A labour of love

Our new hospital has a name, now. It will be called Maternité Solidarité, after Cité Solidarité, where it is located. It’s not far from our current location: about two minutes by car. The name came out of a staff contest we had. I think it is a good, solid, and very appropriate name. But my favorite was another contestant. Haiti has a form of public transportation called a tap-tap. Tap-taps are sometimes mini-buses, but more often pick-up trucks adapted with benches. They hold 15 to 20 people, or more, packed like sardines and hanging off the back bumper during rush hour. Needless to say, with that high a passenger load, on Port-au-Prince roads which are poorly paved and mountainous, their shock absorbers are shot. But they are wonderful to see: painted intricately in bright colours with multiple themes involving sports, airplanes, and religion all on the same car. No matter the quality of the car, there is always a booming sound system. They are often adorned with extra wooden ornaments, on the roof, or hanging off the sides, or framing the windows. Religion is a strong theme and bible references (book and verse) common. ‘Jesus revient’ ‘Dieu tout puissant’ etc. So, in keeping with the religious naming of tap-taps, my favourite contestant for our new hospital’s name (despite my atheism!): Maternité Deliverance. I would add the slogan ‘We save bodies and souls.’

We did some interviews with media last week. The story is here: http://www.miamiherald.com/news/americas/haiti/v-fullstory/story/805159.html

There is a worldwide shortage of injectable hydralazine. This is a major problem because this medication is crucial for rapid, controlled reduction of elevated blood pressure in pregnancy. Pre-eclampsia and eclampsia are by far the most frequent complications we see at Jude Anne, comprising 20-30% or so of our caseload. They are much, much more frequent here than at home, and much more severe. We admit women regularly with systolic BPs over 200, or convulsing (this is eclampsia). The principles of treatment, then, are magnesium sulphate to prevent seizures, something (often hydralazine) to stabilize the blood pressure, and delivery as soon as feasible. Delivery is the definitive cure, although the patient remains at risk for several weeks post-partum (and we see seizures post-partum fairly regularly, too). Hydralazine is not the only medication you can use to stabilize a patient’s blood pressure, but is usually one of the first-line choices, and certainly the one our staff are most used to. We go through 1000 ampoules a week. If we ran out of injectable hydralazine, it would be catastrophic. There is only one manufacturer of injectable hydralazine in the world, apparently. My understanding is that one recently-made batch didn’t satisfy their quality control, and so didn’t enter the market. So supplies are scarce, and the going rate from at least one source has increased from 3 euros per ampoule to 17 euros per ampoule. Logistics has promised me that we will not run out. Meanwhile, last week our Haitian Chief Gynecologist and I wrote a new protocol for anti-hypertensives in order to conserve hydralazine. It involves immediate-release nifedipine capsules as an alternative (we have them in stock). (Labetolol is reserved for resistant hypertension because of quantity in stock and lack of local comfort with it.) Word has it that the worldwide shortage will resolve in January or February, when the next batch will be ready.

At long last, and after several teams-worth of trying, we’ve found a new building for Jude Anne. Really, we’ve long outgrown our space. It is at once a big relief and an enormous task ahead. Our patients, and our mostly-uncomplaining staff, deserve a hospital where one can actually walk around 3 sides of the bed. Right now, we have barely 3 inches between. It would decrease everyone’s stress level. We would be better able to focus on quality of care. But to get there will take Herculean effort. We have a building, with nothing inside, not even walls. We need to create a hospital. The floor plan was a process that involved the builder, our Australian/multi-national hybrid Logistics Coordinator, me, and the whole medical team. It has taken multiple iterations; the most recent change was made last Thursday when the builder was chalking the floor for where the walls will go. Designing a hospital was not on the curriculum in medical school, by the way. However, I am very pleased for the design we’ve made, for work space and patient flow, within the logistical constraints of the building. And now, the LogCo has a ‘To Do’ list, with timeline, of all the other things that need to be accomplished. Item 7: ‘Move Hospital’ I don’t yet know how to this, move a busy, actively-running hospital. (Hm. But I worked in Campbellford Emerg the weekend that Peterborough moved their ER. Does anybody have the plans for that’) Here are the principles of moving, as I see them: 1) have as few inpatients as possible; 2) have as many ambulances available as possible; 3) move the most stable patients first. The specifics, we’ll have to work on.