On our last day we visited the ruins of the Basilique Notre-Dame. You can walk in under the large chunks of
concrete that dangle from rebar like chandeliers gently swaying in the
breeze. We walked up to the top floor
where the rubble still stands as a solemn reminder of death and destruction.
 |
| Basilique Notre-Dame |
 |
| Basilique Notre-Dame |
The Importance of
What We Do
A few blocks away from the Basilique is a local hospital for which I will keep the name anonymous. I had a good idea
of what the conditions were like but never having been there I asked Dr. Alexis
if we could take a tour of the orthopaedic wards. The situation was even worse than
expected. Patients languishing in
crowded, oppressively hot, foul smelling rooms, some of which were only lit by
tiny cell phone flashlights. One horrible
case after another, many of which would have been avoided with a simple well-performed
operation at the appropriate time. In some cases expensive modern
external fixators were seen carelessly applied with complete neglect for postoperative
care. One patient had 10 inches of his
tibia debrided after a relatively straightforward tibia fracture that got
infected. Now he has been there for 11 months in bed. An
emergent debridement and SIGN nail could have put him back on his feet. Now, an
amputation is the only reasonable option, but no one wants to tell him that so
he just hangs there. His Bible and
Sabbath School quarterly are at bedside.
 |
| Emergency Room HUEH during power failure |
 |
| 11 months and deteriorating |
When we arrive back at HAH, our perception of dilapidation,
disorder, and poor nursing care has changed.
We feel like we have just walked in to the Hilton. But the knowledge of those patients at the
government hospital, still suffering even as I write this report is motivation
to continue our focus on treating the underserved. As we renovate our facility and improve the
level of care we have an urgent need to create a communal ward where the
poorest of patients can be economically cared for.
 |
| Hôpital Adventiste |
The Trip in a
Nutshell
Patient care, administration, and organization were the 3
main areas of focus for this trip. Dr. Mark
Mildren PGY4 ortho resident, Corey Burke 3rd year medical student,
John Anderson MD orthopaedic surgeon LLUSM graduate year 2000 and our two
Dominican essentials Lucia Hernandez RN and Maria Adrian MD anesthesia made up
the team. John’s family - Jeannette,
Joshua, and Kaitlyn as well as my son Chad also joined us and devoted most of
their time towards helping Jonathan Euler and the Beehive organization. Francel had many operations lined up for us
as well as a couple of days of clinic.
Due to John’s sports medicine expertise several arthroscopic surgeries
were performed, we also operated on a spine fracture, and did a number of hip
and lower extremity operations.
 |
| Dra. Maria Adrian transporting patient into operating room |
 |
| Mark Mildren transports patient after surgery |
 |
| Mark sets up radiolucent table for spine surgery |
 |
| Francel Alexis, Mark Mildren and Corey Burke start spine surgery |
 |
| Elaine back table |
 |
| Bone loss from infection |
 |
| After extensive transport and reconstruction bone is consolidating with good alignment and increased length |
 |
| Tibia nonunion 2 years after motorcycle accident |
 |
| Nonunion repair and leg lengthening |
Elaine Lewis who is a surgical tech living at HAH for 6
months had the operating room nicely organized and clean. This was much different than the conditions
that we have been faced with on earlier trips.
She motivated us to organize all of our orthopaedic equipment and other
supplies, which we spent a significant amount of time doing. Corey and Mark learned more about orthopaedic
implants than they ever wanted to know.
A big part of doing safe surgery is knowing what you have and where it
is, perhaps this is even more important than quality lighting and the room that
you are working in. Elaine had hoped
that I would throw away a lot more than I did, but without a reliable supply
chain I convinced her to hold on to some items that we will need in the future,
but this came at the expense of her thinking I am a hoarder.
 |
| Hoarded orthopaedic arsenal |
 |
| Organized stock |
I spent a significant amount of time with Edward Martin the
CEO developing a business plan and working out ways for the volunteer and
orthopaedic program to continue in a sustainable fashion. More about that in subsequent report. We also spent an entire day with Dan Brown
the facilities manager reviewing the entire facility and creating a coordinated
plan for the future use of space and how various physical plant improvement
projects will be prioritized. One
notable aspect of this is the plan to remodel the upstairs area of the HIV
clinic (building in front area of the property) for volunteer team
housing. It is a pleasant space about 3x
the size of the current quarters that has several large bedrooms and a common
area.
 |
| Edward Martin CEO |
 |
| Future volunteer team housing (upstairs) |
 |
| Dr. Alexis giving lecture at HAAOT national Haiti orthopedic conference |
Update on Current
Projects
Although our previous operating room was recently reported
to me as being one of the best in Haiti, in reality it was not adequate for
doing the quality and volume of work that we envision. A major renovation was started in January
2014 and continues at this time. The
outcome of this project is beyond my highest hopes, the time and resources
required for this have also exceeded my expectations. Things are progressing and although I
hesitate to mention it, I have been told that by July 1st we should
be able to move in. They actually said
June 1st but in reality at the current rate I think July 1 is a much
more realistic goal. The one thing for
sure is that the attention to detail, quality of work, and improvement from the
previous facility will not be a disappointment to anyone. Dan Brown who is managing the project is a
perfectionist after my own heart. The
lab is also in beautiful condition and as soon as some cabinetwork is completed
the space will be inaugurated.
 |
| New OR HAH |
 |
| New Lab |
 |
| OR front doors countersunk into wall |
 |
| Dan's well organized tool shop |
 |
| Dan Brown and helper refurbish SS sink |
 |
| Medical Gases installed with US standards using silver welding and nitrogen flushing |
In our review of the facility a high priority has been placed
on a cosmetic renovation of the main floor of the hospital. This will be a relatively simple update
consisting of new electrical fixtures, some plumbing repairs, door and window
repairs, air conditioning repairs and paint.
The contractors who did the construction in the OR renovation have
looked at the project and will be giving estimates of time and expense to
complete this. There are several rooms
which are uninhabitable at this time due to mold and mildew (I mean you can not
even breathe in them). Many others have
rotted doors, bare wires, broken lights and leaky plumbing fixtures. This will be a high profile improvement
project that we will need to raise some funding for.
 |
| Some of the many fixtures needing attention |
In recent years we have not had an organized space in which
to place the patients being prepared for surgery. I have made multiple appeals to have a pre-op
room and finally was granted the space.
This is an important part of patient safety and OR efficiency. Patients have been waiting for surgery in the
hallways and entrances of the hospital.
Sometimes it is confusing to keep them straight, we are not able to
effectively update them on when their operations will start, sometimes moms
slip their hungry children bites of food and then don’t admit it knowing that
their long awaited operation will be delayed or cancelled. When I arrived this time the designated room
was in a state of disrepair without immediate plan for inhabitance. Fortunately Chad became an expert painter
last summer when he painted our house and was able to take over the job and
execute a one-day makeover that met the approval of Dan’s quality
expectations. Patients were moved in on
Monday morning utilizing 6 new gurneys.
IV’s were started, gowns placed and the day of surgery progressed with a
new level of patient safety, efficiency and comfort.
 |
| Dan inspects Chad's work in the Pre Op room |
 |
| First patient getting IV started in Pre Op room |
Future Plans
Alex Coutsompos MD was a 4th year medical student
who came to volunteer in 2010 after the earthquake. He is now finishing his general surgery
residency at Loma Linda University and has made a commitment to live in Port au
Prince with his wife and new baby and work at HAH for the next five years. Also some classmates of his Joseph Kim MD (ER
physician) and his wife (pediatrician) have made a long-term commitment to
living and working at HAH. This will
revolutionize the current collaboration and quality of services at HAH and will
be the largest dose of adrenaline given in the resuscitation of this hospital
to date.
John Anderson MD and his family who were with us on this
trip came not only as short-term volunteers, but, with the intention of
learning about how they can perhaps be involved on a long-term basis. They have positioned themselves to be free to
answer God’s calling and if it so be, would consider a full-time relocation to
Port au Prince. The synergy that this
could create for our orthopaedic program would be unprecedented, and as much as
I would like to see this happen I mention it not to commit them but that we all
keep this in a spirit of prayer as to what God has in mind for their family and
the future of our orthopaedic department at HAH.
Donors Note
The accomplishments and plans mentioned above do not happen
without the support of our generous donors.
I would like to thank those who have contributed in a special way and
remind you that your investment is making a difference for the people of
Haiti. It is being used in a judicious
and efficient fashion to rejuvenate the hospital physical plant in order to
more adequately reflect the quality of medical work and the healing ministry of
Jesus Christ that we represent. The
permanence of physical plant restoration is satisfying but even more
substantial is the lasting effects of the operations we perform on the lives of
our patients. The physical burdens
lifted by the operations we perform often make a lifetime of difference and
even affect subsequent generations. In
the cosmic scheme of life you could argue that these acts of kindness last
forever, going well beyond the short span of our lives on this planet. We are especially grateful to Foundation for Orthopaedic Trauma for their support of this trip and the operations that were made possible. Continued support is needed and again past support is appreciated.
Posts
