Sunday, June 10, 2012

Morning Roosters

Roosters crow in the distance, the sky is beginning to turn pink, and a mother hen and her babies walk by as I sit in front of the guesthouse on a tropical Sabbath morning.  Soon it will be time to wake up the residents and take them for a run up the hill.  Even in Haiti we try to respect the ACGME guidelines to make sure they get enough rest.  These peaceful moments in the early morning are one of my favorite.  The warm humid air is reminiscent of our time living here in the West Indies.  Soon music will be permeating the campus as worshipers enthusiastically crowd into the local churches.

As I look over this campus – an oasis in the middle of an area of urban squalor, I wonder what it would be like if Albert Schweitzer the well known African missionary doctor were in charge.  Dr. Schweitzer was an advocate of preserving life and protecting nature.  He did not even allow flies to be killed in the dining room or a tree to be cut down in order to make a new entrance into the hospital.  Here at HAH there has been some new construction and some improvements but the deforestation of banana trees in the front corner of the campus has made visible all the trash that did not get hauled away with the foliage and now one looks out to the block wall topped off with razor wire.  It is a scenario representative of many processes here.  Nonetheless work is being done…

Kids Sabbath School at church next door
Dr. Ian Alexander

On a brighter note patients are still arriving from near and far for some of the most sophisticated orthopaedic operations in the country.  Perhaps to the people in Haiti we are analogous to a Cleveland Clinic or Baltimore International Center for Limb Lengthening.  Dr. Ian Alexander, an internationally recognized foot and ankle surgeon joined me this week, in addition to Dr. Sull, resident from Loma Linda, and Dr. Nepple, resident from Washington University in St. Louis.  Dr. Alexander said he came to learn more about pediatric orthopaedics, but all the rest of us learned far more from his breadth of knowledge and surgical expertise.  We even had a a little extra time for a world class lecture on foot and ankle surgery after finishing surgery on Thursday evening.  This was followed by an excellent spaghetti dinner made by Lucia and Maria.
Kati recovering from surgery (see previous post)
Wilner after surgery and before

 Tim Gerke and his two friends Leah and Andrew were a great help in our operating and recovery room.  Tim and Leah are ICU nurses in Portland.  While in between hospital duties they were busy running back and forth to local orphanages, buying food, supervising construction projects and hugging kids.

Tim, Leah and Roosevelt at orphanage

Many of our patients with the most severe deformities are treated with external fixators which in many cases can be programmed with special software to do gradual corrections.  Gradual correction of severe deformity permits safer, less invasive surgery and is often times less painful.  This has a lot of advantages however does require close patient follow up and these operations really are not “over” until the correction is completely corrected weeks to months later.  We did a lot of follow up and fine tuning on cases from our previous trip as well as some checking on expertly performed cases from the Team Sinai trip last month headed up by John and Merrill Herzenberg.  It has been incredible to have surgeons like John come down and put their vast experience at work on exotic and difficult problems. The most incredible part is the lives that are changed by these operations.

View from top of ridge
The week was finished off by a motorcycle ride through Carrefour and up to the top of the ridge.  Some think I tolerate risk, but Dr. Alexander asked if he could go along with me on the back, superseding any risk that I would likely have taken.  Being the driver was enough for me.  To put it in modest terms the road is a rutted, steep track up the hill with loose softball sized rocks covering much of it.  Anyhow we survived the trip unharmed, with appreciation for God’s grace and the $2 a day travelers insurance policy from AHI.

Tuesday, June 5, 2012

Initial Report Haiti June 2012

This is my 8th trip to Haiti since living on the hospital porch for the 6 months after the earthquake.  Sometimes intermittent visits can be quite encouraging since even slow progress can show dramatic improvements.  The volunteer housing has been upgraded to a bunk house on the front of the property, new air conditioners are cooling the operating room and considerable construction has been completed in the private and new pediatric wards.

New Private Ward


Each time I return I am again reminded of the importance of our long term presence here and the dire needs of our patients.  Several weeks ago I was emailed about a 14 year old girl who had fracture dislocation of her spine.  In addition to being paraplegic she was hardly able to sit up due to the severe angulation and pain in her spine.  Kati’s father died several years ago and then her mother was killed in the 2010 earthquake.  She was living with some relatives in a house that had been condemned due to earthquake damage when a wall fell on her last August.  Her friend was also in the house and suffered an amputation of her leg.  When her uncle found out that Kati was permanently paralyzed, he abandoned her at a local hospital.   An operation had been performed by a visiting doctor but this had only made the situation worse.  Fortunately some workers at a spinal cord rehab unit adopted her.  A recommendation had been made for her to go to the United States to have a surgery to straighten her spine, but they were grateful to hear that the same quality operation could be performed right here at Hôpital Adventiste.

Due to the severity of her deformity, the previous operation and the time since injury the spine straightening operation was somewhat of a formidable task.  Her preexisting paraplegia dramatically reduced the stress of the operation, and Lucia’s prayers were appreciated by all as we carefully mobilized the vena cava and aorta around the front of the spine in order to completely straighten her back. 
Spine fracture dislocation before surgery
Straight spine after surgery

Tonight, an 87 year old man who was in a car accident, arrived in our emergency room with an unstable tibia fracture and some severe lacerations that required an urgent operation.  We were able to treat him with a SIGN nail and we just finished at half past midnight.  We have an amazing team consisting of Alan Sull MD ortho resident from Loma Linda and Jeff Nepple MD ortho resident from St. Louis.  Tomorrow, Dr. Ian Alexander who is a foot and ankle specialist will be arriving.  Tim Gerke and Leah are ICU nurses from Portland who are still with our patient in recovery room.  And as usual Lucia and Maria came over from the Dominican Republic.