Mauritian History and La Nouvelle Clinique du Bon Pasteur

As mentioned in the previous post, I am spending my international clinical elective in Mauritius. Mauritius is a small island located in the Indian Ocean, about 700 miles east of Madagascar. Its history, culture, and traditions are unique among the nations of the world. The first recorded human vitis to Mauritius occurred during the Middle Ages by Arab sailors; the Portuguese landed in 1507. They established a landing base for a brief period of time, but this was abandoned shortly thereafter. At the end of the 16th century, a Dutch ship landed on the east coast of the island and named it "Mauritius" after the Dutch Prince Maurice van Nassau. They established a small colony in 1638. There is no record of any permanent human settlement on the island prior to the establishment of this Dutch colony. There were, however, some famous residents prior to human settlement. Mauritius is the only place the famous Dodo bird ever lived. Sadly, less than a century after its initial contact with humans, the bird became extinct due to its lack of aversion to human interaction, its flightless nature, and the ease with which it was hunted for its meat. The Dutch abandoned Mauritius in 1710. Shortly thereafter, in 1715, the French expanded their Indian Ocean colonization efforts from nearby Réunion Island to include the now-uninhabited Mauritius, where they quickly established a sugar-producing colony. To this day, large expanses of the island are covered in sugar cane fields. The French colonial authorities and settlers brought slaves from other parts of Africa to harvest this sugar cane. In 1810, during the Napoleonic Wars, the British seized Mauritius from France, but the island's inhabitants were permitted to maintain their language and religion (hence the persistence of the French language and Roman Catholicism on the island to the present day). Slavery was abolished throughout the British Empire in 1835; in order to compensate for the shortfall in labor following slavery's abolition, British planters brought large numbers of indentured servants from India to work in the island's sugar fields. As a result of this complex colonial history, present-day Mauritius has a remarkably diverse population made up of people of European (mostly French), Créole (African and European), and Indian descent. Throughout the 20th and into the 21st centuries, there has also been steady immigration from China, leading to even more diversity. Mauritius established its independence from the United Kingdom in 1968, and it has been one of the more economically prosperous and politically stable nations in Africa following the postcolonial movement. Since independence, it has expanded and diversified its economy, shifting from a sugar-producing tropical island to a robust economy that includes sugar production, rum distillation, textile manufacturing, and thanks to its beautiful beaches and tropical locale, luxury tourism. This history has resulted in a complex, robust, diverse nation, where numerous Hindu temples line the narrow streets, the Muslim call to prayer echoes from local mosques, and grottoes dedicated to the Virgin Mary dot the tropical countryside. French and English are the official languages of the nation, but the most commonly spoken language of the people is Mauritian Creole. This is a French-based Creole that has incorporated influences from African and Indian languages. French is also widely spoken, and I have yet to meet anyone who does not know at least some French. English, however, does not appear to be spoken nearly as much as French or as Creole. The government conducts its affairs in English, and many road signs are similarly written in English, but most TV stations and newspapers are in French, and I have met some people who struggle to understand or speak English. Nearly all of the physicians with whom I have been working are fluent in all three.

Since my arrival in this fascinating country, I have been working at the Nouvelle Clinique du Bon Pasteur. It is located in Rose Hill-Beau Bassin, a large town located in northwest Mauritius. This healthcare facility was established in the 1930s by a group of Catholic nuns, the Sisters of Charity. After a time, the Sisters transferred administration of the clinic to the Roman Catholic Diocese of Port-Louis. In the early 21st century, the diocese sold the clinic to a group of private investors, among whom was Dr. François Tadebois, the current medical director of the clinic and one of the physicians with whom I have been working since my arrival.

My days at the clinic have been varied, enlightening, and exhilarating. On my first day, I was treated to a tour of the clinic by Nicolas Tadebois, son of the aforementioned François Tadebois. Nicolas is one of the clinic administrators. In Mauritius, the word "clinic" does not have the same meaning as it does in the United States. When I hear the word clinic, I think of an outpatient physician office. Here, it simply means that the facility is privately owned and operated, whereas the term "hospital" refers to the government-run facilities where patients receive care. As such, the Clinique du Bon Pasteur is much bigger and offers far more services than what a typical American "clinic" would provide. There are about 20 inpatient rooms, an emergency department, an operating theater with three separate operating rooms, a maternity ward where approximately 3 women give birth per day, and a number of physician offices for outpatient consultations. During my first week, I spent most of my time working in the emergency department, which is referred to as the "casualty" here. The standard of care provided in Mauritius is quite high, with treatments and practice founded on the same evidence we use to guide our therapies in the United States. However, the nurses and providers are necessarily much more resource-conscious here. If a patient comes in with head trauma but has no neurological findings, he or she will not receive a CT scan. Gloves are used sparingly (no need for gloves for a simple IV insertion, one nurse told me). Surgical gowns and drapes are made of cloth and reused. Physicians also seem to have more of a direct role in implementing care; they start IV lines, administer medications, and perform wound dressing changes. I find myself enjoying this increased amount of patient contact compared to medical practice in the United States. Many of the issues and complaints plaguing patients coming to the casualty are similar to those I see in Greeley: hypertensive urgency, diabetic management problems, minor injuries. However, based on my anecdotal experience in the casualty and in no way founded on any kind of large-scale observational study, I believe that the rate of postoperative and general wound infection is higher here. Many patients come to the casualty for scheduled dressing changes; some of them sustained wounds while going about their daily business, and others have postoperative wounds from routine surgeries.

I have had the privilege to witness and participate in multiple facets of Mauritian medical care over the last few weeks. I have spent time in the operating room with a brilliant, gregarious surgeon who oddly enough knew my uncle Jack Egan (Uncle Jack was his parish priest when he was a child). I have participated in community outreach with Dr. Tadebois, accompanying him to several sugar mills and poultry packing plants around the island where he provides on-site primary care for the employees of these establishments. I even had the great fortune last week to accompany one physician on a number of home visits around the community, where I received a warm welcome into the homes of some elderly Mauritians. Here, individuals aged over 75 qualify for government-sponsored home visits if they meet certain criteria, and those over 90 automatically quality for home visits. It has been a joy participating in the care of these patients, and I am very grateful to all of the providers who have taught me so much. In the coming days, I hope to spend some time on the maternity ward and observe the Mauritian perspective on labor and delivery.

À bientôt,
Tom

Below, some photos from my day touring the sugar mills with Dr. Tadebois: