Monday, March 1, 2010

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...