Back in the UK

Time has a habit of doing funny things... No wonder physicists and theoretical mathematicians can hypothesise that time is not really linear but actually curved and even wobbles a bit! (I would not be surprised if it also gets tied up in knots as well.)

I have been recovering really well from what was confirmed as Dengue fever - in fact would think I was back to whatever passes as normal - and have been meaning to post something to tell anyone who might have been following these musings that I am safely home. When time, which was behaving itself quite nicely, suddenly does a jump and I realise that I have been home for 6 weeks, (and somewhere along the line gained a year in age).

The journey out of Haiti was accomplished using the luxury of a coach belonging to the Carib Line - a company based in the Dominican Republic and connecting many of the major towns and cities over the island. And when I remember the taxis and tap-taps and motor-bikes seen on the roads on and around Cap-Haitien this is really luxurious - with air-conditioning (so effective that blankets are provided) and a means of constantly adjusting the tyre pressures to maintain a balanced (and presumably safer) driving experience.

(Quite how the mechanics of the system work is beyond me but I have attached a picture to try and explain it.)

The coach line operates daily, with the incoming service arriving in Cap Haitien late in the afternoon. The coach is locked away in a compound over night, and departing passengers are invited to assemble at 8.00am. Tickets are checked, baggage is tagged and loaded, and we are invited to board. The coach is designed to hold over 50 passengers, but it seems like we are less than 20. All of us, if we want it, can get a window seat, and on some signal (which wasn't able to discern) the coach leaves, and so I begin my journey back to the UK.

The coach had comfortable seats, the potential for playing DVDs, an on-board toilet, and a hostess to help negotiate the border crossings.

We arrived at the border in good time - about an hour driving, and parked on a field

of mud (currently dry). We were immediately surrounded by hawkers and beggars offering us drinks, sweets or shoe-cleaning. After walking to the passport-control and having our documents scrutinised, copied, stamped and returned we walked back to the coach and waited for about 30 minutes.

The border crossing is a single track road-bridge crossing a fast flowing river. The river can be crossed directly by the more intrepid, and as no-one seems to notice or intervene, and that includes the border guards from both countries and the United Nations Observers, it is an option to consider for the traveller lacking travel papers. The river is also used for laundry and bathing, though given the colour of the water it is hard to imagine a whiter-than-white finish.

There seems to be no signal, but lorries are crossing either direction but with no clear pattern or priority. But obviously at our turn, the coach started and we crossed from Haiti to the Dominican Republic... only to drive into a yard and be "invited" into a customs shed - with all our luggage. As we parked we were surrounded by many, many children and young adults desperate to carry our luggage (clearly expecting a fee) and it took a fair bit of doing to insist on carrying our own.

(Though I was surprised how tired I still felt after the Dengue - on arriving at Robyn's just 6 weeks earlier I had carried my bag and another with a rucksack on my back up to the second story flat; on leaving it was all I could do to drag my own case down.)

We all had to take our luggage into a barn-like hall where the bags were opened and rummaged through. Quite what was being looked for was not apparent. There are times when wearing a clerical collar has advantages: as the man searching my cases looked at my collar and barely opened the bags, and muttered something like trusting the clergy! And also I found that my immigration forms had been filled in for me, and I was listed as "Religioso" on the occupation section.

On returning to the coach we were all given a big filled-roll and a soft drink and some water. As my appetite was yet to return, I followed the lead of some others and offered my roll to one of the children encircling the bus - it was quickly grabbed and taken away.

Again following some mysterious signal the coach left and we drove to Santiago.

The scenery remaining remarkably constant, while the condition of the housing and roads gradually improved as we came to the city.

The Spanish speaking Dominican Republic has a more "Latin" feel to it than its more French-feeling sister Haiti.

Most of the towns and villages we drove through had their own churches and police buildings; but also cock-fighting pits - though there did not seem to be any contests as we passed.

Having arrived in Santiago there was a few minutes delay before Ruben met us. (Ruben was our driver on arrival 6 weeks earlier, and was back in the Dom Rep to have his truck fixed.)

We were escorted to our hotel and it was a pleasure to enjoy a hot shower and an air-conditioned room.

The hotel staff were very good, and the facilities excellent.

After an early supper - and yes my appetite was returning - we turned in. Ross and Kim had an early start - their transport to the airport came at 5.00am and it was quite emotional to see them go.

I had a further 24 hours to wait, the time was taken waiting for Fiona to arrive, and then a brief sightseeing tour on foot before trying to sleep

After seeing Fiona and Ruben leave for the journey into Haiti, it was my turn to take the shuttle to the airport.

And after the formalities - again involving a rummage through the case, and then as I was one of the random stop and search candidates a more thorough searching of all my luggage it was time to go.

And after 4 hours on the plane, with a sleeping 2 year old and his mother as my row companions, it was really great to arrive in New York and meet Lorraine.

Further musings...

Dr Bell's clinical suspicions that I had contracted Dengue Fever were confirmed by the blood test result that had been sent to Port-au-Prince. Although Dengue is known to be in Haiti Dr Bell claims this was the first case he had seen here, as it appears most Haitians have some form of natural immunity. (Lucky them!) Although I felt as though I had lost quite a lot in the 2 weeks I was unwell, I am also aware of how much I gained as well.

I lost about 1 stone 4 lbs in weight (that's just over 8kg), but that will do me no harm at all!

I also seem to have lost some time - it's hard to explain but the memories I have of the time are very hazy.

What is harder to accept is that I seem to have lost a lot of energy: on several occasions I thought I was on the mend, and got up, washed and dressed, fully expecting to go the hospital to try and work, only to find I couldn't eat any breakfast, and then couldn't even stay upright and had to lie down.

But what I have gained is priceless, and probably beyond words: without meaning to I have obviously been a worry to those at home and those in Haiti - but Robyn had put herself way over the top in my care. The prayers of the Haitian church, as well as those from home, New Zealand and even further afield have been very humbling. The love and care of Cilotte - a Haitian nurse (whose injection technique I can recommend) and of Bernadette - Robyn's cook/housekeeper were so gentle. Bernadette arrived one day and just started praying - in Creole - and Robyn said that she simply felt that is what Jesus wanted her to do.

A good friend from England wrote to me, she said: "There are more ways than one to be a gift. Vulnerability allows others, usually labelled 'the needy', to serve you. Will pray that God uses this reversal for good." I join my prayers to that one.

And now for some more musings and observations - which may find their way onto this blog before it's wound up.

Shopping in Cap Haitian is an exciting adventure. Most of our food is bought by Bernadette from the market. And the market has everything. Chickens are bought live - from vendors who have them on poles - and it is common to see them being brought home on the motorcycles, on what is a one-way journey for them. At least we can know our meat is fresh.

Fruit and vegetables are in abundance, and the avocados and papaya (with lime juice) was a breakfast treat. A lot of eggs are eaten here (well I'll be bound) and they are sold hard-boiled along the streets.

There was one supermarket which for convenience (not for price) we used to visit. It is called the Kokyage and visiting it was a mixed experience. There are not many supermarkets in the UK or NZ that have the benefit of an armed guard at the door. But this supermarket is not alone in this - all the banks, and many other businesses have it as well - guards toting what can only be described as pump-action shotguns but without the butt - more like enormous pistols.

And although I always spoke with the guard, and he became very friendly, it is sobering to imagine what might happen...

The Kokyage is well air-conditioned, which made it a welcome break on the walk from the hospital, but outside is surrounded by children begging. Some of whom are dressed and suited for the part - others look a little too well fed. Robyn says that Haitians are very good actors, and these kids certainly know how to turn on the pathos. "I'm hungry" "Give me a dollar" "Grand-gout" (which is Haitian for hungry). They have even followed us the half a mile or so home with hands outstretched. Robyn advised us not to give, and once we had this in mind, and it was recognised, we were left alone a little. I tried to turn the tables once - and said to them to give me a dollar - and they did give me a Haitian coin (quickly returned!)

Begging does seem to be a fact of life here. It was not uncommon - in fact usual - for people to approach us on the streets because we are white (blanc) and to ask for money. Sometimes it verged on the aggressive. And being rich, it doesn't come easy to be remined of it by people who really do have nothing. But at other times it is a feature of even those we are working with - asking if we can give them money for this project or that item of need. But if we start where do we end? And what is the right judgement - is a lamp-bulb for a projector more important than the work of a pastor? It was very tempting to remind the askers that we are only white, but we are not God. I havn't fully resolved that issue by any means.

Leaving the hospital was very moving.

I managed enough energy to go in for the last 2 days. On the last day I was helping the junior anaesthetist with some spinals, and the anaesthetic nurses had an exam. But they all came into the office having post-poned the exam for an hour and made some very generous gifts - for me and for Lorraine, and the request that I come back. So for someone who has felt so useless over the last 2 weeks it was an emotional moment.

I have various other musings and events, and more importantly people to describe - but that will be for later. I am writing this from the Dominican Republic - and have just bade farewell to Ross and Kim. Fiona arrives later today, and I fly to New York tomorrow.

Port-au-Prince

On January 12 at about 4.50 in the afternoon “the” earthquake hit Port-au-Prince in the south of Haiti.

Officialdom records over 300,000 people having been killed, and the figure is more likely to be in the region of 500,000. The majority being buried in mass graves just outside the city. As in any disaster there are the, perhaps, expected stories of heroism and humanity, but also the rather shabbier accounts of self-interest and human exploitation.

Jean-Claude, Robyn and I flew to Port-au-Prince on a Saturday morning, as ostensibly this was the reason for our being in Haiti in the first place. The domestic and international terminal at Cap Haitien Airport is about 30 minutes from the centre of the city, and to get there involves negotiating the usual traffic obstacles – potholes, other drivers, pedestrians, lorries, tap-taps and a mass of motorcycles. We cross over the river, and the bridge is slowly returning to being a major trading area, as the memory of the earthquake slowly fades and with it the fear of a local recurrence.

At the airport our hand-luggage is x-rayed in common with anywhere else in the world, but the loud “beep” generated as we walked through the scanner seemed to generate scant interest.

Waiting in the “departure” area were several nuns – although Roman their precise orders were not obvious; an Episcopal Bishop and assorted other travellers. Flights were going to Port-au-Prince, The Turks and Caicos, and the Dominican Republic. Our plane could seat about 25, and was piloted by 2 pilots from the Dominican Republic. The flight took about 30 minutes, and we had clear views over the Haitian country, and it appears very green, and largely unpopulated.

Port-au-Prince from the air is at once much bigger than Cap Haitien, and it takes a while for the evidence of the earthquake to become apparent.

We are met by Spentz, who with his family have lived in Port for the last 8 years. He is a business man, and is clearly doing very well. He drove us around the city, and included areas of all degrees of prosperity, as nowhere was exempted from the damage. As he drove it was the almost casual comments that were the most disturbing:

“this was a school – 1300 children were killed here”

“just here a girl was saved after having her legs amputated, but the remaining 12 members of the family all died.”

“this was a bank – all the employees got out of the earthquake, but were killed by a gas explosion”

“on the day after the earthquake you couldn’t walk or drive down this street because of the masses of bodies lying on the road.”

All over the city there are piles and piles of rubble, a very little bit of salvage is being attempted – in the whole of the city we saw only one bull-dozer. There are a lot of tents, and rows and rows of “porta-loos” many of which are just outside the presidential palace. In the more prosperous areas there are more concerted attempts at salvage, but still people are living in tents in the garden.

Spentz was in his car when the earthquake struck – and tried to get out of it, but was not able. His children were at home with his sister, and all of them were unharmed. During the first night there were stories of extreme courage and acts of selflessness – whole communities working together to get people out, and when it was too dark and too late, there breaking out spontaneous services of prayer and hymn singing. But there are darker aspects too – the daughter of one of Robyn’s friends was trapped with a friend. The friend was freed, but because there wasn’t enough money to pay the extracting team her friend was left. Thousands of Haitian dollars exchanged hands in the immediate aftermath of the event.

Spentz was able to voice some of his concerns – and although he is a long way from being a politician it is people like him who are needed for the country – people who can stand back, and look away from self-interest, people who can recognise the faults and lessons to be learned from other countries, and who have a passion for the nation. Interestingly he is increasingly convinced for the need for very firm government – even the possibility of a dictatorship – to start the country back onto the long road of economic and social reform.

If we looked beyond the obvious signs of building destruction, it was very odd to see signs of “normal” life going on as before. On every street there were markets and stalls, as people try to eke out a living. Stalls as varied as sweets, second hand clothes, new suits, and car parts literally in front of piles of rubble the height of a single story building.

It became mind-numbing after a couple of hours, and the return flight became increasingly attractive. I think visiting the area was very important, if somewhat unpleasant, and even verging on the voyeuristic. But perhaps the most disturbing aspect of the visit was watching the reaction of Haitians back in Cap Haitien as they looked at the photographs we had taken: despite having lived with the reality of the events for the last 6 months, seeing them in silent tears was just too much.

From giving to receiving...

When I had first begun to grasp the reality behind the vision/plan that Robyn had for this mission - to be a "Gift" from the church to the people of Cap Hatien, it really hit home, and made what we were doing - or for most of the time trying to do - make sense. So to find myself unable to be that "gift" for several days has been really hard, as well as the physically reality of being knocked right off my feet.

For the best of intentions this entry is an intensely personal one - as I haven't really been able to experience anyone else's world for the last few days.

With hindsight I think I had been feeling unwell for a couple of days - low grade headache, a bit dizzy, not much appetite. On the Wednesday it had been quiet in theatre, and so we had finished early, and we had arranged to go out for a meal with 8 of Robyn's Haitian friends to a local restaurant.

As we were walking to the place I remember thinking quite clearly how I must be adapting to the heat situation because I had stopped sweating, and in fact was feeling a little cold - I kept getting covered in goose-bumps.

(The little girl pictured is Jamily - oldest daughter of JP and Pauline who came to eat with us that night.)

That night was a rather rough one - I shivered and shivered, don't think it was quite a rigor; was dry retching a few times, then slept for a couple of hours, waking up dripping with sweat, and feeling as weak as a kitten.

I cried off work, and eventually went for a blood test at one of the private laboratories that flourish in the town. Robyn suggested testing for malaria, typhoid and a full blood count. She found a thermometer and my temperature was 39.7c (103f). As I was feeling worse all the time she took me to her doctor - who very kindly interrupted the World Cup to see me (and believe me the World Cup is taken very seriously over here.)

Dr Yvan Bell is Haitian, and very gentle and caring. He fully examined me, ordered samples (you can guess) and some more blood tests.

He wondered about Dengue Fever - because I did have some odd little red spots that I thought were insect related.

The test results were inconclusive on every front:

• I had been assiduous in taking anti-malarials, so if it was malaria the parasite might not have shown up;
• there is no specific test for Dengue fever (so I understand)
• and the samples were negative for Shigella, Amoeba, Giardia or Salmonella.

However I was feeling even worse - dry retching every few minutes, having very weird dreams and thoughts - weirder than usual. And by the next day Robyn insisted on a home visit. IV fluids next.

The system here is different to the UK - in case anyone has other ideas. Your friends and family go and buy the equipment and it is set up by you. Robyn duly appeared with a black bag containing some litres of IV fluid, giving sets and a cannula.

Given that we were me, a surgeon, and an ex-nurse there had to be a decision as to who was going to site the needle - I won!

The fluids and anti-emetics (anti-sickness) drugs began to ease things, and after a few days I am starting to feel slightly more normal again. Though I am still completely off any thought of food - which as most of you know is totally unlike me.

What has been so very humbling has been both the care given to me, and the love shown. It's not easy for me to receive, but I just had no choice. Robyn spent a lot of time just sitting with me. On the Saturday when she and the others went to Port-au-Prince Cillotte spent the whole day with me, just sitting in my bedroom reading, and when I was retching and retching she would rub my back and stomach, and sponge me down. She and Bernadette even gave me a bed-bath (very professionally - all modesty preserved, though by then I was past caring).

She also gave me the anti-emetic injections as often as needed.

Bernadette has been very caring too - coming in on Sunday so that I would not be by myself for any time. Such a sense of love and care being given by a people who have so little materially, it has been quite emotional.

I also found myself getting irrationally annoyed (and even angry) about little things - as I have said the water pump is intermittent here. And so to have to have someone go down to the well for water for washing, and for the toilet etc made me so cross when all it would take is for someone to fix the pump. Then I had to think of the tent cities in Port, or the shacks all along the roads, in everyone of which there might be someone just like me - feeling really ill, and no hope of water. Forgive me my self-pity Lord.

Saw Dr Bell again today who agrees that I am on the mend - just got to try and find some more energy. Hopefully next blog will be far less self-centred.

fevers...

Regretfully the blog is temporarily suspended due to a attack of either malaria or dengue fever. (Wikipedia has excellent accounts of both).

More will follow later except to say now that it revealed itself as a fever hovering around 40c and the most draining feelings of nausea and vomiting.

I could not be better looked after - room mate is Ross, who as a colo-rectal surgeon (but more likely as a father of 6 and grandfather of 6) is totally un-phased by all things connected to bodily functions.

And Robyn - once a nurse, always a nurse - who has been wonderful.

Many thanks for those who are praying for me - it not surprisingly makes a difference.

A view from the roof top...

The house in which we are living is tall and narrow. Enoch rents the house, and for a few weeks lived there with a friend. The friend now lives elsewhere, but as the rent is paid in advance - I think on an annual basis - Enoch has the house all to himself.

The previous tenant was a missionary with Medical Ambassadors - and who had made a lot of contacts with the locals, many of whom live close to, or on the street. In making these friendships she paid a price in material matters as she "lost" computers, money, books and more.

Just the other day there was a local boy knocking on the gate - he looked well-fed and clothed - and he said that he used to get peanut butter sandwiches from a white person who used to live here.

There are big iron gates or doors opening onto the street, and space for a car - or "machine" in Creole.

On the ground floor are some small rooms which are usually uninhabited - one of them even had a piano in it, though it had totally lost its tune! But at the moment Enoch is living in one of them. He effectively has an en-suite - for when the water is running.

The main "living area" in on the first floor - a balcony, a sitting/dining room (where the TV is) a kitchen adjoining the toilet/shower, and a sort of hallway with stairs going up and down: down to Enoch's sleeping area, and up to where Ross and I pass the night.

The upstairs room is big and open - big enough for 2 double beds (and a single bed for later), a computer desk and an outside balcony which is pictured. I have tried to show how high the balcony is, and also to what is behind us - a fairly steep cliff with some scrubby trees, and very often a number of goats. During the night the goats can sometimes be heard scrabbling up the cliffs by both their bleating and by the mini-landslides causes.

I say "mini" because just 2 doors away - and again pictured was a small primary school. A few days after the earthquake in January there was an unrelated tragedy at the school: a rock broke away from the cliff and landed on the school killing four of the pupils. Just one more tragedy amongst so much. The school is still closed and the buildings un-occupied.

The upstairs balcony has on it, as you might be able to make out - two water tanks, which are filled by the menacing pump (when it is working) and there is also an impressive looking satellite aerial - except that is useless in terms of TV picture, and the internet (which also uses it) is highly dependent on the weather.

It gives a glimpse of the sea, and is great for seeing the sunrise.

You might also be able to see piles of washing all over the place. Bernadette does our washing, and that of Robyn, Dale and Kim. And it is all hand-washed, then ironed (until just recently all the ironing was done by a charcoal iron - now it's electric).

The process is laborious, but done well. The water is drawn from the well, the clothes are wetted, soaped, scrubbed and rubbed on the concrete floor, rinsed, and rinsed again, vigorously wrung out (there is no "delicates" option) and brought up to dry on the balcony. This is a process repeated all over Haiti - except that the drying is just as likely to be done on the roof of the house, or on a hedge of cactus plants.

Many of the Haitians take a real pride in their appearance, and to see the smart. crisp uniforms on the school children, and the extent to which they dress up for church, it is hard to guess the difficult living conditions so many have to live in.

Bernadette is very good at her job, and the clothes service is fantastic.

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.