"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

Tuesday, December 28, 2010

It's Not Too Late...

to donate to the Hopital Adventiste Ortho Project and still claim a deduction on your 2010 Income Tax Return! We're all bombarded with pleas for financial assistance this time of year but I cannot think of a purer philanthropic endeavor as 100% of your tax-deductable donation will go directly to patient care...no administrative fees whatsoever.  In addition, I've never met anyone who can stretch a buck further than Scott or the Dietrichs.
Earlier this month I had the opportunity to serve 10 days with Scott Nelson and Terry and Jeannie Dietrich at Hopital Adventiste d'Haiti.  You can read about the trip on this blog as well as the Orthopedic Ministries of the Caribbean website.
Jeannie and Terry Dietrich
For those of you who are not familiar with the Dietrichs, Terry and Jeannie recently put a lucrative orthopaedic practice on ice (literally, they are from Wisconsin) for 12 months.  They have dedicated a year of their lives (without financial remuneration) to not only maintain the gains made by Scott Nelson and short-term volunteers since the Big Quake but are attempting to create a viable musculoskeletal program that can be self-supporting for years to come.
Jeannie cleans and organizes equipment, preps patients, and first assists...even more impressive considering she sustained a bad fracture/dislocation of her shoulder 3 wks prior to this photo being taken 
The following is an additional update written by Terry Dietrich shortly after leaving Haiti a few days ago:

The work that was started at HAH in the days and weeks after Jan 12 by Dr Nelson is of inestimable value to the Haitian people. They have never had a comprehensive orthopedic program available in the past.  Now they have at their disposal (especially the indigent patients) expert care that can address generations of neglected and untreated musculoskeletal conditions such as limb anomalies like clubfeet, spine deformities, acute trauma, tumors and infections. From what I have been able to see during the total of seven weeks that I have been involved at HAH, is that it has become one of the few bright spots in an otherwise largely dismal picture of what has happened (or more correctly, NOT happened) in Port-au-Prince since the Big Quake on January 12.  God has certainly worked strongly through Dr Nelson and the hundreds of volunteers at HAH to not only help the Haitians directly injured during the earthquake but hundreds of others such as Staille and the 37y/o lady who came to HAH one week ago yesterday with an unstable pelvic fracture. She had been initially evaluated at Medecins Sans Frontieres and told she would need to be at bed rest for at least 3 months. She was returning to Florida to be with her husband in West Palm Beach, one of the most affluent communities in Florida prior to her injury. Dr Nelson and I finished surgically stabilizing her pelvis at 4am and then cleaned the instruments and restocked the trays so they could be properly sterilized and ready for the next time needed. That work was finished at 5am. We left the hospital 30 minutes later for the airport to return to the United States and Dominican Republic respectively. This was just 36 hours after Dr Nelson had been hand delivered a letter absolving HAH and sponsoring entities of any responsibility for any anything that might happen to him during his continued stay in Haiti. He had decided to stay at HAH to provide ongoing urgent care for patients that still required his expertise for 2 more days after all the expatriates had been ordered to evacuate Haiti. Those extra two days that I was able to have with Dr Nelson were a gift from God. It helped me greatly to be able to finalize several aspects of patient care that I can now be better able to manage.

Dr Dietrich is hoping to establish elective Sports Medicine and Total Joint Arthoplasty programs at HAH to supplement income for indigent patients.  Donations of functioning Linvatec arthroscopic gear welcomed.
Some of the more pressing needs are as follows:
  • Travel expenses for OEC tech to recalibrate C-arm damaged during power fluctuations - ($1,000)
  • Funding for Vieja (Dominican OR nurse, worth her weight in gold) to return for 4 1-week reorganization stints - ($3,000)
  • Set of reusable, heavy-duty cloth surgical gowns - ($5000)
  • Doubling of inverter capacity to protect electronics against power fluctuations - ($6,000)
  • Funding for Ortho Technician training program - ($10,000)
  • Funding for Haitian anesthesiologist to commit to at least 2 full days a week - ($1,000/month)
  • Second OEC 9600 C-arm as this would enable the team to perform simultaneous cases that require imaging as well as serve as a backup - ($50,000)
  • Renovating the Operating Theatre (creating additional room, enlarging existing rooms - ($100,000)
  • Indigent patient fund (presently care is free but in order for the hospital to survive, this policy will be forced to change sooner rather than later) - ($$$$$)
If you're inclined to contribute, simply click here and under the Comments section write "HAH Ortho" and/or any other specific instructions you desire. 

Thanks for the continued support of your thoughts and prayers.  Not only are your fiscal contributions greatly appreciated, but there exists an ongoing critical need for short-term volunteers, especially surgeons, anesthesiologists, and nurses.  Feel free to contact Terry and Jeannie directly at tj.dietrich99@gmail.com for more information.

Saturday, December 25, 2010

Team Sinai Haiti Plans To Return

Team Sinai Haiti's plans were to return for a week of service on December 26, at which time  they would have been the only expatriate medical team present, with the long term volunteers being scheduled out for the Christmas/New Year holidays. Unfortunately, fate intervened, forcing them to cancel their trip.  Read the rest of their story.
All packed up but no place to go!

Tuesday, December 21, 2010

US Worker Held In Haiti Jail - Says He's Being Extorted

Paul Waggoner, humanitarian relief worker in Haiti and co-founder of the international NGO, Materials Management Relief Corps (MMRC) has been apparently unjustly detained in a Haitian prison. Add your voice to call on Senator Kerry to exhaust all means available to him and the U.S. government to ensure Mr. Waggoner's immediate release. 
Over the past couple of days, I have been contacted independently by 3 credible individuals who have brought the plight of Paul Waggoner (aka Little Paul) to my attention.  Each one of these veteran Haiti volunteers have had first hand knowledge of Little Paul and have vouched for his passion for the Haitian people and the contributions he has made to Hopital Adventiste since the Big Quake.
Read more of the story in Jessica Scott's blog, AOL News and the Men's Journal.

Saturday, December 18, 2010

Trip In Brief From Flight AA 816 – 17 December 2010 By Scott Nelson

We thought that it was over when we finished all of the urgent cases of the week about 6 o’clock last night. After returning to the hospital from a dinner with Dr. Hans Larsen president of Societe Haitien de Orthaedie et Traumatologie we were faced with another patient in our emergency room who had been in a car accident. She had a complex pelvic fracture that under normal circumstances could have waited another day or two prior to surgery, but since there are no other options in Haiti for injuries of this type we prepared our instruments and aroused the operative team. We had just enough time to complete the case prior to our 5:30am departure from the hospital. After finishing the case and washing our instruments we went upstairs to finish packing our bags just as the roosters began to crow. This operation represented a culmination of blessings and teamwork that occurred throughout our trip. 

Just a few of the trip highlights… 
  • Brent Scully, Sebastian, and Randy Tall installed an inverter system to protect our sensitive OR equipment against power surges and the frequent power failures that have inevitably caused our C-arm fluoroscope and monitoring equipment to fail. 
  • Terry and Jeannie Dietrich – are perhaps the biggest of all blessings during this week. They are now on site full time and will be able to maintain continuity of care for our patients and provide a system to increase the productivity of our highly skilled surgical volunteers. Terry is also starting an orthopaedic technician training program which will have a major impact on the services at HAH as well as other hospitals around the country. 
  • We spent a significant amount of time organizing and cleaning the operating room as this is an essential element to performing high quality operations and making the most out of our donated materials. Most all of the instrument and implant trays which were donated in the early days after the earthquake by Synthes, Smith & Nephew, KCI, Stryker and others are still in excellent condition and in regular use. 
  • We upgraded the air conditioning in the sterile supply room thanks to Sebastian who did the dirty work. 
  • Our electrical team also replaced the dangerously rusted out electrical outlets and switches in the OR and clinics 
  • The clinic and orthopaedic x-ray rooms were completely reorganized, painted and scrubbed from top to bottom, giving a whole new look which is more in line with the quality operations that we do. 
  • Patients from far and near, new and return, old and young came for evaluation, treatment and follow up. 
  • Many operations were done both simple and complex including thoracic pedicle screw instrumentation for a T3 burst fracture, Taylor Spatial Frames, hip fractures, femur fractures, and tibia fractures amongst others. 
  • Remediation from my former professor James Matiko who was able to refresh my surgical skills and improve upon the instrument organization process. His support and attention to detail goes well beyond the confines of the operating room. 
  • Adventist Hospital in partnership with Cure International is now recognized as the premier center in Haiti for the treatment of clubfoot. 
  • We were blessed by the cancelled flights of American Airlines and political manifestations which prolonged the stay of Dr. Matiko, Greg Bonner (biomed tech), Jere Chrispens (IT) and others. This honeymoon of productivity was ended with the decision of our Adventist leaders to evacuate expatriate workers in a police escorted motorcade early one morning due to the political instability and airport closures. 
  • Jere Chrispens worked tirelessly with the technicians at Fuji to help develop an x-ray archival system for our digital x-ray machine. 
  • Greg Bonner worked longer hours than the surgery team to resolve the fatal error messages that were preventing the C-arm from functioning. Finally at about 3am on the third day of work he wheeled the machine into the OR with signs of victory. Unfortunately the day after he left it failed again due to an unrelated problem and was again repaired by some diligent orthopaedic surgeons. 
  • Even the little things count - like new x-ray gowns (thanks to Jerry Daly) that we are now able to hang on some hooks in the OR made by Brent. 
Although many other people and events deserve mention, I will end by thanking Marni and the boys who constantly encourage service, risk, and hard work. They encouraged me in my efforts to prioritize patient care over evacuation orders and when she found out that I was operating until the last hour of my stay, Marni even suggested that maybe I should stay longer. 
For the first time since January 12 the hospital is void of surgeons, but the patients just keep coming…

Friday, December 17, 2010

Update From Scott Nelson

Received the following note from Scott 7 hours ago, hopefully the case went well and they are safely on the plane by now.  My understanding is that the liaison with the local orthopaedist was to arrange coverage for their patients during Terry's absence.  

Just got back from dinner with Hans Larsen, president of the Haitian Ortho Society.  it was good. On arrival at HAH we found a 27 y F sp MVA with saacroiliac fracture/dislocation. I woke up Vieja and Adrian and they are cooking up the pelvis set to get her operated just in time to catch our ride to the airport at 5:30am. Also I got the C arm working today and we successfully operated on the 69 yo blind guy with the proximal femur fracture (see image below) that was 6wks out. Suffice it to say all is well - map buele. 

Thursday, December 16, 2010

Update From Terry Dietrich

Had 7 cases today including the 69y/o blind gentleman with the subtrochanteric femur fracture, everything went well.  Followed by another BIG clinic which finished about 5:30.  Called Hans Larsen (prominent Haitian orthopod) and went to Petionville for dinner with him at a good restaurant. Made it back before 10 to find a 27 y/o in xray with an unstable pelvic fracture. Going to the OR in a bit...won't get much sleep before heading to the airport at 5:30 to catch my 8:30 flight. 
I saw a great case in clinic today. 53y/o farmer from 3 hours away. Raises just enough rice and beans on his small farm to keep his wife and five children from going hungry. Just hand to mouth, nothing left over to sell and get ahead. Has no animals or machinery to assist with the hard work, mainly a hoe to till and plant and scythe to harvest. Has TERRIBLE knees, bad valgus with instability bilaterally. In addition, the left hyperextends 40 degrees, walks way crouched over. 
Jeannie made it to Cabarete fine after a 9+ hour convoy trip and bus ride. I'll join her tomorrow hopefully by 3pm.

Wednesday, December 15, 2010

Update From Scott Nelson

I received the following update from Dr Nelson this evening.  I also had the opportunity to speak with him by phone earlier today.  Both he and Terry are safe and in good spirits.  
The day was kicked off by the evacuation of nearly all the expatriate employees and volunteers who fled the country in a police escorted convoy just before dawn. A core team of essential medical volunteers consisting of Terry Dietrich, Scott Nelson and our Dominican anesthesiologist and nurse stayed behind to take care of the patients that had been waiting for urgent surgeries and provide post operative care for the recently operated cases. As day broke the patients began to line the hallways. There were more patients than usual since many had not been able to come last week due to lack of public transportation during the riots that broke out across Port au Prince. We operated on seven patients today consisting of several severe fractures of the upper extremity which would have almost certainly gone without proper treatment had we not been there. In spite of the fact that we have closed ourselves down to new trauma referrals, seven more urgent cases are already scheduled for tomorrow. Fortunately there has been no civil unrest at the hospital or immediate area surrounding the property and we hope and pray for peace and God’s guidance as we continue our work.

Back Home

The last couple of days have been a blur for me.  Ended the trip on a low point with a patient who underwent IM rodding Sunday evening then probably threw a pulmonary embolus postop.  Unfortunately, despite the best efforts of our anesthesiologist shackled with limited resources, the young man expired early in the morning a couple of hours before we left for the airport.
Travelled to the terminal uneventfully in the hospital ambulance with red light flashing.  Stood in line for over 4 hours waiting for our boarding pass then embarked on the journey back to Los Angeles via New York.  The circuitous itinerary was courtesy of Delta Airlines as American Airlines still was not flying in and out of Port au Prince.
Had my initial bout of GI distress in LAX, an hour later in Redlands all hell broke loose...I couldn't keep any fluids down.  Thankfully, our surgery center anesthesiologist, Jeanie Sprengel, stopped by the house, started an IV on me and pumped in 3L of fluid before I started to feel better.  I'm currently back in the office seeing patients and am almost good as new.  I'm most grateful for her intervention and even more thankful that I survived the majority of the trip without illness.
Hopital Adventiste's parent NGO, Adventist Health International,  recommended this past weekend that all expat volunteers vacate the premises by today (read more from Jessica Scott) due to escalating civil unrest. Scott, Terry and Jeannie were planning to leave by this coming weekend although I'm waiting to here more of their updated plans.
I didn't get much of chance to post a more detailed summary of our trip with case highlights but will try to due so with a couple of "retroactive" posts over the next few days.
Good to be home but I'm filled with mixed emotion as so much has been accomplished from an orthopaedic surgical standpoint at HAH since the Big Quake and the potential was great.  My fear is now that with Haiti's deepening election crisis after two leading presidential candidates rejected a proposed recount of last month's disputed vote that enthusiasm for volunteer involvement will begin to wane.  I hope and pray that my concerns will not come to fruition.

Saturday, December 11, 2010

C-arm Is Now Functional!

As many are aware, the image intensifier (C-arm) at Hopital Adventiste has been nonfunctional for at least 6 weeks.  For an orthopaedist, that's a major functional impediment and significantly narrows the types of cases that we can operate on.  
There have been numerous attempts by many individuals to bring this radiographic patient back to life all of which have proved fruitless...until Greg Bonner came on the scene.  Greg is a Certified Biomedical Electronics Engineer from Portland, Oregon and travelled to HAH a few days ago with his wife to tackle several pressing projects.  To make a long story short, Greg work diligently, even pulling a couple of all nighters, and finally got the beast up and running again.  Greg is a modest fellow and gave all credit to the Great Physician for solving the problem.  
The first case with the "new" C-arm was a young man with a T3 burst fracture that underwent pedicle screw fixation.  Although not technically impossible, it is much safer to perform this type of surgery under x-ray guidance.
Scott Nelson organizing instruments for the first case with revitalized C-arm
Terry and Scott instrumenting the spine
Image intensifier documenting pedicle screws in place

With respect to other imaging issues, we've also been blessed to have Jere Chrispens, an Information Technology Consultant from Yucaipa, California here for the past week.  He has been working diligently to solve the virus issues plaguing the portable digital x-ray unit we use in the clinic.
Jere on the phone with Fuji tech support

Friday, December 10, 2010

Helping Hands

Got word early this morning that my upcoming Sunday AM flight back home was cancelled so I scrambled to find a flight midweek.  Late for worship, I was met at the front door to the chapel by one of the nurses shouting that a newborn was coding over in the pediatric ward.  I hollered to Tim and Scott inside and we all ran over to help.
The photo above says it all, many hands pitched in attempting to save the little fella's life.  Our efforts were initially successful but he passed on a few hours later.  But the image remains symbolic of Hopital Adventiste's "team effort" volunteer mentality.  I would like to introduce you to a small sample of some of the "helping hands" who have pitched in to get the job done during the past week.
Tim Downey (Appleton, WI) - Nurse Anesthetist
Brent Scully  (Walla Walla, WA) - General Contractor
Sebastian Nicora (Walla Walla, WA) - Electrician

Erin Scott (Washington, DC) - Photographer

Jere Chrispens (Yucaipa, CA) - Information Technology

Randy Tall (Goldendale, WA) - Electrician

Thursday, December 9, 2010

C-Arm Down And Out

The biggest negative to the trip so far has been the fact that the image intensifier has been down for the count since we've been here.   The C-arm is a critical piece of equipment for an orthopaedic service and its absence sorely missed.
Scott on the phone with Puerto Rican tech support
Actually, it has been nonfunctional for the past few weeks in spite of the fact that there have multiple technicians attempting to resurrect it.  There are several patients on the ward and from the clinic awaiting surgical intervention that would be best served with intraoperative imaging.
Terry, Ray, and Jessica rounding on femur fracture patient in traction

The restoration of the C-arm has been the object of a special prayer request in worship over the past two days so your thoughts and prayers would be greatly appreciated as well.

Wednesday, December 8, 2010

Hopital Adventiste On Lockdown

Last night the Haitian presidential election results were posted and the citizens reacted negatively.  In the image below by Damon Winter, Haitians burned tires, trash and earthquake rubble and blocked streets in the capital, Port su Prince.

This morning we met for a group photo before a couple of the volunteers were to leave for the airport.  Shortly after the image below was taken, we were informed that all flights in and out of Port au Prince have been cancelled and the hospital is on lockdown due to the unrest in the streets.  Fortunately, one man's misfortune is our gain as anesthetist par excellence Tim Downey is forced to spend more time with us.

L to R: Terry Dietrich, Jere Chrispens, Tim Downey, Scott Nelson, Jim Matiko, Ray Grijalva
Nathan Lindsey receives word in morning worship that another volunteer missed flight

Tuesday, December 7, 2010

Hopital Adventiste Redux, Part 1

I had good intentions of posting at least a couple of progress reports by now but a combination of a busy schedule, tiredness and a little laziness have foiled my efforts so far.  Scott Nelson and I took the red eye out of LA this past Friday night and flew to Miami by jet then hopped on a small prop plane for the 2 hour flight to Port au Prince.
Scott checking out familiar landmarks as we flew over the DR
We were aware that American Airlines currently had an embargo on boxes (contrary to what has been previously recommended) so we packed everything into bags.  Prior to leaving home, we checked on the AA website and noted that we could pay $100 for an extra bag each so we decided to avail ourselves of that option.  When we checked into the ticket counter, we were informed that only Business Class patrons were afforded that luxury.  Finally, after a little sweet talk, and with the aid of the Excess Baggage Waiver provided to us by Amy Lindsay, the agent gave us the OK and even waived the excess fees.
 Suitcases purchased from a thrift store are an excellent option to transport supplies
Immigration and Customs in Port au Prince were a breeze.  When we exited the terminal, we were accosted with the usual hord of "red hats" wanting to assist us with our baggage, each one who touched our gear for even second expected compensation.  
Scott managed to escape the throngs of "red hats" with only one assistant
Fortunately, Nathan was waiting with the trusted Montero and we had an uneventful trip to the hospital.  It was great to see Terry and Jeanie again and toured the hospital which gave us the opportunity to view the changes (or lack thereof) that had transpired since our last visit.
Scott and Terry reviewing cases for the upcoming week