Last days!

The Monday outpatient clinic was very busy as a result of the long Easter weekend and things were more chaotic than usual. There is no appointment system here in Haiti and people just turn up. There is only one consulting and one plaster room and often 2 or 3 people are being seen in the same room: the concept of privacy doesn’t feature highly here!

Before

 

 

And after

 

My first patient was a follow up from an operation I did 2 years ago. This lady had a very deformed forearm following a plating of the radius and ulna which had failed. She was very pleased to show me her arm which was now straight and functional. There were a whole range of cases: tibial non union, acromioclavicular dislocation, unreduced shoulder dislocation, septic arthritis of the knee in a young child, valgus knees in children, arm and fore arm fractures etc.

After the clinic visited the local orthotic and artificial limb centre and was taken for a visit by the manager who is from Togo and who has been working in developing countries for many years. As I worked in Togo for a year 35 plus years ago we had a great chat about Togo and the current state of affairs of this tiny West African nation. They have a very good workshop and they make all sorts of plastic splints ( note the black colour of the plastic!!) and above and below knee artificial limbs. A great team doing an excellent job with support from outside Haiti of course.

My last operating list started with a patient of Ogedad’s who had a large intramuscular lipoma seated deeply inside the leg which had been increasing in size over many years. Xrays showed a marked thinning of the fibula from the chronic pressure effect. I helped Ogedad do the operation and I was impressed by his surgical skills. The next case was a child with a congenital pseudarthrosis of the tibia but when I got to the operation room they had called for another case with a forearm fracture which was a friend of the medical director of the hospital. Here in Haiti there is no fairness in the system! You need to know people in high places to get anything done: they call this ‘piston’.

I was really disappointed that nobody even cared to talk to me about this and as a result I was unable to show the residents how to do this procedure. As it was early afternoon there was no way that this child would be done that day. He will be sent home and probably be left with a severely deformed leg which will be ignored by the orthopaedic surgeons here because they have no knowledge of how to deal with these problems. I decided it was time to call it a day.

Milot hospital

Ogedad doing the ward round

 

Robyn picked me up from the hospital and we drove to Milot where Ogedad is currently doing a locum. Sacre Coeur Hospital in Milot is run by Catholic Nuns and much better equipped  and organised than Justinien Hospital in Cap. I sat in Ogedad’s outpatient clinic and after that he took us around the hospital. The wards looked much cleaner and less crowded and the orthopaedic equipment excellent including an image intensifier. They have surgical teams flying in from the States every week and this week it was urology. They bring their whole team and take over the operating theatre. They don’t do any teaching and basically do not contribute at all to the development of the Haitian surgical workforce! When Ogedad wanted to book some acute cases he was told by the anaesthetic nurse in no certain terms that only Caesarean sections were done out of hours. So there you go again!

Future ITTP building

Indonesian MINUSTAH contingent

Today on my last day I did some teaching at the Institute for Technicians in Physical Therapy. We first checked out the progress of the building being done up by the UN. We were very pleased with the progress and noticed that all the ceilings inside had been lined with plywood and that they were waiting for the windows and doors. The Indonesian soldiers were extremely pleasant young men and one of them spoke good English. There were also 3 Chilean soldiers there who were responsible for the security of the site and they didn’t appear so welcoming. However after we spoke to them in broken Spanish they started smiling a little!

 

 

 

The teaching session was well received by the students and they asked very good questions. I taught on fractures and went through some of the cases I had seen in the clinic here at the hospital over the last month. The students showed their appreciation by singing a song of thanks at the end of the teaching session.

 

 

At the end of the day I attended an ITTP School Committee Meeting where a was thanked for my contribution to the school and teaching of orthopaedic surgery at Justinien Hospital.

Well my time here in Cap Haitien has come to an end and I am off to Santiago by bus and back to NZ via the States on Friday. I must say that despite all the frustrations I am pleased by the progress which has been made since my last visit. I enjoyed teaching the orthopaedic residents and it was very satisfying to see what a skillful surgeon Ogedad has become. He is indeed one of the future orthopaedic leaders of this country.

Ogedad, his wife Christna and myself

 

My greatest thanks as always have to go to Robyn who has been outstanding. Without all her background organisation, her contacts, her Creole language skills and her great sense of humour my stay wouldn’t have been the same. Also many thanks to Bernadette for her very tasty Haitian cooking and for her happy smile! Thanks to Steve, Lorraine , Jo and Claire for their wonderful company.

Couscous prepared by Bernadette

Miss RO the shining light

I am also very grateful to the United Nations and the Indonesian contingent of the MINUSTAH in Cap Haitien for their work on the school building in Riviere Salee. They have done a great job!

Finally thanks to Hearts and Hands for Haiti and all the sponsors and supporters of our project. Without your help and prayers we wouldn’t have been able to get this project off the ground!

Au revoir Haiti. I will miss you until I return!