Terry Dietrich, MD Trip Report Part 1

The following post was authored by Terry Dietrich, an othopaedic surgeon currently practicing in Wisconsin.  Terry, along with his wife Jeannie, and his orthopaedic PA Karen Fields, spent two weeks last month volunteering at Hopital Adventiste.

Jeannie, Karen and I arrived in Haiti Friday afternoon in a wide bodied aircraft nearly filled with what appeared to be volunteer aid workers.  Two more planes arrived while we were waiting for our luggage.  They seemed to be 90% volunteers also.  It is pretty amazing the outpouring of support and interest that is still happening.  We met with two other volunteers with the Loma Linda program and seven others with the CURE program.  Our “expedited” bags stayed in Chicago for some mysterious reason that was attributed to the volcanic eruption in Iceland.  Maybe it was for the best since our bus was crammed to the ceiling as it was with luggage, bales of donated crutches and the twelve of us.  Of course there were also the driver and his assistant..  Anything else would have to have been tied somehow to the outside or trailed behind.  There was plenty of earthquake damage evident at the airport.  A temporary area was set up for baggage claim and customs.  

As we left the airport, we encountered large tent cities in almost all of the open areas.  Large seemingly random areas had been untouched by the force of the quake and other areas have buildings sitting at crazy angles and piles of rubble.  The drive by of the national palace certainly made an impression.  The internet images don’t do justice to the degree of damage that it sustained.   

The trip to the hospital took over an hour.  The hour passed very rapidly helped significantly by my conversation with our contact, Lubbens.  He is a Kobe Bryant look alike, sound alike. Born in Cap Haitian, raised in Port-au-Prince, he lived with his parents in Florida for more than 10 years.  He missed qualifying for US citizenship under a law passed during the Clinton administration by just a few months based on his father’s naturalization.  He agreed to return to Haiti rather than live in jail in Florida.  His father is pastor of a Haitian Christian church in Florida.  He was seriously dating a Caucasian girl who wanted to marry him.  The girl’s father objected very strongly to the relationship.  Now the girl wants to not alienate her father and has decided not to come to Haiti to marry Lubbens.  He is resigned that it is God’s will and is doing the best he can.  Jobs are very difficult to find in Haiti with the unemployment rate ate greater than 70%.  He is happy to finally have this job with CURE.

Scott Nelson met us at the hospital.  We were delighted to see so many people  that  we know.  Scott’s dad, Peter is here.  A large contingent of medical personnel from Walla Walla is here. It includes Jack Hoehn, classmate and former dorm roommate from LLU,  Don and Shirley Ashley, both pediatricians, Joe Wujek, OB-GYN, and Dusty an xray tech.  Jack’s son, Ted, is an ER doc from Sacramento.  In addition to the Walla Walla group, there is a general surgeon from Stanford.  The CURE group that came on our flight is from Atlanta and includes an anesthesiologist and two nurse anesthetists as well as support personnel.   My good orthopedist friend, Randy Knight, is here for one more day.  He has helped me on at least three of our Dominican trips and has been very supportive financially of our project.  We have exchanged visits in each other homes on several occasions.  Randy and Jeannie went through many years of school together as children.  There are a number of senior medical students here from Loma Linda.  Jessica Claridge is functioning as the de facto head of surgical services.  Her role as chief surgical resident is indispensable.  Other students man the ER and assist in OB.    There are several volunteer OR nurses and a wound care nurse as well.  

Scott’s orthopedic skills, dedication and hard work have led to this hospital being the leading orthopedic hospital in the country.  Many cases are referred here daily that have failed treatment at other hospitals.   Scott estimates that nearly half of the 10 million dollar donation in equipment from Synthes came here.  We ran a small clinic after early church service today and one patient came in with an external fixator on his fractured tibia that had been placed at some other institution, possibly the street.  The bone is not healing satisfactorily and needs cleaning out and revision of the ex-fix.  I’ll do his case tomorrow.  We are all still scratching our heads over the 11 year old boy that was sent here with a painful hip and a diagnosis of “avascular necrosis.”  His hip xray is completely normal.  The pelvis view shows his large bowel filled with material that is radiopaque much like a barium enema.  Is this finding even related to his painful hip?  We are enlisting internet help from specialists on that one.  Randy and I did a hip hemiarthroplasty after clinic and then followed with a wound vac change on a 11 year-old girl with a fractured femur that has been stabilized with an ex-fix. TerrWhatever was provided for lunch was long gone by the time I finished seeing the woman in the ER that had just been struck by a car.

Scott’s father, a dentist, will be working during the next week with a skilled plumber from California to basically replumb the entire hospital.  The hospital water supply had been marginal before the earthquake given the ¾ inch supply pipe that was more than 30 years old.  Water ceased flowing after the quake for more than a week.  Once the water was reconnected with higher pressure, water began to ooze, drip and even squirt from many different walls ceilings and floors in the building.  Fortunately, the OR has been largely spared but who knows for how long.  The replumbing project with expensive Schedule 40 PVC may not look the prettiest when finished, but will hopefully provide higher water pressure without leaks.

April 18

Another large group of CURE volunteers arrived yesterday.  Several primary care physicians and general surgeons are in the group as well as another anesthesiologist.  It will be good to have their support.  Many of our patients have wound issues and the surgeons will be able to help with grafting and wound management.

Our meal at the Auberge du Quebec was good.  The green salad was fresh and the pizza tasty.  It took a long time to get but was worth the wait.  I skyped Cam and emailed my journal to the kids.  I had a nice talk with Joe Wujak last night.  This is his first mission trip and has been a bit of an eye opener.  Jack and I then talked until late.

Rounds started at 6 am and took an hour.  Worship and orientation was at 7:30.  Jack Hoehn is organizing the pharmacy and encouraging directed use of the meds that are in plentiful supply.   We have several patients with wound vacs.  I took two of them to the OR today.  I also debrided the patient with the ex fix on the infected tibia and redid the exfix after osteotomizing the fibula.  The tibia is a couple of cm short but is nicely aligned and now has 4 pins above and 4 pins below the fracture.  Karen , Jeannie and I finished those cases about 2 pm.  Then the general surgeons had a couple of cases.  A new anesthesiologist and two new anesthetists  kept the patients nicely quiet.  Everybody has been great to work with.

April 19, 2010

Rounds again at 6am.  The patients are all doing well. Several were discharged.  The cycle is nonstop, though.  Scott accepted another half dozen transfers from other hospitals that do not have the capabilities to do the types of orthopedic cases that can be done here.  At least 2 came from the facility run by the University of Miami.  They are both recent auto accidents.  One is a D-10 spine fractures that we are planning to stabilize tomorrow with pedicle screws..  The other has fractures of all four extremities.  Today was the big ortho clinic.  We saw 40 + patients and it was moderately chaotic.  Max, our ortho clinic translator/keeper of the numbers, kept things in fair order.  He has good command of English  but strongly accented, unlike Lubens.  He lived in New York for eight years then returned here and built up a business with more than a dozen employees.  He, his wife and four girls ages 6 to 13 all escaped basically uninjured from the effects of the earthquake.  They lost their house and Max lost his business.  He has no idea how he will get it reestablished.  I scheduled about 10 cases today including several foot cases and knee surgeries.  There is an upper extremity specialist coming on Friday so I am saving all of those for him.  

I helped Scott on one of his specialties.  We did a Taylor Spatial Frame with proximal tibial/fibular osteotomies.  The 30 year old lady has unilateral Blounts Disease with a marked tibia vara(bowleg.)  At 7 days the adjustments of the struts begin according to an internet computer program.  Dr Taylor modified the software program from the space shuttle simulator and adapted it for correcting complex limb deformities.  The patients are taught how to adjust the struts each day so that the deformity is corrected as new bone forms and then heals.  The adjustments take 5-6 weeks with weekly monitoring of the progress as well as the frame/pin construct.  The frame is then locked in place for 3 months until the bone is completely united.  The success rate is extremely high and allows for correction of deformities that previously had been very difficult and fraught with potentially serious complications.  It is a treat for me to be able to work with such an accomplished surgeon.  My last case, chronic osteomyelitis of the proximal humerus, ended about 6:30.  Tomorrow is one of our two big OR days for the week.  10+ cases should keep us off the streets and out of trouble.

April 20

Again, rounds at 6am.  Then it was pretty much nonstop clinic and surgery until after 1 am.  We did 11 cases.  A general/vascular emergency held us up for a couple of hours around 6pm.  There were some nice clean cases including an untreated bimalleolar ankle fx with nonunion of med malleolus, knee arthrotomy, and repair of acute Achilles laceration.  The rest were all long bone fractures with infections.  I placed wound vacs on 3 patients.  One has fractures of both femurs, both forearms, and the left tibia.  One lady with an AK amp has necrotizing fasciitis.  I hope we can save her.  Dr Sanjay Gupta came over from another hospital where he wasn’t doing much and he helped see patients in the clinic and helped with one surgery.  I talked with him a bit about our project in the DR and he is interested.  He has a joint replacement fellowship.  The volunteers here are all working so well together and so hard.  It makes it all worth while.  I’m really glad that Jeannie is here with me.  She is a tremendous help.

Read Part 2 of Dr Dietrich's report here.