Weekend 29-30 October 2011
The Saturday started with a meeting regarding the Physiotherapy School Project which is being developed under the auspices of the Evangelical Church of Haiti and also sponsored by Hearts and Hands for Haiti. The success of the project is dependant on securing United Nations funding and being able to achieve long term sustainability through internal or external funding of the running costs.
After the meeting Robyn had organized for one of her friends ‘Shute’ to drive us to Fort Liberte, a small settlement at an hours drive from Cap Haitien. A few friends and friends of friends joined us as well as a little boy called Sebastien. So the car was pretty full but fortunately in Haiti there is no limit to the number of passengers one can squeeze into a car. Fort Liberte is a quaint little sea side town with a beautiful natural harbour and crystal clear water. It has ruins of an old fort built by the French in the 17th century with stunning views over the harbour and town. We visited a number of family members of our Haitien friends and had lunch prepared so generously by one of the families. It also gave me the opportunity to demonstrate my’ Kompa’ dancing skills with Sebastien in the main street of Fort Liberte to the amusement of the locals. Robyn couldn’t resist videoing the whole thing and is threatening to publish it on You Tube. It was a very pleasant and relaxed afternoon and on the way back we had to stop to buy some horsemeat on the side of the road at the insistence of the little boy Sebastien who on the way out had a tantrum and cried as he absolutely wanted his meat. I had to try it as well, of course, and must say that it was rather stringy and salty. Certainly not worth all the fuss made by our little friend.
Sunday as usual started with a 6.00 am church service and like last year I was introduced to the congregation by Pasteur Megy and had to go up to the stage to say a few words. The service was as usual except that the keyboard was so loud that it completely drowned the singing of the choir. After church we went to the local hotel Roi Christophe for brunch and a swim. The water in the swimming pool was just right but obviously to cold for the Haitiens and as a result I had the whole pool to myself. I remember that last year I didn’t enjoy the swim so much as the water was too warm. Finally in the late afternoon we picked up Fiona from the bus station and had an early bed.
Monday 31 October 2011
Work at the hospital started with a presentation by the medical students on the anatomy of the shoulder. As usual this was followed by questions and quizzing from the residents.
We then did the ward round and saw a little 10 year old boy with a very sore and swollen knee with significant quadriceps and leg wasting following a healed supracondylar fracture. Apparently his leg wasn’t right before the fracture and Xrays show a healed fracture and marked soft tissue swelling and a rotational problem at he level of the knee joint. The knee Xray shows an AP of the femur and lateral of the tibia. In the absence of MRI imaging the only way to make a diagnosis at the hospital here is a surgical exploration. I thought of TB, dislocation, tumour but I am not sure. There were quite a lot of empty beds on the ward which meant that the weekend was probably quiet although we saw a patient in ED with a closed femoral fracture, head and facial injuries but overall stable.
The outpatient clinic today was busy because the next 2 days are public holiday: Toussaint and Jour des Morts ( All Saints and All Souls day ). The resident reduced a couple of forearm and wrist fractures in children under haematoma block and even removed a protruding screw from a tibial plate in the plaster room. There were a couple of babies one with clubfeet and another with a healed fractured femur with marked angulation and shortening. The clubfeet were plaster and the baby with the healed broken femur sent on his way with explanations to his mother that the deformity will correct spontaneously over the next 12 months. Finally we saw a 12 year old boy with a localized kyphosis in the lower lumbar spine and a rather flat thoracic spine th
e cause of which is unclear to me.He has no pain and has no neurological deficit. Xrays presented to me were of poor quality and there appears to be an abnormality at the L5 level. Again I have been thinking of TB and we will carry out a few more investigations.
The clinic finished at 3.00 pm and after discussing the next operating list with the resident it was time to go home.
Tuesday 1 November 2011
Today is a public holiday so after sleeping a little bit longer I got up at 7.00 am for a leisurely breakfast including fried eggs, papaya, pineapple, bread, local cherry jam, yoghurt, local honey and Haitian coffee. Yummy! Then we went to visit a newly constructed hospital near Cap Haitien to meet with the Medical Director Dr Toussaint. I went there during my last visit and was impressed by the progress. There were a number of new buildings and the operating block is now completed but the theatres haven’t been fitted out yet. They are also in the process of building a small post anaesthetic unit. There is also a maternity, paediatric and rehabilitation unit including facilities for patients with spinal injuries. The project is funded by the Baptist Church and Haiti Hospital Appeal which is a UK based charity. Attached to the hospital is the biggest cholera treatment unit located in tents currently looking after 200 cholera patients. This was a very informative visit and Dr Toussaint kindly offered his hospital as a clinical placement for the future students of the HHH School of Physiotherapy.
We then returned home and I saw a few patients including a young man I operated on during my last visit for a chronic infection following a forearm fracture treated with plates and screws. He was very thankful that his infection was healed and he kindly brought us some oranges from his garden. He is a teacher at a school close to Cap Haitien and we had a good chat about issues related to education and teaching in Haiti. Class sizes are a big problem: although the limit is 50 I have been told that in some cases the can be as high as 150!! Also the attendance of teachers is very variable and a lot of the time classes do not happen because the teacher doesn’t turn up.
Finally we had another meeting of the Physiotherapy School Committee and the day finished with a wicked treat: icecream!!
The Saturday started with a meeting regarding the Physiotherapy School Project which is being developed under the auspices of the Evangelical Church of Haiti and also sponsored by Hearts and Hands for Haiti. The success of the project is dependant on securing United Nations funding and being able to achieve long term sustainability through internal or external funding of the running costs.
After the meeting Robyn had organized for one of her friends ‘Shute’ to drive us to Fort Liberte, a small settlement at an hours drive from Cap Haitien. A few friends and friends of friends joined us as well as a little boy called Sebastien. So the car was pretty full but fortunately in Haiti there is no limit to the number of passengers one can squeeze into a car. Fort Liberte is a quaint little sea side town with a beautiful natural harbour and crystal clear water. It has ruins of an old fort built by the French in the 17th century with stunning views over the harbour and town. We visited a number of family members of our Haitien friends and had lunch prepared so generously by one of the families. It also gave me the opportunity to demonstrate my’ Kompa’ dancing skills with Sebastien in the main street of Fort Liberte to the amusement of the locals. Robyn couldn’t resist videoing the whole thing and is threatening to publish it on You Tube. It was a very pleasant and relaxed afternoon and on the way back we had to stop to buy some horsemeat on the side of the road at the insistence of the little boy Sebastien who on the way out had a tantrum and cried as he absolutely wanted his meat. I had to try it as well, of course, and must say that it was rather stringy and salty. Certainly not worth all the fuss made by our little friend.
Sunday as usual started with a 6.00 am church service and like last year I was introduced to the congregation by Pasteur Megy and had to go up to the stage to say a few words. The service was as usual except that the keyboard was so loud that it completely drowned the singing of the choir. After church we went to the local hotel Roi Christophe for brunch and a swim. The water in the swimming pool was just right but obviously to cold for the Haitiens and as a result I had the whole pool to myself. I remember that last year I didn’t enjoy the swim so much as the water was too warm. Finally in the late afternoon we picked up Fiona from the bus station and had an early bed.
Monday 31 October 2011
Work at the hospital started with a presentation by the medical students on the anatomy of the shoulder. As usual this was followed by questions and quizzing from the residents.
We then did the ward round and saw a little 10 year old boy with a very sore and swollen knee with significant quadriceps and leg wasting following a healed supracondylar fracture. Apparently his leg wasn’t right before the fracture and Xrays show a healed fracture and marked soft tissue swelling and a rotational problem at he level of the knee joint. The knee Xray shows an AP of the femur and lateral of the tibia. In the absence of MRI imaging the only way to make a diagnosis at the hospital here is a surgical exploration. I thought of TB, dislocation, tumour but I am not sure. There were quite a lot of empty beds on the ward which meant that the weekend was probably quiet although we saw a patient in ED with a closed femoral fracture, head and facial injuries but overall stable.
The outpatient clinic today was busy because the next 2 days are public holiday: Toussaint and Jour des Morts ( All Saints and All Souls day ). The resident reduced a couple of forearm and wrist fractures in children under haematoma block and even removed a protruding screw from a tibial plate in the plaster room. There were a couple of babies one with clubfeet and another with a healed fractured femur with marked angulation and shortening. The clubfeet were plaster and the baby with the healed broken femur sent on his way with explanations to his mother that the deformity will correct spontaneously over the next 12 months. Finally we saw a 12 year old boy with a localized kyphosis in the lower lumbar spine and a rather flat thoracic spine th
e cause of which is unclear to me.He has no pain and has no neurological deficit. Xrays presented to me were of poor quality and there appears to be an abnormality at the L5 level. Again I have been thinking of TB and we will carry out a few more investigations.The clinic finished at 3.00 pm and after discussing the next operating list with the resident it was time to go home.
Tuesday 1 November 2011
Today is a public holiday so after sleeping a little bit longer I got up at 7.00 am for a leisurely breakfast including fried eggs, papaya, pineapple, bread, local cherry jam, yoghurt, local honey and Haitian coffee. Yummy! Then we went to visit a newly constructed hospital near Cap Haitien to meet with the Medical Director Dr Toussaint. I went there during my last visit and was impressed by the progress. There were a number of new buildings and the operating block is now completed but the theatres haven’t been fitted out yet. They are also in the process of building a small post anaesthetic unit. There is also a maternity, paediatric and rehabilitation unit including facilities for patients with spinal injuries. The project is funded by the Baptist Church and Haiti Hospital Appeal which is a UK based charity. Attached to the hospital is the biggest cholera treatment unit located in tents currently looking after 200 cholera patients. This was a very informative visit and Dr Toussaint kindly offered his hospital as a clinical placement for the future students of the HHH School of Physiotherapy.
We then returned home and I saw a few patients including a young man I operated on during my last visit for a chronic infection following a forearm fracture treated with plates and screws. He was very thankful that his infection was healed and he kindly brought us some oranges from his garden. He is a teacher at a school close to Cap Haitien and we had a good chat about issues related to education and teaching in Haiti. Class sizes are a big problem: although the limit is 50 I have been told that in some cases the can be as high as 150!! Also the attendance of teachers is very variable and a lot of the time classes do not happen because the teacher doesn’t turn up.
Finally we had another meeting of the Physiotherapy School Committee and the day finished with a wicked treat: icecream!!
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