Monday, July 12, 2010

KCI Wound VAC Revolutionizes Wound Care in Haiti

The benefits of V.A.C.® (Vacuum Assisted Closure®) Therapy, also known as NPWT (Negative Pressure Wound Therapy) are widely known. This relatively new technology became available in the United States the 1990's and has revolutionized the way we do wound care. Now this technology has arrived at Hopital Adventiste d'Haiti where we have one of the busiest orthopaedic and reconstructive services in the city of Port au Prince. We thank KCI for their generous donation of 10 VAC devices and the accompanying disposables. Our goal is to provide top quality care to the patients we serve and this donation brings a major advancement to the treatment of the many chronic wounds and bone infections that we are seeing due to the Jan 12 earthquake as well as subsequent trauma. It is exciting to give the very best to our patients who have suffered so much.

The stories speak for themselves - these are a few of the many.

Guillame is a 4 year old girl who had severe osteomyelitis of her right forearm. A large amount of dead bone had to be removed however the prognosis is good and with the VAC therapy she only needed to be in the hospital for 1 week.

Luckson is a 21 year old male pictured here with his sister and Rosemarie an occupational therapist from Loma Linda, CA. Luckson had a severe open fracture in the earthquake and was treated elsewhere with a tibial rod which became infected. The implant was removed as well as all infected material, the bone was stabilized with an external fixator and at a later date bone grafted. The VAC has played an essential role in the salvage of his leg which may have been amputated given other circumstances.

It even works for the little ones, this 2 year old girl suffered from osteomyelitis of the tibia and was going to need several sophisticated operations to treat her large wound until the VAC came along and it completely healed without further surgery.

This young man lost his R leg in the Jan 12 earthquake but because of the VAC and a skin graft we were able to save the knee and an adequate amount of bone below in order for him to have a much simpler below the knee type of prosthesis. He is seen here in a tent in front of the hospital.

Mirlanda is an 11 year old girl that is well known at our hospital as we have been battling a very severe infection in her R femur that was fractured in the earthquake. The VAC has played a vital role in her healing.

The VAC has become a badge of honor amongst our patients and they often ask before surgery "are you going to give me one of the machines?".

Thank you to KCI and the wound care nurses and surgeons who have been instrumental in helping bring this technology to those in need.

Thursday, July 8, 2010

One way SDQ-LAX

We won’t call it the “final return” as we already have a trip planned to work again at Hopital Adventiste d’Haiti in August. Nonetheless, the one way ticket symbolizes the close of an era where Hispaniola was home, and the beginning of another, where now we will be merely short term volunteers or tourists when returning to the Dominican Republic and Haiti. The freedoms of lawless driving, inner city living, and caring for gracious Dominicans and Haitians will be on hold.

We leave behind friends who have taught us to value love and relationships as much as the American ideals of performance and production. The difficulties of adaptation will hopefully be softened by our ability to hold on to these world views and remain strong in our intentions to live conscientiously, not forgetting the hardships, suffering and love that we have seen during the past 5 ½ years.

December 30, 2004 En Route to Santo Domingo (NYC subway station) - Chad 7, Alex 5

July 6, 2010 Arrival Los Angeles - Alex 11, Chad 13

Our decision to return to southern California and me to work at Loma Linda University was made with much deliberation and prayer. Yes, we have family and friends there that we love – but we came more for the challenges than for the comforts. My position at Loma Linda allows us to continue with an unchanged mission. Challenge, sacrifice, and most importantly the opportunity to train others for service is what attracted me most to this new position. My education and our unique experiences will hopefully help bring reality to the ideals and dreams of students and young doctors who have come to seek an education at an institution founded upon the precepts of global service and a love for God and mankind.

Loma Linda University Medical Center

I would like to strengthen Loma Linda University Medical Center’s position as a referral center for patients with complex limb and spine deformity. Developing a center of excellence for the correction of congenital limb deformities, limb lengthening, and pediatric spinal deformity, as well as post traumatic limb deformities, bone deficits and nonunions will provide a unique service to patients in the region who often have very few options. This will also form a strong foundation for the education of the orthopaedic residents interested in a variety of subspecialties.

Cure Dominicana continues with the medical leadership of Dr. Ted Beemer. Later this year plans are in place for transitioning his responsibilities to Dr. Dan Ruggles who is a previous resident of mine and subsequently did a pediatric orthopaedic fellowship in Los Angeles. They will continue to need the support of short term specialists as well as those willing to donate their time and resources. The success of that program and the children who have had life changing surgical treatment at that hospital have depended on the expertise and sacrifices of all of us.

The more recent collaboration since the earthquake at Hopital Adventiste d’Haiti continues on as well. A current transition from large volumes of short term earthquake relief volunteers towards a model of medium and long term volunteers with local staff integration is in progress to develop a sustainable program. The hospital has developed a reputation as a premier center for orthopaedic and reconstructive surgery. Orthopaedics is currently being staffed by Mark Perlmutter MD who will hopefully be staying until November when Terry Dietrich MD and his wife Jeannie RN, come to serve on a long term basis. Nathan Lindsey from Loma Linda is serving as assistant administrator along with the tireless work of Brooke Beck RN who continues to provide an essential service at the hospital.

Sunday, July 4, 2010

American Airlines Box Embargo

All volunteers coming to the Dominican Republic and Haiti please be aware of heartless airline agents that will cancel your flight if you are not packed in the appropriate containers.

Whether you're traveling to visit loved ones or making one last business deal, we want to make sure that your checked bags arrive at your destination with you this busy travel season. For that reason, American Airlines and American Eagle will implement limitations on checked baggage and boxes from June 5 - August 24, 2010.

For the destinations identified below, boxes† and excess, overweight (more than 70lbs.), or oversized pieces will not be accepted for transportation. Bags weighing 51-70 lbs. will be accepted with the collection of the applicable charge.

Passengers will be allowed to check a maximum of two pieces which must be within the size and weight limits as follows (dimensional measurements calculated by adding the length, width and height of an item):

  • 1st piece - up to 62 dimensional inches and 50 lbs.
  • 2nd piece - up to 62 dimensional inches and 50 lbs.

†A "box" will be defined as a six-sided container of any size, constructed of cardboard, wood, plastic or metal, which is either square, rectangular or cylindrically shaped and is not normally used for the transportation of items associated with air travel. Plastic tubs/containers and/or coolers are considered to be boxes.

This is a plastic "suitcase" with handles and wheels - acceptable

This is a plastic "box" with handles and wheels - not acceptable

This is a Pelican suitcase with handles and wheels - who knows??

In spite of the six sided and shape definition above it is still unclear what really makes a suitcase a suitcase and a box a box. Maybe it is names like Samsonite and American Tourister instead of names like Rubbermaid and Plano that make a difference. If you want to really be safe cover it in canvas.

AA - Because you have a choice in air travel.

Thursday, July 1, 2010

Team Sinai Impacts Port au Prince

Without using superlatives at the risk of offending our many other wonderful volunteers that we have hosted Haiti, I will say that the recent visit of "Team Sinai" was one of the most impressive to date. This team of 18 people from the well known International Center for Limb Lengthening at Sinai Hospital in Baltimore was led by Dr. John Herzenberg and his wife Merril. Although their stay at Hopital Adventist d'Haiti was only a brief 7 days their volunteer activities started long before and still continue. Due to their extensive trip preparation they came knowing what to expect, properly equipped and even speaking some Creole phrases.

From patient nutrition to clocks on the wall, they came prepared with all the details. The extensive array of surgical equipment and medical supplies that they brought were essential for performing a variety of surgical procedures. During their stay more than 50 surgical cases were realized. In addition to the surgical accomplishments, they enhanced the entire infrastructure to support our patients before and after surgery, and assure good outcomes. Merril even risked a trip across Port au Prince in a taptap to donate her own blood for one of our critical patients.

In spite of volunteers subsidizing the once a day meal cost for our patients, proper nutrition in many of our critically ill patients has still been a challenge. Merril was able to acquire a large supply of Plumpy Nut which the team Sinai members used to top off all of their baggage to the maximum weight restrictions. She also procured the donation of a similar product Medika Mamba which is produced in Haiti and was delivered in a large quantity to our hospital during their stay. Our Haitian patients found both of these products to be quite appealing and made significant progress on their nutritional status and wound healing.

Cases during the week included open reduction of fractures, pedicle screws for a spine fracture-dislocation, hemiarthroplasties for femoral neck fractures, percutaneous pinning of femoral neck fracture, SIGN interlocking nails for acute and old tibia and femur fractures, osteotomies for malunion/nonunion, bone grafting of nonunions, growing rods for osteogenesis imperfecta, external fixator cases, Ilizarov bone transport, wound debridement, VAC changes, and elective clubfeet surgery.

Dr. Herzenberg, who is sought after internationally for his treatment of clubfoot chiefed our Wednesday clubfoot clinic. Mothers who had traveled across Port au Prince, patiently waited for hours, then departed graciously after their children were casted. Although content and thankful little did they know the world class service that they were receiving.

The shared belief of the Jews and Adventists to remember the Sabbath day was a highlight of the week. At sundown on Friday night candles were lit in the Jewish tradition and time was taken to rest. Several emergent cases were necessary to perform on the Sabbath holiday, but this special time of the week helped us to reflect on the real reason we are here to serve - for the our love of God and our fellow man.

Tuesday, May 18, 2010


Staille a 9 year old girl who lives far away heard about the work going on at our hospital and came with her parents to see if her legs could be straightened. Prior to this surgery she was hardly able to walk. Now after a 2 stage procedure to straighten her tibias and derotate the femurs, her legs will function just like all the other kid's.

Sunday, May 16, 2010

Hips in Haiti

Whether you are a donor, a patient, or a volunteer you should know we believe that if you can't do something right than you shouldn't do it at all - especially in Haiti. Whether it is construction, or orthopaedics, we need to make sure our work is "quake proof". Buildings shake; patients often lack follow up, good communication, and many times progress with reckless abandon. Haiti has enough problems without leaving our work subject to future demise, creating even more problems.

This is why CURE International has collaborated with Hopital Adventiste d'Haiti to focus on creating a premier reconstructive surgery center. Inspired by the aftermath of the January 12 earthquake and motivated by ongoing needs, we have developed a referral center for orthopaedic and plastic reconstructive surgery. Calls come in everyday for new cases that need a higher level of care - this week we were referred cases of bone deficits, osteomyelitis, pediatric ortho trauma, post op infections, a pelvis fracture and most recently 3 hip fractures. Most are not easy cases and as time goes on since that Jan 12 afternoon the chronic infections, open wounds, and nonunions are becoming increasingly difficult to treat.

Today was hip fracture day. 3 patients were referred to us from MSF Holland (Doctors Without Borders Hospital).

Patients wait in the pre-op room and get EKG's, chest x-rays, and labs. One had been laying in another facility more than 2 months waiting for this operation - not knowing we were able to perform these operations.

Dr. Don Williamson, CURE volunteer performs anesthesia with Dr. Emilian a Haitian anesthesiologist and his daughter Kelly CNA.

In this case a hemiarthroplasty (replacement of the femoral head) is performed for a chronic displaced femoral neck fracture.

Our second case was a 33 year old man involved in a car accident 1 month ago. We chose to save his native femoral head, reduce the fracture anatomically and reposition the fracture into a better position for healing by performing an osteotomy. We were grateful for the donation of our OEC 9600 c-arm from the Haiti Bones donors which has enabled the performance of these demanding cases.

Frantz takes a post operative x-ray of our last patient of the day. This portable digital x-ray machine donated by Americares enables instant imaging without having to pay for expensive x-ray film.

This is another one of the many hemiarthroplasties performed here since the earthquake. We owe much gratitude to Roger Williams from Temecula, CA for his donation of these implants and Robbie Jackson at CURE DR who spent several days getting them out of customs. These patients will all be up and walking tomorrow with our volunteer therapists from Ukiah Valley Medical Center.

Wednesday, May 12, 2010

The Ideal Resident

Dr. Hasan at 5:55 am waiting to start rounds with updated patient lists for every member of the team.

Unfortunately Hasan Syed PGY5 just left this morning. Future residents will have a tough act to follow. He routinely arises before 5 am for morning prayers after which time he updates the patient census which now has 33 orthopaedic inpatients on it. We are privileged to have a hospitalist, pharmacist, and wound care nurse accompany us on rounds this week. Once rounds are done the ideal resident keeps a written list of all details to be attended to during the day. Clinics begin, the OR begins and he never sits down. Duties of residents (and myself) often include patient transport, mopping OR floors, writing op notes, post op plans & orders, being a cast tech, washing & organizing instruments, and reading up for difficult cases.

Monday, May 10, 2010

Return to the Mission

After a much needed 2 week hiatus from the chaos of the ongoing disaster relief efforts at Hopital Adventiste d'Haiti I returned yesterday to face the challenges. In spite of several recent events regarding reintegration, sustainability, and international communication breakdowns, today was an especially productive and reassuring day. The clinic was filled with patients, 3 operating rooms ran simultaneously, experts from around the Americas worked busily, and administrative meetings reaffirmed the commitment to our mission of serving those in need.

The acclaimed reputation of our hospital from years past has been restored and enhanced because of the excellent services and long term stability that this hospital has provided to the victims of the earthquake and others with urgent and often neglected medical problems. The inherent institutional political challenges after a tragedy of this magnitude have resulted in the following scenarios at other local institutions:
  • Well reputed hospitals have had to completely shut down due to lack of income to pay normal operating expenses and repair damaged infrastructure
  • Attempted survival while refusing the continued expertise of well intentioned foreigners offering free services and destroying the economic norm of local doctors and hospital operations
  • Completely expatriate operated institutions created by foreign NGO's. Some of which have terminated or diminished services due to difficulty with long term sustainability and rapid turnover of volunteers
A mission hospital is by no means immune to institutional politics. Quite the opposite. Many times they are political hotspots due to factors of finance, religion, communication barriers, racial issues, power struggles and small numbers of people working long hours in adverse conditions. In spite of many "challenges" and the inevitable hospital politics we continue to focus on our mission of serving those in need.

We owe our successes to several unique aspects of our institution. First and foremost is the grace of God who has enabled each one of us to serve here with a mission for our fellow man. Many visitors have been impressed that we have both the Haitian staff and our foreign volunteer staff have working together which they have not seen at many other locations around the city. In spite of the fact that we are the closest major medical facility to the epicenter of the earthquake our building did not suffer any significant damage. Although some pre earthquake deterioration had occurred, we have one of the best facilities in the region and have already accomplished major improvements to the physical plant and upgraded many needed pieces of equipment. The commitment of several long term volunteers combined with the efforts short term experts has allowed capacity, excellent services, and stability. We thank our supporting organizations such as the Adventist church, Loma Linda University, CURE International and other collaborators for financially supporting the operational costs during this time when extra services have been provided for thousands of patients who have no ability to pay.

God is with us.Syringofibroadenoma - Before
26 year old girl who suffered for years with a foul smelling tumor on her R foot is doing well after excision and skin grafting. Thank you to Dr. Dror Paley - surgeon, Dr. Craig Zuppan LLUMC pathologist who provided the diagnosis, and the LEAP plastic surgery team.

Sunday, April 25, 2010

Facility Improvements

Volunteers donated US $1 bills to each of the young boys who filled a trash bag with the loose trash that was strewn around the campus. As the donations begin to run out before all the trash was collected the participants were glad to pick up 2 bags per dollar. Our campus is now clean.

Rooms in the SW wing were never finished after the initial construction phase 5 years ago.

Plumbing fixtures and painting was completed by Dr. Peter Nelson and Arpad Soo from San Luis Obispo, CA. The rooms are now ready for patients. We thank the generous donors of Amistad International for the plumbing hardware that was purchased locally as well as in the US.

One of the biggest challenges in preparing these rooms was fixing the sewer system which had been plumbed to drain the toilets onto the front lawn. Arpad, Jerry and crew worked day and night digging trenches around the raw sewage and placing the appropriate drain pipes. Another peculiarity is why the toilet inflow was plumbed into the hot water pipes. Thank you to the expertise of our plumbing crew and their hard work most of these problems are now resolved.

Arpad worked most nights until after midnight repairing leaks and faucets around the hospital. This very important sink in which we scrub our hands before surgery now has new foot pedals thanks to a donation from Ferguson Enterprises in Santa Maria, CA. It is important to use high quality materials as the elements are intense and these sinks sustain a high volume of use.

Scrubbing with the new foot pedals.

Liz Dickinson RN Vice President of Nursing at Loma Linda University Medical Center transformed our operating room with her friend Sylvia. We thank LLUMC and Liz for her hard work and the amazing improvements that were made.

Before this past week there were still cupboards stuffed with instruments from years past. Liz, Sylvia and the Haitian nurses sorted through all of them.

Some sterile packaging of unused instruments dated back to 1952.

The "before" shot of the central sterilization area.

The "after" shot. The newly painted cupboards are awaiting placement of well organized instruments.

New shelving was placed in the sterilization area after relocating the decontamination sink to a separate room.

In spite of our very low infection rate, measures are being taken to continue to make safety improvements for our OR. This decontamination sink had its faucets and drains replaced this week and it was placed in the decontamination room where instruments will be scrubbed prior to bringing them into the sterilization area for final wrapping.

Peter Nelson DDS (R) poses with Kyle Fiess of Maranatha. He used this hammer drill to make approximately 60 holes in the 10 inch walls of the SE wing through which the entire plumbing system will be replaced. Prior to the earthquake the low pressure partially functioning water system delivered water to various plumbing fixtures, many of which were in disrepair. With the installation of a high volume inflow system and increased water pressure many leaks became apparent. This was causing a loss of approximately 7000 gallons of water per day into the walls, foundation, and electrical system of the hospital.

Monday, April 19, 2010

Visit from Adventist World Church President

We were privileged to host a visit from Dr. Jan Paulsen president of the Seventh Day Adventist world church on Sabbath April 17th.

Dr. Jan Paulsen flanked by Dr. Archer - Medical Director and Madame Emily Clotaire - Executive Director HAH, along with national leaders of the Adventist Church in Haiti and others.

From its inception, the Adventist church has been intentional to articulate and practice its mission by communicating the message of the gospel throughout the world. The 15 million member world church continues to support one of the largest systems of mission hospitals and educational institutions in the world.

Pathfinders in front of Haitian police vehicle provide secret service security for the president. The Pathfinders are a worldwide club of Adventist young people involved in service and achievement with some similarities to the Boy Scouts.

The "MASH" vehicle provides transport for the Elder Paulsen's motorcade.

Today, the church operates approximately 175 Adventist hospitals of which about 95 are in developing countries. Loma Linda University in southern California, once called the College of Medical Evangelists, is one of 3 medical schools operated by the Adventist church and was established for the purpose of training physicians to serve in medical ministry around the world. Adventists believe that Christian life includes both spiritual and physical health, thus their involvement in promotion of health and wholeness. Seventh-day Adventists are involved in providing betterment for all human beings and especially reaching out to provide practical help to those affected by disaster as well as others that are underserved and underprivileged.

Loma Linda University Medical Center, Loma Linda CA. "To Make Man Whole"

Saturday, April 17, 2010

Friday, April 16, 2010

More "Junk For Jesus"

A truckload of broken wheelchairs and rusty beds without mattresses arrived at Hopital Adventiste today and workers commenced unloading "the gift." In the image below you can see the look of gratitude on Jerry’s face.
An attempt was made to tell the chauffeur that he had arrived at the wrong location but he assured the staff that there was no mistake.
This incident and post hopefully serves as a gentle reminder that we all need to be careful before donating unclaimed treasures to a third world mission project. Although the needs are great, please examine the practicality of your intent before money and energy for transport then possible disposal is expended.