Monday, September 15, 2014

Hôpital Adventiste September 2014

Dr. Francel Alexis Chief of Orthopaedics at HAH pauses with patient before surgery

Islande is an 8 year old girl with an enlarged left upper extremity.  She has macrodactyly that caused her middle and ring finger to be grotesquely enlarged  requiring amputation of these digits at a young age.  She came to Adventist Hospital with her mother for further treatment of the deformity because they heard that there were some doctors that may be able to help her.  She said the first surgery was done in Cap Haitien by a surgeon named Nelson in 2009.  At first I did not recognize her but after a brief search of my database I found her pre operative images.  This again was a reminder of how sparse the resources are for these patients, how diligent they are in travelling to various parts of the country to look for help, and how important it is for us to make long term commitments in order to build a reputation worthy of the God we serve.
Islande 2009 in Cap Haitien
Islande 2014 HAH

A brief update on the hospital and construction is warranted:
  • Edward Martin was inaugurated last week as the hospital CEO after the resignation of Mdme. Clotaire.  He is taking on the daunting responsibility of creating a financially solvent institution, which requires a major downsizing of staff and the development of some new and innovative business plans.  While paradoxically not loosing the priority of providing top quality care to those who cannot afford it. 
  • Operating room construction is progressing well and the new facility looks beautiful.  Staff will scarcely recognize the layout of the new operating rooms, recovery room and ancillary areas.
  • The new lab is also well on its way to completion and will drastically elevate the level of services offered at the hospital and the perceptions that build our reputation.
  • We were able to perform the same quality and complexity of operations in the provisional operating room in spite of power outages, C-arm malfunctions and an occasional stray fly.

Operating by flashlight in the provisional operating room

There were many dramatic cases this week – each with stories to tell.  Kenn a crippled 7 year old boy with part of his tibia missing from infection was sent by a 16 year old American girl who raised $3000 to have his leg fixed.  Julie who is a 13 year old girl had her right leg injured in the 2010 earthquake causing a partial growth arrest and subsequent development of a severe knock knee deformity.  Marie is a 28 year old women who had a developmental bowed leg since a very young age.  And Phanord a 10 year old boy with a type of dwarfism that causes knock knees.  Each of these people who took just a few hours of our time this week have started down a dramatic pathway of healing that will change their lives. We must remember that it is not our own power that is creating this miracle of healing.  A common thread to all major world religions is the importance of compassion to our fellow man and the acknowledgement of something greater than self.   It is a privilege to be a part of something much greater than ourselves – the God of our fathers and Creator of the universe.  It is also a privilege to be part of a group of people that have contributed so generously to this work in Haiti.  This trip was largely funded by the Foundation for Orthopaedic Trauma  We are grateful for the generosity of this group which makes a huge difference in the lives of each of these children that have been operated.  It also helps us to direct additional funds into the much needed capital expense projects. 

Kenn before and after surgery.  This bone transport procedure will take 47 days to correct the deformity and begin filling in bone which will then consolidate over the next several months.

Icons on the computer programmed prescription show before and after images
Marie before and after surgery for her L tibia Blount's. This case not amenable to acute corrections is treated with Taylor Spatial Frames which operate on the principle of gradual distraction.  This device is adjusted on a daily basis by the patients which allows for extremely precise corrections and less operative morbidity due to minimally invasive surgery.  It will take 44 days to straighten her leg.
Julie prior to surgery

Dra. Adrian giving anesthesia

Genu valgus seen with Ellis Van Creveld Syndrome
Phanord before and after acute correction of B leg deformity

The team (L to R):
Patrick (local host)
Philip McClure MD Orthopaedic Surgeon Brown University RI (planning pediatric orthopaedic fellowship)
Alex Nelson and Austin Thompson (students and carpenters – building furniture for Haitian schools)
Djuro Petkovic MD Orthopaedic Resident PGY-4 Loma Linda University
Robin Kamal MD Hand and upper extremity surgeon, Stanford University
Maria Adrian MD Anesthesia
Scott Nelson MD Team leader
Francel Alexis MD Chief of Orthopaedics HAH (not pictured)
Richard Michel MD Anesthesiologist (not pictured)
Lisa Hwang PT Physical Therapist Loma Linda University (not pictured)

Alex and Charles with one of the desks they built out of recycled pallet wood for a local school