bits and pieces

A couple of photos to try and support my claim that I have been in theatre most days! And that the sun-tan has come from incidental exposure rather than anything planned. I am pictured with Drs Nadine Compet and Jo-Ann Jean-Louis. They are both residents - Nadine has 2 years experience and Jo-Ann 2 weeks! In the other picture is Dr Carmel Leconte - chief Anaesthetist, and only permanent member of the anaesthetic staff. She originally came from Port-au-Prince, but after her marriage she came to the north of the country. Her husband is the head of Obstetrics and Gynaecology at St Justinien.

The case loads are very different from the UK - although there are General Surgery, Orthopaedics, Urology, Oral Surgery, Obstetrics and Gynaecology lists - the content of them is quite different, and the choice of surgery also very different.

There have been a lot of prostatectomies done here - but none have been done endoscopically, all open and (I think) transvesical in approach.

There have been a lot of fractured femurs - motor-bike, football, falling out of cars - but there is no X-ray facility in theatre, so they are all plated (rather than rodded) and I assume get a check x-ray some time later.

70% of the cases are done under spinal anaesthesia - including children as young as 12. The only failed spinal I have seen was one of mine - I did wonder why the anaesthetic nurse asked me to do the spinal as they are usually very keen on doing the job themselves. This patient was 17 years old, and coming for second skin graft to his foot - (he is epileptic and fell into a fire). All was going well as I sat him forward, cleaned his back, but as I started to feel for the space on his back to place the needle he virtually took off out of the table, and that was almost before I had got the needle out of the tray! Despite being almost too forcibly held, he was not going to sit still and I went quickly for a general anaesthetic.

Nadine is very keen to learn and one prostate list all the cases were done using epidural anaesthetic - as she was keen to learn that technique.

One thing I have discovered about teaching is that it has resurrected skills I may once have had but use rarely now. So keen was Nadine to do brachial plexus block, that she persuaded me to teach her site one for a prolonged tendon repair - and it was the only method of anaesthetic necessary, and it worked so well that then every possible time a nerve could be used the request has come to try it out. And so I have to quickly remember how to do (and then teach) femoral and sciatic nerve blocks. And I have been surprisingly impressed with how effective they can be.

Away from theatre, and back to home life. There had been a consistent run of power cuts from about 4.00am to 9.00am. This had been going on for about a week, and given that there had to be cuts, it wasn't a bad time to have them.

But then the pattern changed a little - and moved to midnight to 4.00 am and no power, which was rather more difficult chiefly because of no fans.

The reason we think is because of the World Cup. Haitians in general are passionate about football, and so the World Cup has been a big thing here. There are broadly speaking 2 big divisions: those who follow Brazil, and those who follow Argentina. And it is not uncommon to see the flags of the 2 countries on cars and motor-bikes, and also to see the team strip being worn. The change in power cuts we think is so that the morning matches can be seen.

When the matches are on - life is distinctly quieter. Today Brazil were playing Korea, and a number of the physio patients didn't turn up, and the theatre lists finished early!

But for us the match of the day was New Zealand's opening encounter with Slovakia. That was scheduled for 6.30am our time - which is fine as I generally get up at about 5.00am.

The television at Enoch's has seen better days. To turn it on or off requires a pen to be shoved into a hole (crude but effective), and the picture is pretty shaky and broken. It makes following the ball tricky, but possible - just. Ross improved the picture a little by using some surgical dressing plaster he had to secure the aerial slightly more firmly into its' socket.

We were eating our breakfast to the match commentary - given in Creole, and by 2 commentators who are also in Haiti, just watching the match as we are. Every now and then, the oral commentary is interrupted by a voice from the sponsors - Mattato Supermarket, urging us to shop there and nowhere else.

Just as it seemed Slovakia were to score - the power failed and we resorted to the internet, only to find that the ball was kept out by the NZ goalie.

Power was resumed after five minutes, and we had the misfortune to see NZ go a goal down, but then with seconds left - to equalise. Much shouting from the dining room in Enoch's house!

It seemed to make the day go quite well.

Two photos to finish with - the Episcopal church seen from the front;

and the interior of Robyn's church taken on a weekday. Most of the flowers have been removed for cleaning, but a few have been left out. This in no way gives a sense of the people who are there on a Sunday, nor either of the attendance during the week. I came in for a moments prayer, and all over the building there were individuals or couples either sitting quietly or reading the bible. Clearly in a country which has so very little in material and other resources there is a spiritual hunger that is being met.