Gary Frykman, MD Trip Report

Gary Frykman, an orthopaedic surgeon from Loma Linda/Redlands, Ca, volunteered at HAH earlier this year.  Gary travelled to Haiti with his son Eric Frykman, Director of Public Health, Riverside County, CA and Sang Le, an orthopaedic surgery resident from Loma Linda. 
 
I had the privilege of spending two weeks at HAH in June and was able bring an outstanding senior resident in orthopedics Sang Le and Rosemary Sullivan OTR an excellent hand therapist from the Loma Linda VA.  I was concerned she would not have enough to do but with her energy and ability to be flexible she was plenty busy. She had been a member of the chronic wound team at the VA so she became our lead wound care person especially changing wound VACs. I found that it pays to be adaptable, creative and volunteer to do anything that is needed is the best attitude for any volunteer. Being an upper extremity surgeon I even learned to inset a SIGN nail in the tibia. We even learned to use the complex and sophisticated Taylor special frame used to correct limb deformities.

Sang Le MD with Taylor Special frame on tibia 

The Haitians have suffered loss and devastation we would never think of in our worst dreams. Our orthopedic clinic assistant was a teacher, Max, who lost his 425 student school, his house and car in the earthquake. His money he has not been able to get out of the bank since the earthquake. He has four daughters who have just started school again after the earthquake. 

 An example is the young lady whose forearm was crushed for two days before rescue

Several observations stand out about concerning HAH: The large variety and skills of volunteers sometimes overwhelms logistically the hospital. To their credit, Global Health has worked very with so many and varied organizations who have sent large teams. The day we arrived a group of 16 volunteers from Children’s Hospital Oakland also came, we met a large group from Ukiah General Hospital who had been there for a month. While we were there a group of General surgeons from Brooklyn Hospital came, and a large Jewish Group from Mt Sinai Hospital, Baltimore. We did not have our own expat scrub nurse so we did not get a scrub nurse except for one case. I recommend a surgeon bring his own scrub nurse and anesthesiologist. A strong senior resident also makes life at HAH more livable. The Haitian anesthesiologist only came in at noon so we could not get as many cases done as OR time available.  

Even though we were there five months after the earthquake there are still many neglected orthopedic injuries from the earthquake such as three dislocated shoulders, and three dislocated elbows- each dislocated in a different direction, one medial, one lateral and one posterior. We had time go put two of them back surgically. We also took care of traumatic bunion with fractures and dislocations of all the toes and another with a dislocated ankle. 

  5 month old posterior elbow dislocation

I advise taking pictures of any orthopedic cases you see including the x-rays as the portable digital machine used in clinic does not print films and the images are lost each day after clinic. Incredible more patients are showing up in clinic with CDs of their x-rays from another hospital. You need a laptop in clinic to view the images. We had three patients in one day alone come to clinic with discs with x-ray images. You wonder why but it is cheaper than x-ray film. 

The OR was quite well equipped with much excellent Synthes trauma sets including eight Small Fragment sets. We thank especially Synthes for donating millions of dollars of implants and equipment to the HAH along with their ongoing replenishment of sorely needed implants Even so,  sometimes the implants had to be modified as seen below cutting a hip implant shorter  to fit the  intended patient.

NEEDS: The OR did run out of scrub brushes, shoe covers and hats. I recommend getting a pneumatic tourniquet such as the Zimmer one we use every day for safety. We used only the Esmarch but did not know the pressure. I do know of one case we had a post op tourniquet palsy temporarily probably due to prolonged and excessive pressure by the Esmarch. 

Although short term volunteers can make a difference in the lives of a few patients, the real difference is made by the long term staff such a Brooke and Luke and Scott Nelson and now my friend Mark Perlmutter, orthopedic surgeon from PA. who have made long term commitments.  HAH is being recognized as a facility that can take care of difficult cases.  We were seeing many referrals of complex orthopedic cases to HAH on a daily basis. God willing, the real success of HAH will be the long term dedicated staff supplemented by some short term enthusiastic and capable volunteers. I believe HAH has the potential to become the leading reconstructive surgery hospital in Haiti.