Sunday, November 13, 2011

Operations Update Hopital Adventiste

Chaos, hard work, excitement and challenges usually eclipse my ability to write reports until the controlled rage of the GE turbines on the 757 pull me into my seat and I start assimilating my thoughts. We fluently lift off into the sky leaving behind a different world, looking down at shacks and rubble with a few new roofs decorating the landscape.

Terry and Jeannie Dietrich spent a year working at HAH

It was a week of mixed emotions. Terry and Jeannie Dietrich moved out on Wednesday to go back to Wisconsin. I felt a sense of defeatism and disappointment that we have not been able to inspire any surgeons to make a long term commitment towards the international orthopaedic program that has blossomed since the earthquake. It has enabled many talented surgeons to come down and effectively use their expertise to give a level of care to the Haitian people, that in some ways is beyond even that in the US. They both did an outstanding job of hosting this flourishing program. Amongst many of their contributions was the training of a couple of orthopaedic technicians – Jeanty and Jean Joel have been well trained to prepare the cases, assist in surgery, and maintain organization of the equipment.

Francel Alexis, myself and Wade Faerber

Francel Alexis is a recent graduate of the Haitian orthopaedic residency and is finishing a year long fellowship sponsored through Cure International. He is now at HAH and will hopefully stay there to help anchor down the orthopaedic program and provide follow up for our patients. His affable personality and motivation are real assets to the program.

Thanks to a donation from Stryker we were able to operate this unstable L2 spine fracture in a 22y man who was struck by a car. Fortunately he had no neurologic deficits.

Natalie before surgery. The Spatial Frame was applied to her R foot in March.

Natalie's feet now, 1 month after frame removal. Gradual distraction has given a complete correction without any open surgery. Hopefully her L foot can be operated on our next trip March 2012.

A beautiful correction of genu valgum from rickets performed by Dr. John Herzenberg June 2011.

An entire family with familial hypophosphatemic rickets presents for treatment of lower extremity limb deformities.

Patients are coming from near and far for treatment of a variety of challenging orthopaedic problems. My visits seem to have progressively selected out more and more of the most challenging cases. The complexity of these cases demands intense follow up which will be difficult to obtain without the experience and organizational skills of Dr. Terry Dietrich. For this reason we had to scale back our enthusiasm for treating some of the more complex problems.

Felancia an 11 year old girl with severe tibia vara. After bilateral femoral and tibial osteotomies using Orthofix external fixators she now has normal alignment of her lower extremities.

Todd Nelson with Chantal and her family. Chantal is a patient who had multistage surgery starting in 2009 in Cap Haitian. They found us in Port au Prince after the earthquake and treatment was completed. Her mom now works at HAH.

On this trip I was joined by Marni for the first few days which of course was a delight, as well as Todd Nelson (physical therapist), Wade Faerber (orthopaedic surgeon), Mike Suszter (orthopaedic resident) and Lucia (nurse) and Maria (anesthesiologist) who come from the Dominican Republic. Unfortunately the beginning of the week started off with multiple episodes of power failures which made it unsafe to operate larger cases and required us to cancel many of the patients who had come from far and near and waited months for their operations. A backup gravity flow water system was decommissioned several months after the earthquake and still has not been revitalized which created problems for washing instruments, bathing and even having drinking water during these prolonged outages. It was disappointing to see the deterioration of this infrastructure from previous experiences. Fortunately a 200 KW generator was purchased for USD $41,000 and installed providing utilities during the last 2 days. The challenges prompted me to reevaluate my own weakness in spirit and rely on a higher power to proceed with boldness and force in the face of adversity. Terry introduced us to his jogging route which provided an invigorating start to the day (especially when we could take showers afterward). As usual, friendships were strengthened, professional growth and interaction was enjoyed, and we were all blessed beyond our services and sacrifices.

Mike returns from shopping at Delimart

The future of the orthopaedic program is a bit fragile at the moment. A synergistic long term commitment between local and international surgeons is needed to continue with the current level of charitable services, quality care and educational opportunities. Many people are committed to short term service which has contributed significantly to the program, however strong surgical leadership is needed to effectively coordinate the efforts of this short term expertise. With our past heritage and current momentum it is my hope that we will be able to revive the mission hospital purpose to serve the poor with high quality services and multiply our blessings through education and empowerment.

Saturday, March 26, 2011

Update from Hopital Adventiste

A 7 year old boy with a scarred and contracted leg hops up and down the street in front of Hôpital Adventiste. He has been doing this for the last 5 years since his leg was burned. He lives with his 9 year old brother, their parents are dead. Never before has there been hope. An excision of some scar tissue with full thickness skin grafting and specialized external fixation has been performed.

Mothers bring their babies with severely clubbed feet. Adventist Hospital is now the national epicenter for the treatment of clubfoot and training of cast technicians who perform specialized casting procedures for these children using the Ponseti technique.

Other mothers come with their adolescents who have spent their childhood walking on the tops of their clubfeet which were never treated. Natalie was treated with a Taylor Spatial Frame which will simultaneously correct both the ankle and midfoot deformities over a period of 3 months.

9 year old Beatrice comes in with bowlegs so severe that she can hardly walk. An acute correction was performed with Orthofix external fixators.

Familiar names and faces still populate the orthopaedic clinics. Many volunteers remember the long nights listening to the shrieks of Mirlanda suffering pain and emotional trauma from an infected femur fracture in the earthquake She lived with us at the hospital for several months and underwent many reconstructive procedures to treat the bone infection in her right femur. Today she walks without a limp.

Sondy a victim of the earthquake who suffered an open tibia fracture that became infected is still unable to walk because of a 6 cm section of his tibia that is missing. He had an Ilizarov fixator applied and will transport bone into the defect which will eventually consolidate and give him a normal leg to walk on.

Staille walking with straight legs finds me and gives me a hug. Love, joy, sorrow, frustration, desperation, and victory all culminate in an overwhelming emotional intensity.

Dr. Dror Paley, world authority on limb lengthening and deformity reconstruction, returned for a 4 day trip consulting and operating on the many challenging cases that continue to present themselves. Because of his teaching, writing and expertise world class operations have been provided to those without hope for any treatment at all.

Dr. Ben Chen a 3rd year orthopaedic resident from Loma Linda University oversleeps after a long night of operating. We are careful not to wake him as we strictly adhere to the ACGME regulations for resident work hours and off duty time.

Without the devotion of Terry and Jeannie Dietrich these complex reconstructive operations would be impossible to realize. It is because of their sacrifice that the system is able to accommodate short term volunteers who return home feeling blessed by being able to help these suffering patients in an efficient and organized way. The volume of patients is difficult to control and they continue to work day and night.

Challenges exist in developing a sustainable economic model for the hospital while focusing on indigent care. Challenges exist in finding living accommodations for the long and short term volunteers. It is absolutely essential that in order to carry on our clinical and educational program that we find a full time expatriate surgeon who is willing to replace Dr. Dietrich when he leaves in November.

The trip began with the usual all night trip from LAX. The nights sleeping on my cot on the back porch were short as every spare moment was spent on clinical duties, organizing equipment and performing essential repairs. The final night was spent operating until 430 am and ended in a hair raising trip to the airport. We struck out in the hospital ambulance knowing that tens thousands of people were swarming the airport in anticipation of the arrival of past president Jean Bertrand Aristide who returned from 5 years of exile arriving one hour before my check in time. With sirens blaring we forged through riotous crowds, over sidewalks and through and police barricades in order to make the return flight.