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.

We were trying to understand where all the patients went, when we were closed for moving. It seemed unnaturally easy to empty out the hospital, given how often we are overflowing with patients and delivering most of the city.

It’s still an important question. What happened to people while we were closed? Was there an important impact on morbidity and mortality?

But, as quickly as they evaporated, they’re back. Not the same ones, of course. This morning, I arrived to news that the hospital had admitted 42 patients on Sunday, of whom 20 were normal vaginal deliveries, 5 surgeries (including a hysterectomy and a curettage). Solidarité is filling quickly, even as we are still unpacking boxes and repainting furniture.

Pediatrics had admitted seven babies already. In addition to the 700g premie from the other day, now there is one who is 600g, delivered vaginally after abruptio placenta.

And as I walked into the lab to check the blood bank, I watched the lab tech give to a midwife the last bag of O positive blood. I looked at the hemoglobin result to be sure the patient really needed it: she did, with a hemoglobin measured at 2.3 g/dL.

So now I have two questions. Where did patients go when we were closed? And where are they coming from now that we’ve reopened?

Ladies and gentlemen, I think we’ve made a hospital.

The last night at Jude Anne was quiet, by all accounts. By the time I arrived at Solidarité this morning, staff were in the process of retrieving the last things from Jude Anne. Patients are coming, registering, waiting in the waiting room. Normal hospital things are happening almost as if they have always happened here.

Our inpatient ward was nearly full. I asked them to start sending the post-partum and post-operative patients upstairs, since it had not happened last night. We started organizing to get Pediatrics upstairs to their designated corner also. I figure the settling in, shifting, arranging, will continue for quite some time, some of it planned, some of it organically. There are still boxes to unpack. Some furniture is… not quite lost, but not quite locatable, either. It’s all the more confusing because we have used some pieces temporarily in other services, so now we have to trade and rearrange back so that each service has more or less what used to belong to them.

I returned to Jude Anne late morning, to pack the tiny administrative office we had there. I’d been putting it off: the office is dusty and full of miscellaneous crap. One of the Haitian logisticians was also at Jude Anne, disconnecting all the batteries and inverters, and loading leftover everything into cars to take to Solidarité.

Jude Anne is really and truly empty. It is stunning to finally see this, given that it was so recently full to bursting, with perhaps 100 patients, 50 staff, 30 visitors, and all the furniture and equipment that we were using. Empty, it is clear what a small building it really is. It had been a 35-bed hospital at the beginning, and it really is only big enough for a 35-bed hospital. Empty, Jude Anne is a marked contrast to what it is when packed full. It is also vastly different than Solidarité, which is cavernous and tranquil by comparison.

Yesterday, I was sitting under the mango tree outside of the office at Solidarité, thinking. I think I was thinking about medical supply, stocking, and security: a difficult subject. People kept coming to ask me questions – I am nothing but everything, or perhaps just the central repository of hospital information. The shade of the mango tree is cool and peaceful. And then, a mango fell. It was small but perfectly shaped, and ripe. It is good for labour to have a fruit.

It’s our last day of running two hospitals. Activity at Solidarité has now surpassed activity at Jude Anne. We rounded on eleven inpatients at Solidarité this morning. There were three babies in Pediatrics. Jude Anne held only two patients, of which one was to be discharged after normal delivery, and the other, I decided to transfer to Solidarité. (She was the one operated for ruptured ectopic pregnancy the other day.) The registers said, 11 consultations yesterday at Jude Anne, and 25 at Solidarité.

It’s a bit of a miracle to me that our planned “cross-taper” of activity has worked.

And, the biggest improvement, now that rounds are at Solidarité: it’s quiet. Our discussion doesn’t have to compete with trucks in the intersection, or the generator of the bank next door.

They unpacked and installed the second OR today. Niveau 2, normally our post-op and post-partum (of complicated pregnancies) service, started settling in this afternoon. The idea is to separate our mixed inpatient service back into its component parts, i.e. antenatal, post-op, post-partum. Triage and accouchement will similarly be again distinct services. The lab moved the rest of the stock from the blood bank over to Solidarité, too.

Logistics moved the main generator today. It requires a crane. Electrical wires are in the way. Traffic continues on a busy road beneath. I wasn’t there for that – and I’m sort of glad – but I apparently did manage to call the logistician at a particularly awkward moment. I needed waterproof mattress covers for the foam mattress pieces, so that post-partum could accept patients. He was looking at the generator suspended mid-air, while a demonstration swarmed past, and the midwives were attending to a patient who had delivered in the back of a tap-tap (modified pick-up truck turned commuter bus). Jude Anne has always been an exciting place, even to the last moment.

Now the sign has been painted over. A banner says in Creole that we’ve moved. There are staff there tonight (one triage bed, three inpatient beds, no operating theatre, a lab that can measure hemoglobin – had I known that they were taking the triage beds, I would have asked to leave at least two!). As of tomorrow morning, there will only be a guard.

The work is not done, of course. The remaining furniture and equipment will be moved tomorrow, perhaps into next week. We need to organize and open all the departments properly. Then we start work on what the Czech logistician calls “The List of 1000.” It is a list of all the things, small and large, that will still need to be done to make the hospital function better. The essential has been done (water, electricity, medications). Now we worry about having enough chairs, shelves in appropriate locations, curtains to control radiant heat, etc. The List of 1000 will keep us busy for months.