Tuesday, February 22, 2011

Final update. Over and Out.

Final update:
So the talk to the hospital Doctors went well in the end though it initially looked like another THB moment. With the talk due to start at noon we turn up 5 mins early to check out the room. 10 mins later the person is found with the key to open the door. 10 mins after that we are allowed in the room as it needed to be cleaned, but no worries anyway as no-one has turned up to hear us talk. We’d been promised a projector so we could use PowerPoint but obviously there was a power cut at the time. So 30 mins after we were due to talk 30 Doctors, interns and nurses turn up, awesome! (Were they forced by the chief of staff?). It seemed the talk was well received and hopefully the girls will be able to be more consistently involved in early rehabilitation on the wards.
I have been covering the wards in Claire’s absence. Here’s a rundown of the patient’s I was referred: a gentleman who was stabbed in the neck and now seems to have some sort of incomplete spinal cord injury. Another gentleman who was shot in the abdomen and has lost the use of some of his leg muscles and finally a poor lady whose oil lamp exploded all over her and she now has 2nd degree burns on her face, chest and arm. Yep definitely patients I’m typically not used to treating! The girls cope admirably and between their local experience of such conditions and my general background experience we seem to muddle through.   

Leaving time . . .
So what have I achieved?
 This is difficult to answer. I can tell you what I hope I have achieved. I hope I have helped give Claudine, Audate and Sony a slightly clearer understanding of what, how and why physiotherapists can do what they do. In doing so I hope they have gained a little more confidence and belief in themselves. It is interesting talking to Fiona about this. She explains her concerns on leaving after her previous visit, wandering whether she had helped or hindered? Was ‘a little bit of knowledge a dangerous thing’ or was ‘some knowledge better than no knowledge’. To her (and me) this trip has highlighted that something is definitely better than nothing as demonstrated by the numerous positive outcomes the girls have achieved with their patients. Therefore if I have been able to help up skill the girls any further with simple rehabilitation principles then surely this is a good thing. Fiona, who has done so much great work already (as well as all of the previous volunteers, Dale, Kim and Claire), will continue this beneficial and rewarding training role.

Quick comment on HHH future in Haiti:
In my short time in North Eastern Haiti this is what I have seen: It seems there are literally hundreds of NGO’s with overseas money trying to set up projects for specific purposes to help a poor country struggling for stability. All projects talk about co-operation, collaboration and co-ordination however this seems to be an extremely difficult task in a country lacking in infrastructure but not lacking in corruption. This is not at all to say that it doesn’t occur, as it must do and has (e.g. controlling the cholera outbreak) it just seems it is much easier said than done.
This is where HHH is slightly unique. With Robyn’s many years of experience working here both for the church and within the health arena she has several influential friends and contacts. This has given us a great support network as well as enabled us to cut through some of the Haitian bureaucracy, allowing us to do some valuable work. For that opportunity and experience to work in Haiti as a physiotherapist, I am extremely grateful. It will be interesting to follow HHH’s direction from here. With all their local support they will hopefully be in a unified position to create something sustainable by the Haitian people for the Haitian people. In that endeavour I wish them the very best of success and achievement.

How do I feel on leaving Haiti?
I will never forget my Haitian experience for numerous reasons. See below:
Things I will miss:
·         Homemade Freshly squeezed fruit juice daily
·         The Girls’ natural, generous, contagious laughter when I accidentally mix Creole with French
·         The practicing church choirs underneath our apartment each morning and evening.
·         The patients and families positive attitude towards dealing with horrific injuries
·         Helping the girls understand what they do and why
·         Watching the sun rise over the Atlantic whilst playing basketball with local friends  each morning
·         The girls being able to say ‘uh oh’ in 10 different ways with 10 different meanings
·         Bernadette’s cooking
·         Knowing that each work day you will encounter something completely new and unusual.
·         Homemade peanut butter.
·         Revising my anatomy from a French textbook, a double challenge!

Things I will not miss:
·         Haitian time keeping
·         Dirt / mud everywhere
·         Chlorinated cups of water for a shower
·         Not being able to put toilet paper in the toilet
·         The daily dangerous road crossings.
·         Feeling that if you didn’t have Robyn to talk your way out of trouble with Creole each day you could get in very uncomfortable situations all too easily.
·         Not being able to eat fresh vegetables without washing them first in chlorine.
·         The smell of rubbish filled drains.
·         Robyn’s ring tone. Turns out knowing half the population has its drawbacks!
·         Mosquitoes, daily insect repellant applications and remembering anti-malarial tablets.

But has it been worth it?
Overall definitely yes for the incredible people I have met working with a smile in challenging environments. It is humbling and inspiring. Have I made a difference? I remember what an American missionary said who has been here 25 years. She explained you hope to make a positive difference, but perhaps you make less than you hope. Though it certainly makes more of a difference on you! I’ve only been here 5 weeks but I can understand the sentiment.

Note: I finish writing this blog having just heard of the devastating earthquake in Christchurch. My thoughts and feelings go out to all who have been affected.

Photo's of what i will not miss

Efficient drainage!

Walls of rubbish. Literally!

Open wounds everywhere

Openly urinating in the river!

Stiff joints I can do nothing about

Road travel!

Photo's of what i will miss

Great way to start day!

Amazing what you can carry on a motorbike!

Brave Patient's

Determined Patients

Smiling patients


Teaching / learning sessions

The hub of Cap Haitien life

Bernadette schooling me on real fruit juice making

Tuesday, February 15, 2011

week 4 update

Week 4 update:
Time is flying by, one more week of work left and lots still to do. We said cheerio to Claire this am, so our team of 4 is now 3. We wish her a safe trip home. She was a valued member of the team, with her current inpatient experience making our skill mix complimentary. We will fill her shoes as best we can. We have arranged a talk with the Doctors at the Hospital re the role of inpatient Physiotherapy. Should be interesting.
We are all still enjoying the work and now able to start seeing the fruits of our labour with patients demonstrating some good improvements. My workable French is becoming more workable. I have never made more use of my schoolboy French.
Also it rained. When it rains here it is serious rain. It’s a bit like snow in Guernsey, the whole Island comes to a standstill. It’s a good enough excuse to say you can’t make it to work because you can’t cross the road because of the mud!
In a gap year before University I went to Zimbabwe. There I was taught ‘TAB’ (That’s Africa Baby) to sum up numerous moments of chaos and disarray, and to help you keep your sanity. I am happy (?) to confirm that ‘THB’ also stands here.  Let me give you an example: Last night we went to a ‘cultural evening’. The tickets said start at 1530 so we arrive on time, stupidly. The DJ arrives at 1630 with his speakers and sound system and starts plugging in things. At 1700 the generator cranks up right beside us to power everything as there is another powercut. At 1715 when they are about to start they realize they can’t draw the curtains (painted sheet) they put up so have to tie them up instead! At 1720 it starts. At 1730 we leave unable to hear ourselves think from the sound of the music to drown out the sound of the generator.
On Saturday we went to a beautiful coastal fishing village only accessible by boat and had a swim in the Atlantic. It was glorious. It was good to see that parts of the coastline here have maintained some of their local traditions and the sea is still clean to swim in. There is a private beach beside this village that the locals are not allowed to use. It is used by the Caribbean cruiseliners only. This seems a shame but the subsequent employment it produces for the local community apparently outweighs this exclusivity

Sunday, February 13, 2011

Surrounding sights



Road chaos. Taken whilst moving. No surprise there are such nasty road accident injuries.
 


Haiti
 

ever present





A beautiful coastal village


More Cap Haitien sights


View of Cathedral in centre of town



Where we live. 3rd floor apartment. With typical road chaos and 'blanc' being followed by school kids.
 


Cholera Treatment Centre with steadily decreasing numbers thankfully.
 


View from our balcony. Not surprisingly it is rarely quiet. These guys work 7days a week. Not great for mid afternoon naps when poorly. See below.
 


See above
 


Robyn at old Fort
 

photo work update


Claire looking comfortable on her last day on the ward


Doesn't look right


Lady with nasty burns. Fortunately she smiles, even after what we put her through!


Her mum helping her do her daily exercises


Not looking so comfortable on the day we get her out of bed!


Also not right


arches in between ward buildings


Fiona and Audate helping a child to walk


Sony and I discussing plans for patient treatments.


The girls during a teaching session with Robyn the ever crucial interpreter.




Another poor lady with a very stiff arm



Sharing lunch on Claire's last afternoon. Her experience and company will be missed.


Tuesday, February 8, 2011

Written update

Hospital:
Open fractures, open wounds, strong smells, lack of privacy, crowding and a total reliance on family to provide for you. These are some of the things you notice about the hospital. It is a place of extremes. We’re regularly coming across patients with conditions we have never come across (see large wound and bullet shattering tibia).
Everyone is watching what you do at the hospital because so little goes on during a day on the ward. This means that if you go to help get a patient out of bed you have a crowd of people watching and trying to help you before you know it. This wouldn’t be so much of a problem if the beds weren’t so crammed together and you didn’t already have a student and interpreter in tow.
We’re also learning quickly the benefits of simple physiotherapy principles, not that we didn’t know them before but it’s always good to be reminded why you do something when you see the terrible consequences of not doing it. I never realised quite how stiff joints above and below a fracture can get when they are immobilised for long enough! We don’t see these joint complications in New Zealand as they have been prevented by early intervention / mobilisation.  The problems you encounter here following prolonged immobilisation are off the scale!

How good the girls are:
Right from the start we have been impressed with how well the girls are managing such a challenging caseload. It is amazing what a bit of training in rehabilitation can achieve, and all credit to the previous HHH team. Some of the outcomes that Sony, Claudine and Audate have achieved are remarkable. They have genuine examples of greatly improved function in people following strokes, spinal cord injuries and nasty upper and lower limb fractures. These include (i) a 30yr old gentleman who 6 months ago had no movement or sensation in his limbs and following a spinal fusion and rehabilitation is now walking with a frame, and (ii) a stroke patient that can now walk with a stick and a little supervision when before they couldn’t even sit up without support. It restores your faith in what we can achieve as rehabilitation professionals.

How welcome we feel:
Ever since arriving here we have all felt extremely welcomed, safe and supported within the community. This is in no small part to Robyn of course who, with her many years of living and working here as a missionary, has fluent Creole and built an enormous network of local friends and followers. We live within the same block as the Evangelical Church of Haiti and have been accepted warmly into their vast congregation. This makes you feel that you always have a local person looking out for you even if you find yourself on the very odd occasion not within sight or speaking distance of Robyn. It is comforting in such a sometimes chaotic and intimidating place.
It is not uncommon for the 15 min walk to work in the morning to take 30 mins purely because she meets people she knows on every street corner! This is in no way a frustration either as all the people are friendly and welcoming and grateful, wishing you all the very best for the valued work you do for their country. It is humbling the gratitude and resilience the Haitian community retains despite the numerous challenges it has faced over the years.

Quick update on current political climate:
People were sent home early from work on Weds last week. This was because the election results were due out that evening and the country was expecting some unrest / rioting. Turned out the results didn’t come out till the next morning and the whole country went to work as per usual and there was no trouble. Sweet. Today is Monday. We were supposed to go to work today but the old president was supposed to step down today and has not done so. Therefore the country didn’t go to work today as they were expecting trouble to kick him out. However, quite what would happen if he was kicked out I have no idea as there is currently no-one to fill this role! There are two candidates both with strong support in their respective camps and the outright winner won’t be announced till March so it’s wait and see I guess. Fortunately no evidence of trouble so far and fingers crossed it will be back to work as usual tomorrow. 

Sunday, February 6, 2011

Daily life

Add caption


Room with a view. Our street from our balcony





Typical shop


Hospital Chaos

Typical ward scenario. May not look too bad, try smelling it!


Bullet lodged in shattered tibia. One of the easier patients! Haitians are tough!

Typical poor quality film. This guy waited a month to pay for his surgery like this!

Not uncommon wound. Like this following fasciotomy for compartment sydrome! Bone evident.


Cute kid! 20% burns following hot water spill. Shoulder now moves a bit too!