Hasan Syed, MD Trip Report Part Deux

The following is Part 2 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.  Part 1 of his chronicle can be found here.

The biggest inpatient service at this hospital is orthopaedic surgery. Rounds start at 6 AM and the vast majority of the patients are here for management of some sort of earthquake related open fracture infection. On rounds, we try to have any allied orthopaedic related services with us - wound care, physical therapy, PAs and students who are available join us. Most of us have had to work outside of our normal job descriptions. There are PACU RNs who are working as wound care nurses; physical therapists as recovery room nurses; orthopaedic residents as flouro/scrub/ instrument techs.

One exciting aspect of working in a setting like this is the chance to meet people from around the world and different parts of the US. In my first week, there were plastic surgery teams from Orlando, FL and Italy. “The Italians” as they were called were a hardworking and boisterous group that injected the OR with energy. Every group had a unique personality and it was real fun to interacting with them. The other thing I noticed was that everyone’s hardwork motivated each other. Case in point: Jeannie Dietrich (Terry’s wife) and Karen Fields, the Ortho PA with Terry Dietrich. I don’t believe these two sleep at all and accomplish super human workloads. Definitely keep us going.

In terms of orthopaedic coverage, with Dr. Dietrich, Drs. Fred Liss and Larry Tynes have also been a tremendous help, particularly in terms of upper extremity coverage coverage. There are a lot groups who are here for 1-2 weeks at a time.

There is a small stretch of a few days when I am the only orthopod at HAH; the departure of the above mentioned doctors is simultaneous. This is easily the most strenuous time of my stay, since the orthopaedic team is down to Joe Kim, a 4th year LLU medical student and myself. Joe has done an excellent job, functioning at the level of an intern in running the inpatient service, allowing me to operate and run clinic as well.  

HAH, thanks to the system and excellent orthopaedic care Scott Nelson has established, has developed a reputation as an orthopaedic referral center. Doctors from different areas are constantly in touch with me via cell phone regarding orthopaedic patients that are beyond the level of care they can provide. We have received many transfer patients, to the point where there are no more beds available in the hospital. In order to facilitate this, we have tried to discharge as many patients as possible. HAH also has the only C-arm in the area. This is another reason for the transfers we get. One team from Medicare (University of Miami based tent hospital) brought over a patient with an open femur fracture and operated on the patient at our facility

In my second week here, there a 2 or 3 local hospitals that shut down for a variety of reasons. We have absorbed all of their orthopaedic inpatients. After working up their problems, approximately half of them turn out to be surgical candidates. Some of these hospitals had orthopaedic implants and instruments that they donate to us.

One of the largest teams I have seen arrived on 5/2/2010. Led by Dr. Ron Anderson from Harbor City Kaiser in southern California, 17 members representing key areas wound care, anesthesia, emergency medicine, general and vascular surgery, infectious disease as well as a physical therapist, ortho tech, ortho PA, scrub tech, RN circulator among others. This group truly brings in not only much needed expertise such as wound care and infectious disease (Dr. Spodkov and Nancy the wound care RN are truly a godsends) but a gust of energy. Leine, Naz and Naomi (ortho PA, PT and ortho tech) are miracle workers that all patients really have fun working with. Within 2 days of the team being here, there is a visible uplift in patient care in all facets. I feel it is due to a combination of manpower, expertise and energy.

 Although I was originally scheduled to leave after two weeks, my stay gets extended for another week at HAH. One neat thing I get to see by being here for longer is the tent giveaway by the Kaiser group. Between the team, they brought 79 tents to HAH which they distribute at a mini ceremony. Tents are super critical to the thousands whose home have been destroyed and I can see in the faces of the Haitians who get tents that they are deeply touched.

The electricity, which can go out for a few minutes at a time, went out for several hours today due to a fuel shortage. This crippled the ORs and clinics. In the down time, I made a much needed run to a local food mart. By Haitian standards, this is a remarkably nice grocery store – clean organized isles, nicely packaged food, isles, carts, air conditioned, scanners at the checkout, even pet food…. Walking through the streets to get to this place was once again a stark reminder about the devastation that has become part of common life here.

Last night or more appropriately, in the early morning hours of Saturday, we had a patient brought in with after a machete attack. He had been struck severely in the base of the right skull over the mastoid and across of the back of the left wrist with open fractures and nearly all his extensor tendons lacerated. Dr. Saroyan, a vascular surgeon from Kaiser, Dr. Charles, an ER doctor from Northern California worked on the skull and auricular injury and I worked on the wrist by pinning the fractures and repairing the lacerated tendons. Our anesthesiologists, Drs. Murikatani an Ly from Kaiser were in full force despite being up nearly the entire day before. The case successfully finished ~ 4 am but since there were no nurses to recover the patient, we stayed until the patient woke up.