New week: what's in store?

 07 April 2014

When I arrived at the hospital today Dr Cherubin was giving a talk to all the residents of what was expected of them in relation to how to look after the ward patients, organisation of operating lists and management of acute patients. This was as a consequence of a general concern that some residents were not doing their job properly.

Then there was a talk on Duchenne muscular dystrophy by Dr Martineau following on from a case we saw a week prior. The doctors here know very little about neurological diseases and it was a good session which allowed me to give them the basic skills to at least recognise these conditions which can present in an orthopaedic clinic.

After that we went to see the acute admissions from the weekend and they were all still in the emergency department. No 6 hour rule here!!! There was one compound tibia, one septic knee and pyomyositis of the thigh, one closed femur fracture and humerus, and a couple of soft tissue injuries.

After a quick ward round I attended the outpatient clinic which had mainly trauma cases.

As far as the acute cases were concerned only the compound tibia got to theatre in the evening and the resident on call applied an external fixator.

During the day the operating theatre was mainly empty as the anaesthetists had their teaching.

Access to the operating theatre is a big issue here! Since I came last time they have introduced an operating theatre charge of 80 US $ for acute and elective procedures. And apparently you have to pay upfront. For most Haitians this is a huge amount of money they don’t have and so things do not happen. The other issue is the anaesthetic department which drags the chain constantly. There is always a reason why they can’t do the case. This is extremely frustrating and there is nothing I can do unfortunately. However I suggested that all the residents, who are still single, should marry an anaesthetist to solve this issue once and for all!

08 April 2014

Today is the operating day for orthopaedics. However there is no anaesthetist to be seen. Apparently they are all attending a videoconference teaching session from France! I am sure they will be taught a whole range of things which are not relevant to Haiti or can’t be done because the drugs or equipment is not available.

 

  

 

 

In the mean time I have been attending the outpatient clinic where there is a constant stream of patients to be seen. I saw 2 interesting paediatric cases: one hip dislocation in a 2 yaer old most likely as a result of a septic arthritis and another congenital pseudarthrosis of the tibia in a 5 year old with 5 cm leg shortening. For the dislocated hip one could of cause carry out an open reduction and spica immobilisation but in the circumstances it is probably best to leave the hip out as the joint is not painful although the child will limp and have a short leg.

 

Around 11.30 am I was told that the anaesthetists had returned from teaching and were ready to start the list. Shortly after the residents informed me that the first 2 cases ( twins with severe knock knees) were cancelled because they had the flu. Yeah right! They then called for a child with a 45 degree knee contracture following an osteomyelitis of the distal femur. They did a spinal anaesthetic and my plan was to first manipulate the knee to see how much extension I was able to obtain. As I push on the knee a copious amount of pus squirted out from a small sinus in the thigh. This precluded any operative procedure but it was possible to correct the knee to about 20 degrees which was held with a plaster. He will require further procedures after the infection is healed.

The next patient on the list was a child with an unreduced elbow dislocation despite surgery in the past. Again I was told the same story: patient is coughing so that one was cancelled as well. The last case was the child with chronic osteomyelitis and complete necrosis of the tibia. He had eaten I was told and when I asked the residents later to put him on the list for tomorrow they informed me that the parents had left the hospital with the child trying to  seek help from somewhere else: understandable considering the child had been in hospital for the last 2 weeks. Again that’s Haiti I am afraid to say!

Well that was my operating list for today.