Corey Fuller, MS IV Trip Report

Corey Fuller volunteered in Haiti while a senior Loma Linda University medical student.  Corey has been accepted into the Orthopaedic Surgery Residency Program at Loma Linda and is starting his intern at the LLU Medical Center.  Corey's wife, Juliana, a nurse at the LLU Medical Center, also joined him on the trip to Hopital Adventiste.

I have been eager to visit Hopital Adventiste d’Haiti since my class at Loma Linda University School of Medicine adopted it back in 2007.  My chance came in March 2010 as my senior schedule allowed me to spend a two-week elective at the hospital with my wife. 

The plane ride from Miami to Port-au-Prince was fascinating as everyone on the flight was a volunteer of some organization headed down to help the Haitian people.  There were people from all over the world and from all kinds of professions including doctors, nurses and pastors.  The passion and excitement of a group of people on a mission was tangible and I was excited to be part of it.

We were all shocked upon arrival at the destruction everywhere, starting with major cracks in many of the airport buildings.  Even though I arrived in Port au Prince two and a half months after the earthquake, it seemed as though it had happened the day before.  I didn’t realize that cleaning up the rubble is expensive and yet necessary before the rebuilding can even begin.  Haiti is so poor they can’t even afford to clean up the rubble, let alone rebuild their city. 

Upon arriving at the hospital I quickly made my way to the OR and was happy to see two of my future attendings Dr Matiko and Dr Nelson as well as two future coresidents Dr Hadley and Dr Elsissy.  They were excited to have me on board and quickly put me to work.  We would usually start rounding each morning between 6-7AM and then broke for worship at 7:30.  After worship we would divide into two teams one heading to the OR and the other to run the busy clinic.  The clinic was first come first serve and one morning I happened to walk by the clinic at 6AM and was surprised to see a long line already even though it didn’t start until 8:00AM.  

The experience was great for a medical student as there is always more to be done than can be, and a motivated student can make a big difference.  I was able to assist in surgeries, put on casts, change dressings, reduce a shoulder dislocation as well as run the orthopaedic clinic for one morning by myself.  One particular case that I remember well was a young man who showed up with calf pain for three days, but no other complaints.  He was well enough to walk to the OR table and get himself on it.  However, we realized he was much sicker than we thought when we opened up his calf to the smell of rotting flesh and a whole compartment of dead muscle.  Suspecting necrotizing fasciitis we quickly began successive attempts at amputations climbing the leg until we found bright red living muscle just below the hip.  Unfortunately we caught it too late and the patient died later that night, but I will never forget what it looked like and hopefully will be able to catch it earlier next time. 

Another memorable part of my trip was the English translators.  The earthquake left many college students and teachers unemployed.  As educated individuals, many spoke English in addition to French and Creole and chose to volunteer at the Adventist hospital to serve others in this time of need.  Even though many had lost everything including their jobs, families and homes they never complained and were undoubtedly the hardest workers in the hospital.  Without their dedication and selfless giving communication would not have been possible and the massive medical relief effort at Hopital Adventiste d’Haiti would not have been nearly as effective. 

My experience in Haiti was an important and memorable one.  I was able to help out the orthopaedic team and hospital in many ways and could truly see the difference that was being made by Loma Linda University’s presence there.  As a student I was given a level of responsibility that I’ve never had before in medical school and out of it has come the confidence that I will be able to successfully make the transition from student to resident physician in the coming months.

"Out Of The Rubble" Revisited

Michael Wolcott and Cosmin Cosma have just completed the full length version of their "Out of the Rubble" documentary.

Photos From Southwest Medical Group Plastic Surgery Team

Matt Schoolfield, from the Behind The Lens blog, has posted new photos from their current visit to Hopital Adventiste that you can view here.  

The team was also interviewed by an Oregon TV station that you can view here.

Healing Trauma And Restoring Hope

From NPR’s Talk of the Nation, original air date March 2, 2010: At the time of this interview, It had been seven weeks since a massive earthquake flattened much of Port Au Prince, and many areas in Haiti. Relief groups are helping to reconnect families, make sure aid is distributed evenly, and get Haitians accustomed to life after the quake. This clip from Neil Conan’s interview with world renowned expert of PTSD, Dr. James Gordon, and featured on the Haiti Onward site, sheds light on the critical need for ongoing support for the survivors in Haiti.

Urgent Need #2 - Orthopaedic Volunteers

The following excerpt was originally posted on the David In Haiti blog and documents the inevitable passage of time:

Today marked the end of an era: Dr. Scott Nelson has left the hospital. For those of you who don’t know, Dr. Nelson is an orthopedic surgeon who has been working in the Dominican Republic for the last five years. He came over to Haiti on January 14 and has been here (with a few breaks) ever since. His skills in the OR as well as his leadership will be greatly missed. Hospital administration put together a little ceremony for him. He and Lucia drove off to the DR at 6 this morning. He’ll spend some time there and will move back to SoCal. Bittersweet times, more bitter than sweet. 

Late last night, Scott sent me the following email:

Over the past several months we have built a strong ortho program at the Hopital Adventiste.  It has become a referral center for all types of complex ortho and spine trauma and limb deformity cases.  We have also developed a Ponseti clubfoot casting program that brings in about 25 children each week.  With my departure we have a small crisis in relation to needing some ortho expertise.   At the moment we have orthopods scheduled only until July 9.  We need help if we want to keep this program going.

There is a potential longer-term solution in the works which hopefully we will be able to officially announce shortly.  However, until November of this year, Hopital Adventiste is in need of continuing orthopaedic volunteer support to maintain clinical momentum.  If you, or someone you know, is willing to help out, please contact Global Health Institute for further information.

Team Sinai Haiti Returns Home

Team Sinai Haiti has returned home, safe and sound and have started to post more of their experiences on their blog.  Although they had intended to post daily, the team found themselves to be utterly exhausted by the end of the long days and came to the realization that they would have to post in a non-contemporaneous fashion upon returning home.The following is sample story written by co team leader John Herzenberg.

John, desperate for food, fell from the mango tree he was climbing sustaining a devastating and irreversible spinal cord injury when his 12^th thoracic vertebra dislocated one inch away from his 1^st lumbar vertebra. He stoically accepted his fate, though one point indicated he would prefer to be dead. There is not much that can be done, other than to repair the bone injury with rods and screws, allowing the patient to sit in a wheel chair. We heard that there is a spinal cord rehabilitation unit somewhere in Haiti, so there is hope for John after all. Haiti is tough enough with an intact spinal cord. As a paraplegic, you are really in big trouble in Haiti.  Scott Nelson, our host, is an accomplished spinal surgeon, and he deftly reduced the fracture dislocation, and rodded the spine with modern state of the art pedicle screw instrumentation, allowing John to be sitting up the very next day. The surgery came none too soon, as when we turned John to position him face down for the surgery, he had already started to develop pressure sores on his back from laying on the narrow canvas army cot.

The surgery had been put off in favor of more urgent procedures, but finally, after waiting for two days, we put him on the schedule yet again, even though it meant starting the case at 9 pm and finishing at midnight (with one more to follow...) To my knowledge, Adventist Hospital is the only facility in PAP set up to operate on spinal fractures. Scott has really built up an incredibly versatile orthopedic unit here. 

Plastic Surgery Team Returns For Second Tour Of Duty

The Southwest Medical Group Plastic Surgery team from Washington State have returned to Hopital Adventiste for a second tour of duty.  Follow their progress on the Behind the Lens blog written by team member Matt Schoolfield.  The following is a brief excerpt from his most recent post:

Saturday morning we arrived to Port Au Prince. All of us eager to begin the work we did soon before in May. Seeing the tent speckled landscape from the air was not a surprise. It was a temporary solution for displaced Haitians and is now a permanent fixture. As is the half destroyed buildings teetering on collapse. People congregate below, inside or on top of these Romanesque ruins oblivious of the impeding danger. One hard rain could mean another trauma victim.

In Haiti, Aftershocks Of A Mother's Wrenching Decision

In the chaos after the quake, Marie Lud Francois sent her two older children to an orphanage. But months later, her house remains in ruins, money is scarce, and hopes of bringing them home remain dim.

Watch the video below and read the rest of the story here. 

 

In Disasters, Faith Groups Know Roles

For every hurricane, earthquake or flood, there is help: food, bottled water, crews of volunteers nailing shingles to brand new roofs.  What even grateful recipients of that aid may not realize is that much of it comes from an unlikely hodgepodge of religious groups who put aside their doctrinal differences and coordinate their efforts as soon as the wind starts blowing.

Southern Baptists cook meals from Texas to Massachusetts. Seventh-day Adventists dispense aid from makeshift warehouses that can be running within eight hours. Mennonites haul away debris, Buddhists provide financial aid and chaplains with the Billy Graham Rapid Response Team counsel the traumatized and grieving.

Read the rest of the story here.

The Photographer's Storm

In 2009, Patrick Farrell's haunting images from a brutal hurricane season in Haiti won the Pulitzer Prize for Breaking News Photography.  Farrell was recognized for what the Pulitzer Committee called the "provocative, impeccably composed" photos of the fragile country's humanitarian disaster.  His photographs from Haiti also have been recognized with first place prizes from Pictures of the Year International and the Overseas Press Club among other awards.

The 2008 hurricane season was devastating for Haiti, where over 800 people were killed by four consecutive tropical cyclones (Fay, Gustav, Hanna, and Ike), especially Hanna, in August and September.  I traveled to Cap Haitien in northern Haiti in February of last year and the devastation was incredible and in many respects not significantly greater than the Big Quake that occured in Port au Prince earlier this year.

Click here to view a slideshow of images from his award winning hurricane portfolio.  You can also view here a collection of images Patrick took after the Janaury 12 earthquake this year.

Bridging Hope To Haiti

Maranatha built five One-Day structures at the Hopital Adventiste which are being used for triage, ER, outpatient services and volunteer housing. Maranatha is also rebuilding more than half of the 1.2 miles of wall that collapsed around the Adventist University campus close to the hospital.  Maranatha continues to provide One-Day structures to be used as shelters, schools and churches in Haiti after the massive earthquake rocked the Port-au-Prince region Jan. 12. The organization, in conjunction with Adventist-laymen’s Services and Industries (ASI), has shipped 140 One-Day structures to the country. 

The following video will give you more insight into their activities at Hopital Adventiste.

General Surgeons Wanted!

The Southwest Medical Group Plastic Surgery team is leaving in a few days for their second tour of volunteer duty at Hopital Adventiste.  They have just posted an urgent request on the Behind the Lens blog for a General Surgeon (Attending and/or Resident) to join them.  If you or anyone you know might be available to accompany the team, please contact Trip Coordinator Alex Sokolow at the Global Health Institute ASAP.

A Song For Haiti

Matt Schoolfield from the Behind the Lens blog recently posted the following brief story of inspiration: 

Every so often we meet individuals who define compassion. Their selflessness and dedication to the care of others makes our usual worries of the day seem petty. And we cannot help but be inspired. One such person is our translator at Hopital Adventiste named Bermann Alexis. His life story is extraordinary. Like many Haitians at just 33 years old, he has experienced so much adversity, including losing both his parents to illness while still in his twenties. Despite all he's been through he has dedicated his life to helping others and to his passion of performing Christian music to patients. And his dream is to bring his talent to the US.

Matt had the opportunity to record Bermann performing one of his songs which you can watch below.

"I Am A Nurse And That's What Nurses Do"

The following post was authored by Denise Lauria, RN and is Part 4 of a series from Partners In Health focusing on the experiences of volunteers in post-earthquake Haiti. 

Haiti is the poorest country in the Western Hemisphere, and it is our neighbor. I went to Haiti because I felt that if my neighbor needed help, I would rise to the occasion, no accolades needed. I am a nurse and that is what nurses do. What I saw in Haiti was overwhelming. I was not prepared for the poverty, the lack of infrastructure, and the general chaos. I have seen poverty on TV, but I've never seen such widespread abject poverty as I did in Haiti.

The people of Haiti are a people of enduring faith, hope, and resiliency—they deserve our continued support. I went to Haiti expecting to see wailing and depression, but I found strength, hope, and warmth. What I saw were children laughing and people smiling. I carry a special place in my heart for the people of Haiti.

Read the rest of the story here.

Team Sinai Has Landed!

Team Sinai has reached their destination safely.  Not only highly skilled, they are well prepared and eager to serve.  The following is a brief excerpt from their first post on the ground in Haiti. 

We land, we deplane, we make our way across the tarmac into the terminal.  Unapologetically Haiti greets us in the only way she can.  We are blasted by heat, assaulted by humidity, overcome by noise, and intimidated by a culture that remains a mystery to most of us.  We rally, we steady our nerves, we collect our baggage.  We feel good with the knowledge that all of our bags and our entire team has made it, at least, to the airport.  Only one problem remains… does anyone know how we are going to get to the hospital?  I’ll spare the details, but if you have ever traveled in a third world country, much less after a disaster, you understand how difficult it can be to get to your destination from the airport.  After another hour in the sun, we wade our way through the airport loiterers and solicitors and fill three vans with our crew and bags.  We are moving again.  

I’ve had the honor of volunteering in the wake of several disasters; the atmosphere here in Haiti is no different.  Filthy streets, undulating crowds of people, outstretched hands reaching into your vehicle looking for a donation, animals rooting out a meal, piles of trash clogging the streets, rivers of plastic damming up the gutters, the sweet stench of rotting organic matter, that dry feeling you get in your nose from swirling dust and diesel fumes, crippled buildings, roads, and infrastructure, numerous tent cities, and traffic, my god the traffic!  Ladies and Gentlemen of Team Sinai, you have arrived; this is what you asked for.  

Co-leader Merrill Chaus, RN is a skilled writer and you are encouraged to follow Team Sinai's progress on their blog.

Born For This Moment

Born For This Moment is the story of CURE International’s response to the Haitian earthquake. It features interviews with the committed volunteers who helped CURE International bring hope and healing to the devastated people of Haiti. You’ll also meet Haitian children whose lives were transformed through the dedication of CURE’s relief teams.
 

Displaced Haitians Struggle With Complications Of Daily Life

Medecins Sans Frontieres supports and helps individuals who experience fear, sadness, anxiety, concerns for the future, and feelings of hopelessness. For many people, however, moving forward proves difficult: when the ground continues to shake, and home is a golf course that lacks drainage or an organized system of latrines. Without concrete solutions to the situation they face, the need for psychological support is great.

"Most of the patients present with physical complaints and symptoms such as loss of appetite, memory problems, sleep problems, cardiac palpitations, flashbacks of the event," says psychologist Djénane Marlhen Jean Charles, a member of the local medical staff since 2006.

To help patients cope with anxiety and stress, MSF offers relaxation techniques and counseling sessions. "This strategy works 80 percent of the time,” says Charles. “However, if a patient presents with severe or psychiatric symptoms and requires medical attention, we refer to a psychiatrist and continue to offer psychosocial support.” The patient may be referred to the St. Louis medical center where MSF treats those suffering from severe psychiatric distress.

Dr. Maryvonne Bargue is an MSF psychiatrist who leads a mental health team of 19 people. In an interview at the MSF Saint-Louis Hospital in Port-au-Prince, Dr. Bargue explains in depth how people still feel the earthquake's psychological aftershocks four months later.  

“I Cannot Change Everything, But I Can Do The Best That I Can”

In response to the earthquake that ravaged Haiti’s capital on January 12, 2010, Partners In Health sent hundreds of volunteer professionals from around the world to support  their already established staff on the ground. The following is Part 3 of a series of essays from one of those volunteers, this time Karen Foley from Boston, Massachusetts. The sentiments expressed by Karen are very similar to those by most volunteers irrespective of where they serve.

The Haitian people are the most amazing and resilient people I have ever met. If a patient needed something and their family was not there, another family would step in and help. When we worked on a patient, local Haitian volunteers would hand us the various items we needed. Other people would help to locate supplies if we could not find them.

I am used to working hard but this is the hardest work I have ever done—both physically and emotionally. Still, I could go back to Haiti many times over. The patients that we cared for were extremely thankful and grateful. This experience has made me appreciate so much more, but also appreciate the Haitian people for what they have given me as a nurse and person.

Read the entire story here.

Trip Report From Orthopod David Wood, MD

David Wood is an orthopaedic surgeon who is the Director of Arrowback Medical Group in Colton, California.  Dr Wood has made numerous volunteer trips in the past to South America, Mexico, and Cuba.  He recently spent a week working at Hopital Adventiste and posted a few of his reflections.

It has been a while since my trip to Haiti however, I have continued to follow the progress being made at Hopital Adventiste and look getting back soon.  I wanted to add a few new points and reiterate a few of the old.

THANKS FOR THE MEMORIES

It is easy to forget the huge amount of effort that occurs behind the scenes to make these trip possible.

Scott Nelson, MD is known far and wide and the legends are all true.  He can operate with one eye closed and make diagnoses in his sleep.  The level of care that he provides here with the Taylor spatial frames, clubfoot deformity correction, and rotational osteotomies is found only in the most advanced Centers of Orthopaedic Excellence back home.  His perserverance and skills have made Hopital Adventiste the go to place for advanced musculoskeletal care back home.

Hospital Administrators are not the first ones we think about with mission disasters but without the likes of Andrew Haglund and the Central Supply and Maintenance team of get-it-for-guys Bob Chase, Dan Patchin, and Jerry Northrup, most of what we do couldn't happen.

The surgeon trip reports talk about the number of surgeries performed and patients seen in the clinic but none of it would have occurred without the backup we take for granted.

HOPE FOR THE BEST BUT PREPARE FOR THE WORST

I have been on a lot of mission trips, mostly to Latin America...the area is familiar to me and I can speak the language.  Just before I left for Haiti I heard about the Doctors Sans Borders killing and the looting.  When I got there, my fears were alleviated by the high level of security present in the Compound.

I did take a trip to see the countryside but my Guide was an armed off-duty police officer.  My visits included a seaside resort where life is slowly getting back to normal.

I also visited other aid agencies such as Doctors Without Borders and the European Red Cross.  Dr Hugo, a General Surgeon from Argentina showed me around Red Cross Compound.  The European Red Cross has these camps that are ready to transport to areas of need.  They include inflatible hopital wards,

operating theaters,

living quarters,

and transport vehicles.

The unit above was set up in the regional soccer field and was surrounded by tent cities.   This arrangement works great on a short-term basis but is not optimal for long-term care.

Although there is a lot of good equipment at Hopital Adventiste, you should bring specialty items that you may want or need ortherwise you probably will have to do without.

Sleeping quarters are adventuresome.  Either cots covered with mosquito neeting or a tent.  For the more metro missionary people, I "took one" for the team and stayed the last couple of days at the Hotel Auberge de Quebec...air conditioning, real beds but unfortunately full most of the time.

YOU GET MORE THAN YOU GIVE

As with any things in life, this experience gave me a lot more than I ever thought.  One major thing was seeing how fractures healed up without surgery.  In the United States, we don't get to see untreated fracture.  I am always surprise at the bodies' resilience and ability to heal.

Since there were five of us orthopods and one general surgeon, I helped out in the general surgery clinic.  Even I was able to diagnose and reduce this hernia! 

When I returned from the trip, I was much less flustered by the everyday trials of my practice.

IT TAKES A VILLAGE TO RAISE A MOUNTAIN

For the doctors going, don't forget to take all of the people who make you look good.  I would suggest at a minimum, and OR nurse, physical therapist, and someone to keep the team fed an watered.  We had the followers of the Supreme Master Ching Hai at the hospital during our stay.  They fed us great vegan meals two times a day...what a difference that made.

CONCLUSION

To have food and water and the ability to do the Lord's work in your chosen profession...it doesn't get any better than that!

Keep encouraging your colleagues to volunteer and please continue to donate your time and money.

Stories from Haiti: Marcus Sciadini, M.D.

Marcus Sciadini, MD, an assistant professor of Orthopaedics at the University of Maryland School of Medicine and orthopaedic trauma surgeon at the University of Maryland Shock Trauma Center, talks about his role as a member of the first team sent to Haiti from the University of Maryland Medical Center as part of its ongoing earthquake relief mission. He discusses the challenges faced by the team upon arrival in the devastated country as well as his lasting impressions of both his fellow team members and the patients he treated during his stay.

Dr. Sciadini also talks about the unique obstacles faced by the first team that had to be overcome within the first 24 hours of the mission in order to treat patients who were in desperate need of medical attention. He mentions how rewarding he found the experience and how much he encourages others to help in the relief efforts in any way they can.

“I Will Never Forget My First Day Or My Last Day In Haiti”

In response to the earthquake that ravaged Haiti’s capital on January 12, 2010, Partners In Health helped to send hundreds of volunteer nurses, doctors, and other medical and logistics professionals from around the United States and Europe to help support their roughly 5,000 staff on the ground. The following essay is from one of those volunteers Annie Lewis-O'Connor, NP, MPH, PhD from Brigham and Women's Hospital in Boston, Mass. As we've mentioned previously, the volunteer experience is remarkably similar throughout the quake zone.

Every day was a challenge, and no two days were the same. Each day we came to know our patients and their families a little better, and each day we strived to bridge the gap of cultural differences. It did not take long to form bonds that were strong and have sustained. While we laughed together, we also cried together, but mostly we shared an experience that would hold lasting memories.

I start my Haitian Creole classes in June. I will go back to Haiti. I must go back. I am a better person, my children’s lives have been enriched and impacted profoundly, and my life will be forever changed...I plan to “Stand with Haiti” for as long as I can, as long as it takes.

Read more of Annie's story here.

Post Quake Video

Video report shot by CNN within days after the Big Quake occurred.  Once again, a visual reminder of the devastation, confusion, and frustration that permeated the acute recovery phase.

Ryan Moore, MD Trip Report

Dr Ryan Moore is a PGY-5 Orthopaedic Surgery Resident at Loma Linda University Medical Center.  Ryan left for Haiti last month with less than 48 hours notice to assist Dr Nelson after Dr Syed's departure.  Ryan's service at Hopital Adventiste was greatly appreciated and he and his family are planning on private practice in Central California upon graduation at the end of this month.

Port-au-prince, aside from rubble everywhere and the tent camps which I never visited, seemed to be functioning like I would expect a third-world Caribbean nation to function.  The streets were lined with vendors of junk.  There was disorganized traffic weaving around piles of concrete and deep ruts in the road, blowing dust and exhaust into the air.  Straight-faced people appeared clean and neatly dressed despite their grungy surroundings.  Students in uniform were walking home from school, and people overall had the appearance that they were trying to find ways to be productive. 

At the hospital I was immediately put to work.  I think we completed three surgeries my first day before I was able to find a mosquito-net covered cot to call my own.  When the work was done, I prepared my bedding in the dark, and crashed for the night. 

The next morning after rounds we met for our morning orientation.  The “yellow-shirts” as the South Atlantic Adventist team was affectionately called were leading the volunteers in some good southern-style gospel worship.  Each morning they did this, and I must say- it was the highlight of my trip. 

On Saturday, since there was no scheduled surgery, a couple of us decided to figure out what was going on with the patients.  Teams of volunteers come and go, but the patients remain.  Care plans often disappear with the exiting team.  Two wonderful women came into my life that Saturday- both were nurses from Ukiah-  Tamara and Kristy. 

The three of us spent Saturday rounding on our patients.  To make a long story short, we found that there were issues.   Patients with bad infections were, on average, not receiving ordered antibiotics.  There were wounds requiring attention, but nobody knew what the plan was.  Of course there were the Haitian nurses.  But, when asked through an interpreter what the plan was for any given patient, you just received an annoyed stare.  The Haitian nurses, with some exceptions, seemed disengaged.

That being said, I think that they are interested in doing a good job.  They cover a lot of patients, with a one nurse to 12 patients ration (as opposed to 5 max on med/surg in California).  They also had the challenge of coordinating care with physicians who don’t speak Creole or French.  On top of that, they had to deal with shortages of medications in the pharmacy.  I think there was also confusion regarding the roles of volunteer nurses from the US and the Haitian nurses. 

A few of us were able to initiate an organized system for patient care on the floors, with Haitian nurses being the “charge” nurse, with a volunteer American nurse being there to help with whatever was needed.  We also did some training activities to help the Haitian nurses better understand some of the treatments that we were using.  I saw a spark in their expressions, and I must say that I think these nurses, if shown respect, and given training and resources, will be wonderful.

The hospital seems to be transitioning from a disaster response mode to a more sustainable model.  There are new staff members (such as Luke), who are there to help coordinate the revival of a healthy hospital system with appropriate integration of foreign volunteers.  At the same time there are the Haitian nationals who have been running the hospital for decades who may see American interference in their hospital system every bit as uninviting as the earthquake was. 

Thankfully there are long-term volunteers such as Dr Nelson and Luke who know through training and experience how to approach these situations, and what will work.  They are working in an extremely uncomfortable situation, motivated by convictions inspired by their faith.  I think many improvements will continue to be made through the efforts of these “full-timers”.  They were refreshing for me to work with, and they deserve our full support.

Psychic Orthopedics In Haiti

Orthopedic surgeons are tasked with repairing the architecture of our bodies, setting bones straight when they break and correcting injuries to muscles and joints. It doesn’t take a medical degree to know that, most of the time, those structures lie inside the skin. That means that one of the most important tools available to a modern orthopedic surgeon is the X-ray machine, allowing the surgeon to see the problem and form a plan of action before the patient is on the surgical table.

So how does an orthopedic surgeon work in a tent hospital on the border between Haiti and the Dominican Republic, where the best X-ray device available is one normally used for dogs? You practice “psychic orthopedics,” said Rex Haydon, assistant professor of surgery at the University of Chicago Medical Center. Haydon was one of three surgeons who spoke about the challenges and rewards of aiding medical relief in Haiti in a special session of the Department of Surgery Grand Rounds at the University of Chicago Medical Center.

Read the rest of the story here.

How Rich Are You?

A couple of days ago, I introduced you to Jason Brink and his Crimson Cannonball blog.  I've really enjoyed reading many of his posts and found the following musings of his rather poignant relative to volunteering in general and the Hopital Adventiste project in paticular.  Don't forget to take the little test at the end.

I leave for Haiti in 72 hours.  It is going to be quite an experience to be back out in the world again.  It has been too long since last I have seen the sun rise in other lands.  Too long since I have felt the warm wash of foreign voices crashing around me.  Too long since I have left the safety of the Hilfiger-clad and McMansion housed all-too-washed American masses.  It will be nice to be around people who truly understand what it means to appreciate the small things in life.  The tiny things that we as Americans gloss over in our rush to get from cradle to grave and accumulate as much stuff as possible.  When was the last time you turned on a light and thought, "Wow...that's cool...light with the slip of a switch...I am one lucky dude. Whats this? You mean clean water comes out of this tap when I turn it?  Awesome!!!" 

We really are incredibly fortunate to be where we are.  Chances are, if you are reading this, you are better off than huge chunks of the global population...and good for you...but don't ever let yourself take it for granted.  It is all too tempting to fall into the complacency that luxury affords us.  I know I do, and I hate myself for it sometimes. Don't just soak up the world around you...get out there and change it...make it better...be worth the life you live.

If you have a second, check this link out.  It will be a bit of an eye opener for you.  Put a ballpark of what you made last year in there, and hit the button...its kinda eye opening, I was blown away by it. 

Red Cross Red Crescent Day

Each year, on 8 May, the International Red Cross and Red Crescent Movement marks World Red Cross Red Crescent Day by highlighting the role of its staff and volunteers in saving lives and assisting vulnerable communities around the world.  The following video highlights their efforts in Haiti after the Big Quake.

Explorers Sans Frontieres

Explorers Sans Frontieres is a Philadelphia-based humanitarian organization whose stated mission is “to build cultural connections, one person and one community at a time, impacting our local and global communities.”

A team from ESF volunteered at Hopital Adventiste in early March and you can read their trip report here and view images from their trip here.  One of the team members, Michael Fielder authored a Primer for Volunteers at Hopital Adventiste that was previously reported. 

CURE Clubfoot Haiti Report

CURE Clubfoot Worldwide (CCW) is a program of CURE International that focuses on curing infants born with a condition known as clubfoot. CCW has been in Haiti since 2007.  Prior to the earthquake, the Haiti Clubfoot Program had three very active and functioning clubfoot clinic locations- north (Cap Haitian), central (Port-au-Prince) and south (Jacmel). Last year, the program treated just over 200 children.

After the earthquake of early January, the CURE Clubfoot program, like everything else in Haiti, has had to weather a host of challenges, but they're pleased to report some positive news.

The Crimson Cannonball

Jason Brink recently returned from a volunteer stint with Team Templeton at Hopital Adventiste.  He describes his role as follows:

"I was working on just general maintenance, and just working on keeping the hospital from falling apart.  I was working with Tima Masters, who arrived in the same group as I did, in general maintenance.  When there I told the other volunteers I was on the "Fixing Broken Stuff Brigade."  We did things like fix broken doors, put up towel racks, fix lots of broken cots, and just generally do what we could to improve the basic quality of life around HAH.  I cannot fix bones, nor can I stitch neatly, but I was able to help David make some shoes for Adnisse, and fix the doors in pediatrics Michelle accidentally ripped off.  :P"

L to R:  Tima Masters, Victoria Mulder, Jason Brink

Jason is an excellent writer with eclectic tastes and I spent far too much time last night reading his Crimson Cannonball blog when I should have been dictating my charts. He is also a very talented photographer and you can access a gallery of his images here.  I suggest viewing them in the slideshow mode to optimize the experience.

I wanted to share the following story from his blog and encourage you to spend some time perusing his posts...I found it worthwhile reading.

Today, I made some shoes for a woman who has only walked once in her life.  I was walking down the hallway on some errand when I was met by one of the orthopedic surgeons.  In his hand he held two shoes, the type you would tie onto the bottom of a cast to make it possible to walk.  He asked me if it would be possible to cut the shoes down, to fit smaller feet.  I examined the shoes, and asked if I could see the patient who needed them, to get a better feeling for her disability.  He had mentioned she had a congenital birth defect that had never been corrected, but nothing could have prepared me for the sight that greeted me when I walked into the room.  In the hospital bed (and she is one of the fortunate long term patients who gets an honest-to-goodness bed) lay a woman with a smiling face and bright eyes, her name was Adnisse.  Her younger sister, Mali, was at her side.  Adnisse was draped with a light sheet, but underneath the sheet I could see the ugly bulky shapes of external straighteners. The end of the sheet was pulled back to reveal her feet...two twisted and broken clubs.  

Adnisse is 22, though I would have placed her much younger than that.  She was born like this, and for her entire life has known nothing other than the floor.  Her knees are knobby and misshapen from being crawled on her entire life. Her legs are in external straighteners, elaborate braces with screw points that go down to her bones, in an effort to stretch out her knees so that she can walk on them.   Two days ago, Adnisse walked for the first time.  To visualize what it is like for her to walk, imagine standing up on your feet...but imagine walking on the top of one of your feet, your entire foot inverted.  Then, imagine walking on the side of your other foot, but turn it inward to point at the heel of your first foot.  Her legs themselves were nothing more than sticks, atrophied by 22 years of disuse.  

I stood there, holding these two shoe blanks, looking at this girls feet.  I took some mental notes about what I would need to do, and took the blanks down the hall.  I walked down to the end of the hallway and sat looking out at the tropical rain and thought about this girl.  Adnisse: 22, father killed in the earthquake, mother paralyzed with a stroke, only her little sister to sit by her side and sleep at her feet.  I sat and watched the rain and thought about this...I wept.  This girl, so happy and brave, and drawing the shortest of the short straws in a country of nothing but short straws.  For a while I just sat, my gut twisted by the immense unfairness of everything this girl has been subjected to.  All of this, and I had been chosen to make shoes for her.  

I sat there, staring out at the banana trees and watching the rain as I worked on her shoes.  For the rest of the afternoon I whittled away at the shoes, cutting them apart, tearing out their stitching to break them down to component parts, and then slowly beginning to stitch the new shoes together.  I am not good at sewing, but I wanted this girl to have good shoes, so I worked at it all day.  Once I had resewn the shoes, we padded them very well and took them down to her room.  As we walked in, her sister was toweling down her feet with cool water and trying to rub a cramp out.  They were both happy to see us, and we got to put the shoes on her feet, lift her out of bed to stand on her feet with a walker, and watch her take a few steps into the hallway.  You could see the strain in her face and her body as she struggled to support herself on her walker...a slow painful shuffle down the hall with her new shoes.  She said they made her feet feel better, and that it made her feel more safe than walking with her feet on the bare concrete and tile of the hospital floor.  The shoes still require some modification, but they were a success...I helped a girl take her first steps in shoes of her entire life.

Stephen Mulder, MD/Team Templeton

The following post was written by anesthesiologist Stephen Mulder who came to Hopital Adventiste with a group from northern California.  Once again, as surgeons, we greatly appreciate the contribution of good anesthesia coverage at HAH and are excited that Steve and his team are planning a return visit this Fall.

Reg Rice, ENT/facial plastics surgeon (pictured below) from Placerville protects his patients from yet another flying varmit. I think the air intake for the air cooling system connects directly to the outdoors because the most mosquitos I saw were in the OR.

We operated on a couple of very small kids (3 months and 8 months old). One baby had a large vascular tumor on the lip, and the younger kid had a cleft lip defect.  I used 3.5 and 4.0 oral Rae tubes. Sevo mask inductions with LMA till I had IV access. The precordial stethoscope I threw in at the last minute was absolutely vital to getting these cases done safely.  I did my first intraosseous access on the 8 month old. Those little kids with dark skin hide their veins pretty well. The 18 gauge needle on the flat medial surface of the upper tibia seemed too firm at first but I moved a little medial and got the "pop" from the first cortex and it worked great. It was see one, do one, without the "see one" part.

First case...ooops!

The monitors are marginal with no ETCO2 or gas analysis.  That's fine for local and regionals, but we did four or five dressing changes a day and these short cases were not suited for regional and the patients hated the stick in the back, often requesting to NOT have a spinal.  The infant cases that will be common in the future require a higher level of monitoring. I contacted MindRay (they bought out Datascope) on behalf of LLUGH and with their permission sought a bid for 3 new monitors:

This bid includes the Passport V gas analysis with each machine, all the tubing and disposable cuffs, temp probes, all the gear.  The total cost was 51,000 USD, but they made a generous bid for the people of Haiti that came in at $10,000!  LLUGH has agreed to raise 5,000, I'm kicking in some dough into the pot, and we are asking for donations of two to five hundred dollars from each anesthesia volunteer to complete a tour of duty.  It is a great step forward for quality care, and will make our lives much easier.  I hope to have the machines shipped through volunteers traveling to Haiti, and via Alex Sokolov by mid-June.  Please make any donation to LLUGH and designate it for the anesthesia machines.  Thanks!!

There is a lot of good info from previous volunteers.  I would add one thing.  Take time to enjoy the fellowship of terrific people from all over the country that you will have the pleasure of meeting.  I recommend a trip to the Hotel Olaffson.  Take your favorite translator and your new friends and relax in one of the great classic hotels of Port au Prince.  This hotel is about 20 minutes from the hospital and is near the soccer stadium.  It is in a secure compound and has catered for years to the celebrity types and journalists who have made Haiti their haunt. 

 Steve, Victoria, Jenny, and Madeline Mulder

We have a lot more pics, and many miracles and memories to recall, but there are even more waiting for you.  If you are able--do this trip.  We'll see you again in September!!