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…