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.