested in the lightweight modular building material which has been used for this construction. The unit is brand new and has already suffered water damage as a result of a leaking roof problem. We were able to see the water on the floor ourselves after a night of heavy rain. Quite a number of ceiling panels were water damaged in a building which was finished 4 months ago. This does not sound good for the future of the building and the electronic equipment inside. As this building material has been imported from overseas nobody knows how to fix the leaks: the lesson here is that you should use local building materials which can be repaired by local workers! When we looked at the building from the outside it was clear to our unprofessional eyes that the pitch of the roof was too small: Haitien rain is not like in New Zealand and when it rains here the skies open and it pours heavily for short periods of time transforming the streets into raging rivers. In the afternoon, whilst on our way to the market, we were caught out by the rain and had to take shelter in front of a shop for 1 hour to wait for the rain to stop and the waters to recede. As a result of the rain the temperature has dropped and I am now able to sleep without a fan going all night. Hurray!
Sunday started with a 3.5 hour church service which was interrupted by another downpour of rain as all the windows had to be closed. As it was the first Sunday of the month communion was served to 2000 people a truly amazing organizational challenge handled superbly by the church staff. After that I had my weekly swim in my private swimming pool deserted by Haitien and ‘Blancs’ i.e. Whites alike!
The rest of the day was catching up on emails and reading.
Monday 7 November 2011
The day at the hospital started with the registrar presentations followed by the ward round. The amputee from last week was doing well and so was the young boy with TB of the knee whose antituberculous treatment has been started and his pain is much better now that he is in a plaster. There was only one admission over the weekend in the form of a femoral shaft fracture from a motorcycle accident of course.
Outpatient clinic today was cut short by the fact that the only Xray machine had broken down. When I asked the registrars what normally happens in such a case they told me that some times this means no Xrays for a few days, weeks, or months! Well we could be in for a few challenges.
However I saw a middle aged lady with a marked , almost 75 degrees, deformity of the forearm after a fracture of the radius and ulna 4 months prior. The radius was plated but the plate removed prematurely for unknown reasons. After that a young man was brought to the clinic from ED wit a hand injury. He was assaulted with a machete following an argument over a cow! He lost most of his thumb unfortunately and the only thing I could do was showing the medical student how the clean the wound and stitch up the skin under local anaesthetic. Finally a mother brought her 5 day old baby boy with severe congenital malformations of both lower limbs. On the right side he had a complete absence of the tibia with agenesis ( non formation ) of the knee joint and the fibula attached to the back of the thigh. The foot was turned upside down and associated with an absence of the big toe. On the other side he had a partial absence of the tibia ( missing the distal third) and a clubfoot type deformity with a very small big toe and unstable ankle. I have seen such a case in New Zealand a couple of years ago and based on this I know that this boy will require an amputation through the knee on the right side and a reconstruction of the ankle and foot on the left. This surgery will not be able to be done before the age of 1 because of anaesthetic reasons. In the meantime I will splint the left leg to correct part of the deformity to prevent things from getting worse over the next 12 months. I wonder what the future holds for this young boy in Haiti where there is significant discrimination against people with physical disabilities.
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