My first dip into the clinical arena at St Justiniens Hospital

We made it across the border into Haiti the following morning, but not without some stresses. The Haitian immigration authorities wanted to see my return ticket to prove I was going to leave. We had to trek down a muddy bank through many big trucks blocking what passed for a road to the border bridge over the dividing river to get it, only to find that they did not want to see it anymore. Some official who knew Robyn asked why she was being delayed and they decided to forget the ticket. Meanwhile, the locals just carted goods, chickens and even people across the river without any immigration control. UN soldiers "observed" the border but are considered a joke by the locals because they never intervene, just observe! The road from the border to Cap Haitien was the best we have been on- fast, no potholes and we were at the town in just over an hour. Most of the roads in the Cap are being dug up and reconstructed in a haphazard fashion so there is dirt, dust and mud everywhere.

After a fruit breakfast, we visited the hospital for introductions and I was given a rundown of the programme for each week. I met Dr Barrella, the chief of Surgery and his chief resident,
Dr Bright who speaks good English. I was asked to see a patient with a
mass in the epigastrium. They have no CT, minimal (and very expensive)
ultrasound and were debating what to do. I thought a "mini" laparotomy
for biopsy would help make the diagnosis which I think is probably
intraperitoneal spread of a tumour into the omentum, possibly gastric
or ovarian primary. When we got back to the apartment where eveyrone
had being staying up until then, I began to flag with tiredness, and
lay on a couch, quickly falling asleep and being photographed as shown
in this undignified position by Steve.

I woke to go out for dinner out at a local restaurant but after shifting our bags to where Steve and I were to stay, I completely collapsed into a deep sleep, utterly exhausted.
The next morning, after a hearty breakfast of spaghetti and eggs
cooked by Robyn, Steve and I went to the hospital where I was welcomed
onto the ward round. 3 senior residents were taking the interns on a
round where some very advanced cases were presented. My opinion was
asked for on a few cases, through interpretation. Then there was an
outpatient clinic which was quite an eyeopener. Mind you, they are
working under extreme conditions (even the Haitian doctors were
sweating drops off their faces on the patients in a windowless room
with only open doors for ventilation). They have few resources and a
massive clinic load but such treatment of people as "cases" rather
than individual people would not be tolerated back home. I was more
like a cattle yard than a clinic, with people wandering in and out, 4
interns and 2 residents peering at them in undignified states of
undress and as for that weird hairless white stranger in the corner
who was never introduced, he looked more like a mortician! I witnessed
my first rectal examination in the undignified "knee-chest" position,
popular in some clinics in America but never seen in British style
institutions like NZ. Some people really needed operations for chronic
abscess but were given yet another course of antibiotics. A little
girl with a good story for inguinal hernia was examined by he intern
lying down, and not standing up as is important. I am finding that
because I do not understand the Creole and my smattering of French is
pretty useless that I have not been able to participate as much as I
would like. Nevertheless, the staff have been very welcoming,
translating the basic clinical information into English for me and
asking for my opinion. So my contribution will be limited. It may take
more time to develop and I have yet to go to the operating theatre but
from Steve's position as anaesthetist and having been here for over a
week, he finds the conditions very primitive and sometimes
distressing, but under the difficult circumstances they do
extraordinarily well. This evening, I am much refreshed without the
exhaustion and tiredness of last evening. Tomorrow is a public holiday
(Sante Christe) here so we are having a day off from the hospital as
there is no elective work. I hope I can be of some use. It is clear
that Dale, our physiotherapist has already made a huge contribution in
the rehabilitation area and is very much appreciated. Steve has also
been doing a number of anaesthetics but I am only just starting. I
will wait to see where I can be of most use. I can see that Jean-
Claude will have a massive advantage with his French lingo in teaching
in particular. Nevertheless, it is great to be part of a team making a
contribution. And with Robyn's unflagging enthusiasm for the task
despite her health problems we are all in good heart and enjoying
great fellowship together.