Back in Cap

Had a great time in Guadeloupe but I almost didn’t get there. At the airport in Port au Prince they had never seen a New Zealand passport which caused some confusion. They asked me whether it was part of Europe and when I told them it was near Australia they stared at me as if I was from out of space! They then told me that I needed a visa to enter Guadeloupe which wasn’t correct as I had checked this before leaving NZ. Another person standing in the queue to check in then took over the discussion and he rang the Immigration Department in Guadeloupe who informed me that unless I was from the Cook or Tokelau Islands I needed a visa. I knew immediately that it was the other way round but couldn’t do anything other than wait for my fate to be decided: will they let me on the plane or not? After some time I was told I was allowed to board and that they would sort out the visa issue on arrival in Pointe a Pitre.

After a 2.5 hour flight I got to the island of Guadeloupe which is actually part of France and the Immigration Officer stamped my passport without blinking an eye and let me through no questions asked. Shortly after I was greeted by the immigration officer I had spoken on the phone who apologised saying that he got this wrong and that New Zealanders did not need a visa unless they were from the Cooks or Tokelau. He shook my hand and said welcome to Guadeloupe!

After a short 2 day visit I was back on the plane to Haiti. All went well until it came to the flight between Port au Prince and Cap Haitien. As there are no announcements or departure screens you never know when the plane is leaving! I had noticed that the plane had arrived and that there was quite a lot of activity around it. The next thing I saw was somebody with a spare wheel and jack: in no time was the plane jacked up and a wheel change carried out. Shortly after we took off for a short 20 minutes flight across the mountain range and back home.

I went back to work the next day after a house call from a mother and her child who had severe contractures of his knees and feet (on the basis of arthrogryposis). He had been operated on by a visiting orthopaedic team from the US a couple of years ago but unfortunately his foot deformities had recurred and his knees were still bent preventing him from walking. He will require further surgery but unfortunately I won’t be able to do his operations before I leave as access to the operation theatre here is almost impossible. He will have to wait until I return in year or two.

 

 

The outpatient clinic was busy as usual and I saw another child with Duchenne muscular dystrophy: he had the classic signs and the weakness of his muscles was quite advanced including his arms. He was barely able to get up from the floor but just managed to stand and walk! My guess is that he will be wheelchair bound in a few years and die of respiratory complications in his teenage years. Unfortunately there is no treatment for this genetic disease.

There was also a young girl with marked shortening of her left arm. X-rays showed destruction of the proximal humeral growth plate from previous trauma or infection and as she had no pain and almost full function surgery was not required.

 

 

 

 

 

 

 

 

 

 

 

 

The afternoon was spent teaching the residents and I saw that the hospital has a videoconference unit which is used for video links with France. The anaesthetists use this regularly but the operating theatre comes to a still stand every time they have a teaching session or a meeting! This means that operating lists often don’t start before 11.00 am. We have a unit in Dunedin and I think this could be an opportunity for ongoing teaching of the orthopaedic residents here in Cap Haitien. The only issue is the time difference between Haiti and NZ.

Yesterday my operating list started around midday and I was able to do 2 quick procedures on twins with severe knock knees and that was it. They are very slow at putting patients asleep and as there are no scrub nurses the orthopaedic residents have to set up for the procedure themselves. Nobody knows where things are and the whole thing is a very painful experience for the surgeon I mean.

Between cases I go to outpatients to help them and Thursdays is normally reserved for the clubfoot clinic. I showed them how to do Achilles tendon releases under local anaesthetic and checked on the progress of the Ponseti casting. Overall the service provided by the clubfoot nurse is very good but she requires support from the orthopaedic team.

There were quite a lot of children waiting for plasters and one of the girls was desperate to go to the loo. As there are no toilets the only way to relieve yourself is by using an empty plastic soft drink bottle and proceed in full public view!

 

 

At around 4.30 pm I returned to the operating theatre where the residents had started a tibial nailing. For one reason or another everybody in theatre gets catheterised and as they don’t always have urine bags they use a surgical glove instead: I thought that was great lateral thinking. They now have the SIGN nailing system available which allows them to lock the nails but in the absence of an image intensifier this means that the nailing has to be done open or blind. The resident proceeded with a blind nailing after reaming using non cannulated hand reamers. He managed to insert the solid nail into the distal fragment but the distal locking wasn’t easy and I am not sure whether the screw was actually in the nail or not. However despite this at least he did not open the fracture and I have noticed that they are using very few plates now which has reduced the complications and the outcome of tibia and femur fractures has improved since the introduction of this nailing  system. As the locking allows them to mobilise patients earlier there is less risk of post-operative ankle and knee stiffness. I am looking forward to seeing the post-surgery X-ray if the patient has the means to pay for it.

In the evening there was a Passover Service at the church below our apartment and this provided us with live singing for 3 hours. There were about 3 to 4000 people attending  the service which were all given food in the form of Kasava bread, meat, lettuce and a drink. I was told that they killed 5 head of cattle for the occasion. In the morning they distributed about 500 parcels of food for the poor. An amazing achievement indeed!