Day 8: This is Haiti?

Saturday. Not much happens here on Saturdays, being an Adventist hospital, so we've decided to take one day off on this trip and enjoy it. They won't let us do surgery today anyway. Might as well enjoy the day and venture outside the hospital for an extended period for the first time since arriving in Haiti. As we get ready I learn another one of life's certinties besdes death and taxes: Tom's laughter. We haven't even started our day and he's already cracking himself up about something! On the way out the door we're greeted by the four patients and their families who thought they were having surgery today. On the front steps of the hospital we have to explain to them that there's no anesthesia today and that once again we'll take their numbers down and call them when the hospital opens again for business on Monday. This again totally sucks for them but again there's absolutely nothing we can do. I take down their phone numbers and add them to the list that we've compiled for the next guy, which now numbers 17 people, a week's worth of surgery before he even hits the door! The ride is late (by about 3 hours, kind of like the anesthesiologists here) so we spend the time saying goodbye to the UFGH group (the ER docs, pediatricians, nurses, and therapists from the east coast), playing with the kids, and giving away stuff. I'd brought a bunch of pens and notebooks and give most of it all away in about 10 minutes. We also have time to check out our translator Jeanty's tent, right next to the Canadian tent. He has a pretty nice setup, even with power, as the hospital's been nice enough to provide a long extension cord. I suppose if you're going to lose your house in a quake, setting up a tent on a hospital front lawn with power ain't too bad.

We join Kenny, who's starting med school at UCSF this fall, and Jess, the nurse from Hotlanta, and drive over to the Project Hope compound to pick up the rest of the crew for the beach. It's quite a way from Carrefour, where Adventist Hospital is (southwest of Port-au-Prince) to the Project Hope house (southeast). On the way we see the US Embassy and a large UN compound. We also get a chance to see all the rubble still laying around. Now they say only about 25% of the buildings were completely destroyed, but that's still a ton of buildings, and a lot of the other ones show visible signs of damage. Plus, of the rubble that was there, 98% is still there 6 months later. We reach Project Hope. This is where Kristin the peds resident from Loma Linda, Cheri the nurse from Wisconsin, and Ruth a therapist with Project Hope are temporarily staying. The tradeoff for being so far from Adventist is that this place is really nice. I almost wish I hadn't seen it because I was perfectly fine with my army cot on an open hospital ward! There we also meet up with Natalie, who's of Haitian origin but lives in Ft. Lauderdale. The place is a private residence (even with a pool and tennis court) rented by Project Hope after the quake. There are medical supplies stacked everywhere, even on the tennis court and soon to be in the pool (people as late as last week were emptying out the pool - by hand). At the very bottom I can see where they missed a spot and some happy tadpoles are swimming in the drain. Among the supplies we see an entire 3 pallets of fluoxetine, generic for Prozac. Tom comments that as non-emergent as it may seem, these people have plenty to be depressed about. Either that or it could be prematur- .... ah, never mind. We then drive all together to Wahoo Bay. On the way over there we pass by a large tent camp north of Port-au-Prince, and a lot of scenic countryside and a few small town markets. Natalie, Kristin, Cheri, and I share the pickup's bed and from the look on their faces I'm really glad I'm facing rear and can't see where we're going. Apparently there's a lot of risky passing and swerving going on. After a bumpty hour and a half ride we get to Wahoo Bay which for a $10 entrance fee somehow makes you forget all the poverty outside. This seems kind of wrong, but I figure we're helping the locals out. Once inside, we kind of realize in a guilty way that we don't feel like we're in Haiti. Guilty because we've automatically thought of only the earthquake, injuries, poverty and forgotten, or rather never got to experience, that this is actually a really beautiful country. The beach is awesome, the water is warm, and the beer is cold. Somehow, $2 a bottle changes over the course of the afternoon to $5 a bottle but I'm too tired and content to care. Tom, Liz, and I look at each other and shake our heads at the huge disparities in wealth. The statement "This is Haiti" accompanied by a what-can-you-do kind of shrug we've used all week long, has become "This is Haiti?" for today.

Unfortunately at 5 we need to start heading back because navigating around potholes, pedestrians, and livestock on a 2-lane highway is difficult enough during the day let alone at night, and it gets dark early here. The trip back is highlighted by a massive flat (Potholes every 30 feet for 50 miles? Driving around piles of trash with broken glass bottles? Wow, who coulda seen that coming?) ... whereupon our driver decides that rather than the nice area of empty curb up ahead, the best place to stop is partially blocking an intersection, and no, there's no reason to pull over to the side, just leave the car partially in the road so that when you change your left rear tire you can put yourself and your very vulnerable rear end right in the road, cause that'll probably help other drivers see you better. After narrowly missing the opportunity - er I mean tragedy - of taking care of a pelvic trauma patient at the roadside we finish the ride back home listening to gangsta Creole hip-hop laced with a generous sprinkling of profanity. Let's just say the profanity they use here, though there's plenty of good Creole profanity the OR guys taught us yesterday, is borrowed straight from American hip-hop and you can guess what the words are.
We make it back to Adventist in one piece and meet Rick Wilkerson, my replacement, and sign out the patients to him. This involves going through the list and tell him what surgery everyone's had done and what needs to be done with them. The most important part is the list of 17 people who are still waiting for surgery ... eight of whom are still languishing in the preop room downstairs (one decided to go home and come back Monday - suprising not that she left, bu that she was the only one who did leave. Kind of makes you realize how desperate these peole are for care), and four of whom showed up on a Saturday and were told to leave. It hurts every time I think about that but you just do the best job you can and forget about what you can't - except I can't forget.

We're off early in the morning tomorrow to catch a ride back into Port-au-Prince (Carrefour is kind of a separate-ish development southwest of the capital) for our noon flight. We say our good-byes to the hospital translators, especially Jeanty, to whom Tom has given a bunch of stuff and I gave a pair of running shoes, and Junior, who got a pen and notebook.
The last offcial act tonight, our last night here, is a VAC (vacuum assited closure) dressing change I have to do on the ward for the woman from Tuesday who had an infected left radius (forearm bone) debrided. Jess from Hotlanta is Johnny on the spot with some Vicodin and Toradol for her (sorry, no morphine in this hospital) but her screams still draw a crowd of curious passersby into her room. Fortunately her wound looks great and we stop the VAC and she's OK and still able to smile at me afterwards. I say my goodbyes, tell her and her family that this is her new doctor, wish her luck, nod to the crowd, and leave. The crowd watching you is something I don't particularly like doing, and neither is having to pull a piece of vacuum sponge out of someone's forearm bone without adequate anesthesia because the hospital won't let us use an OR on Saturday, but I'm a visitor here and I just want to do the best job I can and not rock the boat too much. This is Haiti.