Another week in Haiti

Its the end of another week here in Haiti with a variety of experiences to recount. We are living in the house shown left. It belongs to Enoch a well educated and travelled (but single) Haitian who has graciously given up his bed and facilities for us. It is meant to be the wet season here but we have seen very little rain, just hot, hot, hot! It has been very difficult to cope with, especially when the power goes off at midnight and the fans stop, there is no breeze, and the mosquitoes move in for the kill. The mosquito net makes the intense heat even more intense, so one has to decide on avoiding the bites or a minor measure of comfort without the net. My worst night yet was Friday when after a meal of spaghetti bolognaise I could feel it sitting in my stomach and not moving on. After a 4 squit day a few days before, I resorted to the lomotil which stopped the squits but left me a little uncomfortable. When the squits began again on Friday, I decided to wait till the morning but never got any sleep with the heat, stomach squirms, profuse sweating, lack of fan etc. Finally at 1 am I got up to see if a squit would help - it came easily enough but did not reduce my discomfort. So I took what is called a shower here, more like a sprinkle with the odd drop thrown in (Oh how I miss my 13l/min high pressure shower of home). After 5 minutes under the sprinkle, collecting all the water in the baby's bath so it can be reused to flush the toilet, and collecting the drips that come off the faucet, I usually have half a jug of water to pour over my head as a refreshing finale. Having completed my sprinkle, I sat in the darkened lounge for a few minutes before the stomach announced "my turn" and I dashed back to the loo to empty the contents and "flush" the toilet (if you can call an ineffective American style toilet a flush) with the water I had just showered in. I struggled back to bed, but the heat had not abated and I did not get to sleep until about 4pm. The sun rises at 5pm and the fans came on about an hour later so I did get a lie in and a bit more sleep. Another lomotil and a cautious day eating has brought me back round again so today, Sunday, things are back to normal (ie no squits, settled stomach, ocean breeze and a good nights sleep last night.

Sunday is the highlight of my week as we get to have one special treat - a swim at a local hotel. Today it was at the Christophe Hotel. The swimming pool was less soupy than the one last week and I spent about 90 minutes in and out of the coolish water - probably more tepid than cool but very refreshing. This was after church (6-8am) and breakfast at the hotel. The other special treat I had for the first time here was on Saturday night when we had an icecream! I could not resist despite my settling stomach. I did not ask how much it cost.

Well, what of my week? I had previously described surgery as operating in hell. It certainly would not pass any accreditation organization in the west but they do remarkably well for the little they have. They recycle everything. Even the paper disposable gowns are resterilized until they start falling to bits. I have seen some of the donated instruments appear on the trays so that is pleasing. My teaching seems to be appreciated - next week I have to deal with colorectal operations. I have also been asked to cover the residents for emergencies next week as the surgeon superintendent, Dr Kok, will be in the USA. There are 3 final (4th) year residents who seem very knowledgeable and capable, although like most senior registrars in our system they are always keen to operate. We had a good example this week of a shooting where the bullet had entered just above the symphysis pubis and ended up in the left upper lateral thigh. They were ready to go to theater, even though there were no peritoneal signs and a catheter had not been placed in the bladder. When it finally was placed, the urine was clear indicating the bladder was intact so observation was advised. Under these 3 senior residents are about 8 other residents (trainees in surgery) all keen to get some cases under their belt. Most of them get to do dressings in the ward as their main activity, and occasionally they will be asked to come to theatre. I got to spend some time with one of them in his room in the doctors residence on the hospital site. He as a first year surgical resident earns US$200 a month, when he gets paid. Sometimes the government does not pay the staff for months (7 months recently) but they do get their accommodation supplied. When I asked their most senior resident what his future was, he smiled and looked quite wistful as he said, "All I can do is dream". He would love to do further study abroad but there are no openings, even though he is quite experienced and very capable. Jobs in Haiti are few and his future looks bleak. Trained but nowhere to go!

On Friday, I was waiting for action in theatre but nothing seemed to be happening. So I decided

to go to the clinic, but it was deserted. The charts of some patients were there but no docs! Then the penny dropped. The soccer world cup first game was on and everything stopped so it could be seen. During this time a man who had crashed his motorcycle came to A&E and I was asked to assess whether the severe laceration to upper and lower lip could be dealt with under general or local anaesthetic. I thought the latter so between the first and second games of the cup, the team swung into action. I was invited to assist with the debridement of a heavily contaminated wound which had also ripped some of the teeth and bone from his lower jaw and there were compound fractures of the alveolar ridge but the body of the mandible was intact. It was quite a plastic procedure to align the torn lips and repair what we could of the mouth but it came together quite well under local anaesthetic. Fortunately, they seem to have the range of antibiotics that we would use in a similar case in NZ.

Recreation? Yes we do have some time off for that. Saturday, the physios had to work the morning for some American bigwigs who tended to belittle their contribution (which as I have said before, I think has been the most important of the team to date). In the afternoon, we had the use of a 2 door Isuzu 4WD and decided to go to Milot which lies close to the foot of the

Citadel. This fort built in the early 1800s by a despotic Haitian ruler (Christophe) is at 30oo feet dominating the skyline and in its building cost the lives of 20000 slaves. We hope to climb it in 2 weeks. This trip was to view the palace at Sans Souci near Milot, one of 8 he built. It is a very impressive ruin. He clearly was a megalomaniac with a fortress around it and tunnels linking parts of it to the cathedral, all built on a grand scale like the castles in Europe.

On the trip to Milot, the universal joint on the drive shaft of the Isuzu broke, leaving us stranded. The friend of Robyn who loaned the

car, James known as JP, came out with 2 mechanics and had it fixed on the side of the road in no time! But that is the way it is in Haiti. If it cannot be fixed, it is pushed to the side and can be stripped for bits that others may need. All this happened near a roadworks where bulldozers were ripping up the bitumen and as fast as it was ripped up, families of surrounding houses were carting the slabs off to place around their homes as crazy paving - much better than walking through mud when it rains. They may even get some cement to fill the cracks between the slabs.

Transport here is mainly by motorbike, taptap (usually a Toyota Ute with seats and a kind of canopy over the top) or taxi. I have been told off for using a motorcycle as they can lead you anywhere (kidnappings are not uncommon here). Taptaps go certain routes out of town and roar down the rutted and speedbumped roads at incredible speeds excess passengers hanging off the back, ducking and weaving between pedestrians and the motorbikes. But the taxis are something else. They have probably been unwarrantable for years but despite the body rust,

grossly cracked windscreens, unsuspended suspensions, absence of handles on doors, ominous rubbing sounds under the car and a precariously perched "Taxi" sign on part of the roof, they seem to get us round town. It is their amazing maneuverability down streets that barely fit 2 cars in them and then there are the precariously parked vehicles and even trucks that just stop so they have t find another route. Everywhere we go, there is the toot of cars and motorbikes (some sound like sirens or foghorns) as they warn pedestrians to move of be moved! For all this congestion, it is amazing that I have not seen any accident - not that you would notice another dent in the bodywork of most vehicles.

Well I think that wraps up another week in Haiti. The picture right was taken at the Palace at Sans Souci and shows Steve Benford in blue, our English/NZ anaesthetist, Charlot, the tour guide in purple, JP, who came to fix his car that we broke and yours truly. Tonight is is a little cooler outside as I sit in the breeze and it looks as if it might rain. Our well has threatened to run dry and we have occasionally had to hand draw water up out of the well when the pump will not work - either the power has cut off again or the pump broke. All a bit uncertain but the is Haiti.

Do check out Steve Benford's detailed blog at http://frstevebenford.blogspot.com/