"I don't know what your destiny will be, but one thing I know: the only ones among you
who will be really happy are those who will have sought and found how to serve" Albert Schweitzer

Saturday, January 30, 2010

Dr Nelson's Haiti Images

If you would like to view more pics from Dr Nelson's personal gallery taken in Port au Prince after the quake you can do so here. Please be forewarned that many of these images are very graphic in nature.

We are working hard to get a C-arm to the Hopital Adventiste d"Haiti as soon as possible so intramedullary fracture fixation can begin in earnest. Thanks so much to all who have contributed to this project.

Port au Prince - The Initial Days

The following synopsis of the early response to the Haiti disaster was posted on Dr Nelson's blog yesterday.
Perhaps this disaster represents the greatest accumulation of orthopaedic injuries to ever occur in one place at one time. Here in Santo Domingo it felt just like another California earthquake, but soon word arrived that it was far worse. Having made 19 previous trips to operate in Haiti over recent years we were able to rapidly prepare our armamentarium and make plans to mobilize to Port au Prince, 160 miles to the west. By the time we departed on Thursday afternoon less than 48 hours after the earthquake, the chaos of early response teams was just beginning. We lifted off without knowing if we would be able to land in PAP or if there would be anyone to receive us. It was like going into a black hole as we had no information aside from what we were all seeing on CNN. We were prepared with food and water to survive for 2 days and no return ticket.  Team members were (from L to R): Steve Bostian (Executive Director CURE DR), Dielika Charlier, MD (Pediatrician), Lucia Hernandez, RN (OR nurse), Scott Nelson, MD (Ortho Surgeon), and Susan Beemer, RN (anesthetist).
Dielika grew up in PAP and was able to get a single text message through to Johnny Boulos a friend of her brother. After circling the airstrip 20 times we were able to get clearance to land the plane for 3 minutes. We made a steep descent and dumped our equipment onto the airfield and our pilot quickly returned to the air. Fortunately, Johnny had waited for us all afternoon and was there to greet us. To make a long story short we are indebted to the entire Boulos family for their hospitality and generosity in facilitating everything that we were able to accomplish during the last 2 weeks.
We initially made some brief visits to assess the operating facilities at approximately 6 different hospitals. 48-72 hours after the quake there was still not a single operation going on at any of the hospitals that we visited except for Hopital Adventiste d’Haiti where the innovative local medical director had created an operating room tent out of surgical drapes and was performing life saving amputations in front of the hospital. His nurse in the yellow short sleeve dress had just returned to work. She had been comforting her 10 year old son for who was trapped under a cement girder for 36 hours after the quake. A UN crane finally had come to free him and as the heavy cement girder was lifted it slipped from the grip of the crane… Another worker was at the hospital looking for 8 body bags for her family members. At every facility there were hundreds of languishing patients, most of whom were laying outside due to fear of aftershocks. Many of them were developing gangrene, some dying, and others already dead. It was utter chaos and no help was in sight. Where should we start…
With promises to return and help Dr. Archer, the medical director at Adventist Hospital, I returned to the Hopital de la Communaute Haitien where our team had already begun setting up. Here we had earlier discovered two operating rooms with electricity, running, water and even air conditioning­ a luxury in Haiti under normal circumstances. Due to our timely arrival and preparedness we were able to establish a leadership role at this facility and coordinate subsequent surgical teams who arrived to help. I began operating on Friday afternoon – 3 days had now passed since the quake. For the first several days operations consisted of life saving amputations and debridements. Injuries were far worse than they appeared due to the extensive soft tissue damage from crush injuries. This caused compartment syndromes (uncontrolled swelling which leads to vascular compromise) and then to gangrene. Patients were dehydrated, decompensated, and anemic. There was no mechanism or time to get labs, nor anything we could do differently had we been able to accurately assess their status. Patients were dying in the hallway outside the OR while waiting for surgery. Some who were operated died as well, as they were already too critical to save. This presented another difficulty in deciding whether to operate the most serious patients first or concentrate on slightly less critical patients who had a better chance of survival.
After 24 hours of operating, a team from the Hospital for Special Surgery in New York City arrived. They had flown down on the Synthes plane fully loaded with an extensive array of donated implants and materials. Their expertise and equipment combined with the momentum we had already established allowed us to continue operating in both rooms day and night for the next 3 days catching only a couple hours of sleep here and there. We are deeply indebted to the Synthes company and the timely arrival of this team which allowed us to salvage many severe injuries that would have otherwise been amputated. It was an operative marathon like none other and as the hours passed periods of daylight and nighttime melted into one long day. Emotions were high and fatigue was intense. I worked day and night for 6 days until I felt like I was starting to loose my focus and was able to escape the hospital and get a full 6 hours of sleep.
During the first few days the situation went from bad to worse. The many injured patients were developing infections and gangrenous limbs faster than we could operate. A couple days after we began operating the stench of death strengthened and permeated the hallways and courtyards of the hospital. Dead limbs still attached to patients, dead bodies, and amputated parts all contributed. Slowly we were able to overcome this and each day the hospital seemed to metamorphose. Patients were operated, volunteers showed up with bleach, halls were cleaned and chaos was organized little by little. An entire hospital infrastructure was to be created in the ensuing days. Masking tape was used on the foreheads of the victims to delineate OR 1 – emergent cases, or OR 2 – operative but less emergent cases. The first 4 days were spent operating only on OR 1’s which consisted of open fractures, compartment syndromes, and treating severe open wounds and infections.
Wednesday morning one week after the quake the 6.1 aftershock hit and all the patients rapidly cleared the hospital building. We took advantage of the situation by mopping the halls and slowly bringing all the patients back in to the building one by one in an organized fashion. Luckily we had arisen 15 minutes before the shock as part of the cement wall above our heads had collapsed where we had been lying.
Over a period of one week we were able to convert several adjacent rooms into operating rooms and the 2 room OR suite became a 6 room operating facility where we coordinated surgical volunteers from all over the US, Sweden, Jamaica, and Korea and other countries. The arrival of the Dallas team on a chartered 737 with several tons of equipment was a great boost our dwindling operating room supplies and fatigued OR crew. We had to stop surgery for several hours to organize, but in short order we were almost equipped like an American style operating room. During the subsequent 24 hours we treated more than a dozen femur fractures using the SIGN intramedulary nail system. The SIGN nail is a state of the art implant system design for use in resource challenged environments where intraoperative x-ray is not available. We were privileged to be operating with the founder and inventor of the system, Dr. Lew Zirkle who had previously treated a record number of 5 patients in a single day using the implant. In most cases these severely injured patients with femur fractures could immediately begin unrestricted ambulation.
We continue in collaboration with the Hopital Adventiste d’Haiti where the situation is very similar to the Hopital de la Communaute Haitien. The arrival of Dr. Brad Walters from Georgia and Andrew Haglund from Loma Linda University established coordination efforts at that facility. Initial plans are being made to create a large scale ongoing project to treat the generations of people that will be affected with orthopaedic needs for years to come at this facility.
It did become necessary to place armed security at the entrance of the hospital and other strategic locations to provide crowd control and resolve some looting that began to take place as food and supplies arrived on site. However, I personally never felt unsafe and would dare to say that with the additional military and NGO presence, most parts of Port au Prince may be more secure now than they have been in a long time. Of course many render my opinions on security as worthless as they consider me to have a lack of risk aversion.
It was a trip of physical endurance, emotional intensity, and spiritual contemplation. It brought my mind back to a scene several years ago of one of our Haitian patients who fell asleep with her Bible open to Psalm 46:  "God is our refuge and strength, an ever present help in trouble.  Therefore we will not fear, though the earth give way and the mountains fall into the heart of the sea, though its waters roar and foam and the mountains quake with their surging."
On January 25 I returned to Santo Domingo for several days to be with family and attend to my responsibilities. On Saturday January 30 Marni and I will be driving back to Port au Prince to continue the work and relieve those that are on the scene at the moment. We are living day by day and will focus our efforts where we are most needed during the ensuing months.
I would like to acknowledge the efforts of our team members not mentioned above who were also working day and night to support the efficiency of our operation both in Port au Prince and around the world. These in include my wife Marni in Santo Domingo, Robbie Jackson - Cure DR, Erin Card - Cure US, Jeff Douglas and Andrew Haglund in Port au Prince and the many other medical personnel who rapidly activated the delivery of their expertise and medical supplies.

Friday, January 29, 2010

Project Ortho At The Hopital Adventiste d'Haiti

Over a week ago I received an email from Scott Nelson who had made his way to Port au Prince a couple of days after the tragedy had struck and had already started treating patients. He informed me of the incredible need for orthopaedic surgeons in the weeks to come and of his plans to devote several months to working at the Hopital Adventiste d'Haiti in an attempt to make a dent in all of the pathology. He also expressed a need for basic equipment such as a C-arm, fracture table, SIGN nails, autoclave, lab equipment, etc.

For those of you who are not familiar with Scott, he is a graduate of the Loma Linda University Orthopaedic Surgery Residency program. After completing a pediatric orthopaedic fellowship in San Diego he moved his family to the Dominican Republic where he has worked at the CURE Hospital in Santa Domingo for the past 5 years. During that time he has also made 19 1-week trips to Haiti and has become quite proficient working in that challenging environment.
I'm of the mindset that I like to know where my donations are going and I would prefer to contribute to an orthopaedic-related charity in this situation. I know from firsthand experience that Scott is incredibly frugal and resourceful and will see to it that the funds/equipment that are entrusted to him will be well spent.
If you feel so moved to help you may do so in one of the ways outlined below.
Click here to make a credit card donation to Loma Linda University Global Health. In the comments section please write "Haiti Ortho."
If you prefer to write a check, make it out to Loma Linda University and in the memo section include the words "Haiti Ortho." The address is Global Health Institute, 11226 Campus St., Loma Linda, CA 92354. Their phone number is 909.558.8541 if you have questions. Your donation will be sent to Gift Records in Loma Linda University where a receipt will be generated for tax purposes. 

Scott has already received 2 sets of SIGN Nails which will keep him going for a few weeks and he would appreciate help to offset that cost. If you would like to contribute to the purchase of the fracture fixation nails for Haiti, click here and include the words "Scott Nelson" in the comments section.
I have been in contact with Scott over the past couple of days and he is truly grateful for your impending generosity. I have been also been working closely with Jerry Daly of the Global Health Institute to ensure that your contribution is spent wisely. Please don't hesitate to contact me through this website if you have questions and thanks again for your interest in this project.

Thursday, January 28, 2010

Photographing Haiti

NPR's David Gilkey traveled to Haiti just after the earthquake left the capital in ruins. Back in D.C., he reflects on his experiences photographing amid the wreckage.  

Wednesday, January 27, 2010

Tuesday, January 26, 2010

Early Orthopaedic Response To Haiti Disaster

The earthquake created one of the greatest needs for the assistance of the orthopaedic community in our lifetimes.  Fortunately, it responded quickly, generously and efficiently, a fact which is documented in this issue of Orthopedics This Week. Within hours hundreds of orthopaedic surgeons, caregivers and device company employees volunteered to help and rushed to Haiti.
In the article, it was noted that Dr Scott Nelson was the first orthopaedic surgeon to start work in Haiti following the quake.  In the photo above he is joined by SIGN’s Dr Lewis Zirkle on our right at the Hopital Adventiste d'Haiti.

Doctor Commits To Crushing Task

The following article was written by Bill Morem and originally published in the San Luis Obispo Tribune on January 25. 2010.

The work of Dr. Scott Nelson is crushing. It’s crushing in the numbers of people he’s treating in Haiti since the Western Hemisphere’s poorest country was leveled by a magnitude-7 earthquake on Jan. 12.

The wounds he’s seeing are crushing in nature, the horrific result of humans caught in flimsy construction when the quake hit.  And the scope of the tragedy is taking its own crushing, psychic toll on those who have gone to the island nation to help repair the torn and mashed bodies of men, women and children.
Scott Nelson, the son of Peter and Suzanne Nelson, moved to San Luis Obispo in 1970 when he was a week old. In retrospect, it’s safe to say he had medical missionary blood running through his veins: His grandfather, Dr. Olavi Rouhe, served for more than 25 years at a mission in what was then the Belgian Congo. Nelson has said that after having visited his grandfather’s African hospital, church and compound when he was 8, he decided to go into medicine.  That decision, as well as an international outlook, was probably reinforced when he joined his father, a San Luis Obispo dentist, on travels to 25 countries around the world where Peter would work at dental clinics.

Nelson, 39, is a devoted Christian who has followed a family tradition in attending the Seventh-day Adventist Loma Linda University in Southern California. Indeed, his great-grandfather was the president of the university at one time. Nelson graduated from Loma Linda in 1996 in orthopedic surgery with an emphasis on children. He thrives in what he does, says his father, and that enthusiasm has led him to be one of the top surgeons in his field.

As it turns out, Nelson’s Christian ethic and professional skills dovetailed nicely with a nonprofit organization called CURE International. It’s a nondenominational organization that specializes in childhood bone deformities in developing countries.  So he joined forces with CURE and packed up wife Marni and sons Chad and Alex five years ago and headed to Santo Domingo, Dominican Republic, for a five-year medical and faith-based mission.

The work is a challenge on every level. The pay, for example, is $20,000 a year and requires that he return stateside to practice one week every three months at Riverside County Hospital to help make ends meet.

And there’s physical menace attached to his Dominican practice: Each of the 22 times he’s traveled to Haiti to perform surgery on that island nation’s club-footed children, he’s had to be on the lookout for kidnappers who have been known to return at least one abductee without an arm because he could only raise half his ransom.

But Scott Nelson loves what he does and whom he does it for. He takes deep satisfaction in being able to mend a child’s orthopedic deformity, which, really, is somewhat of a miracle that can make all the difference in how that child can make his or her way in life. It’s that fulfillment that his father says led him to say at one time: “The best payment I ever got was two mangoes and a hug.”

When word came that parts of Haiti had been devastated on the other end of Hispaniola from Santo Domingo, Nelson quickly put together a team and chartered a plane for the 160-mile flight to Port-au-Prince.

As we now know, confusion, uncertainty and disorder was already reigning at the Port-au-Prince airport. Who was allowed to land was as much of a panicked mystery as to who was allowed to take off.  After circling for an hour, Nelson, according to the plane’s pilot, “sweet-talked” ground control into letting the plane land for three minutes.  “I got him on the ground,” the pilot later related, “but I don’t know what happened to him.” What happened was Scott Nelson and team immediately went to work.

Peter Nelson has been in sporadic touch with his son; last week, Scott Nelson told his father in a phone call: “Dad, I get about two to three hours of sleep a night. I’ve had about 90 surgeries so far (as of Jan. 19), with another 20 patients lined up and another 100 left outside. I can’t go outside because they’ll mob me (for help).”

“Are you doing lots of plates and rods?” the senior Nelson asked his son.

“No, because of the crush wounds, it’s not reconstructive surgery. I’ve literally been cleaning maggots out of wounds. There’s terrible infection and gangrene. Once we get them healing up, then I can go back and do the reconstructive work.”

When Peter Nelson asked his son how he was holding up, he replied: “I’m doing good right now, but two days ago I thought I was falling apart. But I’m doing better.”

He told his father that the trauma surgeons who had come to Haiti to help him “ just fell apart and started crying; they couldn’t do it anymore. They’ve left now; couldn’t take it. The psychological coping of the situation was overwhelming to them."

“I know they’ve got a lot of physicians on the ground working, but they’re all going to leave in two weeks because of their practices,” Peter Nelson said. “There’s going to be a need for a lot of long-term care, and he’s committed himself to being there for the next six months. He’s going to need long-term support.”

“Thoughts and prayers in his behalf are just as important as money,” Peter Nelson said. “He’s our front man, but we’re all part of the team.”

Haiti Earthquake Montage I

A video and still image montage chronicling the devastating earthquake that hit Haiti.

Wednesday, January 20, 2010

"This Is A Devastated Community"

Paul McMaster, a Doctors Without Borders/Médecins Sans Frontières (MSF) surgeon, describes what he and his team have seen and done since they arrived in Port-au-Prince to bring emergency medical care to earthquake survivors on January 15.

Monday, January 18, 2010

Haiti Six Days After The Quake

Haiti remains a place of profound need, anguish, desperation and danger, with a few glimmers of hope and slowly growing capabilities to receive and distribute the international aid now flowing in.  Click here to view more images.

Has The World Failed Haiti?

After the catastrophic earthquake hit Haiti last week, the US is working closely with the UN and the Haitian government. The US army has been actively involved in helping distribute aid. But after decades of neglect, are Washington and other powers returning to a bigger role in this poor country? And would that come at a price?

Saturday, January 16, 2010

Why Haiti Is Always In A State Of Despair

When it comes to natural disasters, Haiti seems to have a bull's-eye on it. That's because of a killer combination of geography, poverty, social problems, slipshod building standards and bad luck, experts say.  Read more here.

Volunteer Gives Haiti Children Her All

Molly is no longer able to add to her blog, her body was recovered from the wreckage of the Fr. Wasson Center in Petion-Ville, Haiti following the January 12th earthquake.
Molly's family is very proud of what she has done in her 22 years on this earth and hope that you will learn from Molly's writings what drove her to leave a life full of family, friends, hot water, clean water, plentiful food and peppermint frappuccinos, to a life of cold showers, bug bites, rice and beans everyday, and hot muggy days. Its very simple, THE CHILDREN. In Haiti she found unconditional love, simple pleasures, smiles all day and a second family. And it made her smile.
If you would like to help continue Molly's dream and journey, please follow the Friends of the Orphans website set up in Molly's name.

Friday, January 15, 2010

Images Of Horror

Fears of unrest have been growing in Haiti, but survivors of Tuesday's earthquake are beginning to get relief supplies. AP photojournalists have been on the scene since Tuesday.

LLU 2010 Med Students Haiti Update 2009

Loma Linda Medical School class of 2010  started to adopt a hospital in Haiti between their Freshman and Sophomore years, this video provides a quick intro into the project to date.  

Thursday, January 14, 2010

48 Hours After The Disaster Struck

Collected here are more scenes captured during the first two days after the magnitude 7.0 earthquake struck beneath Port-au-Prince, Haiti.

Early Earthquake Photos

Tuesday afternoon, January 12th, the worst earthquake in 200 years - 7.0 in magnitude - struck less than ten miles from the Caribbean city of Port-au-Prince, Haiti.  Here is a moving collection of photos from Haiti taken soon after the disaster struck.

Massive Temblor In Haiti

At 16:53 local time on Tuesday, January 12, Haiti was struck with a magnitude 7.o earthquake centered approximately 16 miles west of Port au Prince.  The footage below was taken a few hours after the quake and shows scores of people flooding the street including those trying to find a place to take the injured. 

Many countries have responded to appeals for humanitarian aid, pledging funds and dispatching rescue and medical teams, engineers and support personnel.  Communication systems, air, land, and sea transport facilities, hospitals, and electrical networks have been damaged by the earthquake, which hampers rescue and aid efforts; confusion over who is in charge, air traffic congestion, and problems with priortisation of flights further complicate early relief work.  Port-au-Prince's morgues have been quickly overwhelmed; tens of thousands of bodies will need to be buried in mass graves.  

Devastating Earthquake Strikes Haiti

Haiti's worst quake in two centuries hit south of the capital Port-au-Prince on Tuesday, wrecking the presidential palace among other buildings.  The tremor hit at 1653 (2153 GMT) on Tuesday, the US Geological Survey said. The quake, which struck about 15km (10 miles) south-west of Port-au-Prince, was quickly followed by two strong aftershocks of 5.9 and 5.5 magnitude. Many people have spent the night outside amid fears of more aftershocks.  The Red Cross says up to three million people have been affected.  Describing the earthquake as a "catastrophe", Haiti's envoy to the US said the cost of the damage could run into billions.  A number of nations, including the US, UK and Venezuela, are gearing up to send aid.
My friend and colleague, Scott Nelson has been working as a pediatric orthopaedic surgeon at the CURE hosptial in the Dominican Republic for the past five years.  During that period, he has also found the time to make 19 trips to Haiti to provide orthopaedic care.  In February of last year, I had the opportunity to join him for a week at the Hopital Universitaire Justinien in Cap-Haitien, approximately 80 miles north of Port au Prince.  It was a incredible experience on many levels, one that I won't soon forget. You can view more images from the trip which hopefully convey a sense of the events that occurred that week and the impact they had on my life. 
I briefly saw Scott on the national news last night as he awaited a flight out of Santa Domingo to Haiti so I know he's trying to make his way over there.  We will closely follow his progress and try to lend a hand to facilitate his efforts.

Wednesday, January 13, 2010

Haiti Earthquake Footage

Haiti Earthquake - First film Of Horror

Magnitude 7.0 earthquake off Haitian coast brings down buildings, bodies trapped in rubble and many fatalities likely. USA has offered assistance if requested. Although the tsunami alert was sounded and later cancelled, It brings little comfort that there was no danger of a tsunami to cause additional damage and deaths to the destruction from the earthquake. 

Tuesday, January 12, 2010