Sunday, April 12, 2015

Latest news from Port au Prince

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 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.