Hasan Syed, Final Trip Report

The following is Part 3 in a series of trip reports authored by Hasan Syed, MD, a PGY-5 Orthopaedic Surgery Resident at Loma Linda University.  Hasan has been working at Hopital Adventiste since the 25th of last month.  He returns home today.  Part 1 of his chronicle can be found here and Part 2 here.  Dr Syed provided the images for this report.

Having been here for a few weeks, I have seen some teams come and go.  Even though many are here only for 1 week at a time, there is always significant interaction between various teams and people get to know each other quite well. This week, the major departing team is from Kaiser Harbor City with 17 team members and the incoming team is from Ukiah, Northern California. The nice thing about this transition is that there is one day of overlap between these two teams which helps tremendously for turnover in terms of patient care. For the orthopaedic surgery service, we have developed an inpatient census list, much like a rounds list in any training program. 

It helps manage multiple issues for individual patients, particularly since our inpatients number between 30-40. As part of the transition between the teams, both the Kaiser and Ukiah teams round together on patients Saturday morning. People on the Ukiah team pick up roles from the previous group in terms of wound care, physical therapy, infectious disease issues, pharmacy, etc. From my perspective, this was the best continuity I had seen in terms of handoff. Nonetheless, no two teams are alike and each bring their own strengths. For instance, Dr. Laura Wedderburn, a Ukiah hospitalist/internist, is now able to manage the medical conditions on the orthopaedic service.

On Sunday May 9th, Scott Nelson returns from his brief hiatus in the States. I am both relieved and excited, especially because I now get to see how HAH really runs in Scott’s presence. Everyone knows of Scott’s work ethic, commitment and altruism. It is no surprise that these are key to why he can turn any place around. However, I get to see another of his talents in action: organization. In my 4 days I   overlap with Scott’s stay, I see how much behind the scenes effort he  has to put in administratively and in terms of organizing things to make this place run. 

On the Sunday he arrives, we have no anesthesiologists and therefore are forced to postpone all our surgeries. Although this is a big downer, it gives us time to organize the new instrument/equipment that had come in a couple of weeks ago from other hospitals. We spend several hours organizing and discarding various trays, restocking equipment, etc. Its time consuming but I see how critical it is. In a fraction of the work space of traditional hospital operating stock rooms, Scott is able to keep an impressive inventory of trays, allowing us to perform fairly complex orthopaedic procedures with limited resources.

The next two days are pretty standard with Scott: super busy clinics, multiple surgeries and lots of inpatient care. We operate both days past 10 pm, with the anesthesia help of Dr Cassy Gabriel, who just came in on Monday with Allen Gabriel, a plastic surgeon. There is a pattern that is beginning to emerge for many of the patients we work on in the operating room and in the clinics - we are treating many refractures/nonunions and malunions from the earthquake. 

In my mind, the initial wave of orthopaedic stabilization after the earthquake was done with external fixators, mostly without imaging. Now, as the external fixators are starting to come off about 3-4 months after the earthquake, I have seen personally more than 10 people with refractures of  upper and lower extremity long bones. In many cases, the fractures were too malaligned to have had a feasible chance of healing. Another more subtle but very pervasive problem is the poor nutritional status of the people. I believe malnutrition is a big reason why so many of our patients have wound and bone healing problems. Even at the hospital, patients sometimes only get 1 meal per day.

The day finally comes for me to leave. One more member of the volunteer staff, Art Andres who has been here for 7 weeks working on facility maintenance, leaves with me to the airport at 6 am for a 9:15am flight to Miami. At the outset on this Wednesday am, I feel we have no chance to get to the airport. There is traffic gridlock on dilapidated roads. 

We move at a snail’s pace and along both sides of the road, we are again witness to abject poverty: collections of open trash line the street, pigs roam gutters/open sewers, people walk in an out of traffic, the air is heavy with pollution and dust. Asidefrom the complete lack of organization or order, people can be seen doing heavy manual labor such as single men pulling large wheeled carts of cargo, women carrying impossibly heavy items on their heads in the hot, humid weather. It is a heartbreaking and oppressive sight to see. 

We get to the airport in about an hour and a half and the process of checking in seems chaotic as well. After an hour and 15 minutes standing in line, we finally get to go through customs and into the boarding gate. As we get in the air conditioned boarding area, normalcy seems to be setting in. I am sure like many volunteers before me, I have mixed feelings as I start to depart. I definitely look forward to the creature comforts of home like air conditioning, a comfortable bed to sleep on, hot water for showers, etc. I feel guilty in the sense that after 3 weeks, I can still return to a fairly luxurious lifestyle but for the Haitian people I served and those that I saw on streets there is no such hope. 

I am sure this is a dilemma most who come here have to deal with when they depart. Nonetheless, compared to previous medical trips I have been to in Nepal, Dominican Republic and Haiti, this one has been the most significant because of the chance to serve the dire needs of the Haitian people affected by the earthquake.