More Hospital Musings

Being based in the Operating Theatres has meant I have less to do with the Hospital Wards than Dale or Ross. But having been to the surgical ward early in my time here it made a big impression on me. And obviously a deep one because Dale confided she was not looking forward to her first visit... Then having been on, she thought it was even worse than she had been expecting. But how much is bad – in any situation or circumstance? And how much is simply relatively bad? What is always unacceptable? And what is acceptable because of culture or condition?

Many, many of the Haitians are very moral, and hold high standards. For example at many of the churches it is not acceptable for women to wear short skirts or tight trousers, and Pastor Megy – from pulpit or more directly – has been known to ask people to sit “decently” to retain modesty. But in the theatre I was immediately struck by how patients arriving in theatre would often lie naked on the operating table, before anything was done to them, and on occasions for quite some time. But there was little sense of embarrassment or humiliation. And it is not limited to the theatre – I have heard about private out-patient clinics where patients are told to take off all their clothes and lie down until the doctor comes in – again with no sheet to cover them while waiting. But in theatre this is something I find uncomfortable – and whether interfering, or imposing my standards, I generally try to ensure patients are covered as much as possible...

The word that, for me, best describes the wards is “crowded”. Crowded with patients, beds, relatives and doctors. There are no screens, and on the surgical wards both men and women occupy adjacent beds. Relatives are essential because they provide the food, help with patient washing and dressing – both clothes and wounds, and in certain cases they buy the medicines.

They very often sleep under or beside the bed the patient occupies, but on the floor. The wards are roofed and walled with window spaces, but they have no glass – as it is not necessary because of the heat.

The surgical ward has a central courtyard which is used for treatment and washing – clothes and patients, and is usually buzzing with activity.

Patients are brought to theatre either by wheelchair or trolley – depending on the case, and the (by now expected) rules of driving apply with an interplay of artistry, ingenuity, goodwill and good luck ensuring not too many toes are run over or fractures bumped! Most patients arrive in theatre with an IV cannula in place, which is good as the heat is good at dehydrating. However consent forms are not used – just being on the trolley and in theatre is presumed as having given consent; and neither are any of the patients fixed with a name band, which is a big departure from the normal and expected practice in both the UK and New Zealand. (And for those who know what I mean – there is no pre-list “huddle”, and neither has the WHO check list made an appearance!)

On Sunday night (I was not involved in attack or treatment!) a local doctor was shot – either as part of an attempted kidnapping or as part of a robbery. He was in theatre for about three hours, and although he survived, he is currently paralysed from the waist down. He was going to be sent to the neighbouring Dominican Republic for further assessment and treatment. He still has the bullet in him. When I went to see him there were members of the UN sponsored Police Force – a Frenchman and an Egyptian, both in their local uniform, joining the general melee around his bed. They were wanting the bullet for forensic analysis, but realistically the assailants are unlikely to be found.

Dr Carmel Leconte had come in to anaesthetise the case, and was telling me today how she, who lives a few miles outside the city, feels unsafe if she is not home by 6.00pm, and when being driven to the hospital to attend to the case at 9.00pm and back at past midnight (by ambulance) she felt very nervous.

We were given strict instructions by Robyn not to venture out alone today– as she had to go to the Dominican Republic to collect the next member of the party – Kim (Physiotherapist) who is due in tomorrow.

On Mondays the theatre is given over to cleaning and emergencies only. While a minor emergency did materialise it was not possible to do anything because (again) the hospital had run out of oxygen. As it happened there was some teaching planned for the new interns and Anaesthetic nurses – and I joined in listening to a well prepared talk on Anaesthesia and Hypertension – delivered in French.

I quite enjoy regional anaesthetic techniques, and am waiting for the opportunity to teach interscalene nerve blocks, and if Dr Nadine is as competent and adept with them as she was with the epidural it will not be long before she is doing them unassisted. One big advantage with patients here is that generally they are not overweight – which makes every anaesthetic technique easier, and secondly (and to me I find this quite surprising) smoking is quite unusual.

Whereas tobacco use seems to be quite high in parts of Africa and Asia, it has a low prevalence here.

I am in two minds about photos to illustrate the wards: in general most Haitians love having their photo taken, but I wonder if it might be infringing privacy a bit too much to take some from the hospital wards. I will just try and add one from theatre – of Nadine after a successful epidural (taken with the patient’s consent!)