Tuesday and Wednesday went by in a flash - Tuesday literally, as we felt the side effects of the largish tropical storm I mentioned which was heading west along the north coast of the Dominican Republic (the other side of the mountains). There was a chance that it might veer south and turn into a tropical depression which is the forerunner to a hurricane, and at the base there was some hasty refreshing of the disaster plan. We had heavy rain and some wind on Tuesday evening / night but were relieved to find the sun out in the morning - the storm had headed further north west and is now headed directly towards the oil slick in the Gulf. My flight to Miami this afternoon took a big diversion and spent some time flying towards the UK before going round the top and back to Miami. The heavy rain left a real mess and we saw, walking through the mud and puddles to the hospital, the misery that is a flooded shelter with the family's clothes and few belongings laid out to dry. I can't imagine what will happen when the hurricane season really gets under way - just hope they'll be spared this year.
Anyway, back to the hospital. On Monday morning we picked up walkie talkies from the doctors' guest house and started work just before 8. The queue for triage was already quite long and the benches outside the ER (A&E) full . Registration, triage and the parmacy are in separate tents outside the hospital ward tent (when I visited triage last week in the evening we disturbed 2 goats using the lower shelves as beds and several chickens, one with chicks, in the roof supports - still can't work out how the chicks got there).
The operating theatre is empty this week as there is no surgeon here - last week a volunteer orthopaedic consultant apparently had a busy case list dealing mainly with earthquake injury complications. There is only one patient in intensive care - a good thing I guess - while the pre-natal clinic has a long queue of pregnant ladies. (By the way, the photos on this page are from a professional photographer and / or me with the staff's permission).I spent the morning in the supply room trying to learn where things are. In earlier weeks HODR volunteers had built shelving and sorted and labelled most of the supplies - before that things were just piled in boxes and it must have been a nightmare trying to find anything. Supplies are very patchy. The general position is that there are big stocks of fairly useless things and hardly anything that is really needed. Apart from drugs, most of which are not in stock, the biggest demand is for paediatric rehydration, and the stock we had for that was about to run out. Most medical and non-medical supplies are brought in their luggage by the rotating doctors and nurses who volunteer through a small US charity, Worldwide Village. There is little possibility of obtaining supplies in Haiti through any other source. We have now arranged for the non-medical wish list to be available to incoming HODR volunteers as well so hopefully there will be an additional trickle of supplies.
In the afternoon I swapped with Pat and worked as a runner in the busy ER. There were 3 doctors, 3 nurses and 2 translators working non stop with 10 examination beds. The runner's job is to fetch and carry for the medical team and replenish what is used form the supply room or pharmacy, if it's available of course. As time goes on though, you get more involved with the cases and try to help with dressings, record keeping and so on. Most of Monday's patients were babies and young children. The most common diagnoses were dehydration, malnutrition and "failure to thrive", scabies, abscesses and infected wounds. The volume of cases (80 - 150 a day in ER) means that the medical team does not have the luxury of more than a few minutes for diagnosis and decisions on treatment for each one. This is clearly uncomfortable for Jason, the senior doctor, who is used to having time for closer involvement. 
As the HODR volunteer nurse Christina has been here for 9 weeks (and the hospital doctors and nurses generally rotate every 1 or 2 weeks) and has seen many typical cases, she is often relied on to help move things along.I returned to the ER again on Tuesday and Wednesday, each day getting more involved with the patients and their families. There were a few more adult patients: several accident injuries, one TB case, a nasty burn, one earthquake injury presenting for the first time (the patient said "well it was the earthquake" meaning he survived and didn't see himself as deserving attention.
But mostly children. Two patients were babies who appeared to be a few days old but in fact were several months old - one 6 months weighing just 8 lbs. This baby girl was brought in by her
grandmother who could no longer look after her. The two of them were the only survivors of a family of 14. The baby will stay in the maternity ward until she starts to thrive and will probably then be transferred to an orphanage. Many orphanage children have been left by relatives (including mothers) who belive that the child will have a better chance there. It's hard to describe the emotional impact of seeing so many children and parents in distress. Many of the mothers are suffering from post traumatic stress sydrome and desperately need psychiatric support - there are no therapists in Leogane at the moment.I ended the day holding and trying to comfort one or two, and then bumped into Christina who had just returned from an orphanage where some of the HODR volunteers work. Of the 36 children there that she and a doctor examined, 30 were sick, all with conjuctivitis and scabies, others with a variety of problems. Christina is always smiling and laughing but she was clearly upset and told me she hadn't talked through what she has seen in that time with anyone else. We shared a crying session before we went back to the base.
My last evening required a compulsory short farewell speech at the nightly meeting. Unusually the noise of the regular evening rain shower didn't drown it out, and I ended up sharing mango juices with friends from the past 3 weeks.
Saying goodbye on Thursday morning just as the teams were getting ready to leave for their projects was difficult, and heading out of Leogane while looking forward to getting home was a bittersweet experience. There is so much more to do there. I hope I get a chance to go back.
Please call me if you want to know more - there's loads!
THE END
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