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.
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