Year In Review From Terry Dietrich

Haiti Adventist Hospital has served the people of Carrefour, Port as Prince and beyond for about 30 years. It miraculously was not significantly damaged on January 12. Within 2 weeks, it was cleared by engineers to function as a hospital. It's normal operation as primarily a small center for OB/GYN and occasional cases of urology and general surgery was totally disrupted. Dr Nelson started caring for the patients injured in the earthquake and did orthopedic stabilizations on hundreds of victims with the help of many orthopedic and specialty teams. Millions of dollars of orthopedic implants for fracture fixation were generously donated by orthopedic companies. Most of that donated material eventually found its way to HAH. He went well beyond caring for the earthquake victims and began treating many orthopedic cases that had been neglected for years and even decades. An example is Staille. Look up the Youtube video that was made of her. She returned to the clinic a couple of weeks ago and the external fixators were removed. She is walking much better all the time. A final video will be made to add to Youtube in a few months. Because of Dr Nelson's unselfish efforts, HAH has become known as the primary orthopedic referral center for most of the country. Patients are transferred here from all regions of the country with spinal and extremity trauma. Arthroscopy equipment has been obtained and now adds another important orthopedic capability.

The hospital is still in recovery mode from the disaster and the overwhelming number of patients, mainly indigents, that have been cared for in the last 12 months. It struggles to meet its overhead. There are high hopes that in 2-3 months the picture will brighten. A new patient wing project which has been dormant for several years is the top priority. Its completion will allow us to attract more paying patients to increase the hospital's revenue stream. Teams of volunteers with expertise in construction could help to finish that project, A strong effort has been put forth to remodel the ORs so that we can begin doing total joint replacement. Boldt construction in Wisconsin has made a generous proposal to see that project through. That would also have potential to improve the hospital's financial picture. If the hospital is strong financially, then it should be possible to fund a program so that excellent perpetual care can be provided to the indigents.

Meanwhile, the challenges continue. The volume of orthopedic cases that present daily in the clinic could be managed by one orthopedic surgeon. However, it would leave virtually no time for anything else. Managing the many challenging surgical cases requires at least another full time orthopedist. The cases cover the entire spectrum of orthopedic subspecialties. Children's deformities, trauma, infections, tumors, spine, sportsmedicine, upper extremity trauma and deformities, and adult reconstruction are evenly represented. Is there a living orthopedic surgeon besides Scott Nelson who has the ability let alone boldness and confidence to even attempt to undertake such a challenge? Fortunately, there are excellent, well trained subspecialists who are generous with their time and resources and have participated already and continue to commit to support the work here. Orthopedists such as John Herzenberg, Bob Cady, Karl Rathjen, Todd Smith, Fred Liss, Allen and Cassie Gabriel, Gerald King, Duncan Miles and many others too numerous to mention, have all made valuable contributions. One of the biggest challenges facing the orthopedic program is the lack of regular anesthesia services. Cases of necessity are at times delayed as much as several days when volunteers are unavailable to give anesthesia. Another urgent need is assistance in managing patients with comorbidities. Patients needing general surgical consultation require transfer to another facility. No equipment or expertise is available for post anesthesia monitoring or ICU management. Blood is difficult if not nearly impossible to obtain for pre and postsurgical patients.

The Haitian presidential election fueled civil unrest in Port au Prince in December, created major uncertainties for specialty teams with plans to work at HAH. Several teams postponed or cancelled their travel plans and leadership made the decision to evacuate all expatriates from the country until fears of more violence subsided. It is too early to tell what lasting effects will result from more than 2 weeks of orthopedic care being unavailable.

Optimism abounds at HAH as volunteers continue to daily throw themselves into the tasks at hand. Training orthopedic technicians is a challenge and delight. It is very gratifying to watch the first trainee, Jean Joel, enthusiastically apply his quick mind to learning new concepts and skills. Working with the Haitian translators gives all of the volunteers daily cultural interaction that is priceless.

The very important prosthetics program is about to get into high gear. In November, Project Hope installed the buildings for housing patients in need of prosthetics and the lab for patient examination and prosthetic construction. The man in charge of the development of the prosthetics program arrived a few days ago. Now the key elements are in place for the hundreds and perhaps thousands of the unfortunate earthquake victims who lost ams and legs and still need artificial limbs.

The need for infectious disease expertise is pressing. Many of the earthquake victims had open wounds, commonly associated with fractures. A significant percentage of those wounds and fractures developed chronic infections due to the delay in proper initial wound care. Many other patients present to the orthopedic clinic daily with chronic bone and joint infections that have been part of their lives since long before January 12. These patients again highlight the years of orthopedic neglect that the indigent Haitians have lived with for decades. It is nearly impossible to obtain timely and accurate cultures to identify organisms. If drug sensitivities could be obtained in a timely fashion, the appropriate antibiotics may or may not be available. Broad spectrum antibiotics are relatively available but who knows for how long. The pharmacy is badly in need of strong leadership and organization and we could always use the assistance of a biomedical engineer.

None of the needs that are presented here added to those not even mentioned are so great that several million dollars couldn't easily solve. Global Health has done a remarkable work at organizing the relief efforts. The funds raised have been applied in effective ways. Perhaps with renewed interest on the anniversary of the disaster, there will be a 10 fold or even 100 fold increase in the financial support of HAH through Global Health that will transform the effort into a world class program.

Much more can be said of this incredible God blessed opportunity. Every person reading these words can be privileged to participate in this work either by a personal commitment to volunteer or a gift of financial support.