Sunday, March 23, 2014

Renovation Update 23 March 2014

Major changes are taking place at HAH with renovation of the operating room suite and installation of a new laboratory.  I travelled this past weekend with Ken Breyer, Assistant VP for Construction and Planning at LLU to assess the progress of the project.  We arrived at 9 am on Friday morning after an all night voyage from Los Angeles.  The progress that has been made is remarkable and the quality of workmanship is impressive.  We spent the entire day going over each detail of the plans with the construction foreman.   A multi faceted team coordinated by Ken has lent expertise in the design and engineering of every detail.  Although the complexity of the project has progressively increased, as well as the time and resources required to complete it; the final results will be worth the extra efforts.

Originally I had envisioned moving a wall or two, repainting and resurfacing the floor.  With the intention to create a first rate facility some additional expertise was consulted and it became evident that a more sophisticated plan would be worthwhile.  Additional storage, larger operating rooms, replacement of entire electrical system, too much to list new pieces of equipment, HVAC design with positive pressure airflow, plumbing changes, new lighting, shelving, new doors, central distribution of medical gases and other details have been added.

Francel and the workers have created a provisional OR suite in the previous emergency room which is quite adequate to handle a variety of cases.

Volunteer surgical teams are anxious to know when the project will be completed.  I won’t guarantee any completion dates but the first construction phase will likely be wrapping up in about one month.  At least two months will be required for the remaining acquisition and shipping of equipment in a container from Loma Linda.  Installation of fixtures, furnishings and special equipment will then likely require another two months.  Best case scenario currently puts us well into July.

Pictured below is a photographic update the progress.


Front Entrance - Desk will be resurfaced and modified
Main hallway inside OR suite - all flooring removed
Ken in front of existing OR 2.  OR 1 on the R is being renamed OR 3
Pile of rubble from tile removal with 8 inches of lime rock
The new OR 1 (was old small OR on the L, now twice as big)
OR 2 showing removal of med room in between OR's
OR 3 also bigger without intervening med room
Ken going over details with foreman Alfredo

Enlarged storage room (only partially shown)
Break room/Kitchen


Plans
Workers take a break
Corbels with rebar designed to withstand major quake
View down hallway from near scrub sinks
Central sterilization
Recovery room (inside OR suite)


Provisional OR - central sterile
Provisional OR
Additional provisional OR


Laboratory area under renovation.

Tuesday, January 21, 2014

Groundbreaking



A monumental event in the recent history of HAH occurred Friday… 

Since the earthquake 4 years ago there has been continual discussion about the deficiencies in our operating room facility.  Various plans have been made to renovate it but do to various challenges none have yet to materialize.  About 6 months ago Dr. Geneus the medical director asked me if we could move forward on getting the job done.  I committed to doing it and a few minutes later called my friend Jean Marc who runs a construction company here in Haiti.  I asked him when he could come over and take a look at the project and he happened to be in the neighborhood and told me that in 5 min he would be at the front door.  This was actually quite coincidental because often when I call him he is not even in the country.  Initial plans were made and the collaboration of many people began to take place.  The leadership at Loma Linda has enthusiastically supported the project and several experts participating in the design and engineering have made trips down here.

I originally scheduled this trip with the idea that I would be here for a few days to check on the mid construction progress.  Not surprisingly start dates have continued to be pushed back and construction has yet to be started.  I thus made it the goal of my trip to set up a provisional operating room and have everything removed from the existing operating suite so construction can begin.

Mdme Clotaire and Francel
When I arrived on Friday I first met with Madame Clotaire who let me know that she was excited about the idea of getting construction started and that they would schedule some meetings next week to finalize design plans for a provisional operating room and then try to create a budget.  I let her know that we had already conceptualized the design and just needed to have her come up to the emergency room to have the workers create some space as demolition of the OR was to start on Monday.  There was a pause and a smile and within 15 minutes she was in the ER giving orders.  Immediately the workers started moving the furniture and groundbreaking was officially begun!

I then called Jean Marc to see if it might be possible to launch the demolition on Monday.  Fortunately he said yes and that he would send his foreman over to review the plan on Saturday night.  By sundown Friday evening only a fraction of the work was done, but much had been accomplished.

Workers Activate
After a Sabbath afternoon hike up the hill we came back to the hospital and worked late into the night disassembling shelves, moving equipment, organizing materials, and setting up an entire new operating room.  Fortunately by the time we had to leave for the airport the previous operating room was cleaned out and ready for renovation.

On Monday January 20 the construction crew arrived and started demolition.



Moving Out

Ready for Construction

Haiti Update January 2014



Okay, we all know that I have fallen behind in my reports on the latest news from Haiti Adventist Hospital.  I am sorry.  Generous donors, eager volunteers, and interested supporters have been patiently awaiting this long overdue report. 

This report is prompted by some exciting projects that are taking place as well as some generous end of year donations that will bring them to reality in 2014.  It should be remembered that January 12 marked the 4th year anniversary of a day that changed the landscape of Haiti.  Many lives ended that day; many were changed forever, including my own.  The question I get asked the most frequently is “are things getting any better down there?”  A hard question to answer.  Are things getting better anywhere in the world?  Will it be good that soon you will be able to stay in a Marriott Hotel in Port au Prince rather than staying at a locally owned place where dinner takes 3 hours to be served, they are out of 3 items on the menu and you might get sick the next day?  Maybe that is good.  Maybe it will give local workers some low paying jobs.  Maybe it will stimulate economic activity.  Or maybe it will just return the majority of your tourist dollar to corporate America.  Do we measure improvement in terms of GDP and creature comforts or strong faith, interpersonal relationships, and love for God?  If it is the latter then don’t forget that Haiti is already more advanced than the United States.

Independent of these difficult questions is the fact that health and healing is always needed and in the last 4 years many people have participated in providing this to the Haitian people.  The hospital has recently faced some significant economic challenges.  Part of this is due to the fact that charity care does not provide salaries for the nurses, pay the utility bills, and maintain the infrastructure.  The amount of volunteer services has had a significant impact on medical economics throughout the country making it more difficult to provide profitable services in the health care industry.  Balancing affordable care for the poor with profit generating health care services is always a challenge.  In the last 4 years the emphasis has been much more on the former than on the latter.  Sound business plans have yet to be developed.  Two very important concepts are necessary in order to successfully take care of patients with and without resources in a mission hospital:
1.      Excellent Services
2.      Provision for charity
With top quality services people with resources can be attracted and charged for services.  Donors and volunteers will want to participate in something of quality but it must be made available to people even if they have limited resources.

In the interest of both of these concepts, construction is scheduled to start this month to renovate the operating room suite, create a new clinical lab, and create an outpatient clinic area in the polyclinic building out front.  I have been most closely involved with the operating room project.  This will include enlarging the two existing theatres and doubling the size of the third minor procedure room to make three reasonably sized theatres.  Other improvements include:

  • ·         Operating room lights
  • ·         Central suction
  • ·         New autoclaves
  • ·         New flooring
  • ·         Recovery room
  • ·         Expansion of storage space
  • ·         Staff male and female toilets
  • ·         Dressing room
  • ·         Break room
  • ·         Centrally plumbed medical gases
  • ·         New doors
  • ·         New cabinets
  • ·         Electrical update with backup power system

The space requirements will be accommodated by moving the front set of double doors towards the central nurses station which will significantly increase the amount of available space.

The new clinical lab will be on the main floor at the end of the hall on the right which was used for a period of time as a central depot.  As with the operating room, professionals of various disciplines have been involved in the layout and design of this project.  The challenge of creating a top quality facility with the given space constraints and other considerations of practicality has not been easy, but I am confident that the hard work we have all been putting into making this a success will pay off and that our operating rooms and lab will be some of the best in the entire country.  A big thank you to all who have supported this project with your generous donations, time and expertise.  Stay tuned.

Monday, July 1, 2013

Lineda


Before surgery in Port au Prince

I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.   Matthew 25:40


Lineda is a 10 year old girl who first presented to me at Hôpital Adventiste in Port au Prince Haiti.  She came over on the back of a motorcycle in a rainstorm with her mother from her home in Cité Soleil – one of the most impoverished and dangerous slums in the world.  Nonetheless she was wearing a pretty blue dress and had a beautiful smile and sweet demeanor.  Unfortunately 2 years prior she had experienced a febrile illness that resulted in complete paralysis from the waist down.  Due to the condition she began to develop severe scoliosis and in addition to not having function of her legs she was unable to even sit up.  They came hoping that something could be done.  The situation was seemingly hopeless for all of us.  I explained that neurologic recovery with this condition is not humanly possible.  They understood but pleaded with me to at least straighten the spine so she could at least sit up and go to school.  I explained that an operation of this magnitude cannot be safely performed in Haiti, but perhaps there was another option.

Lineda and her mom at LLUMC
Post operative image
Four weeks ago she arrived at LAX nearly one year after the day I met her.  She came with her mother and Sabina, an aid worker for a planned operation at Loma Linda University Medical Center.  After several committee meetings the leadership at LLUMC decided that the benefits of getting Lineda to sit upright in her wheelchair would justify the financial commitment necessary for the undertaking.  The parents saved up enough money selling soda out of an ice chest in Cité Soleil to buy two airline tickets.  A donor provided living expenses, doctors are gave their time and expertise, and Depuy Spine generously donated the $30,000 worth of implants required for the case.  These efforts were all coordinated to produce a small miracle for this girl. And I must say that without Sabina to kindly advocate and persist in this coordination it would not have happened.

With so many people in need how can the system accommodate?  Maybe we can not do everything for everyone, but when you see Lineda’s million dollar smile one can only think in terms of one patient at a time.  Spanning the globe the Adventist health care system reaches the “least of these” and in this unique situation has again exemplified the healing ministry of Jesus Christ.  From the streets of Cité Soleil, Lineda has been taken from a situation of grinding poverty, to one of the best medical centers in the world where the quality of Christ’s healing ministry can be represented in the treatment for her complex condition.

Yesterday here in Port au Prince Lineda came for a post op visit to have her sutures removed.  The whole family came with her to express their gratitude.  Lineda is very happy to be back in Haiti and is especially excited to be with her friends.  Apparently she has been eating triple portions of home cooked Haitian food.   They invited us to their home to enjoy some of this next Sabbath before we depart.
Post op visit with the family at Hôpital  Adventiste 30 Jun






Thursday, December 27, 2012

Haiti December 2012




Once again we take to the skies in a well worn American Airlines 767 with a petulant flight crew and crowded cabin. We lift above the grinding poverty of PAP.  Sitting beside me is a Haitian man on his first trip to America and first time on an airplane.  The flight attendant serves him a cold drink and he looks at me with a smile on his face and says “I think I have left Haiti”.  I wonder - will life be easier?  More comfortable?  Happier?    As we touch down in the United States I contemplate these questions even more as we look out at the flags flying half mast - thankful to be blessed with a belief system that makes me feel humbled, privileged to serve and rich in peace.  This is why we go…

Chadme in recovery room
Chadme is a 17 year old girl who had such severe knock knees (genu valgum) that she has been forced to walk on all fours most of her life.  This was caused by rickets a problem related to vitamin D deficiency.  Last year Dr. John Herzenberg an internationally renowned limb deformity surgeon from Baltimore performed two separate reconstructive operations  at Haiti Adventist Hospital to correct her leg deformities.  On this trip we had the privilege of removing her last fixator.  In the recovery room she was tearful and called me down to give me a hug and thank us for changing her life.  She can now go to school for the first time and learn how to read.  This is why we go…

On my trip home I gave a presentation at the AAOS Disaster Relief Course in South Florida.  One of the other lecturers spoke about the phases of disaster response which concludes with the exit phase.  In many ways this is the most difficult phase – how do you shut down a hospital full of people?  I felt thankful that in the Haiti disaster response we have not had to answer that question nor do we intend to.  Speakers raised questions about how patients get follow up care after having major orthopaedic operations in a disaster – another difficult question for many.  We did not stop to ask that question in Haiti, we just keep working.  It was a privilege to represent Loma Linda University at this course, a school founded more than 100 years ago for the explicit purpose of training physicians to work in underserved and austere environments.  And even though big challenges remain in Haiti I am grateful for the institutional support as well as the generous support of donors and volunteers that have made this continued effort a reality.  These successes do not come without significant sacrifice.  Especially sacrifices by people such as Terry and Jeannie Dietrich who really helped stabilize this program by giving a year of their time, as well as Dr. Francel Alexis the current chief of orthopaedics at HAH who makes short term trips and complex operations a reality for those of us who cannot be there full time.

Sometimes the challenges seem overwhelming, but after seeing the results of bringing world class surgeons such as John Herzenberg into the lives of patients like Chadme, the joy and blessings brought on by this effort are even more overwhelming.  This past week we treated another patient with a similar deformity hardly able to walk, we did a hip fusion in a man with an untreated, painful acetabular fracture who raised his hands in joy as we scheduled his operation, we treated a man transferred from Albert Schweitzer hospital with a cervical spine facet dislocation who will continue to have full use of both arms and legs, we straightened knee contractures and operated on clubfeet.  The list goes on…  Without this hospital the majority of these patients would have no other options, leaving them with lives of disability.  It was a privilege to have Dr. Rob Quigley a 3rd year resident and Dr. Joseph Hahn a 4th year resident accompany me on this trip.  Many cases presented that they had never before seen in their training.  Not only are these operations life changing for the patients but these experiences are defining moments in the careers of many of us involved.  These are sacred events helping us to become better surgeons and better people. 
Fanfan - a new patient with rickets similar to Chadme
After placing external fixators to perform a gradual correction

May the Lord Bless you in this holiday season.