On my way to the pharmacy to drop off an urgent prescription request, I found a motorcycle at the bottom of the two concrete steps up to the pharmacy area. The owner was washing his bike. I asked him to move the bike to an area ten meters away that was not obstructing the path and stairs. He understood this and made movements as if to move. I went ahead to the pharmacy. Of course he was still there a minute later. I stood there and waited while he moved. He chose the spot because at that time of day, the path and the steps were in the shade of a tree. The spot I suggested was in the sun. His total disregard for the convenience of staff and patients is pretty incredible.
An EMT asked me to assess a child after dark. The patients who wait in the triage area sit on chairs. I needed some light and there were chairs twenty meters away under some light bulbs. A middle-aged woman was lying asleep on three chairs and three healthy men were sitting talking on another three chairs. These people were all family members of patients admitted to the hospital. There was one chair in the middle. I needed at least two chairs for the child to lie down. The male Haitian EMT started to ask the sleeping woman to move! I stopped him and asked the men to move, which they did without fuss. Unbelievable chauvinism!
All the furniture and equipment was cleaned out of the NICU, so that the unit could be sterilized. Once empty I saw three ant colonies erupting from the walls. One was from a corner and two were from cracks where the floor meets the wall.
There were gas fumes in the unit for about 45 minutes this morning. Very strong, headache-triggering gas fumes. Not a healthy situation for children or staff. I asked one of the interpreters to try and figure this out. He looked around, as I already had, and then reported, “The gas seems to be worse in the unit.” “Thank you,” I replied for his help. “Brilliant,” I thought for what was self-evident to everyone in the unit. A mother finally solved the riddle. Someone had left a gallon of gas in an open container in the hot sun, just under a window outside the unit. They carry gas for motorcycles in small containers.
The noise in the unit is a big problem. The walls are concrete and do not absorb sound. About a quarter of the children are not attended by a parent because they were abandoned and the few nurses on duty are obliged to care for multiple children. The abandoned children often cry for prolonged periods. Sometimes they are hungry but often they cry for attention. The unit is crowded and there is one family member allowed for every child. Even without crying children, the staff, family, and children talking in the unit is noisy. There is a TV continuously on in one area and a radio with Haitian music in another. A road is on the other side of one of the walls of the unit and the traffic noise is continuous. This morning one of the children, a six year-old boy was screaming with very typical "attention-seeking" behaviour. After about ten continuous minutes I asked the interpreter to ask the mother to take the child outside the unit for a walk. The smiles on the staff and the other mothers looked like applause for this request.
Today the NICU children were in the regular unit and each child has at least one monitor to follow blood pressure, heart rate, respiratory rate, or oxygen saturation. The incubators have temperature alarms. The ventilator for one of the infants has alarms. Each child has an intravenous pump with an alarm. Each alarm has a different noise. The monitor alarms need to be set with correct limits so that the alarm does not go off for normal events but the monitors are not set with the correct limits and they commonly go off for normal events. Batteries run out in pumps and this generates alarms. The sum total of all the alarms and the background noises in the unit is that the REAL ALARMS are often missed! For most of the day I set myself up in a place where I could see the values on the monitors of the three sickest children.
There was no filtered water in the hospital last night or for half of today. The tap water is not safe. In the absence of filtered water there is no water, but keeping up with hydration is important for staff. I gave one of the guards $5 and he sent out for five 16 oz bottles of Coke and this was the hydration for several of us in the middle of the day. Filtered water arrived at about 3 PM.