Today’s operating list: malunion radius and ulna, biopsy tumour proximal tibia, 4 week old fracture midshaft radius and ulna and intramedullary nailing 3 week old fracture femur with 5 cms of shortening. I was told as usual that we would start at 7.00 am but when I arrived about 7.30 the operating was very quiet and they told me that there was no oxygen and that the only thing on offer was spinal anaesthesia for lower limb operations only. So that meant the 2 forearms were cancelled and they sent for the patient with the tumour.
In the meantime we saw a few patients on the ward including the child with fever and a swollen thigh from yesterday. He was afebrile this morning but still not very well with ongoing pain in his thigh. An aspiration of the midthigh down to bone did not reveal any collection of pus. I asked about the blood results but they hadn’t been done yet. However he was on IV antibiotics. An elderly lady was admitted last night with a painful hip and Xrays showed a fracture of the base of the neck and the greater trochanter with early callus formation and on questioning the residents further it turned out that the injury was 6 weeks ago. She was given crutches, told to remain non weightbearing for another 4 weeks, and discharged with an outpatient appointment.
The first patient in theatre was eventually ready. He had a swelling of the anterolateral aspect of the leg below the knee with bone destruction of most of the lateral tibial condyle sparing the fibula. To me it looked like a giant cell tumour or chondroblastoma as the subchondral bone was involved. There is no pathologist in Cap Haitien and all biopsies have to be sent to Port au Prince. Apparently it takes 3-4 months to get the results back and the residents thought that would be just in time for my next visit!!!
The second case a femoral rodding was done well by one of the residents despite a crucial reamer missing off the tray, a difficult reduction and a small butterfly fragment cause when passing the nail across the fracture. However the patient had a completely stiff knee at the end of the procedure as a result of the quadriceps shortening and he will require intensive physiotherapy which again is not easy to achieve here.
Unfortunately that was the end of our list as we were told that here were no nurses to wash the instruments. Before I left I saw one of the residents and the interns standing at the sink cleaning the instruments from the previous case. Yes that is Haiti!
To finish off the day I was told that we did not have any electricity at home because the owner of our flat hadn’t paid the electricity bill. However after pulling a few string somebody from the electricity company came and reconnected us and everybody was happy!
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