Mike Suszter, Ortho Resident Trip Report

Mike Suszter is a senior Orthopaedic Surgery Resident in Riverside, California and recently returned from a volunteer trip to Haiti. 

One day in September I was contacted by my residency director, Dr. Wade Faerber, and asked if I would like to join him in Haiti with Dr. Scott Nelson. Being familiar with Dr. Nelson and having heard about previous trips to Haiti I jumped at the opportunity, brushed up on my French, and expedited a new passport. 

In the weeks prior to the trip I was filled with nervous excitement and was not sure what to expect. I had what seemed to be a million questions. What would the country be like? How had Haiti rebounded from the earthquake? What kind of food would there be? The days before the trip I found myself frantically packing and trying to anticipate every need (bug spray, surgical attire, snacks, and of course extra batteries for the camera).

Upon arriving in Haiti I was welcomed with 95 degree heat and 90% humidity. We were then picked up and escorted to the hospital. On the way from the airport I had my first exposure to Port-au-Prince, the Haitian people, and culture. The city was alive with people similar to worker bees around a honey hive. The sights, sounds, and smells were unbelievable. The city was alive with millions of people all working hard to help each other. Whether it was selling fruit at the market or filling tires at the side of the road everyone was busy and working hard…which was a small amount of foreshadowing for my week. 

Upon arrival to the hospital, we were greeted by numerous volunteers from all around the world. Each brought a special gift/talent to the hospital and the Haitian people. At a hospital one would expect nurses, doctors, and prosthetists to be among the volunteers, which there were many, but in addition there were physical therapists, architects, electricians, medical students, and theology students. It was amazing to learn about the many projects and experiences all these volunteers had to share. 

After we claimed our sleeping quarters, our group was eager to go out and experience Haiti. On a hike, led by Dr. Nelson, we trekked through the small villages and mountains of Haiti. Being out of shape I certainly struggled up and down the mountains, but once to the top we were all re-energized at the beautiful sites that overwhelmed our optic nerves. Who would have thought that a country so devastated by natural disaster 2 years ago would be so peaceful and beautiful? 

The following 6 days were mainly work days at the hospital. We started off with a clinic day where we saw an amazing array of patients. There were patients with untreated injuries from the earthquake, congenital disorders, acute injuries, and infections. As our Creole/French was not very impressive, we worked hand in hand with several local Haitians who acted as our translators/cast techs. I was very impressed with their work ethic, compassion, and casting capabilities. I was also surprised at the immense amount of technology that had been obtained by the hospital since the earthquake. Heck, the portable x-ray machine was far better that the ones we have at our institution. 

Throughout or clinic day we amassed an entire week’s worth of surgery. As to not bore you with all the surgical details, we worked tirelessly for 4 straight days in the OR to help as many people as possible. Our surgical case list was quite varied, from spine fractures to limb alignment surgeries. Working with Drs. Nelson and Faerber was fun, educational, and……..well one of the greatest surgical experiences ever!!!!! One of the most memorable moments came after we had done a surgery on a young girl with Blounts Disease (bow legs). After surgery we wheeled her out to the recovery room and found her mom, who immediately started crying (tears of joy) and gave Dr. Nelson a giant hug of appreciation. That moment reminded me how much of an impact we can have on people’s lives. 

That week we did many surgeries (big and small) and made just a small scratch in the need for orthopedic care in Haiti. Throughout my trip I was amazed at the state of the art care that was being provided in a small 18 bed hospital in the middle of a third world country. It re-energized me, encouraged me, and exposed me to medicine in the third world. 

After 7 days it was finally time for us to return home and upon getting back to my house I emptied my suitcase and did a survey of the things I had brought back with me: 

     1. 2 metal fish ornaments 

     2. 10 bug bites 

     3. 700 pictures 

     4. About 15 new friendships 

     5. A million stories 

     6. Most importantly a desire to volunteer my time in the future to this and other 

         volunteer programs around the world

L to R: Mike Suszter, Wade Faerber, Scott Nelson, Francel Alexis

In the coming months I may forget the French that I brushed up on but I will never forget the amazing pride and friendliness of the Haitian people and drive of the volunteers/employees at the hospital and can hardly wait for the next trip. 

I would like to thank LLUMC, Dr. Nelson, Dr. Faerber, and all my patients for allowing me the opportunity to grow both professionally and personally.

Operations Update From Hopital Adventiste

Dr Scott Nelson is returning home from another week at Hopital Adventiste.  In addition to the excerpt noted below, you can read the rest of his report on the CURE Caribe Blog.

Chaos, hard work, excitement and challenges usually eclipse my ability to write reports until the controlled rage of the GE turbines on the 757 pull me into my seat and I start assimilating my thoughts. We fluently lift off into the sky leaving behind a different world, looking down at shacks and rubble with a few new roofs decorating the landscape.

It was a week of mixed emotions. Terry and Jeannie Dietrich moved out on Wednesday to go back to Wisconsin. I felt a sense of defeatism and disappointment that we have not been able to inspire any surgeons to make a long term commitment towards the international orthopaedic program that has blossomed since the earthquake. It has enabled many talented surgeons to come down and effectively use their expertise to give a level of care to the Haitian people, that in some ways is beyond even that in the US. They both did an outstanding job of hosting this flourishing program. Amongst many of their contributions was the training of a couple of orthopaedic technicians – Jeanty and Jean Joel have been well trained to prepare the cases, assist in surgery, and maintain organization of the equipment.

Francel Alexis (far left in image above) is a recent graduate of the Haitian orthopaedic residency and is finishing a year long fellowship sponsored through Cure International. He is now at HAH and will hopefully stay there to help anchor down the orthopaedic program and provide follow up for our patients. His affable personality and motivation are real assets to the program.

Uncertainty

The following post was written by Amy Lindsay and can be read in its entirety on the Beauty In The Mess blog.

Today was a sad day. A day of change and uncertainty as we said good-bye to Terry and Jeannie Dietrich. They served whole-heartedly for the year that they were here and it was great having them here. Now we will have to find a way to move on and continue the orthopedic program even without them. They will still be back for a few weeks here and there, but currently we don’t have a long-term replacement for Dr. Dietrich, which is disconcerting. There may be an orthopedic surgeon that might be able to come down, but as of right now there is a lot of unknowns about how it will all work.

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.