"I don't know what your destiny will be, but one thing I know: the only ones among you
who will be really happy are those who will have sought and found how to serve" Albert Schweitzer

Sunday, September 19, 2010

Haiti Revisited

Haiti continues to struggle to recover from the devastating January 12 earthquake that killed up to 300,000 people, left millions homeless and shattered the capital city.  In the image below by Carlos Barria, pregnant women wait in line for tent distribution near the presidential palace in Port-au-Prince.
View the rest of the images in the series by Reuters here.

Saturday, September 18, 2010

Thursday, September 16, 2010

Dr Lawrence Lavine, Volunteer Anesthesiologist

Nine months after a devastating earthquake, the people of Haiti still are recovering.  But “things are better there than I thought they’d be,” said Dr. Lawrence Lavine, a Crystal Lake anesthesiologist who served last week on a medical mission trip through CURE International.
Lavine, 66, last visited Haiti in February, when he worked 12-hour shifts for two weeks, often as the only anesthesiologist at Hopital Adventiste d’Haiti.  About 300 initial cases then were arm and leg amputations.  This time, Haitian doctors are back to working regularly, and all the patients are staying in hospital rooms instead of living in tents outside. Hopital Adventiste d’Haiti offers free services to its patients and also serves as a public feeding center.
Read more of the story here.

Tuesday, September 14, 2010

Habte's Transformation

Because of his clubfoot, Habte was mocked by his peers. Even his mother thought he would have been better off if he had died due to the pain she knew he would endure for having a physical disability. They have all changed their minds now after seeing him running and playing football. Habte’s mother thanks God for Habte’s transformation.
Although the setting is Ethiopia, similar stories have been generated time and time again from the clubfoot program initiated by Dr Nelson and his team at Hopital Adventiste.

Monday, September 13, 2010

Seven Months Later

Dr Mark Hyman arrived in Haiti shortly after the January earthquake, and worked alongside Partners in Health staff to help provide medical care to survivors. Seven months later, he returned and filed the following report. Read his full essay in The Huffington Post.
Seven months after the January 12, 2010 earthquake that devastated Haiti, I returned for the third time. This time, not to help the wounded, to perform surgeries, but to help facilitate further funding for the University Hospital and to feel and see with my own eyes what changed, what hasn't and what needs to. The world has moved on to the next disaster, from the BP Gulf Oil Spill to the floods in Pakistan, but the memories of that first week after the quake, the smells, the loss, the destruction, the extraordinary heart of the Haitian people, worked its way under my skin. It is a part of me. It is the poorest nation in the Western hemisphere where 55 percent of the population earns less the $1.25 a day and 58 percent of children are under-nourished, and it is not rebounding. Though there is less rubble in the roads and pockets of rebuilding have started, still today 1.6 million people are homeless and still in the tent camps (often made from sheets and sticks), or living on the median of a highway in Carrefour, doused in exhaust and dirt and hoping to survive each night as they sleep with cars flying by, deprived of all human dignity and decency as they bathe and defecate in view of everyone.

Sunday, September 12, 2010

Haiti: Disaster And Recovery

William Daniels arrived in Haiti ten days after the apocalyptic earthquake of January 12th. The world had been watching in disbelief horrific images of mountains of bodies burning in the streets or thrown in mass graves. However, in spite of the fact that the devastating consequences of the earthquake were still visible, there already were signs of life getting back to normal

During the short time he spent there he saw the situation begin to evolve. Kids were beginning to play football again, some smiles were back on people's faces, and barbers who had lost their shops in the quake were working in the street. William could feel and see that people were trying to get back to some kind of 'normal life'. But behind these early signs of a return to normality, a huge and concentrated humanitarian crisis is slowly taking root.

View the rest of the images here.

Thursday, September 9, 2010

Hospitals Awash With Supplies But Struggle To Pay Staff

In the months following the January 12 earthquake, donated medical equipment and supplies were shipped into Haiti by the container-full, overwhelming hospitals across this disaster-ravaged nation. Much of it will never get used, and even worse, the unopened boxes sometimes obstruct doctors from locating supplies they actually need to treat patients.
But organizations seem unwilling to donate the one thing Haitian hospitals say they desperately need: Money that can be spent at their discretion, for things like salaries, fuel for the generator, and oxygen.
Read the rest of the story by Sarah Ryley here.  Image below of donated supplies at Hopital Adventiste by Tamara Fitzpatrick.

Wednesday, September 8, 2010

One Nurse's Experience In Haiti

Tiffany Cupp, a pediatric emergency room nurse at the University of Chicago Medical Center, talks about being one of the first American medical volunteers to arrive in Haiti after the January, 2010 earthquake. As the first pediatric nurse at the Community Hospital in Port-au-Prince, Cupp formed a bond with an 8-year-old girl named Yveline who was rescued from the rubble of the house where both her parents died.
Tiffany returned to Haiti in March for her second tour of duty and worked at Hopital Adventiste with our team. Read more of her story here.

Tuesday, September 7, 2010

Terry Dietrich Trip Wrap-Up

Orthopaedic Surgeon Terry Dietrich and his RN wife Jeanie recently returned home from another volunteer stint at Hopital Adventiste.  They are currently making plans to devote a year of their lives in service to the people of Haiti.  Terry and friends have made a commitment to try to raise funds for the projects that he outlined in the following document. Any suggestions that you the reader might have will be greatly appreciated.
We are on our way home from Haiti. Our week was filled with memorable experiences. Nearly half of the 200 patients we attended in the orthopedic clinics this past week were injured on January 12. Of those patients, nearly 50 surgical procedures were performed. These included wrist, knee and ankle fusions, bone grafting of ununited fractures, fixation of fractures, skin grafting, removal of tumors, correction of club foot and other congenital deformities, and knee arthroscopy. The sophisticated Taylor Spatial Frame was placed on several patients. This device is used to realign bones that have become deformed from poor fracture treatment or from conditions such as Blount’s Disease that cause bones to deform during growth.
Port au Prince continues to be a major disaster zone. The recovery from the fourth most deadly earthquake in the history of the world is agonizingly slow. Of the estimated 230,000 people who died, nearly half are still entombed in the rubble. I was told that only 2 % of the rubble has been removed. Of course, that means that the people who lived and worked in those buildings are still without a place to live and have no livelihood. There are people and organizations making efforts to help with the recovery but it is a seemingly impossible task. There is a bright spot in Port au Prince. It seems to be the silver lining in the black cloud that enveloped the capitol city on Jan 12. The development of Hopitale Adentiste d’Haiti into the major referral center for orthopedic surgery is nothing short of miraculous especially given the devastation and chaos created by the earthquake. Before Jan 12, it was a struggling little clinic that had never done orthopedic surgery. Now, mainly because of the dedication and vision of Dr Scott Nelson and the support of Loma Linda University, it is making a terrific impact in the entire country. The sophisticated orthopedic procedures that are done routinely at HAH exceed what is done in many good hospitals in the United States. Limb deformity corrections for severe congenital and posttraumatic limb deformities are done on a daily basis. Joint arthroscopy has just been established and can now be done routinely. Many volunteers continue to flock to HAH to provide services that had never been available to even the wealthy prior to the earthquake. It appears to be one of the few projects that have been making a significant difference in Port au Prince since the earthquake.
There are many needs that still need to be addressed for HAH to realize its potential. Volunteers still sleep on army cots or on the floor in unfinished parts of the hospital. These volunteers are an important part of the treatment given to patients. They include administrators, surgeons, nurses, x-ray specialists, anesthesiologists, therapists, physicians, plumbers, electricians, builders, surgical assistants, coordinators and students. There will be needs for volunteers for many years as Haitians are slowly trained to assume these positions. Housing needs to be acquired to accommodate the volunteers. Funds need to be raised to finish the new patient wing. This unfinished project began more than 5 years ago. Finishing that wing will make it possible to attract patients that can pay for their medical care. That income stream is vital to keep the hospital financially viable as it continues to care for the needs of the indigent. A total joint replacement program would help bring paying patients. The current operating rooms are not of adequate size. The equipment necessary to perform joint replacement requires a large space to accommodate the array of tools, materials and equipment and reduce the risk of contaminating sterile areas. An entire addition to the hospital with new operating rooms is planned. That will be a project that will take 3 years or more. The current operating rooms could be reconfigured to create a room of adequate size for joint replacement surgery. That reconfiguration would involve updating the entire surgical theater area to improve traffic flow and provide more effective fly control. These projects to provide volunteer housing, finishing the new patient wing and updating the operating rooms could be finished for approximately $200,000. Another very important project to ensure continued access to high quality medical care for the indigent is a fund dedicated to subsidize their care. The interest from $500k would be sufficient as a starting point. There is still a relatively high awareness of the needs in Haiti. Fund raising can still be done. Identifying the institutions and organizations that can provide financial support is the starting point.
I am personally contributing a year of my life to this project. I was impressed during my two weeks at HAH in April of the need to continue the work that Dr Nelson has started. He cannot continue to live in Haiti due to family and professional responsibilities. My wife and I will be moving to Port au Prince in November of this year and will stay for one year. I will continue to coordinate the orthopedic services that have been established. I plan to implement new programs such as joint replacement. A training program for Haitians is a high priority. Identifying my replacement will need to be done. Fund raising for the above projects is key.

Sunday, September 5, 2010

Damon Winter Haiti Images

Damon Winter is a staff photographer at the New York Times specializing in documentary, editorial and portrait photography.  He recently won the Visa d’Or News award in Perpignan at the International Festival of Photojournalism for his compelling images of the Haiti earthquake and its aftermath.

Saturday, September 4, 2010

The Burden Of Aid

During her five-week International Reporting Project Fellowship Ruxandra Guidi traveled to Haiti to examine the effects of foreign aid on human rights, violence and poverty. This gallery, with photos by Roberto "Bear" Guerra and music by Luis Guerra, depicts the harsh living conditions in Haiti, a country gravitating from one humanitarian crisis to another.

Friday, September 3, 2010

7 Days In Haiti

In the immediate aftermath of the catastrophic earthquake that struck Haiti, Tim Scott and Will Decker of Travel the Road, enter the capital of Port-Au-Prince to find a city in chaos. Their mission, to find hope amidst this tragedy, brings them to the downtown district where they witness the miraculous rescue of a man trapped beneath rubble for 15-days, without food or water. But soon after, violence erupts when rogue Haitian police begin shooting civilians for scavenging. Street riots, gunfights and civil unrest threaten to tear apart the city, and when all hope seems lost Tim and Will make contact with local believers who show them the power of the human spirit and an unshakeable faith for a better future. 

Wednesday, September 1, 2010

Terry's Haiti Journal - August, 2010

Aug 20 - The Thedacare Orthopedics Plus Haiti Relief team from Appleton Wisconsin is locked and loaded. The team:
1. Todd Smith (Orthopedic surgeon)
2. Terry Dietrich (Orthopedic surgeon)
3. Jeannie Dietrich (RN/Trip coordinator)
4. Jodi Zimmerman (RN)
5. Becky Czechanski (RPT)
6. Kristen Daniels (RTRM)
7. Hannan (RTRM)
8. Trent Jerzinski (Health Care engineering/construction specialist)
9. Ed Mueller (Linvatec representative/arthroscopy equipment specialist)
We have included a wound specialist, JanKlass, from San Diego as well as an anesthesiologist, Karl Eckhardt, from Walla Walla, Washington. Both are high priority for the types of patients that are cared for at the Hopitale Adventiste d’Haiti.
This team was formed to respond to the orthopedic needs of the people of Haiti in the aftermath of the devastating earthquake of January 12. The site for our work will be the HAH. This small mission hospital in a suburb of Port as Prince was developed in the weeks following the earthquake to care for the many patients with fractures and other orthopedic injuries. Dr Scott Nelson was the first orthopedic surgeon to arrive in the city just 24 hours after the earthquake. He decided after assessing the medical facilities to focus on HAH as the best site to provide orthopedic care. No orthopedic surgery had ever been done at HAH before the earthquake. In the past 7 months, he has done a remarkable job of developing the orthopedic capabilities of HAH. It is now regarded as THE referral hospital for orthopedics in the entire country. Many of the patients that are cared for there are victims of the earthquake with residual infections and/or deformities that were unable to be treated in the chaos following the disaster. Many patients with orthopedic injuries that have occurred since the earthquake are now also treated at HAH.
The goals of the team are:
1. Provide orthopedic care for Haitians
2. Develop an arthroscopy capability for HAH (the first such program in the country)
3. Assess the physical needs of the hospital. 
4. Develop strategies for raising funds to support costs of providing orthopedic care for indigents.
Dr Nelson and other volunteer orthopedists have been inundated with orthopedic cases especially in the indigent population. There is a huge ongoing need for volunteers to continue to provide this care. The government orthopedic hospital is largely limited to treating the patients with acute trauma. Their resources are limited. Arthroscopy will increase the range of orthopedic services and bring a modern orthopedic capability to the country. The Hospital physical plant has major needs. The operating rooms are very small making it difficult to accommodate the equipment necessary for modern orthopedics. Storage space is hopelessly inadequate.
All team members plan to spend the night near the airport in Chicago. We leave at 9:20 tomorrow.
Aug 21 - The trip to Haiti had some anxious moments. We arrived at the airport before 7 am. We were informed that the maximum number of checked bags per person is 2. The Website indicated 3. We were able to repack and use the overweight allowance of 70# for 3 of our bags. We had a very helpful AA desk agent named Eli Ortega. Jan met us in Miami. Karl arrived in Port au Prince yesterday. There were 3 other AA planes on the tarmac when we touched down. Baggage claim was near total chaos. All of our luggage made it in good condition. The hospital contact got us to the vehicles and secured the luggage. It was a fairly long walk. On our trip through the city, it appeared as if there has been virtually no work done to remove the rubble or rebuild. It really leaves an impact to see the incredible amount of destruction in the city and the piles of rubbish and the tens of thousands of tents. We met with Nathan and Amy at the hospital and gave the group an orientation. We are anxious to start seeing patients and putting our new equipment together and start using it.
Aug 22 - The forecast was for a light day. We started with morning report at 7:30. We just finished our last case n the OR and it is 10 pm. We have 6 cases on the schedule tomorrow including a man who came in to the ER with fractures of the tibia, femur and proximal humerus. The C-arm gave us grief today and wouldn’t boot up. We are hoping we can get it figured out by tomorrow. Ed got all of the arthroscopy equipment unpacked and is anxious to start using it. Ben scrubbed in on some cases and was a big help. The whole team has jumped in with both feet. It is a great team to be a part of.
Aug 23 - As expected, the ortho clinic was huge. Scott managed it pretty much by himself while Todd started the first case in the OR. I made rounds with the rest of the team. Our patients are doing well except for the patient with the multiple fractures. His hemoglobin was 6.0. We asked for blood and are still waiting. Meanwhile, his Hgb has dropped to 4.7. Since malunions and nonunions are treatable, we have decided to not operate until blood is available. We did a lot of cases today and finished by 8:30. They all went well even though we don’t have a C-arm to check our reductions. We might have to make some adjustments to some of the fractures. We ran 2 rooms a good share of the day. It is great to have 2 anesthesiologists. Jeannie has been spending a lot of time with Lucia learning how to set up the OR and how everything is organized. We used the new drill/pin driver on 2 cases today and it works great. Ed scrubbed in and assisted Todd on an ORIF of an elbow fracture. Ben helped me on several cases. It is really fun working with these guys. Trent made contact today with the Haitian student. I don’t know what happened with that yet. I am sure that tomorrow will bring more new challenges.
Aug 24 - The ortho clinic was even bigger today. I saw a man with a clear cut torn lateral meniscus. He will be the first Haitian arthroscopy case. I put him on the schedule for tomorrow. We have about 8 other cases on the list as well for tomorrow. All of our cases went well today even though we don’t have a C-arm. Todd helped Scott with a Taylor Spatial frame. I did a knee fusion on a pt with post traumatic arthrosis. Todd grafted a nonunion of a tibia with post ICBG. I saw the mystery patient in clinic. He has a healed incision on his buttock that looks like he had a hemiarthroplasty. The staples were still in. He said his surgery was done here at HAH 5 weeks ago. His xray shows that he has an intertroch hip fracture with no evidence that the fracture was ever fixed. His medical record is missing. We may never find out what transpired. The blood finally arrived for our trauma patient at 7:30 tonight. We got 2 units so will get them in tonight then do his surgery early tomorrow. I sure hope he makes it. There is a nearby house that may be where we will be staying for the year. We’re going to look at it tomorrow. I spoke with Dr Archer today after he made rounds with us. He was pleasant and very agreeable.
Aug 25 - We had another very good day. The clinic was huge with more than 40 clubfoot patients. There were an additional 35 regular ortho patients. Joseph Fritzner returned to the clinic. I operated on him at least a half dozen times in April. He had fractures of both arms, both femurs and left tibia into the knee. He had an infection in the tibia fracture as well as a compartment syndrome. I almost amputated his leg on 2 occasions. His leg is doing well as are the other extremities. He uses a brace on his left ankle and still walks with a cane. He and his wife were happy to see us as we were to see him. Scott has a good system set up for the clubfeet so it went smoothly. The whole area of the hospital around the ortho clinic was massively packed all day. Both rounds and surgery went very well. All of our patients seem to be recovering from surgery nicely. It was a great day in the OR. Dr Smith did the first arthroscopy case ever in this hospital and maybe the first ever in the country. It went very well. The patient had a torn lateral meniscus as I had thought when I saw him in the clinic. The new equipment worked very well. It is exciting to be involved in a project like this. I am very thankful to Ed Mueller and Linvatec for making such a generous contribution. We have seen more than a half dozen patients in the clinic that need joint replacement. The small ORs are inadequate. The possibility of removing the wall between OR 3 and the storage room and then combining them into a large OR that would be suitable for Total joint surgery was discussed with Dr Archer and the hospital administrator. They are very enthusiastic about the possibility. Combining that with finishing the new wing would undoubtedly attract many paying patients. All of our cases went well today including the ankle fusion that I did. We were able to finally wash out the open femur fracture and then put in an interlocking SIGN nail as well as fix the tibia with another locked SIGN nail. Fortunately he is thin and we were able to use a tourniquet and blood loss was negligible. Nathan took Jeannie and me to the house across the street where we will probably be living when we come back. We will be sharing it with about a half dozen other volunteers. It is a large house that appears to have been unoccupied for a long time. It has a very large yard surrounded by a high block wall. I think it will work very well for us. If we were going to be living here for several years, we would find our own house to live in.
Aug 26 - Still no C-arm. Scott continues to make efforts to get it running. His optimism hasn’t waned. The portable unit is working very well now and we have used it in the OR for a couple of cases. Todd did a second arthroscopy and then he and Scott put a Taylor Spatial frame on the patient and osteotomized his tibia. Clinic was much smaller today. Todd and I saw the patients and scheduled several cases for tomorrow including another arthroscopy. Scott had a long case to start the day. The child has fibular hemimelia – the small bone in the lower leg didn’t grow properly. The leg is crooked and short. He corrected everything and put on o TSF to lengthen the leg. His surgical talents amaze me. I did another ankle fusion. Scott and I finished the day with a 15 y/o boy with spastic hemiplegia. We corrected his foot and ankle with a lengthening of both the Achilles tendon and posterior tibial tendon and a split anterior tibial tendon transfer. I finished it at nearly 10 pm.
I had a meeting with a representative of the University of California system. They have a very strong interest in having extensive participation with HAH. Professors, clinicians and students from UC San Diego, UC Davis, UCLA, and UC San Francisco want to rotate many surgical and medical specialties through here. The possibilities here are seemingly limitless. Dr Archer presented me yesterday with preliminary drawings for the reconfiguration of the OR so that we can have a large enough OR to be able to begin a total joint program. He and the hospital administrator are very enthusiastic about the idea.  Tomorrow will be our last day. It has been a tremendous week so far.
Aug 27 - Today was really a fun day. We had 8 cases scheduled and did them all. Our first case was a lady with a grapefruit sized mass in her left shoulder. It felt like a lipoma. I had Ben do the incision and then he dissected the whole thing out. It was a pretty amazing experience for a college student. He then assisted me on my third ankle fusion this week. It went well. He put in a couple of the screws. Our last case was a wrist fusion. He put in most of the screws. He did really well. He has very steady hands. Todd did 2 more arthroscopies and Ed scrubbed on them both and actually did the second one. He is totally wired about the experience. Our work here at the hospital is over for the week. It has been a very worthwhile experience for all of us.Scott’s wealthy Haitian friend, Jean Marc, came to HAH today and brought some construction people. They looked at the new wing project and the OR and agree completely with Scott and me that it should be finished to appeal to the wealthy. It would include putting in a more appealing tile. They did all of the very nice work on Jean Marc’s home that Scott has visited. It would be great to have it finished to really have high end appeal. We can offer services to the well to do and the income could subsidize care for the poor. Scott thinks that the necessary money would be relatively easy to raise. They are going to give us an estimate by Monday. I’m going to have Scott take them over to the house across the street and have them also give us some ideas about how to make it more livable.