A day on the wards: 8:30am
Standing at the entrance of the large park in the middle of the General Hospital in Port-Au-Prince it was easy to understand why the builders had approved it. The branches of lush tress provided an inviting canopy beneath which one could allow day dreams to float towards the distant mountain peaks that seem to tickle the sky. A pathway that began straight soon gave the option of semicircular walkways leading in opposite directions. Radiating from these paths were other walkways that led to the various hospital buildings.
After "The Event", the moniker now used by some Haitians to refer to 1/12/10, the park took on the special role as host to patients who no longer trusted the indoors. Tents were set up and beds were arranged in seemingly random fashion across the park. Gone were the days of hearing chirping birds and seeing butterflies. Occasionally a sliver of sun could be seen meandering it's way between branches and tents to scorch the already barren earth.
Walking though what the physician responders were now calling "The Forrest" it was easy to see how difficult it might be to locate a particular patient.
I strolled through and gazed at families washing clothes and cooking meals next to the beds of patients. Sometimes two or three family members huddled at various angles on the patient's bed as if on a raft boat that would soon set sail across the sea of people now inhabiting the park.
This however was not my destination.
I emerged from the park and walked towards a low rise building with a set of cold impersonal and imposing set of iron gates.
The once carefully brushed green paint on the gates had long surrendered it's luster to dust, rust, and cryptically etched initials and short messages.
Who was "AG", "NB", "CF"?
Why had someone scratched:
"Manman Marie aide nous" (Mother Marie help us)
"Bon Dieu" (Good God)
"Delivre nous" (Deliver us)
I walked through the entrance of what until recently was solely the women's medical ward. The damage suffered by the men's inpatient unit during the quake led to coed wards.
Twenty steps from the entrance, another gate, this time with white peeling paint. It was not immediately clear whether the gates were intended to keep individuals in or out. The dim lighting in the anteroom did not invite optimism.
Even in the best of times one could imagine that little attention had been paid to wall decorations, plants, or other embellishments. A health education remained the lonely resident of a small bulletin board.
It occurred to me that while many outdoor tents had been set up for patient care due to fears of another quake, this was the only INDOOR inpatient ward.
Turning to the left there was a long narrow corridor with four entry ways marked by the sunlight that tried desperately to bend in competitive announcements of the extent to which they had tried to flood their respective rooms.
A sheepish look back towards the green gate confirmed that it was not being closed behind me and I steeled myself as I began to walk down the corridor.
Before I could reach the ward I smelled it.
It was the distinct odor of flesh that had given occasion of a meal to organisms feasting and releasing gases now reaching my nose. You could be fooled to think about fruits...but it would be rotting fruits.
The plan was for me to take over this new coed critical care unit that housed both medical and surgical patients.
I stepped into the first ward area and noticed that halfway on the right side of the room there was a doorless entrance leading to a second unit, which was connected to a third, which was finally connected to a fourth unit.
I introduced myself to two nurses and we began to discuss patients by going to each bed in succession. The nurses, both volunteers from the US, diligently took notes on orders as well as other tasks to perform. I knew that results from the few serologic tests available would take 2-3 days and that except for the most acute cases, radiology was almost non-existent. These minor obstacles, I thought, could be overcome by a careful history and physical examination. At times I had to maneuver around a relative resting across the bed to reach the patient's limbs.
The physician who had previously run the unit had agreed to join the morning evaluations. Almost an hour into rounds, as I reached the 12th patient, he pointed to his watch.
"Hey...uuh...you have other patients"
-Yes, I know...two more.
"No. The other wards"
-What? Where are the other doctors?
"One guy showed up yesterday but I think he got spooked and did not come back after morning rounds"
-So who's going to cover those wards?
"You are it"
-How many patients are there?
"Well we lost three overnight...so you only have sixty"
One doctor, two nurses, sixty patients...things were about to get interesting.