Tuesday 29 November 2011

Today was my last operating list. When I arrived in the operating theatre at 7.30 am there was dead silence. Nothing had started for the day. I thought that was a bad omen.

I found the residents outside the theatre calling ‘orthopedie, orthopedie, orthopedie …’ to alert the anaesthetists that we were here and ready to go. As there was no action we went to the ward to see a 67 year old lady with a displaced neck of femur fracture who requires a hemiarthroplasty. They have uncemented Moore prostheses here but not in all sizes and sometimes the Haitien patients have small femoral canals which makes the fitting of the prosthesis challenging and sometimes impossible. The only other option then is a resection arthroplasty.

There were 4 orthopaedic cases on the list today: non union proximal phalanx thumb in a 5 year old, patellectomy, femoral nailing and plating of a distal tibial fracture. The patient with the tibial fracture jumped the queue because he is a friend of the medical director and normally would have to wait for a couple of weeks for his surgery. The first case took about 20 minutes operating time and then a patient of the senior registrar, not on any list, was taken into theatre for a general surgical procedure out of the blue without discussion. Whilst waiting I had a look at the store room to see whether there was any useful orthopaedic equipment hidden away in old dusty cartoons and I found 2 brand new US Army pneumatic tourniquets with a bicycle pump which was what I was trying to find in NZ and here there were 2 and nobody knew about them. I tried them with the residents and they work perfectly well even if there is no power!!!

The second patient on the orthopaedic list was called for at 11.30 but as his blood pressure was slightly elevated he was cancelled by the anaesthetist. Then we were told there was a C section and at that stage I went to have some lunch with the residents. As Robyn and I had an appointment with the Director General of Health I had to leave the hospital at around 1.30 pm. I will see tomorrow whether the residents managed to do the femoral nailing and the tibial plating.

The meeting at the Ministry of Health was straightforward and after that we visited a patient who had a hemiarthroplasty for a neck of femur fracture 2 months ago and when we got to the house she was in bed. She had been told by the local orthopaedic surgeon that she was not allowed to walk for 3 months. She didn’t have any crutches but was given a wheelchair. Her hip felt fine to me and I advised her to go and see the surgeon next week and to get some crutches.

The paraplegic patient which I was told would be transferred from another hospital from the central part of Haiti is now apparently being flown here tomorrow which is my last day. I told the referring hospital that I cannot guarantee that I will be able to do the surgery before I leave but they said they take the chance as there is no other option available to them. The patient has a C6C7 dislocation and my plan is to do an open reduction through a posterior approach, sublaminar wiring and fusion. We shall see what tomorrow brings!