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.
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