Today Bernard Mevs Hospital was in full swing. The clinics are running at full speed, which means:

• The wound care team had 67 patients to see today
• The rehab outpatient caseload was around 20
• Approximately 30 patients were waiting for the ortho clinic, which consists of an ortho tech changing out casts and adjusting external fixation devices (which they use like sliced bread around here)

So imagine this quantity of patients all waiting (it is a first come-first serve schedule...kind of like EPIC!!). And there are at best 20 chairs in partial shade to accommodate this crowd. And by crowd I mean men and woman (by far more men than women) with large external fixation devices poking out of every bone you can name, attempting to set things straight.

Then you have the wound care crowd who have the type of infections an infectious disease clinical team would be challenged to serve (and remember there are limited antibiotics here) and then your basic neuro and ortho injured patient. They line up as early as 6am to wait to get their number to wait to be called... and there is virtually no complaining or voices raised. And that's just the ortho/rehab clinic. There are many medical clinics running as well.

I should take a moment to explain that one major difference we experienced this time around is that the hospital requires the patients or their families to pay for every item before services are provided – Both inpatient and outpatient. So for example, if someone needs a blood transfusion, the family has to find two willing people to donate 1 pint each at a blood bank across the city before the patient receives a transfusion. Now if the patient should need 2 units, then 4 people are needed to donate and so on. So there is no such thing as a stat blood transfusion. Before a nurse can give any medication, the family has to pay administrative fees, then the prescription goes to pharmacy. A stat prescription takes at least 15 minutes, a basic prescription can take hours.

The hospital also is very strict about who can get through the gates into triage and from triage to inpatients-ER. The tragic story of today was shared by one of our EMT's working in triage. A man had been mugged and resisted so the person mugging him bit his nose off and here is this guy with a missing nose. Well, guess what? – the plastic surgeon won't be here until Wednesday so he was going to be told to leave when our team member Lindsey inquired if it was ok to at least clean out his wound and bandage him up.

On the brighter side, today we saw Ilani – the woman running the sewing program. She was in the sewing room with two woman and it wasn't clear to me at first that each of these woman were missing an arm. These are above-elbow amputees sewing. Very impressive work and watching them maneuver the fabric was pretty inspiring. The business is called Project Stitch and they sell their wares on the internet — Ties, baby clothes, cloth bags, etc.

We spent today roaming between inpatient units and outpatient clinics. Lovins went home today and he was happy with his huge smile.

My little friend with sickle cell wasn't doing too well today so we let her rest. I saw several babies with severe hydrocephalus... one picture says so much… There are so many hydrocephalus babies here, many who have been abandoned. I could go on forever about this dilemma but am too tired right now to begin a conversation on medical ethics...

Today's highlight was the outing to the UN for dinner. It started with staff buying one another a beer. Then a man who works at the UN bought the entire team a round of beer, followed by another (I do not like beer so I have been the sober friend-in-attendance). Well,.. Let's just say that it is 12:30 AM and most of the group is up on the roof now enjoying the local rum smuggled in by someone (who shall remain unnamed). One thing I can say about this group is that everyone is looking out for everyone else and today, many staff needed a night on the town (up on the roof?)

Tomorrow we all have the day off! — Another new addition from previous years' trips. They are taking us out for a little sight-seeing and then to a resort with a pool for the day... Wow, rest and relaxation... What a deal!

That's all for now.

On to Day 4…