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Saturday, 30 January 2010

Christopher - Day 3 Has one day ever changed your life?

I wonder if you have lived a day which has changed your life. Well I suppose that I just have. This was my first day doing surgery in Haiti. I don’t want to get into gory details but I have never seen anything like this in all my life. They tell me that last week was much worse. Well all I can say is that I am glad that I didn’t see it.

The grounds of the University hospital in Port-au-Prince has become a tented camp. Each of the tents is a ward with twenty patients in it. The tents spread in every direction as far as the eye can see. Where there are trees the patients are under tarpaulins stretched between the trees. That area is called ‘The Jungle’ and is the biggest ward of all.

In there are two doctors, forty beds, some firemen from Spain in beautiful uniforms who smile all the time, and then some Haitian nurses. I am not sure where the nurses came from because this is a land of disaster and just next door to ‘the jungle’ is the rubble of a huge building, which was the Nursing School. It collapsed.

On the ground floor all the second year nurse trainees in the whole of Haiti were having a lecture. On the first floor, all the third year nurse trainees in the whole of Haiti were having a lecture. There was not a single survivor.

I am having trouble getting my head around this. I am trying to relate it to the John Radcliffe Hospital in Oxford. Well here goes... Imagine all the car parks around the hospital covered in tunnel tents six metres wide and thirty long, filled to the brim with patients relatives and carers.

Milling around in the paths between the tents are volunteers from every country in world, carrying stretchers, moving boxes of equipment and leading patients or relatives in and out of the hospital.

Those parts of the hospital still standing (outpatients) have been converted into operating theatres. We are operating on trolleys set up in the middle of a waiting room, using head torches to work.

Yesterday, two of us working side-by-side did twenty five cases all supervised by one anaesthetist who literally danced between the tables keeping patients alive but asleep. Calm, swift, and confident he was like a good Puck, always there just when we needed him. As for the wounds. No! I don’t want to talk about them. They are dreadful.

A ballet dancer for the National Dance team has lost a leg. She is lovely and smiles a little, but I have got to try to save the rest of her leg. I have no X-Rays. I am guessing.

This is a very important decision and I am trying to work out quickly what is best to do. If I take too little she may die of gangrene, and I desperately don’t want to take too much. Meanwhile the physicians looking after the wards are popping their heads through the door and asking if we can take another amputation or an infected wound.

Medical expertise from around the world

There are at least eight operating theatres working simultaneously in different parts of the hospital each run by different countries with different expertise.  The Norwegians have a surgeon with a skin grafting knife, so tomorrow we will try to get the patients who need grafts to them. A young man has lost the back of his elbow. The skin muscle and joint itself have all gone but the soft-tissue at the front which carries all the nerves and arteries to the hand is fine. I can’t amputate this arm when the hand is working perfectly, but the wound is already infected and I must make a decision.

I stick my head into the door of the US operating theatre. I want to meet them and I need some help and support here. I run the case past a softly spoken Head & Neck surgeon from New York. He listens carefully, agrees that this is a problem which needs evacuation to their hospital ship, and walks over to a harassed looking doctor in the corner with a clip board.

Next moment I am asked if I can have the patient outside the door in ten minutes as there is a helicopter leaving for the hospital ship and they have plastic surgeons on the ship. We bring him across on a stretcher, tuck our meagre notes under his legs and within moments two soldiers from 82nd Airborne have transferred him onto their gurney, slipped him into the back of a Humvee ambulance and are away to the helicopter landing strip.

Minutes later, John the American is back in our operating theatre asking if we can take three cases as they are swamped, with another influx. We start working a little faster still. Each patient who has had an operation has written in bold letters on the dressing when and what is needed next. That is almost the sum total of the notes available. Patients are being moved the whole time, so we may have a name but we cannot always find the patient.

The fire service volunteers from Spain are brilliant at this. They have beautiful black and red jump-suits and always say “Si. Esta Possible”. We give them the name of the patient and with seraphic smiles and a stretcher between them they trot off into the melee of tents to find the patient and bring him back. I don’t know how they do it as they only speak Spanish but their way with people is wonderful to watch.

When I was in Afghanistan I saw people do brave and kind things. I also saw them go that extra mile and finish a job that they really didn’t have to do. Here I have seen an even higher level of commitment. Everyone in our team from the porters up is working, thinking, anticipating, to the utmost of their ability. Giving their best. Every time I needed something it was there before I even asked. If it wasn’t there because we did not have it, then someone was running across to another team operating somewhere else to see if they could borrow some equipment or help.

The end of the day

We have to stop as darkness falls but as we finish the last case of the day, two more loads of supplies arrive. Doctors of the World (Med├ęcins du Monde) is the most fantastic organisation. While we are working as a whole team of logisticians, a chain of people stretching back to Paris, Madrid, Montreal and London are beavering away day and night to get the right kit to us as quickly as possible. We have gone through thousands of dressings today. As the day ends, new ones arrive from the other side of the world. Now that is what I call organisation.

Friday, 29 January 2010

Christopher - Day 2 Making my way to Haiti across the Dominican Republic

Making my way to Haiti across the Dominican Republic

When we arrive at the airport in the Dominican Republic (the opposite end of the island from Haiti), there is no one to meet us. This is frustrating because there is no back-up plan so we must simply wait. Just as doubts are really beginning to set in, the driver arrives and starts a convoluted journey which seems to involve picking up various ladies and members of his family and shuttling them to where they want to go.

The flights in to Port-au-Prince are impossible. There are so many aid flights trying to get in that there is a ten day back-log. Our logistician team quietly organise a mini-bus and we are off on a five hour journey over the mountains to Haiti.

Now the road is full of traffic going both ways. Low loaders with heavy plant on them, aid vehicles and buses loaded with people and their goods. At first you could miss the damage. A wall around a garden has fallen over, then you notice that a house has one storey too few. The first and second floors are just sitting on a pile of rubble. As we get nearer to the centre, some houses are fine, others have completely collapsed. There is no rhyme or reason to it.

In and around this patch-work of disaster people are getting on with their lives Every open space is a camp of polythene sheets. Every street corner is a small market for food and staples, and brightly dressed people are moving everywhere carrying, talking, trading.

Over the rubble, life has started again…

Life has started again and is spreading a thin but colourful veneer over the death and destruction beneath. The only jarring note is the machine gun mounted white UN armoured cars at every main junction guarding against civil unrest and looting, but then they were probably there before the earthquake.

The airport where we plan to rendez-vous with the rest of our team is a chaotic mass of tented camps with national flags flying and piles upon piles of water, food, tents, and other equipment. Helicopters are shuttling in and out, while teams from all the countries involved move busily around each in their team uniforms. I imagine that jousting tournaments in the middle ages would have looked a little like this with a tented camp of followers around each knight’s pavilion. The co-ordination of this multi-national, multi-cultural, multi-lingual collection of people itching to help must be an absolute nightmare for the UN.

Our headquarters in Haiti

The headquarters of the French Doctors of the World (Med├ęcins du Monde) is based around the house and gardens of a business man who has lent his home to the charity for the duration of the crisis. Their offices have been destroyed. We are all in tents in the garden. No-one is keen to sleep under concrete roofs for the moment, but the ground floor is serving as a wonderful combination of office and communal meeting area.

With a little coffee, some Camembert cheese and some wine, the French have a miraculous ability to create a comfortable ambience that we can work out of. There is a curfew after dark so nothing will happen now until first light. Then the work begins. Must just go and find my dictionary and look up the word for forceps!

Thursday, 28 January 2010

Christopher - Day 1 The Call to Duty

It starts with the phone call and the first bump of excitement. You are completely in the control of the humanitarian organisation who have chosen you. They have a veritable team of young logisticians focusing on you, putting everything that you need in place, air line tickets, visas, equipment permits etc. You just sit in the canoe and enjoy the ride.

Of course there is lots that you have to remember too: travel light , don’t forget anything,like mini-screwdrivers to repair your spectacles. It is difficult to work out what equipment will be there and what will not, what is likely to be useful and what will just be a burden. Language has got to change too. This time it will be French.

The flight is a surreal experience in its own right. The book I am reading draws me into its crescendo of suspense and at the same time I am coming closer and closer to a place where a lot is going to expected of me but I am not sure what! Why on earth did I volunteer to do this? What on earth am I going to be able to do which will be of any use? Surgery in 3rd world areas and in disaster zones is always fraught with problems. The conditions are such that you would not normally agree to operate, but the patients have no choice and ‘anything may be better than nothing’. However that does not mean simply diving in.

You need to be strategic and try to work out how you can do the most good for the maximum number, and that may mean turning away heart-rending cases that you would love to try to help but should not. The team of logisticians trust you implicitly. They discuss amongst themselves what is best to do in their areas, but it is unusual for us specialists to have anyone to share our decisions with. When we do, they are usually from a different country, a different culture, and a different language.

I really ought to be getting used to it by now, leaving in a bit of a rush on a humanitarian mission.

Dr Christopher Bulstrode - Our volunteer in Haiti

Dr Christopher Bulstrode, an Oxford surgeon flew out to Haiti for Doctors of the World on Sunday 24th January to help treat victims of the devastating earthquake. During the three weeks he is due to spend on the island, he will be helping run mobile clinics.

He has agreed to share with us what his routine in this emengency situation is like.

Doctors of the World's Frontline Diaries goes live

As well as providing medical care for vulnerable people around the world, our volunteers are also front-line witnesses to some of the world’s worst human and natural catastrophes.

In this blog, we want to give a voice to our volunteers in the field. In that context, no-one can convey the terrible suffering, urgent needs and dedication better than them.

Their altruistic commitment and tireless effort are absolutely invaluable. Nothing could be achieved without them.