Meet Louise Reid Boyce Nichols, RN, MD

There's a lot of enthusiasm on the Team Sinai Haiti blog these days for their upcoming trip to Hopital Adventiste.  Many overseas volunteers have interesting backgrounds and Dr Nichols is no exception as this post authored by Merrill Chaus details.

We're leaving in a few weeks, and all of our team members are kicking it into high gear, gathering supplies, packing and preparing for our mission. Tonight, we introduce Dr. Louise Reid Boyce Nichols, AKA "Reid". Reid has four names and two titles. She began life as a nurse at Johns Hopkins, and switched teams to the doctor side, and is now a fully trained orthopedic surgeon. This year, she is completing a fellowship in advanced limb lengthening and reconstruction techniques at Sinai. As part of the fellowship program, all fellows are encouraged to accompany one of the attending surgeons on an international mission. This year, the three fellows (Dan Prince, Marie Gdalevitch, and Reid Boyce) have been on missions with either my husband John or his partner Shawn Standard to Nicaragua, Dominican Republic, and now Haiti. Lucky Marie gets to go twice...DR and Haiti.

Reid was originally scheduled to go on a two week surgical mission to Eritrea, until political unrest put the kabosh on that trip. The good news is that she is able to join us in Haiti instead.  In her own words....."I have wanted to travel to Haiti to help since the earthquake. I watched as a friend started an Orphan Relief Fund while I worked at home. I am a doer, not a watcher.  I feel very blessed to join a team of exceptional people who I hope will do exeptional things."

Trip To Cap Haitien

The following article was written in 2008 by JB Forbes, a reporter/photographer  for the St Louis Post/Dispatch who accompanied Dr Nelson and his team on one of their quarterly trips to Cap Haitien.  Although the trip took place prior to the Big Quake, operating conditions were very similar to now in Port au Prince.  Cap Haitien had recently endured Hurricanes Gustav, Hanna, and Ike and its infrastructure was battered making operative conditions (frequent power outages, limited water supply) equally challenging.

I recently spent a week at Justinien Universitaire Hospital, the general hospital in Cap Haitian, Haiti. Fortunately, I was not there as a patient. No one should suffer that fate.  I was asked by my friend Dr Howard Place, professor of orthopedic surgery at St Louis University Hospital, to accompany him and his 16 year-old son, Greg, as part of a team of people going to the hospital to help the people of that region.

Dr Place was going to the hospital at the request of Dr Scott Nelson, another orthopedic doctor who is based in the Dominican Republic. Dr Nelson is sponsored by CURE International, a nonprofit organization that helps the poor in third world countries. Dr Nelson makes trips to Hospital Justinian four times a year to operate for free on broken bones. He never has a shortage of people in need. From his hospital in the Dominican, Dr. Nelson brought three nurses and a fifth year resident, Dr Sam Chen, to complete his operating team. 

In four days, the team did 36 operations in less than perfect conditions. The hospital usually has about four hours of electricity a day. Fortunately, a non-profit group added battery power to one of the three operating rooms so that the doctors could continue working even though it meant opening the windows to let a breeze blow through the hot operating room, along with a few more flies.

The doctors find this kind of surgery challenging because they are not used to seeing such old injuries and deformities in the United States as they do in Haiti. Poor Haitians will sometimes wait months, if not years to get broken bones and club feet fixed. When they come to the hospital, they have to bring their own sheets, pillows, medicine, food and water. Many have trouble paying for the x-ray needed to diagnose their injuries. Infection is often one of their biggest threats. Dr Place had to tell three different families that their children would never walk again because they had suffered severe back injuries. But he implored the families to take good care of their injured family members because it was so easy for them to get bed sores and infection. 

While we were there, one woman went into septic shock and died just hours after a doctor changed the bandage on her infected, broken arm.

The doctors spent many long hours fixing broken bones and saving lives. My job was to help in any way I could – and to take pictures. So, I scrubbed floors between operations and then photographed the doctors doing their lifesaving work. Dr. Place’s son, Greg, and I made a trip to the street market in the center of the city. We both had trouble getting past the smells and the flies and the begging.

A trip to Haiti certainly makes you appreciate everything we have here in the United States, but it also makes you wonder why a country so close to ours seems to be so forgotten except by all the non-profit organizations. Thankfully, doctors such as Dr Place, Dr Nelson and Dr Chen see the need for helping those less fortunate.The doctors could use our help. All of Haiti needs our help.

"Born For This Moment" Documentary

The Born for this Moment documentary is the story of CURE International’s response to the Haitian earthquake.  It features interviews with committed volunteers, including Dr Scott Nelson, who helped CURE International bring hope and healing to the devastated people of Haiti.  It also introduces Haitian children whose lives were transformed through the dedication of CURE’s relief teams.  You can view the trailers Dr Nelson Interview and Jose's Story to get an idea what the film is all about.

CURE International transforms the lives of disabled children and their families in the developing world through medical and spiritual healing, serving all by establishing specialty teaching hospitals, building partnerships, and advocating for these children.  They are a reputable organization truly worth contributing to.

If you would like your own copy of this documentary, please email info@cureinternational.org.

Meet Volunteer Marie Gdalevitch, MD

Dr Marie Gdalevitch is a Canadian orthopedic surgeon who will be joining the Team Sinai Haiti when they travel to Hopital Adventiste next month. Marie is currently in Baltimore for fellowship training in Limb Reconstruction surgery at Sinai Hospital. A few months ago, she accompanied Director Dr John Herzenberg's partner Dr Shawn Standard on an orthopedic mission to the other half of Hispanola, the Dominican Republic. That trip had been planned well before the January 12 earthquake, and so unexpectedly, Marie and Shawn found themselves in the midst of a disaster relief mission. In addition to being a highly skilled surgeon, Marie is also a pretty decent hockey player, and a die-hard Montreal Canadienes fan. She is finishing her fellowship in Baltimore next month, and headed to Australia for yet more training in her chosen subspecialty of pediatric orthopedics. You can meet more of Marie's team members on the Team Sinai Haiti blog.

In her own words...."I am Canadian, born and raised in bilingual Montreal where there is a large and vibrant Haitien community. After hearing news of the earthquake, I felt helpless at the tragedy that was unfolding on televions worldwide. Only to realize that I was heading to Dominican Republic on a pre-earthquake organized medical mission trip. Two weeks after the earthquake, I found myself in San Juan, DR working at one of the bordering hospitals, treating Haitien refugees. My experience was short and the help our small team provided was a drop of water in an ocean of need. I felt I had left prematurely and with much unfinished work. I often wonder what happened to my patients? Did they survive? Did they walk? Did they return to Haiti and if so what were their living conditions? The prospect of being able to return, with a bigger team, and the hope of doing more, is extremely invigorating. I approach this upcoming trip with much anticipation, but also with heightened awareness. No matter how much we contribute, I will likely remain humbled and wondering upon my return."

Haiti's Steps To Recovery

Amputation has become one of the defining injuries of January's catastrophic earthquake in Haiti. Thousands were left without limbs after being caught in collapsed buildings. The task now facing NGOs and charities, such as Handicap International,  is to fit prosthetics and rehabilitate victims.  In this clip, there is also a heart warming story about a young girl rescued from a quake collapsed building, separated from her mother, exported to another country as an orphan, then ultimately reunited with her family.

Team Kaiser Permanente

Nancy Broderick and Ann Napton recently volunteered at Hopital Adventiste d'Haiti.  They were both part of a 17-member team from Southern California Kaiser Permanente.

Nancy wrote, "Wonderful experience but part of the reason was due to the amazing team I went with.  The politics was the negative but we were there to serve."  She stated that she wished she had brought "more types of food, freeze dried, mixed nuts, trail mix and Powerade.  We craved salt."  She noted that she wore scrubs most of the time and indicated that there were plenty of them left over from previous volunteers.  She added that "The patients were like sponges absorbing everything you are doing for them."  She closes with "It was one of those wonderful life experiences that is very hard to put into words."

Nancy, on the left, teaching how to do a dressing change

Ann submitted the following report:

Hi there, we came back from Haiti last Sunday, Mothers Day. What a great day to come back and be with my family. Your resident, Hasan, what a great man he is. He is a wonderful human being and a great doctor. He always had a smile on his face. I am on OR nurse. We had an orthopedic surgeon, an OB Gyn surgeon and a general/vascular surgeon with us. If I had to do it over again, I would bring another team of OR nurses. The only problem with that is that there are only 3 ORs and with the LEAP, ortho and general surgeons there wouldn't be anywhere for the other surgeons to work.We worked at least 16 hours a day then the emergencies would come in at night. It was a very rewarding experience, even with all the political transition going on. We were in very short supply of sterile gowns and drapes. We were told not to bring any supplies. That was very frustrating, we were trying to do a c-section with no gown for the assistant!! There wasn't anyone to help us. I felt like we were on our own, which was OK but it took us longer to find things. Also, I questioned the sterility of the packages. Some had steam and gas tape on them! I wanted to organize the place but we didn't have time. We didn't see much of the outdoors, only when the power went out because they ran out of fuel. We had a great team with an engineer and ortho tech, ortho PA, PT, there were 17 total. They were the best to work with. One thing which seems small that I would bring are earplugs so we don't have to hear the roosters!! Also, I would bring more food. We all lost weight which is not a bad thing but the lunch they were supposed to provide was gone by the time we got there. These are pretty petty things I know, but maybe it will help the next volunteers be more prepared. I'm grateful I was able to this. Ann. I would suggest bring goodies for the kids. they loved that we gave them food each day.

They Are The Faces Of Hope

Alex Coutsoumpos is a senior student at Loma Linda University School of Medicine and has served at Hopital Adventiste d'Haiti on more than one occasion.  Upon graduating this coming weekend, he will be entering a General Surgery residency at Loma Linda University.  Our team had the opportunity to work closely with Alex at Hopital Adventiste d'Haiti and were impressed with his ability to function in a resident-level capacity as he at times single-handedly ran the General Surgery service.  Alex has expressed an interest in mission service upon completion of his training and we wish him all the best.

Alex submitted several photos along with the following introduction:

Haiti has left me with many mental images and experiences that I will never be able to shake.  Being a man of few words doesn’t help my efforts of trying to communicate what I experienced.  Photographs, on the other hand may assist my feeble efforts.  The enormity of the disaster that occurred is still strongly felt even 3 months after the initial quake.  However there is an overwhelming sense of resilience that permeates through the people.  This sentiment is noted as people strive to move forward, help others and reclaim their future.  These people through their powerful examples motivated me to keep working everyday.  They are the faces of hope.

"My Trip To Haiti" By Peter Garriott

A Story Of Survival

A young Haitian seminary student shares his story of survival after the Big Quake of January 12, 2010.

Haiti Reconstructive Plastic Surgery

In February of 2010, five weeks after the earthquake in Haiti, Partners In Health called on Dallas based plastic surgeon, Dr. Fred Duffy to perform Reconstructive Plastic Microsurgery in a last ditch effort to save the limbs of the patients who were filling their field hospital in the rural village of Cagne. Without this surgery, many of the earthquake victims faced amputation. This essay is to shed light on the importance of Reconstructive Microsurgery and its use to treat crushing limb injuries as well as to bring awareness to the devastation these injuries bring to their victims.

The Real Meal Deal

Toward the latter part of April and early May, some volunteers were reporting a scarcity and even complete absence of the previously "guaranteed" prepared meal at Hopital Adventiste d'Haiti   At least 3 seasoned volunteers, Drs Scott, Hasan and Ryan have confirmed that at least over the past two weeks there has been one Haitian meal of generous proportion available for all the volunteers each day.

However, it is important to note that volunteers are still responsible for their own breakfasts and suppers.  In addition, there remains an abundant selection of "leftovers" discarded by departing volunteers that you are welcome to scavenge.

Anesthesiologist Cassie Gabriel Trip Report

The following trip report was authored by Cassie Gabriel, an anesthesiologist from Vancouver, Washington.  As surgeons, efficient and safe anesthesia is vital to a  productive operative experience so we are especially grateful for Cassie's report and hope that it serves to stimulate other anesthesiologists/anesthetists to consider a volunteer stint at Hopital Adventiste d'Haiti.  I especially appreciated her last two recommendations at the bottom of her report: take the time to pass on some of your knowledge to the Haitian staff and enjoy the shared volunteer experience.  You can read more about the Southwest Medical Group Plastic Surgery trip on the Behind The Lens Blog.

My husband Allen and I have long held a shared desire to apply our skills to serve others in need. Allen is a plastic surgeon and I am an anesthesiologist. We are both graduates from residency programs at Loma Linda University, Allen holds an academic appointment at LLUMC and we are currently practicing in Vancouver, WA.

Almost immediately after learning of the devastating earthquake in Haiti, Allen tried to contact Scott Nelson, an orthopedic surgeon serving in the Dominican Republic. Allen knew Scott as an attending at LLUMC and worked with him on a previous medical mission trip to the Dominican Republic in 2008. It took a few days, but we eventually heard back from Scott who assured us that much help would be needed in the future for physicians in our specialties.

We were able to plan a trip to Haiti on May 9th. Our team included ourselves, Shelby Gialich (Allen’s medical assistant), and Matt Schoolfield, a freelance photographer and graphic designer for public relations at Southwest Washington Medical Center. Matt wanted to document our trip as a way to educate and encourage continued awareness and support for the people of Haiti.  In the picture below Scott Nelson introduces Matt to a new imaging medium.

The trip getting there was long with two layovers in SLC and JFK. We arrived tired, but anxious to get to the hospital and start working. The airport is third world but the drive to the hospital is truly an eye-opener for those of us accustomed to traffic laws and the right-of-way of pedestrians!

After a short orientation, we got right to work, I headed to the OR and the rest of the crew hit the floors for wound care rounds. We worked late and hit the cots around midnight for some much needed rest. Despite the uncomfortable heat and humidity, we fell asleep right away. Two hours later, we were awakened by an emergency room volunteer asking us to come see a young girl who was crushed by a wall that was all that had been remaining of her home. She lay very still and had severe injuries to the entire left side of her face. Unsure of exactly how extensive her injuries were, we took her immediately to the OR, knowing it was her only chance, so we would do everything we could to help her.

She never cried, she trusted us implicitly, and as we sat her on the operating room table, she laid her head on Shelby’s shoulder and placed and arm around both Shelby and Allen. Our highly esteemed scrub Lucia thoroughly washed out the wound, admonishing us that unless she got ALL the rocks and dirt out what we were going to do would be pointless. Allen spent four hours carefully reconstructing her face which had suffered extensive soft tissue damage, but to our great relief, no skull defect.

After a long but rewarding night, Scott was gracious enough to offer us some respite in an air-conditioned “suite” that doubled as his office. An air mattress never looked so inviting! We slept a refreshing four hours and then up for another day of providing much needed wound care and anesthesia for the ortho, plastics, and general surgeons.

An anesthesiologist's perspective:

Supplies in general are plentiful. I was able to find almost everything I wanted by searching the various storage rooms. It was time consuming and sometimes frustrating to have to look for things I could use. Previous volunteers have made some progress in organizing the vast amount of supplies sent in, but there is still much to be done. I really just tried to separate stuff I could use from stuff that was useless (circuits not compatible with our anesthesia machines for example). During longer cases, I would clean and organize, with the goal of making the most commonly used equipment/medications easily available. Again, in time I found almost everything I wanted. Bonuses were an abundant supply of propofol, yankauer suction sets and a much-needed delivery of Fentanyl. I did not find many circuits or facemasks, but a whole box of filters made re-using the circuits easier! I used a lot of LMAs and performed several spinals, so spinal kits and LMAs in common sizes like #4 and peds sizes are always needed. Not many Haitians need a #5 so there are hundreds of those lying about (lots of 3s too). There is no EtCO2 or gas analyzing capability yet.

Morning "pain rounds" = restart IV prior to easing pain

Patient histories are sketchy and charts sparse (and sometimes in French). Translator/transporter volunteers are available to help and they do an amazing job! Scott Nelson has worked hard to have standards that make the pre-op process run more smoothly such as ordering pre-op Hgb/CXR/EKG on all patients. Unfortunately, the best-laid plans…many patients did not have all these done, but we do have a Hemocue machine in the OR and I never felt I needed to put off a case for lack of information.

Ryan (PGY-5 LLUMC ortho), Albert (translator/transporter), cute Haitian patient, Cassie (anesthesiologist), Shelby (medical assistant), Kathleen (Ukiah team nurse extraordinaire)

We will be back at HAH on June 19th for another week with two additional team members (a scrub tech and a nurse). I plan to bring some specific anesthesia items and if anyone who has been at HAH recently wants to let me know of things that are running low I would sure appreciate it!

Finally, some recommendations from our group…

• We felt well taken care of staying at the hospital in the volunteer quarters-running water, clean drinking water, one delicious meal per day, air-conditioned break room with Wi-Fi, ready access to patients in need!
• Including the Haitian hospital staff/volunteers allows for better continuity of care when you leave. Pick out one or two and teach them (and learn from them). They are there always and our flying in and out with all our individual styles and preferences is challenging for the most patient workers.
• Enjoy the atmosphere of beautiful people working together to heal Haiti one patient at a time.

 Allen and Cassie enjoying a refreshing Haitian mango after busy day

The Trials Of Job

The following story was authored by a Haitian podiatrist currently training in the US and was originally posted on the Team Sinai In Haiti blog.  

My name is Job Timeny. I was born and raised in Cap-Haitien, Haiti. I am a resident in Foot and Ankle Surgery at South Jersey Regional Medical Center, Vineland New Jersey. I am so glad to be part of Team Sinai. Ever since the earthquake, the desire to go to Haiti and serve my fellow Haitians was heavy on my heart. I was ecstatic when Dr Herzenberg invited me to come along while I was in a 2-months rotation at Sinai hospital.

Being able to help will be a way to connect with myself and give back to my country. To be honest, it could have easily been me in the current disastrous situation as many of my friends and classmates who moved to Port-Au-Prince to continue their education or simply for a better life. I was fortunate to instead move to the US to continue my education and now I am happy to return to my native land to serve those in need.

Gratitude, thank yous, and praises are not my motives. I’m fulfilling my duty as a Haitian-American and a physician.

“ Haiti renaîtra de ses cendres.”

See Hopital Adventiste From The Air

To see Hopital Adventiste from the air, go to Google Maps and enter the GPS coordinates 18.531087, -72.386270 then click Search Maps.

Therapeutic Communication

The introduction below was written by Jessica Scott, an RN who voluntered at Hopital Adventiste d'Haiti earlier this month.

I traveled to the hospital May 12-19th with a group from the South Atlantic Conference of the Adventist Church.  Our group was made up of members from Florida, Georgia, and Texas.  I am from Atlanta, GA and am actually not Adventist but came along through a friend of a friend.  I am a Surgical Trauma ICU nurse and had been signed up with many volunteer agencies since January 14th, but had been unable to go with any of them.  While there I worked in the Emergency Room and did the wound care for all of the post-op surgical patients.  I thoroughly enjoyed my time,  was not ready to leave, and hope to return to Port-au-Prince soon. The conditions were actually not as bad as i had anticipated, having spend a few months in Tanzania several years ago. But the tent cities and displaced children continue to be an issue.  I was impressed that so many people seem to have returned to their ways of life despite the destruction around them.  The hospital is still in dire need of organization, but is doing immense amounts of good.

The following is an excerpt from her Therapeutic Communication blog:

Twenty eight days ago I sat on the roof of my Uncle's beach house in the Florida Keys looking at the ocean, towards what I imagined was Haiti, and wondered if I would ever get there. I had been signed up with three different organizations since January 14th trying to get there. They had all fallen through.

I wondered many times if it was God telling me not to go. That despite the strangely strong calling I felt towards the disaster maybe He didn't want me there. Maybe I couldn't handle it.

I don't think I ever believed that I was going to Port au Prince until our plane landed at the tiny airport. It was strange how familiar the place felt and how incredibly at peace I was being there. The first two days were frustrating and overwhelming and I wondered what in the world I had come to do.

On the sixth and last day I got it. After loading our critically ill patient into the Land Rover turned ambulance I was finally understanding. After we got her situated with medications in hand and vital signs visible and stable I had a moment to stop and notice what I was doing. It was odd, but I knew that this was what I was meant for, this was why I had come. 

You can read the rest of her adventure starting here.

Bowlegs

Staille is a 9 year old girl who lives far away but heard about the work going on at Hopital Adventiste d'Haiti and came with her parents to see if her legs could be straightened. Prior to this surgery she was hardly able to walk. 

Now after a 2 stage procedure to straighten her tibias and derotate the femurs, her legs will function just like all the other kids.

This is the type of surgery that would have been very difficult to perform without the personnel and equipment that many of you readers have contributed to either by volunteering your expertise or donating funds and medical supplies.  We thank you for your past support and would like to encourage your continued involvement.

Time Passes But Medical Needs Persist

Four months after Haiti's devastating earthquake, Doctors Without Borders/Médecins Sans Frontières (MSF) teams continue to adapt their activities to meet changing, but still major, medical needs. The organization continues to provide primary and secondary care to the population at no cost, working out of approximately 20 sites and operating several mobile clinics.

“More than one million people are still living in deplorable conditions, beneath tents or plastic sheeting, without a clear sense of what's ahead in the coming months,” says Stefano Zannini, MSF's head of mission in Haiti. “In the meantime, the rains are intensifying, flooding the sites where earthquake victims live several times a week.”

Read the rest of the story here.

Introducing The Team Sinai Haiti Blog

The following post was authored by returning volunteer Merrill Chaus.  Merrill and her husband John Herzenberg, MD have organized a team of volunteers who will be leaving for Haiti in June.  John is the Director of the acclaimed International Center  for Limb Lengthening in Baltimore, Maryland.  You are invited to monitor their progress in the Team Sinai Haiti Blog.

In just a few weeks, our 18 member team will be leaving Baltimore for Port au Prince, Haiti. We represent Sinai Hospital of Baltimore. Our mission is to provide support to the Hopital Adventiste d'Haiti (Haiti Adventist Hospital - "HAH") in Carrefour, Port au Prince. This is a 70 bed hospital, though we've been told that the hospital census has swollen to ~300 following the earthquake of January 12, 2010. The focus of our team is to provide reconstructive orthopedic surgery to the earthquake victims, and general support to HAH. Our team members include three orthopedic surgeons, one podiatrist, one anesthesiologist, one family practitioner, five nurses, one physical therapist, one surgical instrument technician, and three volunteers. 

This is my second mission to Haiti, the first having been in January 2010, shortly after the earthquake. During that mission, I worked with a group called IMANA (Islamic Medical Association of North America) in an impromptu field hospital set up in an abandoned amusement park.

This time, I am organizing a group together with my husband John Herzenberg, an orthopaedic surgeon at Sinai Hospital of Baltimore. We have assembled a great team of volunteers who are highly motivated and eager to help at Adventist Hospital. HAH survived the earthquake relatively intact, and has been functioning under the leadership of an incredibly dedicated young orthopedic surgeon from Loma Linda, California, Dr Scott Nelson (more about Scott in a later post) since January. Tomorrow we are having an organizational meeting at our home. More to follow...

A Drive Through Port Au Prince

A short video produced by Matt Schoolfield from the Behind The Lens blog which gives you an idea what it's like to drive through the streets of Port au Prince four months after the big Quake.  The music is by Haitian artist Bélo.

Haiti One Voice

Haiti One Voice is dedicated to providing basic essentials and educational materials for Haitian children, specifically those who do not have living parents or who are not able to live with and/or be cared for by their families.  They are a small grass-roots organization founded in February 2010 and based in Northern California.  They came into being following the Big Quake in Haiti and have committed to ongoing efforts to help children who are affected not only by this one disaster but by the long-established state of poverty and disempowerment throughout the country.  To learn more about their specific work, please visit  their  Projects page.

Trip Reports Welcome

This blog was conceived with a decidedly orthopaedic focus but we soon realized that the restoration of Hopital Adventiste d'Haiti is truly a team approach encompassing many facets of the volunteer spectrum.  To that end, we welcome input from physicians of all specialties, nurses, medical students, physician assistants, therapists, contractors, pastors, social workers, administrators, organizers, and cleaners...anyone with a story to tell.  

 

You are encouraged to:

• send in a report even if you volunteered weeks ago
• tell us a little bit about yourself and the makeup of your team if applicable, where you're from and your dates of service
• tell us what the trip meant to you
• provide up to date information (if recent volunteer) regarding current conditions at HAH
• read the Things to Bring and Volunteer Info sections and suggest additions or corrections
• present memorable moments, acquaintances, and experiences
• share a few photos from your trip
• send us links from other volunteer blogs or other relevant sites of interest 
• forward the haitbones link to anyone who might be interested in writing a trip report

In other words, we are soliciting your aid to keep ongoing enthusiasm for the project alive in spite of waning coverage for the plight of Haiti in the mainstream media.

Please email your blog contributions to rongeur@gmail.com 

Thank-you for your service and continued support.

Duncan Miles, MD Trip Report

The following post was authored by Duncan Miles, a Plastic Surgeon in Redlands, California.  Dr Miles has volunteered in Haiti on more than one occasion and can be seen below performing a burn contracture release with Dr Terry Dietrich in 2008.

On my trip to Cap Haitien in 2009, I first met Chantelle, a little girl with terrible burn contractures involving her right arm and both hips...she was profoundly disabled and walked as if she was sitting in a chair.  We began to lay plans that day for Duncan to start working on her.

When I saw Chantelle this March, I couldn't believe it was the same child...she was smiling and could walk normally thanks to the skills of Dr Miles and other volunteers who performed multiple surgical procedures on her over the past few months.  Chantelle is pictured below with Pete and Zach.

Drs Matt Hiersche, Jason Mussman and myself left for Port au Prince on March 7 and returned on the 14th. We arrived at the hospital at 2:00 pm Monday and were operating by 3:30 that day. After our last operation on Saturday we had done 26 cases ranging from skin grafting and amputations to mastectomies and laparotomies. We had treated 2 month olds to 95 year-olds and two American physicians.

We saw some horrendous wounds and heard heartbraking stories yet saw triumph in the face of adversity. We met a man who had a head injury during the earthquake who recovered after 24 hours and realized his sister was missing. He recruited friends, found her in the rubble and dug her out a day later. She lost her left hand but survived.  Seven weeks later he was still at her bedside.

We were told of a man who brought his twelve year-old daughter to the hospital to have her femur fracture fixed so he could sell her in the sex trade. We saw mothers with newborns begging for  tents as they had no place to sleep. We saw a mother arrive at the hospital carrying her son  on her back. He was wasting away from an unknown disease. She’d been carrying him for weeks looking for someone to help them. We saw children flying kites made out of garbage bags and playing with cars made out of Gatorade bottles.

We met Haitians and volunteers from all over the globe working side by side:  feeding the hungry, fixing the plumbing, donating supplies, organizing volunteers, caring for the sick, cleaning the hospital, sterilizing instruments, providing a power supply,  providing pastoral care and providing shelter.

I was humbled by the generosity of spirit and endurance of those who provided services.  I met some who had been tirelessly working since the quake. I was equally amazed by Haitians’ will to survive and  their drive to rebuild their lives and communities. Some lost entire families.

You can download and play a movie on iTunes made by team member Matt Hiersche, a first-year Plastic Surgery Resident at Loma Linda University.  The video shows some of the conditions and patients treated during their time of service at Hopital Adventiste d'Haiti.

Ashley Cohen Video Trip Report

Ashleigh Cohen recently returned to Colorado Springs after spending six weeks this year in Port-au-Prince. She was interviewed on the FOX21 Morning News to share her experience in helping at the Hospital Adventiste d'Haiti.  Some of her duties included coordinating all of the incoming and outgoing volunteers, managing tent/food/water distribution, placing orphans in orphanages, and assisting with psychosocial support for quake victims.

Ashleigh is pictured in the middle in the image above along with, L to R, Scott Nelson, Christa Chandy, Andrew Haglund, and Brooke Beck.  Make sure to view both Part 1 and Part 2 of Ashleigh's interview.

Four Months Later, Progress Painfull Slow

Four months after the massive quake, progress in Haiti is painfully slow.  People are afraid to return to their homes, even if they've been deemed safe.  Life in camps is difficult, but for many, it's the best option they have.  Despite their tremendous suffering, many Haitians hang onto the hope of a better future.  Read the rest of the story here.

Behind The Lens: Portrait Of Haiti

Introducing the Behind the Lens blog by Matt Schoolfield.  Matt recently accompanied the medical team below from Southwest Medical Group Plastic Surgery based in Washington State.

Matt is a graphic designer and talented photographer whose role it was to document the trip.  However, his duties soon expanded and he even found himself scrubbed in the operating room to lend a helping hand.

Matt writes: "I can't begin to describe what it meant to be part of this trip. It had been a dream of mine before and ever since the earthquake to come to Haiti and contribute anything I could to the relief efforts. Everyday I was humbled to witness extraordinary acts of selflessness and courage and Hopital Adventiste. I will never forget the volunteers, patients and extraordinary stories of survival. My hope is to inspire others and increase awareness of the tremendous need that still exists."

Make sure to take a look at the gallery of images collected from their trip here.

Terry Dietrich, MD Trip Report Part 2

The following post was authored by Terry Dietrich, an othopaedic surgeon currently practicing in Wisconsin.  Terry, along with his wife Jeannie, and orthopaedic PA Karen Fields, spent two weeks last month volunteering at Hopital Adventiste.  Part 1 of Dr Dietrich's report can be read here.  Thanks to Karen Fields for providing the photos.

April 21

Work in the OR ended at midnight after getting bumped for a C section for nearly 2 hours..  I finished the day with the lady with the AK amputation.    Her wounds look MUCH better.  She probably is going to live.  I’ll have the plastic surgeons see her tomorrow.  Dr Guptay came over again from the U of Miami facility since there isn’t much orthopedics being done there.  I helped him with a hip hemiarthroplasty.  He is  a total joint specialist.  He got a bit stuck at one point and I solved the problem for him.  I assisted Scott on another Taylor Spacial Frame.  This is a 15 y/o with a 40 degree back knee.  He has a partial growth arrest.  It is really remarkable what this device is able to do.

April 22

Two of our patients didn’t show up for their scheduled surgery so I finished  before 7 pm.  We had some good cases.  Two were tibial fractures that we fixed with SIGN interlocking nails.  A different orthopedist came from the U of M facility today.  He will be coming back in a couple of months to work for a week here.  He is from Iowa and will bring his wife(OB-GYN) and two teenaged children.  Scott and I showed him how the SIGN nailing system works.  We planned to fix the pt with the tibial plateau fx with a hybrid fixator but he still needed debridement so we just debrided him again and put the wound vac back on. We are incredibly busy, but that is what we came to do.  The volume of cases is really enormous.  Today was just 13 hours of nonstop orthopedics.  The patients just keep flowing in to the clinic and transferred from all the other hospitals in the country.  We constantly work with plastic surgeons, general surgeons, pediatricians, neurosurgeons, anesthesiologists, ER docs, wound care specialists, therapists, nurses and technicians of all types.  Fortunately, many of the hospitals want to get their patients back as soon as possible after we do their surgery.  A surgeons dream - operate, operate, operate and have somebody else take care of the patients afterwards.  Scott Nelson leaves tomorrow so I will be in charge until I leave next week.  I'll probable age a couple of years during the next 7 days. I feel so fortunate to have such a good supply of energy.  A hand/upper extremity surgeon is supposed to come tomorrow for a week and an LLU ortho resident is supposed to come  on Sunday.  Scott says he will be a big help.  There have been a lot of key people who left today or will leave tomorrow including Jan the wound nurse  and Kaye a terrific physical therapist.  They will be missed, but you never know who might show up in the next group of volunteers.

April 23

Same start time.  Wrapped up the OR at 11 pm.  Scott left at 6 this morning.  The day was a bit chaotic but we managed to get a lot done.  Sanjay came over again from Medishare and stayed until 8 pm and was a big help.  He is a really good guy.  He is planning to come back again in July/ August.  His wife is from San Sebastian, Spain and spends those two months there with their kids and her family.  He says San Sebastian is a really neat city.  It is on the north of Spain next to France on the Mediterranean.  It has great surfing and restaurants and is really beautiful.  He and I did the patient with the femur fx and the tibial plateau.  We didn’t do the SIGN nail on the femur because the ex-fix pins had some drainage so we decided to replace the ex –fix with better pins and improve the alignment.  We did fix the tibial plateau with a hybrid fixator and it went well.  I am going to try to do the same with the patient with the infected tib plateau if the infection is cleared.  The 80 y/o with the ex-fix on her femur also had pin issues and we decided to just revise her ex-fix instead of doing a SIGN nail.  Sanjay was disappointed.  He really wanted to do one before leaving in case Scott isn’t here when he comes back.  I was able to do the girl with the very unstable recurrent dislocation of the patella.  It went well.  I finished with the 15 y/o with the infected tibia.  He had a large piece of dead bone(sequestrum) surrounded by massive new bone.  I removed the dead bone and shortened him about 2 inches and put in an ex-fix.

Fred Liss orthopedist upper extremity specialist from Pennsylvania got here today.  His wife, Dianne(teacher), is with him.  He did the GSW to the forearm and it went well.  He seems to be a great guy.  He has a connection with a health care organization that is meeting with the president of Haiti to make a long term project with one of the closed hospitals. They plan to open it as a public hospital and over 10-20 years gradually turn it over to the Haitians.

April 24

Scott left yesterday so I'm trying to do my best SN impersonation.  I have a hand surgeon from Philly who is great.  A team of Italian plastic surgeons is here for 5 days.  They have taken over many of the wound patients.  They have done several flaps and grafts and do many of the wound vac changes.  They are way cool and fun to work with.  They have 3 anesthetists and nurses and scrub techs.  Their organizer, Paula, speaks good English.  They are very organized.  Another orthopedist just arrived from Milwaukee.  He will both be here for a week.  A 5th year ortho resident from LLU is supposed to come in tomorrow or Monday.  We've been operating all day today.  I hope to finish in time to get a break this evening.

Our cases went well today.  A 24 y/o came in to the ER first thing this morning.  The tire of a passing bus exploded and something hit his leg about 3 or 4 inches below the knee and knocked him down.  It left a wound about the size of a nickel that bled profusely and he couldn’t stand up.  Xrays showed a fractured tibia with multiple fx lines starting just below the knee and extending more than halfway to the ankle.  I took him to the OR right away and debrided the skin wound and opened it up a bit to clean the bone and irrigate the wound well. I was able to close the wound and get him in a nice padded cast.   We’ll keep him on IV antibiotics for a few days just because the environment is not clean.  

Another 20+y/o man came in to the clinic this morning with a closed displaced mid tibia fracture and I admitted him for surgery tomorrow.  I’ll put a SIGN nail in him.  The patient with the infected proximal tibia fracture is not doing as well as I had hoped.  He had a high fever and pain.  We changed his dressings in the OR today.  He had some evidence of infection still but it doesn’t seem as deep.  Fred and I washed him out again and packed the wounds wide open and then splinted the leg.  We won’t wait 48 hours but will take him back to the OR tomorrow for another dressing change/washout.  I’m still hopeful we will be able to save his leg.  The Italian anesthesia staff helped us all day.  Two of our patients for vac changes ate so we put them off until tomorrow.  We’ll have more time then anyway.

We ventured out in Scott’s vehicle and “explored” a little on the way to join Fred and Dianne at their hotel for something to eat. The Italian team was all there too.  The food selection was a bit limited since they were out of green salads, vegetable soup and Red snapper.  A soft warmish tropical rain fell during the last half of dinner and lent a soothing effect.

Fourteen hours of work on my day of rest (Saturday) is not what I have chosen if there was a choice.  Through the years I have discovered the delightfulness and personal necessity in my life of a weekly day of rest.  The Biblical Sabbath that God gave to Adam and Eve in the Garden of Eden at the end of creation week is one of the best gifts that man has ever been given.  The 24 hours of the Sabbath starting with sundown Friday and ending with the setting of the sun on Saturday are a joyous time that I anticipate every week.  As each week goes on and I expend more and more energy and get progressively more tired, that 24 hours of rest look better and better.  There is such peace, knowing that I will have that time to disengage from the continual involvement in physical activities that can be totally draining.  There is no need to attend to the list of ‘to do’s” around the house.  Quiet meditative music is commonly my choice for the beginning of this special day.  Enjoying fellowship and worshipping with church members who also appreciate the rest and physical and emotional refreshment of the Sabbath is almost always a delight.  An afternoon walk with friends enjoying the outdoors commonly caps the weekly experience.  Unfortunately, none of those things happened on this particular Sabbath.  Earthquakes with their devastating effects do not respect my particular world view.  The Haitian people whose lives have been violated  are now struggling with so much loss.  When the loss takes the form of severe physical injury, the need is pressing for action to relieve pain, suffering and save lives and limbs.  That God ordained 24 hour break just isn’t an option under these circumstances.  There will be another to come soon – six days from now in fact.  I look forward to it with even more anticipation than usual.

April 25

I thought Sunday would be lighter and it was – only 12 hours.  Rounds starting at 6 finished a bit faster than usual since several patients have been discharged and the new patient admissions haven’t been as heavy to the orthopedic service.  I gave a short worship talk to the volunteer staff then had the morning report and introductions of new arrivals.  Lee Tyne, orthopod from Milwaukee, is here for four days.  He has been to Guatemala on many orthopedic mission trips.  He does total joints and fractures and arthroscopy at a government hospital there.  The prostheses are donated by Zimmer and Stryker and other companies to their church.  They apparently get them without difficulty even since the Justice Department issues.  I hope that contact might help us with our project in the DR.**  Hasan, the LLU ortho resident made it today.  He worked with Scott for a month in the DR several years ago.  He will be a big help and make the transition possible when we leave this Friday.  He will be by himself for 3 or 4 days.  A new wound care specialist is here and is a huge help.  She taught me several new things today about the wound vacs.  Our patient with the postop infection of the humerus is cleaning up, but the plate and screws are still exposed in the bottom of the wound.  We had other wounds for dressing changes including the patient with the infected tibia/ compartment syndrome.  His wound looks MUCH better and for the first time I am optimistic that his leg can be saved.  We’ll take him back to the OR again tomorrow to try our best to stay on top of it.  Maybe by Tuesday or Wednesday we can place the hybrid ex-fix and get a wound vac back on.  We did the SIGN nail on the fractured tibia.  It was not easy to reduce the facture but we succeeded and now the fracture is fixed.  Our 6 pm finish was our earliest so far.  It gave us a chance to go over to the nearby hotel where Fred and Dianne are staying and swim in the pool.  The Italian team were there and we had a great time swimming and playing with the beach ball in the pool.  We talked with Fred and Dianne for a long time over soup and French fries.  They are really fine people.

April 26

Today started much earlier than anticipated with a frantic call from a volunteer nurse who had been called to the ER to see a 6 y/o girl who was having a grand mal seizure.  The doctor responsible for the ER hadn’t responded when called.  I tried unsuccessfully to call Brooke, the coordinator.  I went down to the ER and the usual sized crowd of about a dozen Haitians were crowded around the stretcher.  The child was breathing and not seizing which seemed a good thing.  The nurse had given her some Valium.  Her temp was 103 which accounted for the seizure.  Rectal Tylenol was next.  Within about 15 or 20 minutes she started to wake up. She didn’t seem any worse for the event but of course Creole to me sounds as if it is always being spoken in a postictal state.   5:15  came around pretty quickly.  Our 6 o’clock rounds took nearly 1 ½ hours.  Everybody seems to be progressing satisfactorily.  I get a kick out of winking at the kids and giving fist bumps, thumbs up, and high fives to the guys.  They were all pretty reserved at first but they are really warming up.  The big, bad Monday orthopedic clinic went nicely with the four of us churning through the patients.  We were able to spend thoughtful time assessing everyone.  Two infected joints walked(limped) in.  One was a knee and the other an ankle.  Neither had any injury.   We got them both admitted immediately and into the OR for open drainage.  One patient vividly portrays the importance of a team approach and staging of management to give people the best chance of getting their lives back in order.  He is a 40 y/o man who had both femurs fractured in the Jan 12 earthquake.  He had surgery here at Hopitale Adventiste D’Haiti and Scott fixed both of his femurs surgically with SIGN nails.  That was done several weeks after the injuries when the hospital was opened again and had electricity, water and sewerage.  He is now nearly 3 months postop.  He walked into the clinic today with two crutches.  Xrays showed both fractures are healing satisfactorily.  I found that he still has marked muscle weakness in the left thigh.  Before the quake he had his own business buying wholesale and selling to retailers.  The quantities were modest and he handled all of the boxes himself being the only employee of his business.  I’m hopeful that Andy, our physical therapist, will be able to help him strengthen his quads so that he will be able to discontinue his crutches.  It is tough to carry those boxes when your hands are full of crutches.

The patient with the many fractures and the postop infection in the lower leg is doing much better.  His blood count dropped very low so we transfused him.  The wound is really clean. I’m planning the hybrid ex-fix tomorrow.  The possibility of amputation is certainly much less now.

I was able to close Mirlanda’s thigh wound over a drain.  I hope the drain doesn’t freak her out as much as the wound vac did.  She has filled sections of nearly all of our nights with long stretches of loud screaming.  I imagine the thousands of people who live in the blocks around the hospital think we practice sacrificial voodoo most nights.

After finishing surgery and making quick rounds this afternoon, I went outside the hospital to check out the grounds.  In back I found 5 men loading old junked and worthless hospital beds into a truck.  The junk has been accumulating over the years and not only is an eyesore but I’m sure has led to poor JACO scores.  The truck was about half full.  I helped them hoist about a half dozen more large contraptions over the side and into the back.  Then I took apart a couple of larger ones that they would have had to leave otherwise.  They were fun to work with.

April 27, 2010

6am rounds  went faster today.  Jeannie has been working incredibly hard to get patients that are medically stable ready for discharge.  Her multiple tasks defy description in a journal of this nature.  Nurse, lab tech, counselor, wound specialist, PT assistant, phlebotomist, pharmacy tech, supply specialist, surgical schedule organizer, patient transporter, discharge planner, social worker, photographer, fly abatement specialist, and chief confidant to the acting director of orthopedic services.  Those titles cover about 50% of what she does.  Our inpatient list is about half as long as when her buzz saw first hit this institution.  We still have many problems that require careful planning.  Fortunately there has been a bit of a lull in new patient admissions.  I have been called about several possible transfers but the patients haven’t shown up.  

Dr Liss gave a short talk this morning before morning report.  Several other volunteers also spoke a bit.  Clinic today was harder than yesterday.  It seemed that the decision making took longer than usual on many cases.  The volunteer translators and other local volunteers were not all their usual enthusiastic selves especially in the afternoon.  For some reason the kitchen staff only prepared enough meals for about ¾ of the patients.  There was none for the volunteers , local or overseas.  A ten year old girl came in with a history of a foot injury 8 years previously.  She had been casted for a period of time.  In the last 7 years she has been living “on the mountain.”  She presented with a foot plantar flexed 90 degrees.  She walks without a limp but has some pain after longer distances or increased activity.  She will be a fun case for Scott to work with.  Two more infections came in that we took to the OR.  There were several upper extremity cases that were elective.  I am so glad to have DRs Liss and Tyne here with their upper extremity expertise.  The toughest case was a dislocated elbow that had recurred after an attempt had been made to openly reduce her and repair lat ligaments several weeks after the quake.  She had been dislocated several weeks.  Dr Tyne chiefed Dr Hasan and they openly reduced the joint and fixed it with a pin.  She will have a very stiff elbow but it should be functional.  Certainly it should be better than a chronically painful dislocation.  Anesthesia may be a real issue for us in the next few days.  The Italian plastics team has been really helpful in providing anesthesia but today is their last day.  The Haitian anesthetists don’t get here until sometime later in the morning.  Today they wanted to leave before 5 pm even though we still had a couple of cases.  We were really spoiled last week with the anesthesia team from Pennsylvania.  Scott and I were able to do cases until midnight or later every day.  I can only hope that God will provide some help in that area.

I was very disappointed with our patient Joseph with the many fractures.  The leg wound looks clean and would have been ready for hybrid ex-fix.  Unfortunately, his hgb is very low(6.4) and we discovered a deep necrotic sacral pressure sore today.  The plastic surgeon evaluated him and feels that a diverting colostomy is essential to get the pressure sore to heal.    There is no general surgeon here so that might not be possible until the next one comes.   We may need to do a high AK amputation in order to be able to adequately position him to keep pressure off the sacrum.  The effort to save his leg has been great and now to lose it when it was nearly clear of infection is a bigger decision than I wanted to make.  A patient with a femur fracture was transferred from the University of Miami facility.  He was injured in a motorcycle accident this morning.  He had classic Haitian “field traction.”  A padded walking boot on the foot of the leg with the broken femur with a bag of stones hanging from it.  Fred and I got a good laugh from that.  We’ll try to get a SIGN nail in him tomorrow.

The many Haitian kids that are all around are a total delight.  They come up in small clots with big smiles and grab your hand and giggle and then run off.  They love to use my camera and take pictures of each other and us.  The vast majority of Haitians seem to be taking everything in stride.  Perhaps the centuries of living in abject poverty punctuated by periodic catastrophes have numbed them to what might be.  This new disaster is just another episode in the ongoing procession.

Jeannie really wanted to get in the pool at the hotel where the Liss’s are staying so we hoofed it the 8 or 10 blocks.  It did feel really great to get in.  We had a good time again with the Italians until the hotel staff came out and told us the pool was closed at 6pm.  It was 7:30.  She wasn’t carrying anything that looked like a weapon so we made the decision to tone down the activities and stay where we were.  I figured that someone with a gun would clearly have enough authority to convince me that the pool really did close at 6.

Several others from the hospital were also at the hotel to eat dinner(remember our one daily ‘provided’ meal that didn’t come today?).  We all(14) crammed into the hospital ambulance for the ride back to our cots and air mattresses.  The driver even gave the siren a short blast during the ride.

April 28

Our patient rounds went well.  Everyone is progressing quite well, even Joseph.  Last night I analyzed the reasonable options for him and the pros and cons.  I finally decided that adding an external fixator to his partially fixed femur fx would likely give enough stability that then he could be positioned and bridged off his sacral pressure sore.  We would also be able more effectively to deal with the large open wound from his knee to his ankle and possibly fix the proximal tibial fracture with a hybrid external fixator.

Worship and morning report were quiet.  Several midwives and a med student from LLU are new since yesterday morning.  Several volunteers have expressed appreciation for the worships.  I have been using Richard Swenson’s book, “A Minute of Margin.”  This mornings thought was on the ‘Secret of Contentment.”  Contentment is the freedom that comes when prosperity or poverty do not matter.

Our clinic was extraordinarily chaotic today.  The clinic x-ray tech didn’t show up today.  Something about not getting paid for 4 months and then not getting the promised lunch yesterday.  That meant going to plan B.  It is less satisfactory for the patients, making them wait several more days in some cases.  We had 10 or more clubfeet patients – most bilateral.  I taught Hasan and Fred the Ponseti technique.  Karen did most of the casting.  They all went well but they take time.  Many new and follow up patients came in.  We scheduled a bunch of cases.  I had nonstop interruptions – mostly calls regarding transfers.  One call was from “Love a Child” which transfers patients to us for surgery.  The lady wanted to pass on equipment that had been donated to them after the quake.  She sent me a list that looks like it includes 200- 300 thousand dollars of orthopedic implants.  Everything is still new in the boxes.  That call was certainly worth taking.  A group from the University of Miami facility came with two patients that were being transferred to us.  An orthopedist, Dr Naren Gurbani, was in the group.  He does lots of ankle fusions and we have one scheduled for tomorrow.  He was excited to come over and do it with Hasan.  He is from LA.  A total of 7 patients were transferred in today ending the minidrought with a flood.  If we had anesthesia we could get a lot of cases done.  Dr Gurbani says that he should be able to bring one with him from Medishare.  We have about a dozen cases on the board.

The plastic surgeon with the LEAP program is a great guy.  We have worked together on a number of our cases, including Joseph.  Their anesthetist is from New Orleans.  He might be able to help us some tomorrow too.  We were able to work in all of our surgical cases while wading through the sea of pathology in the clinic.  One patient was brought from about 6 hours away by a neighbor.  She has the most unbelievable case of bilateral Blount’s Disease I have ever seen.  The neighbor speaks perfect English.  He is married to a woman from Kansas.  They live and work mainly in Kansas but come down periodically to their home here.  When I told him that we could do an operation to straighten her legs he got tears in his eyes.  The Taylor Spatial Frame will be perfect for her.  I want to do her surgery with Scott.

We got the femoral ex-fix on Joseph tonight.  His sacral wound looks much better after the debridement yesterday and the huge lower leg wound is totally clean.  Tomorrow we are going to try to get a hybrid  ex-fix on the tibia fracture.  It should help greatly to position him so that the sacral wound can be treated properly.  Hasan and I took the patient with the femur fracture down to the OR to use the C-arm to help clear his C-spine.  We finished everything a little after 7 pm.  We are all pretty bushed tonight.

April 29, 2010

Another incredibly busy day.  Clinic was busier than usual.  Lee had to leave for the airport at 10 but he helped us a lot until he left.  The local anesthesia didn’t get here until nearly noon.  Fortunately, the LEAP anesthesia helped us get started.  Dr Gurbani came from Medishare and brought an anesthetist.  He did the ankle fusion with Hasan.  He may come back tomorrow and help.  Fred saw many patients in clinic and did several wound cases.  We told him and Dianna goodbye since they leave early in the morning.  It has been terrific working with him.  We plan to stay in touch.

The implants were sent over from “Love a Child”.  It turns out they are all used sets that were donated by US hospitals.  None of them are complete and some of the boxes hardly have any screws.  There is still quite a bit of stuff that is useful.  I wish I had time to go through it all and organize and consolidate it.

Two video journalists from the US came this afternoon to see the needs of the hospital.  They are involved in ongoing fundraising for medical hospital supplies.  The interview I gave will air in Denver sometime.

We had to put off the hybrid tibial ex-fix on Joseph until tomorrow.  As it was, I didn’t finish the last case tonight until nearly 10 pm.  Then cleaning and organizing the trays and instruments took about an hour.  The Haitian workers that clean up in the ORs don’t know which instruments go in which boxes so the surgeon needs to do that task.  They are usually bloody and need cleaning and washing first.  We take so much for granted.  There would be a major delay if a set of instruments like the SIGN nail tray were opened up to do a case and some key instruments weren’t in it.  It might mean opening up most of the sterilized trays to find what was missing.  Then other cases would be delayed waiting for things to be resterilized.  Eventually we should have well trained people here full time but it is a wrk in progress.  The case was a great one.  I did a femoral SIGN nail and then fixed the femoral neck fracture with cannulated screws around the nail.  It was a technical challenge because the femoral neck fracture had displaced.  The reduction and fixation are nearly anatomic.

Tomorrow we leave.