Saturday was a very quiet day reserved for some retail therapy as Fiona was leaving after the weekend. We have a 14 year old girl called Lovely staying in our flat and the other day I asked her whether she had any books as I often see here sitting around doing nothing or watching TV. I was surprised when she told me that she has no books to read and that her school does not have a library (nor any computers for that fact). We therefore decided to find her some books and Fiona bought her a lovely illustrated dictionary which I am sure will help here with her French studies .I also was told by Lovely that some days the teachers just don’t turn up and the kids are left on their own at school without anything to do. Also kids don’t have any opportunities to play as there are no playgrounds nor any sporting facilities. The only time you see them on the streets is on Sundays when the neighbourhood kids take over the streets to play soccer using some very small locally made goals. Looking at them with my eyes as a retired soccer coach I must say they have very good skills.
On Sunday we were invited by Reuben’s wife, Jacqueline, for Sunday lunch which meant that we had to take a local Taptap to get to their place on the outskirts of Cap Haitien. We were squeezed like sardines in a tin and they managed to fit at least 20 people into a people mover which had not a single functioning shock absorber left. We got to our destination in one piece and had a lovely relaxing time followed by a nice lunch. Actually I spent most of my time entertaining a 5 year old boy called , Sebastien, who expected my full attention 100% of the time. I had to invite all sorts of games and make things from stuff lying around the garden to keep him entertained. We got a ride back into town from one of Robyn’s friends and as it was Sunday the day finished with an ice cream.
Monday 21 November 2011
After farewelling Fiona I walked to the hospital to join the ward round which had just started. There were only 2 admissions over the weekend one 1 year old child with a femur fracture appropriately treated with gallows traction and a closed tibial fracture in a young lady which had some lacerations which were sutured. The resident opted for application of a long leg plaster which I thought was a very good option as the fracture was reasonably aligned. All the other patients were doing well and a number were ready for discharge.I enquired about the little boy admitted last Friday with a very painful and swollen arm and I was told that he has been transferred to the paediatric ward but nobody could tell me whether he had improved or not.
Outpatient clinic was busy this morning and we saw about 20-30 people including some patients referred from ED. We sutured one thumb extensor laceration following a machete injury under local anaesthetic and saw as usual some interesting patients. There was one new born with an obstetric Erb’s palsy and another child with a high temperature and a swollen and painful thigh and knee on the basis of acute osteomyelitis of the femur.
Then there was an old man who complained of hip pain but Xrays were normal and the resident had not examined the patient. It turned out that he had a large lump overlying his hip possibly a lipoma, soft tissue sarcoma or TB of the bursa of the greater trochanter. I asked the resident to aspirate the lump but there was no fluid. He was referred to the general surgeons for an excision biopsy. Finally there was a young boy with severe burns to his upper limbs who has been on the ward for at least 6 months. He is under the care of the general surgeons who look after the burns and he has major contractures of his elbows and right wrist. He will require extensive Z plasties of his elbows and wrist to restore the movement of these joints. However that might not be enough as he probably has developed secondary tendon and joint contractures. Interestingly he got burned when dressed in newspaper for a play at school when another boy grabbed some matches and set him alight!
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