First Day

Without two prior trips to Haiti, this first day might have been overwhelming. Nothing like experience!

Hôpital Albert Schweitzer has a very dedicated and small medical staff for the number of patients. Back in the "dark ages" during my fellowship at Sick Kids in Toronto, there were substantially more physicians per inpatient. That was 40 years ago!  

Hard work, organization, a dedicated support staff, and spirit compensate for the lack in medical staff. I'm impressed.

The day starts with teaching rounds at 7 AM. Today the topic was Benign Prostatic Hyperplasia - a urology topic. Go figure!

From 8 AM, the children admitted to hospital are reviewed. Today there were five physicians - the head of paediatrics, a family physician who works full time at the hospital, two interns who spend one month in paediatrics, and me. 

I have the most experience or the least, depending on the patient and the perspective. I have only modest experience with the culture, the language, and the various tropical infectious diseases. However, if you add up my years of paediatric experience, I have more than all the other four combined! They are all very young!

Fortune smiled on me for my first patient. The prior night a 6 year-old boy was admitted with generalized swelling and heart failure. The swelling and heart failure is due to glomerulonephritis, a kidney problem. Nice to start out with a problem in my specialty!

I am slower with the inpatient assessments because I needed to learn how the system works. As well, the medical chart notes are written in a mixture of French or English. My ability to read medical French is OK and physician handwriting being what it is; the language difference is not a big deal. My interpreter could not read the French notes any better than I could read the English! 

My interpreter, Gerard, has good experience at the hospital and he is very helpful. Thank you Gerard.

And so it went for three hours in the hospital.

From 11 AM, four of the docs, including me, saw patients in the outpatient clinic. Only about 45 children were assessed and again I was the slow poke. I only saw 7 of the children, which implies the other three docs each saw about 12 patients. My assessments got faster as the afternoon progressed.

The medical problems at the outpatient clinic were similar to what a paediatrician might see in the office in Canada. Bronchitis, pneumonia, ear infection, anemia, and so forth. Nothing complicated today.

Later in the afternoon the head of paediatrics was called to attend an emergency Cesarean section for fetal distress. The baby did not cooperate and breathe for the first 1 to 2 minutes, which was tense. Everything worked out pretty well with some suction and bagging with oxygen.

At 4 PM the docs make rounds on every patient in the hospital. This was not a very thorough round, but the head of Paediatrics is on call and he knows them all very well. He is very capable and confident. He is the major reason why the unit functions so well notwithstanding the limited number of physicians. He knows his paediatrics and would do well in any North American hospital.

Once the night orders were written, I left in the dusk for the house where I eat and sleep.

Each day will be much the same but I will get better and faster and hopefully by the end of my stay I will be able to keep up with the rest.