Singing in heaven, Operating in Hell

I have been here for 1 week now and experienced highs and lows, exemplified by the last few days. Sunday was church day, with the main service at the indigenous Evangelical church of Haiti commencing at 6am! And what a crowd! About 3000 people crammed into the building occupying 4 levels and those who were on the lowest level and at the upper levels unable to see the pulpit had closed circuit TV to view the proceedings. It was already hot when it started but there were numerous fans going. We were placed in a prime position as I was going to be introduced to the congregation. The service went on for three and a half hours. There was a lot of singing, including a great male choir. There were keyboards and a xylophone which kept the pitch right when the power went off as it did once. We were more concerned about the fans that slowed their rotational movement of precious air. But in some ways, the singing of 3000 voices was even more effective without the accompaniment. The sermon, as preparation for communion that Sunday was on Numbers chapter 5 which deals with the Levitical law of dealing with a jealous husband who accuses his wife of two timing! It was extraordinary the way he developed it into the way we should examine ourselves before we take the communion emblems. During the distribution of the emblems which took about 20 minutes each time, there was more delightful communal singing and some items. Most of the tunes were familiar to me but the Creole words were new. There was joy and enthusiasm in the faces of many of the people. I gave a short greeting from New Zealand, explaining why I was here. I have been asked to take the sermon in 2 weeks time - HELP!

Traditionally after church, people have pumpkin soup for breakfast - not just the liquid kind but laden with small potatoes, beef bones, some other veges, all very nice. Then came the highlight of the day - a trip to a local hotel that had... wait for it.... a swimming pool! Ah the bliss of being wet all over (even if it was tepid water), relaxing with a view over the bay, iced drink, ham and cheese sandwich in hand, being cooked like a lobster... oops! I tried to stay

in the shade and kept my sunhat on except when in the pool but with a lid like mine, the sun is bound to have a go at it. It is not painful or really burnt, just red. But it was worth it.

In the afternoon we were back at the church for a session on spiritual medicine led by Pastor Megy for doctors and nurses involved in the church. At this time, my stomach was starting to churn, the 'D' had manifested themselves without the 'V's so I decided to forgo any tea. I have continued to have the "squits" yesterday a 3 squit day and today only one so it is improving.

Monday was fairly quiet - a ward round, a clinic, then the chief of Surgery Dr Barrella did his weekly round. He has a good rapport with the students and is like a big cuddly teddy bear. My opinion was asked on a few cases but I am feeling a little redundant otherwise. However, they decided to give me a teaching session starting at 7am the next day with the topic of biliary surgery. I had a quick review using the RACS website library to get the main headings. I forwent breakfast to get to the hospital on the back of a motorbike about 6.45 and about 15 docs attended. I am not sure how many could understand my English but half way through, one of them started translating as he could see some listening with their eyes closed.

After almost 2 hours, I called it quits. They had 2 operations scheduled that day but there had been a city wide power cut that morning so theatre was less than functional. I was invited to do the first case- repair of an umbilical hernia. With no fans or air conditioning, in thick gowns (reused) and gloves, I could feel the sweat poring down me. They do not have theatre nurses - the surgeons do it all, including the swab count (not), checking needles and selecting instruments. Early on I asked for the sissors and was handed some enormous shears that did not cut anything. So I tried the diathermy which worked only when the power came on, for a few minutes, then cut off. I ended up using artery forceps to do the disection. Meanwhile, the lighbulb over the table could not cast a shadow and during the power cuts disappeared completely leaving me struggling to see what I was doing. Each time the power came back on, the diathermy had to be reset. Then they could not find any sutures so we waited for 5 minutes while the senior hunted some down. They had not seen a Mayo repair of an umbilical hernia before and it was not easy under the conditions and with the minimal instruments available. But I got there and was glad to get out of that steaming theatre and get a cool drink. The next operation was an inguinal hernia done by the senior resident. He asked how I repaired hernias, but decided he would do his standard "Bassini repair", a technique abandoned by most western surgeons decades ago and for all the reasons I saw demonstrated. No local anaesthetic is used, it creates enormous tension on the groin structures producing a lot of postoperative pain and has a significantly higher recurrence rate than modern techniques. I got the distinct impression that because they do not get to operate very often, and there are about 8 residents in training all wanting to get their hands on cases that my presence was depriving them of opportunity to do things themselves and I can fully understand that. I know as a junior how I longed to get cases under my belt and to have some visiting bigwig stepping into my shoes was not appreciated. Nevertheless, I feel that despite the language problem the teaching was appreciated so I think that will be my niche.

So by midday, having taught for 2 hours and operated for 3, I was exhausted, dehydrated and very sympathetic to their difficult plight. I did bring some new instruments, (Courtesy of Braun NZ) for them so I will be interested to see if any of them appear in the trays during my stay. In the meantime, they have asked for a lecture on gastric surgery in 2 days time (7am again) so I will be hitting the books as it is some years since I did any. But that is tomorrow's task.

The second physio, Kim arrived this evening so now we are a team of 4 plus Robyn. Steve has been busy much of the day doing an orthopaedic list but on Monday, he had nothing to do as the hospital had run out of oxygen because on Sunday night they had done an emergency laparotomy on a doctor who had been shot in the back. That operation used all their theatre oxygen supply. Such is the situation in Haiti. Till next time, au revoir.