A labour of love

Rainy season started three days ago. Or perhaps over the weekend, while I was in the mountains resting and relaxing.

At any rate, the dominant element is water. It’s been raining heavily for two hours. It’s deafening. I can’t hear the music on my computer as I type.

Today at the hospital, logistics told me we had a problem. A fairly big, serious problem, which took precedence over the meeting we were supposed to have about the logistics priorities for Solidarité in the weeks to come. Today’s problem was the priority; the other priorities will have to wait.

The problem is: water. More specifically, the hospital plumbing and the hospital septic tank. Water backing up from the drains. Septic tank full every four days. Pipes exploding, because too much pressure, or not properly assembled. Apparently we might have to pump gray water into the yard on Monday because of the urgency of the matter. I don’t quite understand it all. I hope it’s just gray water, and nothing more toxic than that.

I do understand that we can’t run the hospital without proper water available. Also required: a proper way to dispose of it, especially if contaminated with biological waste. Logistics told me that triage and the delivery room might not have running water while they try to get things worked out. Unfortunately, that is an indeterminate period of time, so we are trying to think of other ways to get water in, at least temporarily. I asked for more Purell from the warehouse.

And now, after two hours of downpour — the new hospital is on a plain — the logistician is going back to Solidarité. (As if 12 hours of work wasn’t enough!) Flooding, he says.

I have commented before about Haitian culture being very church-oriented. Shops have religious names. Vehicles do, too. So do some people.

Our Haitian water and sanitation guy is called Dieupuissant (God Almighty). But I must stop making jokes about floods.

Day Zero is defined as the first day that we look after patients in Maternité Solidarité.  Or, as it turns out, the first day that we’re in place and ready to look after patients, should they materialize.  Our first official day of opening is Friday (13 February).

Yesterday, the technician came by to make sure our hematology machine was properly installed. Decontamination (of used surgical instruments, etc) was also set up, on freshly-laid tile counters.  Mostly, though, we tried to have a quiet Sunday.

This morning, I discovered one good thing about being up for breakfast at 6am.  The full moon was just setting over the bay, huge salmon pink orb. It was the only moment of peace for the whole day.

There are two patients in Jude Anne, so all there is well.  Transfers to public hospitals continue to go smoothly.  Our staff are under-occupied.

At Solidarité, the construction workers were taking out the wood supports for the concrete roof of our septic tank, the one for OR runoff.  We briefly lost, then found, the keys for the medication cupboards.  Anaesthesia told me they were missing a number of the medications they needed: some were in a cupboard they hadn’t discovered yet, some hadn’t been delivered because they require cold chain… and the cold chain order had been delayed, or forgotten.  And of the things they had received, it seemed that there were inaccuracies in the count. It’s clear that we have a lot to do to secure our medications, with keys, and counting, and orders. We had a medical supply meeting that lasted three hours in the afternoon.

But before that, in deciding whether or not to open to any potential advance patients, I resisted.  I said, we cannot have a maternity without oxytocin (part of the cold chain order).  Or misoprostol (in rupture in the warehouse, but available in the pharmacy at Jude Anne).  I was waiting for those medications to arrive and be delivered to the departments before saying that they could let patients in.

One patient straggled in before I gave the go-ahead: staff re-directed her elsewhere.  Finally, everything was in place by 3pm.  After that, no one.  Now we have two hospitals where staff are under-occupied.

As I left at around 6pm, I ran into the Haitian logistics supervisor.  I asked him why he was still at work.  He was arranging the switch of the generators, training the guards, refilling the diesel.  Ok, I said, as he ran off. And five minutes later, he was back.  He asked me to talk to the medical staff.

And this was the inanity of the day. The medical staff, with no patients, were sitting chatting on the first floor.  It was hot.  They wanted the water cooler from Jude Anne to be moved over as soon as possible.

I said, this is not high on our list of priorities right now.  We are struggling to have the basics that this hospital needs, like running water and stable electric current.  And essential medications like oxytocin.  For the moment, you are going to have to drink water at room temperature.