Ridgecrest Resident Volunteers In Haiti

This article was originally published in the February 27 edition of The Daily Independent from Ridgecrest, California.

When Allen Patee remembers February 2010, his thoughts will undoubtedly center on a life-changing experience. Patee, a senior medical student at Loma Linda University, recently returned from two weeks volunteering in Haiti.

“A couple of years ago, my class at Loma Linda ‘adopted’ the Hospital Adventiste d’Haiti in Port-au-Prince. Our 170-member class raised $70,000 for equipment, such as autoclaves, for the hospital. Loma Linda oversees 24 hospitals in 16 countries, and over 40 medical clinics, which belong to Adventists Health International,” Patee said.

Loma Linda’s medical students are chosen for commitment to their faith and a desire to serve others. The university is allowing qualified students to take time off and volunteer in Haiti. Patee worked as a firefighter and EMT prior to enrolling in medical school.

“With the needs in Haiti so great, Loma Linda allowed me to go for two weeks and get credit for it,” Patee said.

On a layover in Florida, Patee met another group headed for Haiti — ACTS (Active Community Teams Serving), a non-profit, inter-denominational, faith-based group of volunteers. They had one open seat on their plane, which was landing in Port-au-Prince. Otherwise, Patee would have had to fly into the Dominican Republic and try to make his way across country.

“I flew in with the ACTS group and spent part of my time helping them in medical clinics,” Patee said. “I think God set it up.”

ACTS has a clinic across the street from the hospital, with a fenced back yard. Patee and other volunteers lived in tents in the yard.

“I took a pad to sleep on and a mosquito net. I used someone else’s tent. It’s pretty hot there — a tropical paradise, with mango trees in the yard. I also took a water bottle with a filter on it. There is no sanitation or clean drinking water. The local water works is in shambles. Some volunteers ran a long pipeline from a spring on the mountainside down to the hospital, so that we could have water,” Patee said.

The hospital is completely full, with the overflow patients sleeping on the grounds, under tarps or in tents.

“One man, with a broken leg, called me over and asked why we had come. Then he started quoting from Matthew 25:35, “For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me.' He was so grateful for our help.

“As I talked to him, I learned that he was an English teacher at the local school. He had 90 children in his class. Only he and 10 of the children survived,” Patee said.

Volunteers have found the people friendly and very thankful for the assistance.

“A doctor in a typical clinic in Ridgecrest will see 30 patients a day,” Patee said. “We saw 65 to 75 per day. When we did clinics in rural areas, we might see 1,000 a day. We traveled in a beat up old bus to the rural areas. When we arrived at one site, the people started singing hymns and praying. They told us they had been praying for someone to come help them and that we were sent from God.”

Most of the acute issues have been handled; now the volunteers are working on basic health issues. Medications are running low — even Advil for pain is in limited supply. Food is distributed from warehouses under the watchful eyes of U.N. guards.

“We can help relieve their pain for a few days, but it’s not a solution. It’s worth the effort and it makes a differnce, but they need so much more,” Patee said.

Haiti is the poorest country in the Western Hemisphere, Patee said, and the people do not have the means to improve conditions. Most eat only one meal a day, if they can find food and have the money to purchase it. Only 25 percent of the population have jobs. People are living on the streets, with an estimated half million homeless. Some have sheets tied between trees for a bit of privacy, but that offers little protection from the rainy season, which will start soon.

“ACTS is looking for volunteers who can help with construction — just basic skills to help put up shelters. You can drive for an hour and see nothing but rubble,” Patee said.

“ACTS also serves hot meals every day. You can find out more about them at ACTSWR.org.”
Round trip flights are about $300 to $400. Volunteers need passports, tetanus, Hepatitis A, and typhoid shots, and a supply of malaria tablets to take each day. They should also bring a water bottle with a filter, mosquito net, sleeping pad, and tent, if possible.

“It’s definitely roughing it, but I’d love to go back.” Patee said. “I was blown away by all of it. We have so much and they have so little. If every American gave 10 cents a day for a month, we could get these people back on their feet.”

When he graduates in May, Patee will be assigned to another facility to train in emergency medicine. When not in school, he lives in Ridgecrest with his wife, Mercedes, who is a flight surgeon for VX-31.

“Mercedes and I have an amazing relationship,” he said. “We pray together every day. We don’t have a TV — our time together is valuable. She was in Iraq for six months last year and I’m gone half of each week for school.”

For more information on Loma Linda’s relief programs, see the Web site www.LLU.edu and look for links to Haiti.

Canadian Medical Missions In Haiti

I'm proud to note that my country of birth, Canada, has been one of the largest contributors to the relief effort in Haiti, sending more than 2,000 troops in the wake of the massive earthquake that devastated the Caribbean nation in January. It has also allocated $555m over five years in aid, making it the second largest donor after the US. Since the quake, Canada's mobile medial unit has flown dozens of missions into cut-off communities.

Scenes From PAP And HAH

A video of scenes from Port au Prince and Hopital Adventiste d'Haiti by Michael Wolcott posted on the Out of the Rubble blog.   

Everybody's Leaving But We're Still Here

The following article was written by Andrew Haglund, Acting Administrator of the Hopital Adventiste d'Haiti, and was originally posted on the LLU in Haiti blog.

Hello blog-o-sphere, sorry it's been so long since I've made a post. Seems every time we think things are getting better we are dealt a new deck of cards. We have been as busy as ever here but with new and varying challenges. While post-op ortho cases are gradually being discharged and leaving the property we have been plagued with significant traffic in our ER. To make matters worse it seems that more and more NGOs and government groups alike are ending their Haiti relief missions already. What this means is that our ability to transfer patients out to places that may have resources we don't is dwindling and will soon be gone. Our two best transfer options for critical patients have been the USS Comfort and the University of Miami Field Hospital. Word on the street and confirmed by our own challenges in transferring patients to either, is that both will be ending their missions here in Haiti shortly. By default, we have become the regional trauma center for the entire west side of Port au Prince and most of the communities on the western peninsula. This was never our intent and we are ill equipped for such responsibility but, we will carry on and are committed to the Haitian communities we serve.

Sorry to be cynical but apparently the collective goal of many response agencies working here was to: return Haiti's health care system to the pre-quake state and then go home. Well folks we (LLU and the volunteer groups that have and continue to work here) exceeded that goal just by showing up. The idea that that goal is an acceptable level makes me want to scream. This nation has lost upwards of 225,000 people, almost 1 million of the surviving population are without proper food, water, shelter, or sanitation and somewhere between 7,000 - 10,000 have had limbs amputated, not to mention the huge number of patients with surgically treated injuries. To think that the international community can come here for 6 weeks and then turn their backs is simply unacceptable. LLU is not leaving our work here in Haiti and we continue to need your support. Please if you have the means to help our work, click on the red button at the top of this blog and support our cause.

Aftershocks

We have had two 4.7 aftershocks this week both in the middle of the night. Significant aftershocks continue to be a very real reality here and are detrimental to the already fragile psyche of the Haitian population and our volunteer medical staff. During an aftershock our patients in the hospital all go running and screaming out of the building, many dragging their IVs on the ground or ripping them out all together. This is a major obstacle for us to overcome.

Shelving update

I am pleased to report that we have more than 20 shelving units built and in use in the various operational units around the hospital. We have more shelves being built and more on the way. This one simple thing has radically improved the efficiency of our operation.

BCFS Texas Strike Team

We have been blessed for almost two weeks now to have a group of volunteers from San Antonio Texas here at the hospital with us. This team is a highly trained incident management team (IMT) that have worked in multiple disaster zones such as Hurricanes Katrina, Ike, 9/11 and others. They have helped us implement an Incident Command System (ICS) structure that has dramatically increased the efficiency of our relief effort. We have implemented specific roles that each of us play in order to decrease overlap of duty and maximize productivity. ICS stresses the creation and dissemination of very specific objectives to be completed in each 24 hour period. These objectives are shared twice a day at 7:30AM and 7:30PM in a very structured staff briefing. Overall this system seems to be steering us rapidly towards our goal of resuming normal hospital operations inside the building. Much work remains but ICS has been very helpful in moving us forward.

Numbers
70 post-op patients still outside in the tents
15 patients inside the various wards in the main building
21 sick babies
10 pregnant moms waiting to deliver
16 volunteer staff with GI issues in the last week
18 hour work days still the norm for Andrew 

Keep Haiti in your prayers and thoughts as much work remains here.

Colorado Orthopaedic Surgeon's Journey To Haiti Part 2

This is the second part of a two-part series of audio slide shows a recent trip to Haiti that Colorado Springs-based Orthopedic Surgeon Rick Meinig organized to help treat severe injuries in Port au Prince after the January 12 earthquake. 

Colorado Orthopaedic Surgeon's Journey To Haiti, Part 1

After waiting a week after the January 12, 2010 earthquake in Haiti to hear back from a variety volunteer organizations that take doctors to disaster areas, Colorado Springs-based Orthopedic Surgeon Rick Meinig felt compelled to take matters into his own hands. Using connections he found mostly through Facebook, he rounded up a team of doctors, 1,000 lbs of donated medical supplies and a private plane to go to Haiti and help the wounded. In the week they were there, Meinig and his team helped over 100 people with excruciating wounds and fractures. Though they performed many amputations during their time there, they were also able to help many save their limbs. 

Crystal Lake Doctor Returns From Haiti Earthquake Zone

This article was written by Amber Krosel and published in todays issue of the Northwest Herald serving McHenry County, Illinois.

When Dr. Lawrence Lavine left Haiti last week, he returned home feeling a sense of hope.

“Things are getting better,” he said.

The Crystal Lake anesthesiologist served on a two-week medical mission to the country, which continues to recover from a devastating Jan. 12 earthquake.

Lavine, 65, worked 12-hour shifts day and night. Toward the end of his visit, he often pulled double-duty as the only anesthesiologist at Hopital Adventiste d’Haiti.

“I had to catch sleep whenever I could,” he said.  But the experience was “absolutely positive,” and Lavine wants to return in April.

Although Lavine isn’t new to mission trips – he began with trips to the Republic of Panama 12 years ago – Haiti was different.  Arms and legs were amputated during the first few days of Lavine’s stay, accounting for about 300 initial cases. Caesarean sections and appendix removals also were performed.

Lavine’s team rested in tents and sleeping bags in a large room at Hopital Adventiste d’Haiti, which offers free services to its patients and also serves as a public feeding center.  Lavine chronicled his two-week stay there through private journal entries, which depicted area scenes of deteriorated buildings, military presence, and death.

“Imagine having your home collapse on your family,” Lavine wrote in his journal. “Imagine having your spouse die, some of your children becoming severely injured, and some of your children dying.  “Some such widows are seen in our emergency room,” he continued. “They are so overcome with grief that they no longer care to feed themselves or their children.”

About one-third of the local nurses and orderlies themselves had lost family members to the earthquake. During Lavine’s first meal in Haiti, one of them passed him a thank you note written in English. The author asked that he always keep it on his person for good luck.  It is that gratitude – along with the constant pouring in of supply donations from all over the world – that helped keep Lavine motivated. Although he expects relief efforts to continue for more than a year, he wants to be invited back.

“It is my belief, and I have faith, that despite the trials and tribulations we receive in life, we are all blessed by a goodness provided by God,” Lavine wrote. “When we allow our better nature to come forth, we make the unbearable bearable.”

Dr David Marks Talks About The Volunteer Experience

The following video was obtained from the Out of the Rubble blog...check them out!

Physical Therapists Needed In Haiti

Orthopaedic Surgeon, Stuart Mackler, MD talks about the need for Physical Therapists in Haiti after the earthquake.  If you are Physical Therpist or know of one who is interested in volunteering at the Hopital Adventiste d'Haiti please contact LLU Global Health Institute.

DuWayne Carlson, MD Trip Report

DuWayne Carlson is a graduate of the LLUSM and is an orthopaedic surgeon currently in private practice in Lincoln, Nebraska. 

It is hard to write a synopsis of an experience like this.  I have been on other mission trips doing orthopaedics that had a lot of need.  But for the most part, the patients on my other trips needed mainly their medical care.  In Haiti, the medical needs were only the tip of the iceberg.  The lack of food, lack of housing, and the grief over lost friends and/or loved ones almost eclipsed the medical needs at times. 

Personally, I grew in my willingness to accept that I am not in control of outcomes.  I may try and work towards a good outcome through God's strength and with prayerful consideration, but God still has a bigger picture to deal with.  He sometimes says, no.  You  can view my devotional on the web page www.findGodatNBR.org

Cases I saw were mostly open fractures (tibias usually), open wounds without fracture, and femur fractures.  I arrived in Haiti 9 days after the earthquake and did primary debridements on open fractures as late as 14 days after the earthquake.  Thankfully we only did 4 amputations the 11 days I operated at the hospital.  The remainder we attempted limb salvage on.  Early results were good with fasciocutaneous flap coverage on a couple, but who knows the ultimate results.  

We started operating on femur fractures at about 11 days after the earthquake.  One reason we delayed somewhat was that the SIGN nails were not available until then.  Kids got plated or externally fixed and adults got the SIGN nail though length was difficult to reestablish at nearly 2 weeks from injury.  Thankfully Scott had a technique of getting the length back that was not too difficult, but did involve a fair amount of stripping.  I think the stripping was worth the restoration of length (as long as they do not get infected).

I really do not have an organized presentation of the experience, but I hope this has helped a little.

DuWayne Carlson

In the photo above, Dr Scott Nelson and Dr DuWayne Carlson work simultaneously to insert an intramedullary nail in a fractured femur.

Out Of The Rubble

Introducing a new blog "Out of the Rubble" hosted by two documentary filmmakers, Micheal Wolcott and Cosmin Cosma, working out of the Office of University Relations at Loma Linda University.  It's a behind the scenes look at the documentary that they're filming based at Hopital Adventiste d'Haiti on behalf of Adventist Health International and Loma Linda University.  I encourage you to visit their site, they have some interesting material there.

Sustainable Dave Video

The images in this video were taken by David Chameides. He writes, "While the devastation was beyond comprehension, what I will carry with me are not the memories of fallen buildings but those of a proud and noble people who refuse to bow in the face of extreme adversity.  I will always be humbled by their perseverance and gentle kindness."

CURE Drill System

I can attest to the ingenuity of this system as I have used it in both Haiti and Malawi with success.  It is reliable, effective, safe, and most important...cheap!  This article was written by the originator of the CURE Drill System, Dr Scott Nelson, and was originally posted on the CURE Caribe blog. 

This drill system was designed out of the need for a safe and sterile low cost solution for an orthopaedic power system in the developing world. Many local surgeons in this environment are using overpowered hardware store type drills that are used with marginal sterile technique and because they often function at over 2000 revolutions per minute, tissue necrosis is created with a host of secondary ill effects.

 

While the demonstrated system can be created by any adventurous orthopaedic surgeon, considerable effort has gone into researching the appropriate model drill, removing the commercial chuck to allow use of the stainless steel surgical chuck, and creating a cover that is safe and functional.

The components consist of the 9.6v DeWalt cordless drill which is a variable speed drill that has two different gears. The low gear is appropriate for reaming and power driving screws and fixator pins while the high gear is best for drilling. Of all the consumer drills researched the specifications and weight of the DeWalt 9.6v drill most closely matches that of the available orthopaedic surgical drills (for a fraction of the cost). This drill is comfortable for hand surgery as well as for performing ORIF and IMR's of the long bones. The 3 1/2" shaft is canulated up to a certain point allowing the surgeon to safely choke up on K wires.

 

The nonsterile drill is placed into a sterile cover which is carefully closed by a scrubbed member of the surgical team without touching the drill. The sterile surgical chuck is then threaded onto the 3/8" bolt (clockwise) and the cover is closed. The sleeve covers approximately 2" of the shaft proximal to the Jacob's chuck which provides an adequate sterile margin. At the end of the case the surgical chuck and cover are removed, washed, and sterilized in the autoclave. An ideal set up would include at least 2 surgical chucks and several covers in order to do multiple back to back cases. 

Sets are available through Jerry Daly at www.lluglobal.org and are sold for the cost of the materials and shipping. Or you can create your own if you have the patience and time to work out the details.

Brock Cummings, MD Trip Report

Dr Brock Cummings, LLUSM graduate and alumnus of the LL orthopaedic residency, returned home last night after spending over a week earlier this month volunteering at the Hopital Adventiste d'Haiti and kindly sent the following report.  Dr Cummings is currently in private practice in Northern California. 

My team arrived in Port-au-Prince late Friday night, the 12th.  The trip was made rather difficult due to the severe weather over much of the US which ended up costing us our anesthiologist.  He was unable to make it to Florida and didn't arrive in Haiti until the 18th.  We did have some anesthesia services from other teams but not always available.  The best word to describe the situation at Hopital Adventiste is "dynamic".  Everything is constantly changing.

 As has been stated by others, orthopedic surgery was not my only job.  There were frequently too few scrub teams and transport personel to go around.  We frequently transported, prepped, scrubbed, operated, and transported back to the post-op area ourselves.  At times, we were called upon to evaluate nonorthopedic problems.  Radiology is very primitive.  Getting an axillary lateral view of the shoulder or a cross-table or frogleg lateral of the hip is not going to happen unless you position the patient yourself.  As of my time (Feb 12th - 20th) there were no intraoperative imaging options but it sounds as if a C-arm will be delivered shortly.  However, space to maneuver and store the C-arm is going to be a challenge in the small and crowded ORs.  

 Surgical supplies are in fairly good supply but organization is desperately needed.  Things are steadily getting better in this regard.  During my time there, shelving was arriving and there were volunteers working on trying to unpack and organize the stacks of boxes, many of which had literally hundreds of random surgical supplies and products.  The teams before me had made great strides towards assembling basic sets of surgical instruments which was very helpful.  There were small and large fragment sets, external fixation sets, and a SIGN nail set packed and sterile (?).  The small and large fragment sets had basic stuff but none had a full compliment of plate options and none had a full set of screws.  Single packed sterile screws were found in some of the previously mentioned boxes of random supplies.  I spoke with Dr. Scott Nelson who was back in the States at the time and he has plans for getting a supply of screws and a method of organization for refills.  There are Haitian workers who do much of the sterilization of the instruments but they don't always keep the sets together.  We found it worked best to hand carry the sets back to them and assist in keeping the sets together.  This is particularly true of the SIGN nail set and it is up to the surgeon to restock the set with the nail size which was used.  A new autoclave arrived while I was there but was not yet installed by the time I left.  They removed 2 non-functioning autoclaves which required the use of a skillsaw, leaving sawdust covering the entire central supply/sterilization room, including hundreds of individually peel-packed instruments.  Once the new autoclave is functional, it would be beneficial to sterilize all of the peel-packed instruments which were sterilized who-knows-how-long ago, prior to shipment from who-knows-where.  One consistent shortage was working suction, and if suction was available,  sterile tubing usually wasn't.

 The kinds of cases predominantly needed at this stage are not very glamorous.  Lots of wound care needs including debridements, skin grafts, and revision fracture care. However, an untreated fracture or dislocation still shows up occasionally.   If not already familiar with the use of the SIGN nail, it would be worthwhile downloading the techniques from www.sign-post.org.  You need a username and password which are "sign" and "03signtech" respectively.  This may not be as important once the C-arm arrives but it is helpful to be able to put in a femoral, tibial, or humeral nail with distal interlocks without the aid of imaging. There are a huge number of external fixators walking around outside and pin site infections are starting to show up.  Except for the most severe infections, antibiotic treatment is limited to oral meds due to limited capacity in the hospital.  Post-op instructions, in terms of when to change dressings, pull pins, etc, were written on the dressing or cast since there are no patient charts.  Patients are pretty good about keeping their limited records and x-rays and bringing them with them when they return for follow-up.  

 In terms of manpower, it is helpful to have more than 1 orthopedist at the hospital at a time.  When I arrived, there were 3 of us and that number seemed ideal.  More than 1 room could be going on easier cases and it helps to have an experienced assist on the larger cases.  Additionally, as the magical 6 week post-op mark is approaching for many of the patients, having someone available to evaluate x-rays, remove casts, and change dressing is essential.  I was the only ortho the last 3 days I was there and felt I wasn't doing a very good job adequately covering all of the work.  Fortunately I had a very capable medical student, Daniel Patton who functioned like a resident, and also had the help of a general surgeon with ortho experiene from Martinique, Dr. Kanor, who made it managable.  As time passes, having an ortho "clinic" becomes more and more important and 2 rooms, not too far from x-ray have been reserved and stocked with casting and dressing supplies. 

The comforts of the hospital are rapidly improving.  There is now quite consistent electricity and running water (no hot water).  Safe drinking water is easily accessable.  Vegan food is provided and it sounds as if it will be for the immediate future.  Several people got sick while I was there and everyone seemed to think it had nothing to do with the food or water.  Most were feeling well in 24 hours but a couple ended up going home early because they weren't improving.  There were multiple confirmed cases of malaria in Haitian patients so take your prophylaxis.  

The Haitian people are wonderful.  They are truely appreciative, quick to smile, and incredibly stoic.  I had a lady with a Weber C ankle fracture with a widely displaced syndesmosis, and a femoral shaft fracture, stabilized in an angulated position with an ex-fix.  We revised the femur to a SIGN nail and took down the scarring in the syndesmosis and fixed her ankle (except for the medial maleollus which had an overlying wound).  She asked for no pain meds post-operatively until I went by to see her late that night and encouraged her to take some meds.  She left  the hospital the next day with a few percocet.  I saw her 2 days later and she stated she didn't need any more meds.  Not your average Californian!  The kids are truely spectacular.  If it weren't for the Baptists getting everyone on edge, I might have smuggled 1 or more home with me. 

Unless a permanent local orthopedic workforce is established, there will be a long-term need for volunteer orthopedists to continue to help these destitute but wonderful people.  It is important that we not lose interest after the media coverage disappears. 

Brock Cummings

Gerald King, MD Trip Report

Dr Gerald King, LLUSM 77A graduate and alumnus of the LL orthopaedic residency, spent a week earlier this month volunteering at the Hopital Adventiste d'Haiti and kindly sent the following report.  Dr King is currently in private practice in North Carolina.

It was certainly an amazing experience. Having been to Haiti  before and of course seeing the pictures on TV, I would say that nothing was shocking. That said , the place is in a desperate situation/condition from which I am not sure that it is recoverable. The destruction is massive and the need overwhelming.

The people are remarkable, can you imagine people with 3 week old fracture dislocations of their hips lying around on mats in this country patiently waiting for someone to help them? These people have patience, humility, stoicism, pain tolerance and acceptance that I can only dream that I or my patients would have.

I agree with someone that said that there  should be no egos among those that want to go to help. You better be willing to do anything to help or you will get little done which means being everything from an orderly, IV tech, scrub tech, assistant, surgeon, etc. There are no heroes in the workers, only those that have survived. 

The needs continue to evolve from amputations, which by the 2-3 week period we were doing little of, to delayed fracture management and wound coverage/debridement, etc. The more comfortable you are with trauma and trauma reconstruction, the more beneficial you will be.

The hours are long, up at 6am and surgery usually ended about 10:30pm.  Provide/made our own food  which we carried in.  Bottled water provided, running water inconsistent.  Slept on a mat on the floor. We scrubbed with brushes and then had someone pour bottled water over us to rinse. We did the best we could with sterile technique but it left something to be desired.

I was outside of the hospital grounds for only about an hour and a half total for the entire week as the needs were massive and we simply did not have time to leave.

There is a short list of what you need to take. Scrubs for every day if you are going to a hospital. Bandage scissors, good headlamp to do surgery by. Footwear that you can rinse off after surgery. Fanny pack to keep everything that is important to you in.  I would recommend a small camera rather than the full size one that I took. Personal wipes and cleaning wipes as showering is at best inconsistent. You will not likely be able to wash anything other than rinsing it out. Electricity was consistent so I would take an electrical pot to heat up some water to use for cooking your MREs or having a cup of coffee, etc. You will be camping for whatever time you are there.

Hopefully this will be helpful. Obviously my comments are in regards to the Adventist Hospital and I cannot  make any comments about other locations or facilities.  Scott Nelson is remarkable and deserves our support. I am a big fan. The fact that he is willing to stay there and provide continuity of care rather than reinvent the wheel with each group that comes through is priceless. He has accumulated impressive equipment considering the location. The facility desperately needs better sterilization capabilities.  

Jerry King

Haiti Relief Volunteer Application Process

LLU/GHI coordinates and processes volunteers for Adventist Health International Services (AHIS), which manages and operates the Hopital Adventiste D'Haiti, in Port-au-Prince.  AHIS requires the forms to be filled out on their secure website in order to complete the volunteer application.  Click here to begin the process.

Update On C-Arm For Hopital Adventiste d'Haiti

Thanks to the generosity of many, a refurbished OEC 9600 C-Arm has been purchased at a fair price and is in transit to Florida Adventisit Hospital where it will await air transport to Port au Prince. 

The unit will also be equipped with the MediCap USB 100 Digital Image Capture Device necessary to document SIGN nail procedures which will facilitate an implant restocking.

Although sufficient funds have been raised to cover the cost of this unit, there remains a need to procure additional items (surgical instruments, autoclave, lab equipment) so you are encouraged to contribute if you have not done so already.

Missionaries Go To Haiti, Followed By Scrutiny

The following is a selection from an interesting article published in the New York Times about the Hopital Adventiste d'Haiti and its mission.
 

In Carrefour, a bustling suburb of Port-au-Prince, the capital, the Church of the Seventh-day Adventists, which has worked in Haiti since 1904, runs a hospital, a wastewater purification plant, a bakery, a radio station and a bookbinder. Even before the earthquake, the church was considered to have far more of a presence in Haiti than the government.

But other religious workers are operating in a far more bare-bones manner, with whatever they managed to carry in their luggage.

“You had missionary doctors parachuting in here doing amputations rather than setting or treating wounds because they knew their charter jet was leaving in two days and they would not be able to oversee follow-up,” said Dr. Scott Nelson, an American orthopedic surgeon and Adventist missionary, as he lifted a moaning man onto a soiled stretcher. 

“The community trusts us, but when other groups make shortsighted decisions it undermines everyone’s credibility,” he added.

Dr. Nelson and other veteran missionaries faulted the new arrivals for frequently acting on their own instead of collaborating with more established missionary groups that plan on staying in Haiti for the long haul. It is tension, some experts say, that can arise from the differing reasons that missions have for being here.

Update From Hopital Adventiste d'Haiti Interim Administrator

Andrew Haglund, geoinformatics (GIS) expert at the Loma Linda University School of Public Health, is an acting administrator at the Hopital Adventiste d'Haiti, coordinating logistics and supplies.  This video was shot during his recent visit home and gives you some further insight into relief efforts at that hospital.

Haiti: The Disaster Before The Earthquake

In December of 2009, less than four weeks before the powerful earthquake destroyed Port-au-Prince, the San Damiano Foundation spent 8 days filming in the capital city, with a special focus on the massive slum of Cite Soleil, where more than a quarter of a million people live in unthinkable squalor and deprivation. No running water, no electricity, no sewers...nothing but endless misery. Even after filming in dreadful slums in India, Africa and South America, Cite Soleil shocked them. Besides intense poverty, the slum is riddled with violence. Death and disease are in the air. And that was before the tragic earthquake. The film they are making is about the necessity of compassion. 

We Are The World 25 For Haiti

Recorded on February 1st, 2010, in the same studio as the original 25 years earlier. The 25th Anniversary recording features over 80 artists and performers. The recording of We Are The World 25 For Haiti embodied the same enthusiasm, sense of purpose and generosity as the original recording 25 years ago. Every one of the artists who participated, regardless of genre or generation, walked into the room with their hearts and souls completely open to coming together to help the people of Haiti.  

A CURE Volunteer's Haiti Diary

A very worthwhile read chronicling the "International Experience" in Haiti can downloaded here.  It was written by Kaye Wilkins, MD, a renowned pediatric orthopaedic surgeon at The University of Texas Health Science Center at San Antonio.  There are encouraging positive comments relative to the medical mission work of the Seventh-day Adventist church in general and the Hopital d'Haiti in particular.  Dr Wilkins is pictured below on the left standing next to Melanie Jobe.

OAO/KC Donation To CURE International In Port Au Prince

This video records Ken Peters interviewing Dr. Scott Nelson of CURE International on location in Port Au Prince, Haiti. Open Arms Outreach/Kairos Caribe has delivered eight suitcases of emergency medical supplies to the Hopital Adventiste d'Haiti on behalf of Lakes Region General Hospital in Laconia, NH. Dr. Scott said to him, "Every day we see miracles here and today you are one of them." Dr Nelson and his team are working night and day doing orthopedic surgery in the compound of the Adventist Hospital. 

One Month After The Earthquake

Haiti Volunteer Information From Dr Nelson

Thanks to the many volunteers interested in helping with the efforts in Haiti, it has become impossible to answer all the individual email inquiries. Planning weeks into the future is also difficult as the situation and needs are dynamic and changing by the day. If you are interested in volunteering or donating please go to www.lluglobal.com or www.cureinternational.org to find out the latest information and sign up. The volunteer teams are scheduled through the Loma Linda Global Health Institute in collaboration with CURE International at the above sites. Our efforts are currently focused at the Hopital Adventiste d'Haiti and include plans to provide ongoing care to earthquake victims while establishing a functional hospital and creating an orthopaedic and rehab focused long term teaching program.

Currently we have had ample surgeons, however nursing and ancillary staff has been in short supply. Many of the employees have lost immediate family members in the quake and have yet to come back to work. As time evolves local workers will fill in some of the workforce needs. However due to the high patient load and current lack of staff, RN, MD, and other ancillary volunteers are needed in the emergency department, pediatrics, OB, and rehab as well as surgery.

Surgical disposables (gowns, gloves, drapes, and dressings) are needed items and will continue to be in short supply. We are currently depending on donations for these items as a functional supply chain has yet to be established. Other needed items can be coordinated through Jerry Daly of LLU Global Health Institute or Heather Hunter of CURE International.

Helping Haiti Everybody Hurts Documentary

Documentary video of the devastation caused by the earthquake in Haiti and the making of the Helping Haiti single "Everybody Hurts".   

Jose's Story

In the midst of the chaos of CURE’s work in Haiti, there was one boy everybody was talking about. You couldn’t miss his adorable face and sad eyes as he looked up from his mat on the floor. Bryce Fluried, CURE International's multimedia producer, saw him and grabbed the first interpreter he could find.  Here is Jose’s story.

Photo Essay: HAITI - Eight Days After The Earthquake

This six-minute clip consists entirely of still photographs by Gerry Straub which feature both the massive destruction of Port-au-Prince as well as the injured patients being treated.

Haiti Earthquake Montage

Stages Of Life Awareness

Dr Nelson reflects on why one would serve in Haiti or the developing world in general.  Another video courtesy of David Puder from Loma Linda University's School of Medicine Class of 2010.

Emergency Surgery In Haiti

Paul McMaster recently has just returned from Haiti, where he was a surgeon as part of Medecins Sans Frontieres' emergency team. Here, he describes the experience and the difficult decisions that have to be made in such a situation.

Susan Beemer Talks About Her First Days In Haiti

When she returned to Santo Domingo, CURE had the opportunity to sit down with Haiti Relief Team member, Susan Beemer, regarding her experiences in Haiti in those first days. Susan and her husband, Ted, are recent additions to the CURE Dominican Republic staff with Ted taking over the medical director responsibilities at that hospital as Dr. Scott Nelson transitions on.

Open Ulna Fracture In Haiti

Another video posted by David Puder taken last year on a trip with Dr Nelson to Cap Haitien.

An Anesthetist’s 10-day Mission

Dr. Philippe Touchard, an anesthetist, is head of emergencies at the Pasteur Hospital in Langon, near Bordeaux. Forty-eight hours after the January 12 earthquake, he flew to Haiti to reinforce MSF’s surgical teams in Port-au-Prince. Here are exerpts of his journal of this short mission.

Day 1, Wednesday, January 13: Just a few hours to decide
“I hear about the disaster on Wednesday morning, and the first phone call come through at the hospital a few hours later. MSF wants to know if I can leave for Haiti right away. I’ve already been there on mission twice, in 2006 and 2008, working in MSF's trauma center in Port-au-Prince. The next day, I’m at Mérignac Airport, along with a coordinator, another anesthetist and two logisticians. We’ll travel in a cargo plane carrying the supplies needed for a field hospital. We finally take off on Friday morning, with a landing in Port-au-Prince planned for the next day.”

Day 4, Saturday, January 16:  Landing Permission Refused in Port-au-Prince
“We circle the capital for two hours, waiting for the control tower’s permission to land. We finally start our descent. But at that moment, the pilot is told to pull the head around and head for small airport on the tip of Santo Domingo. There is nothing we can do about it. We are pulling our hair out. We end up landing in Samana, in a small airport that wasn’t remotely geared up to receive a plane like ours. A departure is announced for that evening. But once again, landing permission in Port-au-Prince is refused. So everyone jump into action—the Dominicans are incredibly helpful. We offload the 25 tons of supplies from the plane and transfer them on to 5 trucks. On Sunday, at 6pm, we are on the road, heading for Port-au-Prince.”

Day 6, Monday, January 18: Arrival in Port-au-Prince
“We arrive at the border at 4 a.m. Two hours later, we are finally let through, and the nightmare seems over. But we pile into another humanitarian aid traffic jam, and find ourselves snared up in a convoy of nearly 200 vehicles organised by the United Nations. We inch our way forward at three kilometres (1.8 miles) an hour. At some point, one of our trucks is stopped without us noticing, and we are separated, without any news. Then another truck breaks down. We finally reach Port-au-Prince on Monday at midday, with three trucks out of five, even though we need every one. And then our taxi breaks down.

We leave by foot, in the heat, picking our way through the rubble. I cross this familiar city, and I have the impression, six days after the disaster, that it seems strangely normal. Life has re-started, the streets are full of people, traffic jams. There is neither silence nor cries, just the hum of city life. Then I see the collapsed houses, crushed under the weight of their roofs. In the streets, passers-by ask us for masks. They say they are scared of epidemics, but probably they also want to escape from the corpses smell. They ask what we’ve brought, and they are disappointed to learn it is a hospital. They want food. On arrival at Trinité hospital, I see for myself why it was so urgent to get the inflatable hospital through.”

Day 7, Tuesday, January 19: Surgery in the Streets
“I didn’t know that Trinité hospital was in ruins, like almost all the others, and that we were working in the street. The first surgical teams, who’d arrived two days before, have been operating for about 18 hours a day. We operate on wooden tables, in the heat, with the noise of the generators in the background. Night falls at 5 p.m., and the light fails, so we carry on with head torches for another six or seven hours. The conditions are really dire, but we have no choice. Each procedure has to be carried out that day, to avoid the onset of gangrene. Fortunately I have everything I needed for anaesthetics and pain management. The pharmacy was in another building that hadn’t been destroyed.

It’s complicated and frustrating not having all the equipment at hand. I saw a tetanus case, a child of 10 years old. She was convulsing on the first day, and stiff, with spasms, by the second. Tetanus is hard to treat if you're not properly equipped. You need to administer a sedative to relax the patient, and then monitor her really closely, as her breathing can stop. This patient was on oxygen, and we monitored her as best we could, but it was a hit-and-miss affair. We needed a properly equipped intensive care unit, where there weren’t so many risks. The worst, the most annoying thing, was that we had breathing apparatus in the cargo plane, but as we’d been delayed, it wasn't yet installed. I heard afterwards that the little girl had been transferred to another, better equipped facility, so she’s sure to still be alive”.

Day 9, Thursday, January 21: Working with an experienced team
“There are a fair number of us, six surgeons and five anesthetists. But it isn’t too many. Two teams work in the two operating theatres, carrying out two or three amputations a day, and also procedures on limbs that have been already amputated. They pose three or four external fixtures for stabilizing the open fractures. Another team takes on 10 to 15 dressings a day; they have to be changed every 24 hours at most. They are major dressings, and often need changing under general anaesthetic. Then there is the care in the surgical ward, and triage. We take in new patients every day.

All the medical staff has the right reflexes, which is hugely precious in massive emergencies like this. For example, when a patient refuses an amputation, we leave the Haitian Trinité medical staff to explain why the procedure is necessary, to reassure him or her. They soon bring patients around to the idea, speaking to them in Creole. As Trinité was a trauma center, we'd already dealt with this type of situation. The staff is trained to take the patient’s consent into consideration and manage this sort of difficulty. We also set up systematic vaccination against tetanus in the casualty unit, integrating protocols into the care, which means that despite these horrendous conditions, we can maintain medical quality.

Day 10, Friday, January 22: Already Time to Leave
“I worked for four days, instead of six or seven, because of the landing permission refusals. But I don’t regret coming here. On the medical front, my mission counted a great deal; we were dealing with critical emergencies. And on top of that, it meant a lot to me to work with my former team, to find them again after all they’d been through. I didn’t find it easy at first. I wondered who was alive, who was dead. I dreaded asking the survivors questions about their families. But a deep feeling of solidarity soon gained the upper hand.

I’ll go back before the year is over. There’s so much work left to do. The trauma center was already busy before the earthquake, so just imagine it now. When I was crossing Port-au-Prince, on my way out, I noticed that nothing seemed to have changed compared to when I arrived. No tents, people were sleeping outside, in public parks, in the streets. No or few distributions, the inhabitants were still hunting around for food. And at the airport, 100 metres or so away from the town center, I saw row after row of aid supplies, still sitting on the tarmac. This aid had reached Port-au-Prince.”

Haiti Aid, A Life Changing Experience

 

University of Miami School of Medicine's Dr Barth Green spoke to Harry Smith about the relief effort to aid the Haiti earthquake victims and being part of the first medical teams in Port-au-Prince.  Not only does Dr Green believe that there is a need to rebuild Haiti, but that it's great opportunity to build a New Haiti.

Chronic Osteomyelitis In Young Haitian Girl

Video from CURE trip to Cap Haitian with Dr Nelson.  With the number of open fractures that occurred during the recent earthquake, it seems likely that this type of case will be an all too common sequelae in the months to come.

US Military To Leave After Humanitarian Mission In Haiti

The Haiti earthquake created a huge and urgent need for water, food, medicine and other services - a need that required governmental and private response. There has been some criticism, by officials from other countries, of the huge involvement of the U.S. military. But U.S. officials say the only organization with the capability to deliver huge amounts of emergency supplies and personnel was the American military.  Pentagon Correspondent Al Pessin reports on what the military brought to Haiti, and its plans for the future. 

Haitians Turn To Faith For Support

Some Haitians trying to rebuild their shattered communities are turning to their faith. VOA's Mike O'Sullivan reports from Port-au-Prince that many Haitians now worship in the open air after their churches were badly damaged or destroyed by a devastating earthquake nearly three weeks ago. 

LLU School Of Medicine 2010

The students of Loma Linda University School of Medicine's Class of 2010 have recognized their responsibility as future physicians to make a difference. They believe they have been charged not only to recognize the needs, but to take steps to bring about change. To that end they have partnered with Hopital Adventiste d'Haiti in Port Au Prince, Haiti.

Visit their website which features stories of their classmates and their mission experiences. It is their hope to bring together a community of people who believe that together they can make a real difference.

Operating In The Dark In Haiti

This video was produced by LLU medical student David Puder during a volunteer trip last year with Dr Nelson to the Hopital Justinien in Cap-Haitien located in northeastern portion of Haiti.

David writes, "As we started to operate on a patient who had been waiting months for surgery, power went out. This case was at night, so there was no light. Dr. Nelson proceeded with the case, and used the SIGN system which does not require power.   This trip was funded by CURE international, however I have no formal relationship with them at this time. Since then our class has adopted a hospital in Haiti which is currently providing earthquake relief." 

Haiti Hospitals Say Patients Need Long-Term Care

Workers at a Haitian hospital say health care needs have moved beyond emergency treatment for earthquake victims to long-term care for the injured, including amputees, as well as psychological counseling. Mike O'Sullivan reports from St. Damien Hospital in Port-au-Prince, Haiti. 

Dr Jobe Returns From Haiti

Dr Chris Jobe, chairman of our Loma Linda University Orthopaedic Surgery Department, along with his wife Melanie, returned a few days ago from volunteering for a week at the Hopital Adventiste d'Haiti.  Read more about his trip here.

Dr Nelson Interview

Last week, CURE was able to spend a few minutes with some of the doctors providing aid in Port-au-Prince to record their experiences on the ground. Among those interviewed was the leader of the initial CURE Relief team, Dr Scott Nelson, who was the medical director of CURE’s hospital in the Dominican Republic. Here is what Doctor Nelson and others shared.

Read more about the efforts of CURE International here.  You can also read more of Dr Nelson's thoughts on his personal blog.

American Doctor In Post-Op Ward