Sunday, March 21, 2010

Thank You

I often receive a lot of undeserved admiration and accolades for the Haiti disaster relief efforts as well as the medical work we have been doing for the last 5 years on the island of Hispaniola. I say ‘undeserved’ not just to be humble or deny that there has been some sacrifice involved, but because the credit should not be given to me.

First of all God gave me parents that love me, a brain that functions most of the time, and a life of opportunity not known to all. Praise Him.

Second, I have a wife that supports my workaholic tendencies, handles risk, and tolerates discomfort. Her sacrifices have gone far beyond my own and the rewards have been relatively meager. Some have said she deserves a purple heart, others have commented that there is no one who could be more difficult to live with than me. Probably both are understatements. Most wives would not tolerate the gypsy lifestyle and a husband who has very little routine in life. At least the wives of other orthopaedists can make up for their husband’s erratic schedules by going shopping and living in comfort. Instead of complaining she advocates for the poor and injured. She does what it takes to hold the family together and keep me working. She is amazing and deserves more accolades than she gets.

Third, there are many others that also deserve credit – many more than I can list here. All of the many devices that occupy the shelves of my surgical arsenal are gifts from companies and various individuals. All the expertise that surrounds me is a gift of time from many capable and generous individuals. Even many of my personal belongings are gifts. The air mattress I sleep on, the blanket on top of it, the electric fly swatter, 4 out of 5 pairs of shoes I own, and camera – to name just a few. I also owe a lot of credit to all of the people that work full time at the CURE home office to support those of us on the front lines. We often get the credit and they do the work. Robbie Jackson at CURE DR spends most of her working day doing things that I get credit for. I also owe thanks to Steve Bostian, Phil Hudson, and Andrew Haglund our administrative directors in the DR and Haiti who have made big sacrifices to facilitate the ultimate goal of caring for patients. There are hundreds more who deserve accolades, including the many donors who have given money towards this cause.

Friday, March 19, 2010

Dr. Dror Paley and Team

It has been truly a privilege to have Dr. Dror Paley and his team visit our hospital this week. The Haiti relief efforts have been a constantly evolving process. Doctors and nurses have come and gone, injuries have continued to evolve in various ways, and supplies have waxed and waned. Dr. Paley's visit came at a key time in the chronology of the relief efforts. We are now 9 weeks after the earthquake and the evolution of the injured victims is becoming increasingly complex. There are still people with untreated injuries and many others that were operated on who require secondary procedures. This week we were able to take advantage of Dr. Paley's expertise in limb reconstruction and trauma surgery in the treatment of these extremely challenging cases.

Dr. Paley wrote the authoritative reference on limb deformity correction and is recognized worldwide for his pioneering in these concepts. I have been to his course on limb deformity many times and was also able to spend one summer with him and his partners in Baltimore doing a mini fellowship. The concepts learned have revolutionized my thinking and abilities to treat some of the challenging and exotic problems faced in the developing world. His work here this week not only benefited the patients operated but the many that will continue to be treated with the new principles that I always learn from him.

My well used copy of Dr. Paley's book

This week we did more than 30 orthopaedic cases at Adventist Hospital. Maybe not that impressive until one realizes that we were also seeing 30-50 patients a day in our clinic, rounding on all of our post op cases, organizing and refilling all of our instrument trays, transporting patients, cleaning operating rooms and participating in other aspects of the overall hospital management which goes far beyond orthopaedics. The credit for all this work must be given to his entire team as well as the other volunteers at the hospital who are working day and night to make this all possible. The Paley team consisted of:
  • Servando - Ortho PA
  • Jennifer - Ortho PA
  • Mark - Ortho Technician
  • Terry - Operating Rm RN
  • Keith Dowell - General Surgery MD
  • Aviva - Instrumentation Coordinator
  • Jonathan - Public Relations

I have been threatening to hire a few local hit men to kidnap various members of this team, and I can assure you that the ransom will be very high. Their expertise, hard work and caring attitude has enabled us to provide the loving and quality care that we strive for at Adventist Hospital.

Dr. Paley with the electric fly swatter - one of our most valued OR devices

Some of the difficult cases we treated this week included:
  • R hip traumatic dislocation (Injury 12 Jan)
  • Comminuted L subtrochanteric femur fracture
  • R radius and ulna fracture (Injury 12 Jan)
  • L femur fracture (Injury 12 Jan)
  • Revision external fixation and bone grafting tibia fracture
  • Reduction and fixation of ankle malunions (Injury 12 Jan)

When I saw a mother bring her infant child to the clinic with a congenital short femur it was inspiring to see Dr. Paley talk to this mother. She ironically had no idea that she was talking to a world expert who has innovated the most advanced lengthening techniques for treating this rare disorder. Ultimately Dr. Paley had to ask me what we should do about this problem since the normal infrastructure for providing limb lengthening does not exist in Port au Prince. Without letting the logistical challenges limit our thinking we recorded her contact information, made her a follow up appointment and will make future plans to give her the appropriate treatment.

Dr. Paley's Jewish heritage convened well with the Adventist observation of a Sabbath rest. After a busy and rigorous week of work it was much welcomed by all. Dr. Paley and his children Jonathan and Aviva led out in a ceremonial Sabbath blessing on Friday night to remind us of this special time. Because restoration of life is always a priority in the work God has given us we still have some urgent operations to do today, but feel refreshed and blessed as we conclude another week at Hopital Adventiste d'Haiti.

Special thank you to CURE International for providing the logistics and support for these surgical teams and other volunteers helping at the Adventist Hospital that enable top quality reconstructive surgery options for victims of the Haiti earthquake.

For more information on this past week's events and the Paley surgical team please see

Tuesday, March 16, 2010

CURE Nurses

Since our entry into Haiti on January 14 our CURE Dominicana nurses have played a vital role in the CURE relief efforts in Haiti. These nurses are a very special group of dedicated people that have a wide variety of skills. In North America our nurses are much more specialized and typically a scrub nurse does not necessarily know about central supply organization, sterilization processes, or how to take care of pre and post op patients. These Dominican nurses don’t even require union mandated coffee breaks, overtime pay, or political correctness. They typically take up nicknames amongst each other describing various physical characteristics like old, young, fat, skinny, black, brown, or ugly. Whether complementary or derogatory they all indicate endearment.

Their sacrifices and hard work should be truly commended. We entered an environment with no infrastructure, no equipment, and an overwhelming workload. While caring for the patients in a variety of ways, these nurses found time in between cases to assemble instrument trays, mop floors, wash instruments, and organize the storage room amongst many other things. Many caring nurses have come and gone and their work has not been unappreciated but special recognition is warranted to these CURE nurses who have been here with me since day 2 after the earthquake working day and night. Those who have seen them in action can truly appreciate this.

Lucia AKA "Vieja"

Thursday, March 11, 2010

The Donor's Dollar

Disaster relief is typically one of the most inefficient uses of the donor’s dollar. Think about it. Premiums are paid to purchase last minute items, overnight deliveries are made, volunteers are buying last minute air tickets, and extra funds are used for security and support of volunteers in a situation where there is no infrastructure. Due to lack of communication, urgency, and constantly changing needs, heaps of materials arrive that are not always needed. We experienced all of this. (BTW the breast implants and total knee replacement parts that were sent down were not needed at any point during the disaster relief) When the relief efforts are over many of the expensive pieces of donated equipment sit idle, deteriorate or are scavenged. This is not to be critical, many of these factors are uncontrollable and the job has got to be done. It is just the nature of the situation.

At the Hopital Adventiste we are doing a lot more than just disaster relief and because of this, your donations will have much more than just a transient effect. For a short period of time we were buried under the heaps of stuff that was generously provided. But, thanks to Dan and Marilyn Patchin from Portland, OR as well as many other Haitian and American volunteers it is now well organized and we are working efficiently with the needed supplies to offer a top quality level of care to those we serve. The donor’s dollar is also multiplying as we take advantage of synergistic collaborations with other organizations who are interested in our vision for a long term program with the highest of standards. We were very fortunate to receive an autoclave from Hope Force International as well as a portable digital x-ray machine from Americares (see photos).

We thank these organizations for their generosity as well as each and every one of our donors who have generously given. Some of the ongoing weekly expenses that we are currently supporting are:

  • Diesel $3000 for electricity
  • Oxygen $600
  • Transport of equipment and supplies $500
  • X-ray film and envelopes $750
  • Housekeeping, maintenance, & repair supplies $1000
  • Lab supplies $500

One time capital expenses include:

  • Water main $4000
  • Translator honorarium (30 people x 6 weeks) $2700
  • Shelving $5000
  • Generator parts $1000
  • Repair of perimeter wall $5000

In addition, payroll is about $42,000USD per month. All our services are currently offered for free. Without an income source this is not easy to come by, but we must pay our employees as they re integrate back into the workforce.

We want to again thank all of you who have contributed. The challenges ahead are great. But with God’s guidance and power we continue to give our all and not get discouraged.

Tuesday, March 9, 2010

We're making progress

Welcome to the Hopital

Greetings on a beautiful bright and sunny morning here in Haiti. After a quiet weekend of overcast skies, fog, and rain, Monday morning has brought us a cloudless sky and beautiful sunshine. While we continue to face many challenges around the hospital, significant progress is being made and I would like to highlight a few of those areas with some pics.

Patients waiting in the main hallway on a not so mad Monday

Depot Central d'Haiti

Pharmacy stock room

Tent distribution for discharged patients

Thank you all for your prayers and support.

Monday, March 1, 2010

C-arm Arrives

It was an emotional moment when our OEC 9600 C-arm arrived today at the Hopital Adventist d'Haiti. It was on the night of Jan 14 just after my arrival in Port au Prince, less than 48 h after the earthquake that I sent Dr. Jim Matiko a brief message that he should start looking for a C-arm and get it down here as quickly as possible. For those of you who do not know - this is a machine that can give us instantaneous radiographic images. Since their inception in the 1970's they have revolutionized orthopaedic surgery. Seeing the magnitude of the orthopaedic problems, and knowing the time involved in making a transaction of this nature I knew it would be important to initiate the process ASAP. Now less than 7 weeks after the 7.0 we will be able to greatly expand our surgical spectrum. We have a 75 year old man named Albert who was admitted 2 days ago with an intertrochanteric hip fracture who will be the first beneficiary of this new technology tomorrow morning. Even before the arrival of this machine we have been able to do procedures available at few other hospitals in Port au Prince. Because of our long history, our current operations and stability as well as our long term vision we are increasingly becoming a center for advanced orthopaedic procedures. Thanks to the Arrowhead Orthopaedic Group and other donors we have now taken a major step towards fulfilling our vision as a center of excellence.

It was quite a task unloading this monolith. The first image taken was a thumbs up of my right hand. The Haitians were amazed by the technology and one said "where ever the Americans are people will live". We also have a beautiful printer to print the images which the patients keep with their medical record for follow up care.

From Mike Howard MD - Visiting Plastic Surgeon 25 Feb 2010

Dr. Mike Howard is a plastic surgeon volunteering with the LEAP foundation who provides reconstructive plastic surgery and is collaborating with us providing their services at our hospital. His report follows.

During our drive across PAP to Adventist - it was again obvious that the downtown was harder hit; more destruction in the more densly pop areas; or was it the poorer construction? Unconsciously found myself holding my breath as we drove by flattened buildings. The stench of death is still everywhere.

Our route to took us by the harbor. The US Comfort is out there. Pretty cool looking. Rumor has it that the only functional CT scanner in PAP is on the ship. Rumor also has it that they are pulling out soon.

In fact, there are lots of rumors here in Port au Prince. We hear Aristid (sp?) Is coming back. Others swear they will kill him if he does. (That is fact, not rumor). One rumor, broadcast on major radio, blames the French for the quake. ("They got us again." and "It may have been a nuclear bomb from France").

We walked in to Adventist and found a line of patients down the hall waiting to see the plastic surgeon, having been told that they may need surgery. And in fact, most did.

The consistent presence there is by Scott Nelson, an orthopedic surgeon from CURE/loma linda, who's been in Santo Domingo for the several years. He's been doing some monthly work in Cape Haitian, a town a few hours from PaP. They moved their whole operation to PaP shortly after the quake. Having been at Adventist for a few weeks, he is the default International Medical Director there. Overhearing conversations between cases, it appears he too is doing a lot of good, building relations and supporting the existing Haitian admin. The pre-quake relationship between Loma Linda and Adventist has helped tons. They have med students and residents rotating here! Impressive.

A 4th year medical student named Matt took me down the hallway for post-op clinic/wound rounds/pre-op clinic. In a matter of minutes he had my day's OR schedule filled. Matt is awaiting match day, going in to ortho. Here, he has been functioning at much higher of a level than a student. We joked about the 80 hour work week concept here... Internship will be a chip shot for him. Maybe even a buzzkill.

A Canadian fireman then grabbed me and took me out to the hospital's tent city - site of the minor uprising earlier this week. There he had several more surgical cases for me, including a cleft lip and several more wounds for flaps or grafting. We put one more wound on our schedule for the day and gave the rest the name and number of our clinic at HCH. Scott and I coordinated another day of OR time next week for the LEAP team. Easiest OR block time ever negotiated with the OR committee:
Scott, "You guys want a room on Tuesday or Wednesday?"
Mike, " Sure."
Scott: "See you then"

The tents are crazy. There must be over a hundred ranging in size from a Coleman pup tent to a giant white one with a huge red Canadian maple leaf on it. It is almost as magestic looking as the Comfort in the harbor. The tents are packed with cots and matresses. And patients. And family members.

Out in the Canadian tent, between cases, I found my hand patient from earlier this week. I changed his dressing. Several more members of God's Little Cleaning Crew had shown up and been busy over the past 3-4 days. The wound was quite clean. I didn't have time to close him today; hopefully next weeks LEAP team or the ortho guys will be able to do so.

The cases went well. Wendy and Jim did a great job of showing up to a hospital they've never stepped foot in and putting toether an OR room and anaesthsia. Uneventful is good.

All of the patients, save 2, will spend the night in the PACU and then tomorrow get sent outside to the tents.

2 patients with rather complex wounds of an amputation stump and a wrist got VAC'd. Scott had "acquired" 2 VAC machines that were brand new. These were the first VACs placed on patients in this hospital. When they showed up in PACU, the machines created quite a stir. Lots of excited Creole. I told them to trust me, we do this all the time over at HCH (3 times does count as 'all the time', right?). More excited Creole. Then smiles and hugs. Then pictures of Scott, me, a machine and an amp wound vac.

One patient I operated on today really has captured the heart of the Adventist volunteer staff. Scott's wife has written it up in detail and I will forward it when he sends it to me. In short, Rochelle is a 26yo law student who was in class when the quake struck. Her brother, Eddy, dug her out of the school building a day later. Her left arm had to ultimately be amputated below the elbow. Another plastic surgeon had covered the stump with tissue from her groin 3 weeks ago. It had healed well and today she was ready to divide the pedicle connection between her arm and groin. When I get home, I am going to google the surgeon who did her flap to give him some followup on how well she's doing. Tomorrow or Sunday, Matt will discharge her to the tents. Her brother kept hugging everyone.

This case, among many others, really get me thinking about DVT prophylaxis. There is none. All we have is early ambulation and prayer. Have several physical therapy teams here helping with the first. But, as with everything, they need more of both.

A lot of Rochelles story came from a nurse named Brooke. After the quake, she felt a calling to go, so she sold her house and furniture and jumped on Loma Linda train heading south. She's an ER nurse and will be here until May. Maybe longer. She and several others were heading out to a local club tonight for some r&r. "Not everything was destroyed...". Brooke's remaining US possession is a 2009 Subaru outback. Its for sale too. Anyone interested?

The cases went a little longer than we had planned, so our trip back was after dark. I could sense that Jackson wasn't too pleased. I thought it was a security/safety thing, but midway home realized that probably was not it. Rather, with no streetlights, the driving juju was a bit more tense. Same number, if not more pedestrians and motorcycles. Same agressive Jackson driving.

In fact, driving back through downtown felt very big-city comfortable. In the dark, without street lights, all you could see were the people and tent fronts, illuminated by candles and small lights powered by small generators. Rows and rows of port-a-potties. Plenty of little metal grill carts with delicious smelling barbeque. People everywhere, milling about, smiling and laughing. Tents. We all agreed that it felt like camping out for superbowl tickets in NYC. Or Mardi Gras, minus the beads and parades. Until we passed another illuminated pancacked building front and I found myself holding my breath.

We got back to HCH. They had had a good day. The OB pt was extubated in the ICU. Her skin color looked much more appropriate for a Haitian. Chris was very happy.

We collected the rest of the crew, less Jesse and Liz, who were still in the OR w the Haitian OB doing yet another c-section. Not sure how the case would have gotten done without our anesthesia team here...

Over pizza at a nearby resturaunt, we all swapped stories from the day and began processing the past week.

Liz and Jesse joined us late. Spent an hour talking to Liz. She passed on a very big "thank you" to the rest of the team from the Haitian OB doc for the help last night. "She is alive thanks to your team". Quite interesting to get the Hatian-American perspective and hear about her and her husbands interest in returning to live in Haiti. With her nursing skills, the opportunity is endless. I think her eyes were opened as much, if not more, than mine by the the trip.

As we were getting ready to leave, another American team from 2 tables over came over and asked if there was a general/trauma surgeon in our group? They had just been called about 2 gunshot wound patients brought to their hospital. They don't have a general surgeon there. While we made some calls to help locate a general surgeon, I spoke with a nurse on their team, Julie, who quit her job as a news anchor in Duluth to come down. When she goes back, she is headed to NP school.

The stories from this place are amazing and the craziness just does not stop...