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.