Sunday, February 21, 2010
This drill system was designed out of the need for a safe and sterile low cost solution for an orthopaedic power system in the developing world. Many local surgeons in this environment are using overpowered hardware store type drills that are used with marginal sterile technique and because they often function at over 2000 revolutions per minute, tissue necrosis is created with a host of secondary ill effects.
While the demonstrated system can be created by any adventurous orthopaedic surgeon, considerable effort has gone into researching the appropriate model drill, removing the commercial chuck to allow use of the stainless steel surgical chuck, and creating a cover that is safe and functional.
The components consist of the 9.6v DeWalt cordless drill which is a variable speed drill that has two different gears. The low gear is appropriate for reaming and power driving screws and fixator pins while the high gear is best for drilling. Of all the consumer drills researched the specifications and weight of the DeWalt 9.6v drill most closely matches that of the available orthopaedic surgical drills (for a fraction of the cost). This drill is comfortable for hand surgery as well as for performing ORIF and IMR's of the long bones. The 3 1/2" shaft is canulated up to a certain point allowing the surgeon to safely choke up on K wires.
Directions for use
The nonsterile drill is placed into a sterile cover which is carefully closed by a scrubbed member of the surgical team without touching the drill. The sterile surgical chuck is then threaded onto the 3/8" bolt (clockwise) and the cover is closed. The sleeve covers approximately 2" of the shaft proximal to the Jacob's chuck which provides an adequate sterile margin. At the end of the case the surgical chuck and cover are removed, washed, and sterilized in the autoclave. An ideal set up would include at least 2 surgical chucks and several covers in order to do multiple back to back cases.
Sets are available through Jerry Daly at www.lluglobal.org and are sold for the cost of the materials and shipping. Or you can create your own if you have the patience and time to work out the details.
Wednesday, February 10, 2010
Thanks to the many volunteers interested in helping with the efforts in Haiti, it has become impossible to answer all the individual email inquiries. Planning weeks into the future is also difficult as the situation and needs are dynamic and changing by the day. If you are interested in volunteering or donating please go to www.lluglobal.com or www.cureinternational.org to find out the latest information and sign up. The volunteer teams are scheduled through the Loma Linda Global Health Institute in collaboration with CURE International at the above sites. Our efforts are currently focused at the Hopital Adventiste d'Haiti and include plans to provide ongoing care to earthquake victims while establishing a functional hospital and creating an orthopaedic and rehab focused long term teaching program.
Currently we have had ample surgeons, however nursing and ancillary staff has been in short supply. Many of the employees have lost immediate family members in the quake and have yet to come back to work. As time evolves local workers will fill in some of the workforce needs. However due to the high patient load and current lack of staff, RN, MD, and other ancillary volunteers are needed in the emergency department, pediatrics, OB, and rehab as well as surgery.
Surgical disposables (gowns, gloves, drapes, and dressings) are needed items and will continue to be in short supply. We are currently depending on donations for these items as a functional supply chain has yet to be established. Other needed items can be coordinated through Jerry Daly firstname.lastname@example.org (LLU Global Health Institute) or Heather Hunter email@example.com (CURE International).
The challenges continue as we work for the past, present and future… We work for the past - to repair an infrastructure that was broken long before the earthquake. We work for the present – treating our many patients, some presenting with new injuries, babies being born, and Jan 12 trauma that is becoming increasingly difficult to operate now 4 weeks out. We work for the future – laying the foundation for a long term top quality orthopaedic and rehab program at Hôpital Adventiste d’Haiti.
Hôpital Adventiste d’Haiti (HAH) has a strong reputation in the community and is known throughout
Previous condition of patient rooms
Renovated post operative area
Organized anesthesia equipment
We continue to treat orthopaedic injuries some new, some now 4 weeks old. In addition to orthopaedics the emergency department, pediatric and
Boys in front of Hopital Adventiste d'Haiti
Patient awaiting prostheses
The orthopaedic needs of this country were great before the quake and now they are even greater. Thousands of people will be suffering for years into the future from the injuries that occurred last month. This represents an opportunity and responsibility to lead the way with a quality orthopaedic and rehab program which will provide services otherwise not available in this country. This will likely involve some additional construction with extra OR space, orthotics and prosthetics lab, rehab center and inpatient and outpatient areas. The key factor however, for a long term program is having long term professionals who are willing to make a life sacrifice to teach, build relationships and be here on the ground for more than a few weeks or months at a time. The human and economic resources may seem great, but the sacrifices of our forefathers years ago in establishing this institution were no less significant. And we should not let our minds be limited to what can only be accomplished by menial sacrifice, but hold forth a vision that involves giving our best to these deserving people.