The Future Is Now

Dr Francel Alexis graduated in 2004 from the Medical School of Haiti State University.  He subsequently completed a year of general internship then rendered his one year of mandatory year of social service to his country.  He subsequently completed 4 years of an Orthopaedic Surgery residency at the same university where he went to medical school.

Francel is currently engaged in a 14-month Pediatric Orthopaedic Surgery Fellowship comprised of spending 8 months at the CURE Hospital in the Dominican Republic and 6 months here at Hopital Adventiste under the tutelage of Dr Terry Dietrich.

Here at Hopital Adventiste, Dr Alexis divides his time between very busy clinics and the operating room where he has proven to be an eager student.  Francel would like to eventually private practice as the only Haitian fellowship-trained pediatric orthopaedic surgeon in his country.

Pictured below is Dr Zeno Charles Marcel who recently graduated from the Universitad de Montemorelos in Mexico.  ZJ is currently fulfilling his year of social service by working with Dr Dietrich here at Hopital Adventiste.  ZJ's goal is to complete an orthopaedic  surgical residency in the United States and eventually return to serve in an underserved nation such as Haiti.

Jonathan Mills, pictured on the left in the image below, is a 2nd year medical student at Loma Linda University. During his summer break between first and second years, Jonathan has spent several weeks volunteering on the orthopaedic service here at Hopital Adventiste.

All three of the aforementioned gentlemen have been performing in an exemplary fashion and have increased our productivity immensely.  Their enthusiasm, energy, and willingness to serve have been greatly appreciated. It appears that the spirit of volunterism in our speciality is alive and well and the future is indeed bright.  

Advanced Clubfoot Reconstruction

A club foot, or congenital talipes equinovarus, is a congenital deformity involving one foot or both. The affected foot appears rotated internally at the ankle and inverted at the foot with the toes pointing downward. Without treatment, persons afflicted often appear to walk on their ankles or on the sides of their feet. It is a common birth defect and Hopital Adventiste sees an inordinate amount of these patients in the orthopaedic clinic.  

Most patients can be treated nonoperatively with serial casting but resistent and neglected cases require surgical management.  Typically most of the worst cases, like the patient featured below, are referred to this facility for treatment.

Dr Nelson has become skilled at using the Taylor Spatial Frame for correcting many of these advanced deformities.  The technique involves the use of an elaborate system of wires, pins, rings, nuts and bolts to employ gradual distraction to correct the pathology.

The correction algorithm is based on data inputed into a computer program which tells the patient or family member how much distraction to perform, typically only a small fraction of the overall correction each day.  The patient often wears the machine for several months before the desired result is achieved and the device is removed.

Blue Monday

Most orthopods prefer operating as opposed to seeing patients and this group is probably no exception.  After worship/hospital staff meeting we walked the gauntlet (see image below) through at least a hundred patients plus family member anxiously waiting to be seen.  

In reality, there were a number of really interesting cases to review ranging all the way from tumors, infections, fractures and congenital abnormalities.  

There were also a couple of surprises including the young man below on whom Scott and I had fixed bilateral radial clubhands on a trip to Cap Haitien in February of 2009.

The patients lined both hallways and overall were incredibly longsuffering and understanding including the little fellow below awaiting scheduling for corrective clubfoot surgery.

In between  seeing patients in the clinic, we fit in a few surgical cases.  In the background of the image below, Adeel and Jim are performing a proximal row carpectomy for a 5 month old trans-scaphoid perilunate dislocation of the wrist.  We were very fortunate to be able to use formal surgical tourniquet pictured below in the foreground.  This machine was procurred by Redlands, California orthopaedic surgeon Gray Frykman.

ICU nurse Wes Easter (on the left in the image above) was 2 for 2 on his first intubations performed under the tutelage of anesthesiologist Maria Adrianne (on the right in the image above).  We will soon be entering the inaugural nurse anesthesia training program at Loma Linda University. 

One of the innovations were experienced this clinic visit, was the use of the ipad for image review, a technique perfected by ortho resident Adeel Husain.  The concept really streamlined the review of xray images and was effective in presenting cases, including mini movies of patients ambulating, to Dr Nelson.

The image above depicts 16-case surgical load for today, probably won't get it all completed but we'll give it a good shot.

First Real Day On The Job

Before going any further, it might be worthwhile to introduce all of the members of our team:  Adam Lorenzetti (PGY3 LLU Ortho Resident), Adeel Husain (PGY4 LLU Ortho Resident), Wes Easter (LLU ICU Nurse), Ken Kuck (LLU Surgical Tech), Jim Matiko (Redlands Ortho Surgeon),  and team leader Scott Nelson (LLU Ortho Surgeon).  We are all pictured below gathered around Terry Dietrich's newly completed, custom designed with orthopaedic theme, Tap Tap complete with Scott's picture on the side.

Kneeling from L to R are Adeel Husain, Ken Kuck, and Wes Easter.  Standing from L to R are Adam Lorenzetti and Jim Matiko.  Peering out over his photo from the rear of the tap tap is Scott Nelson.

We spent most of the day sorting, cleaning and organizing equipment.  The lady on the right, affectionately known as "Vieja" is Scott's former nurse from the Dominican Republic who frequently makes the long journey across Hispaniola to join him when he comes.  Her organizational skills are legendary and she kept us focused throughout the day.

It was great to have Adeel join the team.  We not only appreciated an extra pair of hands and his enthusiasm, he also brought our six remaining suitcases that Spirit Airlines had failed to deliver on time.

The hospital continues to provide us with one meal per day which usually consists of some variation of rice and beans and something extra like mixed vegetables or fried plantain.  We all agree that the meals have been pretty tasty.

Since Wes will soon be entering Loma Linda's inaugural nurse anesthesia program, we bequeathed to him the unenviable task of organizing the equipment and meds in the anesthesia cubicle.

In addition to the housekeeping activities in the OR, we managed to squeeze in a couple of surgical cases.  In the image above, Ken, Adam, and Adeel are removing hardware on a patient with a postoperative spine infection. Peering over the drapes is Maria Adrianne, an extraordinary anesthesiologist from the Dominican Republic. Not only is she clinically competent, she gives excellent neck massages to exhausted surgeons.

It's great to be here and we all feel privileged to serve and be part of this program.