some photos




View from rooftop of our apartment

 



Empty bin (of course) Port in background. View from outside rehab centre

 

Work

Where am I!

Justinien Hospital Centre for Rehabilitation. This is a multi roomed building right on the coast away from the hospital. It has a large (ish) gym area room with three plinths and some gym equipment. It is air-conditioned. I have never loved an air-conditioning unit more. I am hotter when I go to bed than when I am working, and it is cooler in the evenings thankfully. It is in many ways amazingly well resourced and in other ways totally useless! I will try and explain this. Following the earthquake a lot of aid resources were sent to Haiti. One such project that benefitted from these resources was the brainchild of Andre Vulcain’s who decided a rehabilitation centre was required for victims (especially amputee’s) of the disaster as well as any patients discharged from the hospital requiring physical therapy input. The building already existed it just needed staff and equipment. Equipment arrived by the container load however no current physical therapists existed in Haiti. As explained in the first blog 3 nurses were recruited to train to be physical therapists. This sounds fine but if it wasn’t for HHH fortuitously arriving on queue with trained Physio’s they wouldn’t have got any training. The poor girls are stressed out running a clinic by themselves following three months of basic training in Physio concepts and no support apart from when we turn up. The situation is crazy but I don’t want to bog you down with health planning in Haiti! Suffice to say they a grateful when we turn up. Equipment wise the centre has two concreted in heated whirlpools! I’ve only seen them in old text books, never used them. But not to worry they don’t work so are used as storage containers instead! They have more bandages and dressings than they know what to do with as well as knee and wrist braces, crutches, moon boots, and frames and finally giant wheelchairs and giant pressure cushions that would fit two people at least (can you guess where the equipment came from?). In total the centre has thousands and thousands of dollars of equipment that the nurses have no idea how to use. One of the giant commodes we noticed had ended up at the hospital and was used as a waiting area bench for three people! A lot of the equipment is obviously targeted at people with amputations however I’m afraid to report I haven’t seen one amputee patient yet, where are they?

What’s the work like?

How do I explain this? Each day I have worked so far I have encountered conditions I didn’t think really existed or were possible. I will try and explain why. 75% of the patients are referrals from orthopaedics the rest of the patients seem to have had some kind of stroke. The resources and equipment available to the surgeons is limited therefore affecting the outcome potential. This is compounded by the fact that patients at the hospital have to pay for and provide EVERYTHING. This means that they have to bring their own food and bedding and if they are prescribed a medication then relatives have to go and find and buy the drugs out of the hospital. Claire explained a case where a gentleman was on bed rest without traction with a fractured femur and tib/fib and finally had surgery one month later when he had saved up enough money for the surgery! This may also explain some of the reasons for some of the injuries we are encountering. On top of this there are no Physio’s working at the hospital so joints are not encouraged to move as much as they might and therefore are presenting sometimes so stiff and deformed you’re not sure what you can really achieve. Patients are never on pain killers and you’re putting them through their painful paces and they do it with a smile. Ok a wincing smile! But it is remarkable!




The rehab centre

 




What can i do with this knee?

 


Fortunately there are braces.





Fiona with one of the nurses (Claudine) a patient and interpreter standing by.

 

Cap Haitien

Where am I?

So I’m sat at the table in the partial light of our luxury flat (relative to local standards) in Cap-Haitian. I don’t want the bedside light on too much otherwise the local mosquitos might get too excited and the fan is on to blow around warm air instead of opening the door to allow in more local friends! I am sweating, this is not unusual. I have just had a shower which consists of pouring cups of chlorinated water over myself in the bathroom under torch light. They drilled the holes for the lights and wired it up just never got round to fitting the lights! This too seems not unusual.

What’s it like?

Travel to Haiti was without its hiccups, Robyn was there awaiting us at the bus stop. We only had to get off the bus twice at border customs to have our bags checked. The Dominican border control was a respectable building, the Haitian a metal container with a door cut out. I’d heard the litter around was bad, I can confirm it is bad! The Haitian government provided skip bins on the roadside; they were filled then set alight and uncollected. The rest lie at the port unused. Let me tell you about the cholera. To date I have seen no evidence of people with Cholera what so ever. This comes as a mild surprise as I know people with cholera are around however they are not allowed to be admitted to the hospital and therefore will not be referred to the Physio department. By all accounts there is a large cholera treatment centre on the outskirts of the city where all people are sent. It seems all the relevant aid agencies have done an effective job of education, rehydration and hygiene. There is apparently a very catchy ‘Mr Cholera’ TV advert that all the kids love which helps. The fanciest building I have been in by far is the mobile phone store. It is slightly strange stepping off the main street of mud into an air conditioned modern shop. More people have blackberry’s than I have seen in any other country I have been in. The fact that I have spent most of my recent years in NZ either reflects well or badly on NZ dependent on how you look at it. Everyone here has mobile phones. I’m afraid to report though that the health system has not quite kept pace with the digital telecommunication advancements in recent years. The contrast of consumerism versus infrastructure is notable. Crossing the road is dangerous, road rules do not exist, and neither do car warrants surprisingly. I haven’t yet been in a taxi that I could open the door of or that didn’t have a smashed front windscreen. The only vehicles that would pass an inspection are aid trucks. They are all white land cruisers with their respective emblems on the side and darkened out windows. I don’t know who drives them. UN, Medicine Sans Frontiers, Oxfam, Red Cross and UNICEF all have a presence here. I have a quick game of basketball before work at 6am with some local friends of mine outside the UN Nepalese head quarters. There is an election currently going on. Quite what will happen following the results due shortly no-one can quite tell me. I don’t know whether this is good or bad.

What is the work like?

Well that is another whole blog in itself. Unsurprisingly it is unlike any other physio work I have ever done. . .