CURE CARIBE

Operations Update Hopital Adventiste

2011-11-13T05:03:00.000-08:00

Chaos, hard work, excitement and challenges usually eclipse my ability to write reports until the controlled rage of the GE turbines on the 757 pull me into my seat and I start assimilating my thoughts. We fluently lift off into the sky leaving behind a different world, looking down at shacks and rubble with a few new roofs decorating the landscape.

Terry and Jeannie Dietrich spent a year working at HAH

It was a week of mixed emotions. Terry and Jeannie Dietrich moved out on Wednesday to go back to Wisconsin. I felt a sense of defeatism and disappointment that we have not been able to inspire any surgeons to make a long term commitment towards the international orthopaedic program that has blossomed since the earthquake. It has enabled many talented surgeons to come down and effectively use their expertise to give a level of care to the Haitian people, that in some ways is beyond even that in the US. They both did an outstanding job of hosting this flourishing program. Amongst many of their contributions was the training of a couple of orthopaedic technicians – Jeanty and Jean Joel have been well trained to prepare the cases, assist in surgery, and maintain organization of the equipment.

Francel Alexis, myself and Wade Faerber

Francel Alexis is a recent graduate of the Haitian orthopaedic residency and is finishing a year long fellowship sponsored through Cure International. He is now at HAH and will hopefully stay there to help anchor down the orthopaedic program and provide follow up for our patients. His affable personality and motivation are real assets to the program.

Thanks to a donation from Stryker we were able to operate this unstable L2 spine fracture in a 22y man who was struck by a car. Fortunately he had no neurologic deficits.

Natalie before surgery. The Spatial Frame was applied to her R foot in March.

Natalie's feet now, 1 month after frame removal. Gradual distraction has given a complete correction without any open surgery. Hopefully her L foot can be operated on our next trip March 2012.

A beautiful correction of genu valgum from rickets performed by Dr. John Herzenberg June 2011.

An entire family with familial hypophosphatemic rickets presents for treatment of lower extremity limb deformities.

Patients are coming from near and far for treatment of a variety of challenging orthopaedic problems. My visits seem to have progressively selected out more and more of the most challenging cases. The complexity of these cases demands intense follow up which will be difficult to obtain without the experience and organizational skills of Dr. Terry Dietrich. For this reason we had to scale back our enthusiasm for treating some of the more complex problems.

Felancia an 11 year old girl with severe tibia vara. After bilateral femoral and tibial osteotomies using Orthofix external fixators she now has normal alignment of her lower extremities.

Todd Nelson with Chantal and her family. Chantal is a patient who had multistage surgery starting in 2009 in Cap Haitian. They found us in Port au Prince after the earthquake and treatment was completed. Her mom now works at HAH.

On this trip I was joined by Marni for the first few days which of course was a delight, as well as Todd Nelson (physical therapist), Wade Faerber (orthopaedic surgeon), Mike Suszter (orthopaedic resident) and Lucia (nurse) and Maria (anesthesiologist) who come from the Dominican Republic. Unfortunately the beginning of the week started off with multiple episodes of power failures which made it unsafe to operate larger cases and required us to cancel many of the patients who had come from far and near and waited months for their operations. A backup gravity flow water system was decommissioned several months after the earthquake and still has not been revitalized which created problems for washing instruments, bathing and even having drinking water during these prolonged outages. It was disappointing to see the deterioration of this infrastructure from previous experiences. Fortunately a 200 KW generator was purchased for USD $41,000 and installed providing utilities during the last 2 days. The challenges prompted me to reevaluate my own weakness in spirit and rely on a higher power to proceed with boldness and force in the face of adversity. Terry introduced us to his jogging route which provided an invigorating start to the day (especially when we could take showers afterward). As usual, friendships were strengthened, professional growth and interaction was enjoyed, and we were all blessed beyond our services and sacrifices.

Mike returns from shopping at Delimart

The future of the orthopaedic program is a bit fragile at the moment. A synergistic long term commitment between local and international surgeons is needed to continue with the current level of charitable services, quality care and educational opportunities. Many people are committed to short term service which has contributed significantly to the program, however strong surgical leadership is needed to effectively coordinate the efforts of this short term expertise. With our past heritage and current momentum it is my hope that we will be able to revive the mission hospital purpose to serve the poor with high quality services and multiply our blessings through education and empowerment.

Update from Hopital Adventiste

2011-03-26T07:45:00.000-07:00

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.

KCI Wound VAC Revolutionizes Wound Care in Haiti

2010-07-12T04:43:00.000-07:00

The benefits of V.A.C.^® (Vacuum Assisted Closure^®) Therapy, also known as NPWT (Negative Pressure Wound Therapy) are widely known. This relatively new technology became available in the United States the 1990's and has revolutionized the way we do wound care. Now this technology has arrived at Hopital Adventiste d'Haiti where we have one of the busiest orthopaedic and reconstructive services in the city of Port au Prince. We thank KCI for their generous donation of 10 VAC devices and the accompanying disposables. Our goal is to provide top quality care to the patients we serve and this donation brings a major advancement to the treatment of the many chronic wounds and bone infections that we are seeing due to the Jan 12 earthquake as well as subsequent trauma. It is exciting to give the very best to our patients who have suffered so much.

The stories speak for themselves - these are a few of the many.

Guillame is a 4 year old girl who had severe osteomyelitis of her right forearm. A large amount of dead bone had to be removed however the prognosis is good and with the VAC therapy she only needed to be in the hospital for 1 week.

Luckson is a 21 year old male pictured here with his sister and Rosemarie an occupational therapist from Loma Linda, CA. Luckson had a severe open fracture in the earthquake and was treated elsewhere with a tibial rod which became infected. The implant was removed as well as all infected material, the bone was stabilized with an external fixator and at a later date bone grafted. The VAC has played an essential role in the salvage of his leg which may have been amputated given other circumstances.

It even works for the little ones, this 2 year old girl suffered from osteomyelitis of the tibia and was going to need several sophisticated operations to treat her large wound until the VAC came along and it completely healed without further surgery.

This young man lost his R leg in the Jan 12 earthquake but because of the VAC and a skin graft we were able to save the knee and an adequate amount of bone below in order for him to have a much simpler below the knee type of prosthesis. He is seen here in a tent in front of the hospital.

Mirlanda is an 11 year old girl that is well known at our hospital as we have been battling a very severe infection in her R femur that was fractured in the earthquake. The VAC has played a vital role in her healing.

The VAC has become a badge of honor amongst our patients and they often ask before surgery "are you going to give me one of the machines?".

Thank you to KCI and the wound care nurses and surgeons who have been instrumental in helping bring this technology to those in need.

One way SDQ-LAX

2010-07-08T05:04:00.000-07:00

We won’t call it the “final return” as we already have a trip planned to work again at Hopital Adventiste d’Haiti in August. Nonetheless, the one way ticket symbolizes the close of an era where Hispaniola was home, and the beginning of another, where now we will be merely short term volunteers or tourists when returning to the Dominican Republic and Haiti. The freedoms of lawless driving, inner city living, and caring for gracious Dominicans and Haitians will be on hold.

We leave behind friends who have taught us to value love and relationships as much as the American ideals of performance and production. The difficulties of adaptation will hopefully be softened by our ability to hold on to these world views and remain strong in our intentions to live conscientiously, not forgetting the hardships, suffering and love that we have seen during the past 5 ½ years.

December 30, 2004 En Route to Santo Domingo (NYC subway station) - Chad 7, Alex 5

July 6, 2010 Arrival Los Angeles - Alex 11, Chad 13

Our decision to return to southern California and me to work at Loma Linda University was made with much deliberation and prayer. Yes, we have family and friends there that we love – but we came more for the challenges than for the comforts. My position at Loma Linda allows us to continue with an unchanged mission. Challenge, sacrifice, and most importantly the opportunity to train others for service is what attracted me most to this new position. My education and our unique experiences will hopefully help bring reality to the ideals and dreams of students and young doctors who have come to seek an education at an institution founded upon the precepts of global service and a love for God and mankind.

Loma Linda University Medical Center

I would like to strengthen Loma Linda University Medical Center’s position as a referral center for patients with complex limb and spine deformity. Developing a center of excellence for the correction of congenital limb deformities, limb lengthening, and pediatric spinal deformity, as well as post traumatic limb deformities, bone deficits and nonunions will provide a unique service to patients in the region who often have very few options. This will also form a strong foundation for the education of the orthopaedic residents interested in a variety of subspecialties.

Cure Dominicana continues with the medical leadership of Dr. Ted Beemer. Later this year plans are in place for transitioning his responsibilities to Dr. Dan Ruggles who is a previous resident of mine and subsequently did a pediatric orthopaedic fellowship in Los Angeles. They will continue to need the support of short term specialists as well as those willing to donate their time and resources. The success of that program and the children who have had life changing surgical treatment at that hospital have depended on the expertise and sacrifices of all of us.

The more recent collaboration since the earthquake at Hopital Adventiste d’Haiti continues on as well. A current transition from large volumes of short term earthquake relief volunteers towards a model of medium and long term volunteers with local staff integration is in progress to develop a sustainable program. The hospital has developed a reputation as a premier center for orthopaedic and reconstructive surgery. Orthopaedics is currently being staffed by Mark Perlmutter MD who will hopefully be staying until November when Terry Dietrich MD and his wife Jeannie RN, come to serve on a long term basis. Nathan Lindsey from Loma Linda is serving as assistant administrator along with the tireless work of Brooke Beck RN who continues to provide an essential service at the hospital.

American Airlines Box Embargo

2010-07-04T19:45:00.000-07:00

All volunteers coming to the Dominican Republic and Haiti please be aware of heartless airline agents that will cancel your flight if you are not packed in the appropriate containers.

Whether you're traveling to visit loved ones or making one last business deal, we want to make sure that your checked bags arrive at your destination with you this busy travel season. For that reason, American Airlines and American Eagle will implement limitations on checked baggage and boxes from June 5 - August 24, 2010.

For the destinations identified below, boxes† and excess, overweight (more than 70lbs.), or oversized pieces will not be accepted for transportation. Bags weighing 51-70 lbs. will be accepted with the collection of the applicable charge.

Passengers will be allowed to check a maximum of two pieces which must be within the size and weight limits as follows (dimensional measurements calculated by adding the length, width and height of an item):

1st piece - up to 62 dimensional inches and 50 lbs.

2nd piece - up to 62 dimensional inches and 50 lbs.

†A "box" will be defined as a six-sided container of any size, constructed of cardboard, wood, plastic or metal, which is either square, rectangular or cylindrically shaped and is not normally used for the transportation of items associated with air travel. Plastic tubs/containers and/or coolers are considered to be boxes.

This is a plastic "suitcase" with handles and wheels - acceptable

This is a plastic "box" with handles and wheels - not acceptable

This is a Pelican suitcase with handles and wheels - who knows??

In spite of the six sided and shape definition above it is still unclear what really makes a suitcase a suitcase and a box a box. Maybe it is names like Samsonite and American Tourister instead of names like Rubbermaid and Plano that make a difference. If you want to really be safe cover it in canvas.

AA - Because you have a choice in air travel.

Team Sinai Impacts Port au Prince

2010-07-01T02:42:00.000-07:00

Without using superlatives at the risk of offending our many other wonderful volunteers that we have hosted Haiti, I will say that the recent visit of "Team Sinai" was one of the most impressive to date. This team of 18 people from the well known International Center for Limb Lengthening at Sinai Hospital in Baltimore was led by Dr. John Herzenberg and his wife Merril. Although their stay at Hopital Adventist d'Haiti was only a brief 7 days their volunteer activities started long before and still continue. Due to their extensive trip preparation they came knowing what to expect, properly equipped and even speaking some Creole phrases.

From patient nutrition to clocks on the wall, they came prepared with all the details. The extensive array of surgical equipment and medical supplies that they brought were essential for performing a variety of surgical procedures. During their stay more than 50 surgical cases were realized. In addition to the surgical accomplishments, they enhanced the entire infrastructure to support our patients before and after surgery, and assure good outcomes. Merril even risked a trip across Port au Prince in a taptap to donate her own blood for one of our critical patients.

In spite of volunteers subsidizing the once a day meal cost for our patients, proper nutrition in many of our critically ill patients has still been a challenge. Merril was able to acquire a large supply of Plumpy Nut which the team Sinai members used to top off all of their baggage to the maximum weight restrictions. She also procured the donation of a similar product Medika Mamba which is produced in Haiti and was delivered in a large quantity to our hospital during their stay. Our Haitian patients found both of these products to be quite appealing and made significant progress on their nutritional status and wound healing.

Cases during the week included open reduction of fractures, pedicle screws for a spine fracture-dislocation, hemiarthroplasties for femoral neck fractures, percutaneous pinning of femoral neck fracture, SIGN interlocking nails for acute and old tibia and femur fractures, osteotomies for malunion/nonunion, bone grafting of nonunions, growing rods for osteogenesis imperfecta, external fixator cases, Ilizarov bone transport, wound debridement, VAC changes, and elective clubfeet surgery.

Dr. Herzenberg, who is sought after internationally for his treatment of clubfoot chiefed our Wednesday clubfoot clinic. Mothers who had traveled across Port au Prince, patiently waited for hours, then departed graciously after their children were casted. Although content and thankful little did they know the world class service that they were receiving.

The shared belief of the Jews and Adventists to remember the Sabbath day was a highlight of the week. At sundown on Friday night candles were lit in the Jewish tradition and time was taken to rest. Several emergent cases were necessary to perform on the Sabbath holiday, but this special time of the week helped us to reflect on the real reason we are here to serve - for the our love of God and our fellow man.

Bowlegs

2010-05-18T20:41:00.000-07:00

Staille a 9 year old girl who lives far away heard about the work going on at our hospital and came with her parents to see if her legs could be straightened. Prior to this surgery she was hardly able to walk. Now after a 2 stage procedure to straighten her tibias and derotate the femurs, her legs will function just like all the other kid's.

Hips in Haiti

2010-05-16T16:51:00.000-07:00

Whether you are a donor, a patient, or a volunteer you should know we believe that if you can't do something right than you shouldn't do it at all - especially in Haiti. Whether it is construction, or orthopaedics, we need to make sure our work is "quake proof". Buildings shake; patients often lack follow up, good communication, and many times progress with reckless abandon. Haiti has enough problems without leaving our work subject to future demise, creating even more problems.

This is why CURE International has collaborated with Hopital Adventiste d'Haiti to focus on creating a premier reconstructive surgery center. Inspired by the aftermath of the January 12 earthquake and motivated by ongoing needs, we have developed a referral center for orthopaedic and plastic reconstructive surgery. Calls come in everyday for new cases that need a higher level of care - this week we were referred cases of bone deficits, osteomyelitis, pediatric ortho trauma, post op infections, a pelvis fracture and most recently 3 hip fractures. Most are not easy cases and as time goes on since that Jan 12 afternoon the chronic infections, open wounds, and nonunions are becoming increasingly difficult to treat.

Today was hip fracture day. 3 patients were referred to us from MSF Holland (Doctors Without Borders Hospital).

Patients wait in the pre-op room and get EKG's, chest x-rays, and labs. One had been laying in another facility more than 2 months waiting for this operation - not knowing we were able to perform these operations.

Dr. Don Williamson, CURE volunteer performs anesthesia with Dr. Emilian a Haitian anesthesiologist and his daughter Kelly CNA.

In this case a hemiarthroplasty (replacement of the femoral head) is performed for a chronic displaced femoral neck fracture.

Our second case was a 33 year old man involved in a car accident 1 month ago. We chose to save his native femoral head, reduce the fracture anatomically and reposition the fracture into a better position for healing by performing an osteotomy. We were grateful for the donation of our OEC 9600 c-arm from the Haiti Bones donors which has enabled the performance of these demanding cases.

Frantz takes a post operative x-ray of our last patient of the day. This portable digital x-ray machine donated by Americares enables instant imaging without having to pay for expensive x-ray film.

This is another one of the many hemiarthroplasties performed here since the earthquake. We owe much gratitude to Roger Williams from Temecula, CA for his donation of these implants and Robbie Jackson at CURE DR who spent several days getting them out of customs. These patients will all be up and walking tomorrow with our volunteer therapists from Ukiah Valley Medical Center.

The Ideal Resident

2010-05-12T21:03:00.000-07:00

Dr. Hasan at 5:55 am waiting to start rounds with updated patient lists for every member of the team.

Unfortunately Hasan Syed PGY5 just left this morning. Future residents will have a tough act to follow. He routinely arises before 5 am for morning prayers after which time he updates the patient census which now has 33 orthopaedic inpatients on it. We are privileged to have a hospitalist, pharmacist, and wound care nurse accompany us on rounds this week. Once rounds are done the ideal resident keeps a written list of all details to be attended to during the day. Clinics begin, the OR begins and he never sits down. Duties of residents (and myself) often include patient transport, mopping OR floors, writing op notes, post op plans & orders, being a cast tech, washing & organizing instruments, and reading up for difficult cases.

Return to the Mission

2010-05-10T21:19:00.000-07:00

After a much needed 2 week hiatus from the chaos of the ongoing disaster relief efforts at Hopital Adventiste d'Haiti I returned yesterday to face the challenges. In spite of several recent events regarding reintegration, sustainability, and international communication breakdowns, today was an especially productive and reassuring day. The clinic was filled with patients, 3 operating rooms ran simultaneously, experts from around the Americas worked busily, and administrative meetings reaffirmed the commitment to our mission of serving those in need.

The acclaimed reputation of our hospital from years past has been restored and enhanced because of the excellent services and long term stability that this hospital has provided to the victims of the earthquake and others with urgent and often neglected medical problems. The inherent institutional political challenges after a tragedy of this magnitude have resulted in the following scenarios at other local institutions:

Well reputed hospitals have had to completely shut down due to lack of income to pay normal operating expenses and repair damaged infrastructure
Attempted survival while refusing the continued expertise of well intentioned foreigners offering free services and destroying the economic norm of local doctors and hospital operations
Completely expatriate operated institutions created by foreign NGO's. Some of which have terminated or diminished services due to difficulty with long term sustainability and rapid turnover of volunteers

A mission hospital is by no means immune to institutional politics. Quite the opposite. Many times they are political hotspots due to factors of finance, religion, communication barriers, racial issues, power struggles and small numbers of people working long hours in adverse conditions. In spite of many "challenges" and the inevitable hospital politics we continue to focus on our mission of serving those in need.

We owe our successes to several unique aspects of our institution. First and foremost is the grace of God who has enabled each one of us to serve here with a mission for our fellow man. Many visitors have been impressed that we have both the Haitian staff and our foreign volunteer staff have working together which they have not seen at many other locations around the city. In spite of the fact that we are the closest major medical facility to the epicenter of the earthquake our building did not suffer any significant damage. Although some pre earthquake deterioration had occurred, we have one of the best facilities in the region and have already accomplished major improvements to the physical plant and upgraded many needed pieces of equipment. The commitment of several long term volunteers combined with the efforts short term experts has allowed capacity, excellent services, and stability. We thank our supporting organizations such as the Adventist church, Loma Linda University, CURE International and other collaborators for financially supporting the operational costs during this time when extra services have been provided for thousands of patients who have no ability to pay.

God is with us.Syringofibroadenoma - Before
26 year old girl who suffered for years with a foul smelling tumor on her R foot is doing well after excision and skin grafting. Thank you to Dr. Dror Paley - surgeon, Dr. Craig Zuppan LLUMC pathologist who provided the diagnosis, and the LEAP plastic surgery team.

Facility Improvements

2010-04-25T10:10:00.001-07:00

Volunteers donated US $1 bills to each of the young boys who filled a trash bag with the loose trash that was strewn around the campus. As the donations begin to run out before all the trash was collected the participants were glad to pick up 2 bags per dollar. Our campus is now clean.

Rooms in the SW wing were never finished after the initial construction phase 5 years ago.

Plumbing fixtures and painting was completed by Dr. Peter Nelson and Arpad Soo from San Luis Obispo, CA. The rooms are now ready for patients. We thank the generous donors of Amistad International for the plumbing hardware that was purchased locally as well as in the US.

One of the biggest challenges in preparing these rooms was fixing the sewer system which had been plumbed to drain the toilets onto the front lawn. Arpad, Jerry and crew worked day and night digging trenches around the raw sewage and placing the appropriate drain pipes. Another peculiarity is why the toilet inflow was plumbed into the hot water pipes. Thank you to the expertise of our plumbing crew and their hard work most of these problems are now resolved.

Arpad worked most nights until after midnight repairing leaks and faucets around the hospital. This very important sink in which we scrub our hands before surgery now has new foot pedals thanks to a donation from Ferguson Enterprises in Santa Maria, CA. It is important to use high quality materials as the elements are intense and these sinks sustain a high volume of use.

Scrubbing with the new foot pedals.

Liz Dickinson RN Vice President of Nursing at Loma Linda University Medical Center transformed our operating room with her friend Sylvia. We thank LLUMC and Liz for her hard work and the amazing improvements that were made.

Before this past week there were still cupboards stuffed with instruments from years past. Liz, Sylvia and the Haitian nurses sorted through all of them.

Some sterile packaging of unused instruments dated back to 1952.

The "before" shot of the central sterilization area.

The "after" shot. The newly painted cupboards are awaiting placement of well organized instruments.

New shelving was placed in the sterilization area after relocating the decontamination sink to a separate room.

In spite of our very low infection rate, measures are being taken to continue to make safety improvements for our OR. This decontamination sink had its faucets and drains replaced this week and it was placed in the decontamination room where instruments will be scrubbed prior to bringing them into the sterilization area for final wrapping.

Peter Nelson DDS (R) poses with Kyle Fiess of Maranatha. He used this hammer drill to make approximately 60 holes in the 10 inch walls of the SE wing through which the entire plumbing system will be replaced. Prior to the earthquake the low pressure partially functioning water system delivered water to various plumbing fixtures, many of which were in disrepair. With the installation of a high volume inflow system and increased water pressure many leaks became apparent. This was causing a loss of approximately 7000 gallons of water per day into the walls, foundation, and electrical system of the hospital.

Visit from Adventist World Church President

2010-04-19T20:19:00.000-07:00

We were privileged to host a visit from Dr. Jan Paulsen president of the Seventh Day Adventist world church on Sabbath April 17th.

Dr. Jan Paulsen flanked by Dr. Archer - Medical Director and Madame Emily Clotaire - Executive Director HAH, along with national leaders of the Adventist Church in Haiti and others.

From its inception, the Adventist church has been intentional to articulate and practice its mission by communicating the message of the gospel throughout the world. The 15 million member world church continues to support one of the largest systems of mission hospitals and educational institutions in the world.

Pathfinders in front of Haitian police vehicle provide secret service security for the president. The Pathfinders are a worldwide club of Adventist young people involved in service and achievement with some similarities to the Boy Scouts.

The "MASH" vehicle provides transport for the Elder Paulsen's motorcade.

Today, the church operates approximately 175 Adventist hospitals of which about 95 are in developing countries. Loma Linda University in southern California, once called the College of Medical Evangelists, is one of 3 medical schools operated by the Adventist church and was established for the purpose of training physicians to serve in medical ministry around the world. Adventists believe that Christian life includes both spiritual and physical health, thus their involvement in promotion of health and wholeness. Seventh-day Adventists are involved in providing betterment for all human beings and especially reaching out to provide practical help to those affected by disaster as well as others that are underserved and underprivileged.

Loma Linda University Medical Center, Loma Linda CA. "To Make Man Whole"

2010-04-17T21:04:00.001-07:00

Friday, April 16, 2010

More "Junk For Jesus"

A truckload of broken wheelchairs and rusty beds without mattresses arrived at Hopital Adventiste today and workers commenced unloading "the gift." In the image below you can see the look of gratitude on Jerry’s face.

An attempt was made to tell the chauffeur that he had arrived at the wrong location but he assured the staff that there was no mistake.

This incident and post hopefully serves as a gentle reminder that we all need to be careful before donating unclaimed treasures to a third world mission project. Although the needs are great, please examine the practicality of your intent before money and energy for transport then possible disposal is expended.

Another Day

2010-04-13T21:14:00.000-07:00

The Supreme Master send off: Last evening Franz expressed gratitude on SUPREME MASTER TV.COM for the send off of the members of the Supreme Master of Ching Hai International Association. They have been providing over 3000 vegan meals everyday for the last 3 months at our hospital. This was followed by an educational session about the Supreme Master. See http://www.godsdirectcontact.com for more information. Aside from the avoidance of killing cockroaches and a daily 2 and a half hour meditation most Seventh Day Adventists could meet the master's criteria for healthy living, ecological awareness, and avoidance of harmful substances without undue difficulty.

New wheelchairs: Haiti is mobilized by Fundacion HHS (www.funacionhhs.org) who delivered more than 50 wheelchairs to our patients and injured residents living in tents. Thank you.

Nurses Training Session: The new Haitian ortho team learns how to assemble the Synthes cordless drill and load drill bits (L to R is Lilian, Bonhomme, Julie, and Cyril)

A patient waiting outside ortho clinic

Water filtration system: Two motorcycles power the 12v power supply needed for the drinking water filtration system donated by Global Medic. They produce more that 20 bottles (5 gallons ea) of drinking water for the staff and patients

11pm in the kitchen: With the exit of the Supreme Masters the deficiencies of our kitchen, crew and food budget became more evident. Brooke our director of nursing along with 3 physical therapists and some Haitian volunteers finished off their night scrubbing the kitchen.

Situation Update

2010-04-10T18:27:00.000-07:00

CURE volunteer Dr. Jack Frankeny (Harrisburg, PA) comforts an earthquake victim prior to surgery

Two recovering earthquake victims share experiences

Another week of challenge and accomplishment has come to an end. Again a big thank you to all of our supporters in the homeland that make these accomplishments possible and the challenges surmountable. I would like to share a few statistics from the last week to give our supporters a more accurate picture of the great things they are helping to accomplish and help to focus the efforts of incoming volunteers.

4-10 April 2010

71 total patients operated at HAH
34 Ortho/plastics reconstructive cases
26/34 ortho/plastics cases were for earthquake related trauma
8/34 cases were non quake related deformity and tumor cases
8/34 cases were children
165 outpatient ortho patients seen

Volunteer stats

We had approximately 15 foreign volunteers last week on site
We now have 56 volunteers
This time next week we are expected to have 87 volunteers
Our current volunteers hail from more than 11 states and 5 countries
Current volunteer staff includes 5 medical students, 17 physicians/surgeons, 13 nurses, 4 physical therapists, amongst others

Today

Weather - 81 degrees F heavy rains
1 aftershock
5 power failures
8 urgent orthopaedic cases, C-section, and laparotomy

13 y/0 girl with a Taylor Spatial Frame placed for the treatment of a bowed leg

A new birth 9 April 2010

The rooms and halls are filled with patients. More and more patients continue to be referred to our center for reconstructive surgery. Most are suffering the sequelae of severe earthquake related trauma and complications of early surgery performed under less than ideal circumstances.

Reintegration with Haitian staff continues. Those that visit our hospital from other organizations are always impressed by our combined staffing of Haitians and foreigners as many other institutions are completely operated either by one or the other. At times communication barriers and differences in work styles create challenges, however our common goal of extending the healing ministry of Jesus Christ to our patients supersedes our differences. This creates a synergy, educational exchange, and sustainability that benefits our staff and patients.

Teamwork

2010-04-06T22:30:00.000-07:00

Liala (Italy) and Sherry (Texas) program the VAC machine, an advanced wound healing device for difficult open injuries. Working with Handicap International and CBM they have been providing excellent physical therapy for our patients. According to their report we are operating the largest orthopaedic reconstructive surgery service of all the major hospitals in Port au Prince. They are currently seeing 58 patients per day who are admitted or reside in tents on our property. Although our surgical numbers have continued to rise, the onsite therapy census has decreased from over 150 patients several weeks ago. This is due to the relocation of many patients who were living in tents in front of the hospital. We also have 35 amputees on site, many of whom have already received prosthesis thanks to our partnership with HI/CBM.

Our Haitian nurses check out medications from our newly relocated pharmacy. Reintegration is a high priority for all of us as we work towards a sustainable future.

Grigoriy (Loma Linda University MS3) transports patient for surgery with Haitian translator

Dan and Marilyn Patchin (Portland, OR) stand amongst supply boxes that they organized over the last 6 weeks. Dan is a retired OB/Gyn and they did an amazing job of organizing, distributing, and training local personnel to help us use our donations more efficiently.

Rebuilding

2010-04-03T18:45:00.000-07:00

The challenges of rebuilding in Haiti and specifically at the Adventist Hospital are great.

We must remember that Nehemiah also faced a daunting and seemingly impossible task. With God's help he succeeded. The walls of Jerusalem needed to be rebuilt after years of lying in ruins, but the obstacles seemed insurmountable. “Now therefore, O God, strengthen my hands,” he cried out. Nehemiah was a man of prayer and he was a man of action. How long did it take to accomplish this great work that some had said was impossible? Just fifty-two days.

Then the people came to the dedication of the wall and they sang together:
“O give thanks unto the Lord,
For He is good:
For His mercy endureth for ever!”

God is indeed good and He is still with us. As He said to those who were laboring to re-build the temple “Be strong, O Zerubbabel,… and be strong O Joshua…; and be strong, all ye people of the land,… and work: for I am with you, saith the Lord of hosts.” Haggai 2:4

With prayer and action there are still great things to be accomplished.

The "Rebuilders" - Dan Patchin MD - Supplies Chief (L), Bob the Builder (C), and Jerry Northrop - Facilities chief(R). These are some of the silent heroes of HAH, and even if it is taking them more than 52 days to rebuild the infrastructure of Haiti there is no doubt that God is their leader and that great things are being accomplished.

Thank You

2010-03-21T16:56:00.001-07:00

I often receive a lot of undeserved admiration and accolades for the Haiti disaster relief efforts as well as the medical work we have been doing for the last 5 years on the island of Hispaniola. I say ‘undeserved’ not just to be humble or deny that there has been some sacrifice involved, but because the credit should not be given to me.

First of all God gave me parents that love me, a brain that functions most of the time, and a life of opportunity not known to all. Praise Him.

Second, I have a wife that supports my workaholic tendencies, handles risk, and tolerates discomfort. Her sacrifices have gone far beyond my own and the rewards have been relatively meager. Some have said she deserves a purple heart, others have commented that there is no one who could be more difficult to live with than me. Probably both are understatements. Most wives would not tolerate the gypsy lifestyle and a husband who has very little routine in life. At least the wives of other orthopaedists can make up for their husband’s erratic schedules by going shopping and living in comfort. Instead of complaining she advocates for the poor and injured. She does what it takes to hold the family together and keep me working. She is amazing and deserves more accolades than she gets.

Third, there are many others that also deserve credit – many more than I can list here. All of the many devices that occupy the shelves of my surgical arsenal are gifts from companies and various individuals. All the expertise that surrounds me is a gift of time from many capable and generous individuals. Even many of my personal belongings are gifts. The air mattress I sleep on, the blanket on top of it, the electric fly swatter, 4 out of 5 pairs of shoes I own, and camera – to name just a few. I also owe a lot of credit to all of the people that work full time at the CURE home office to support those of us on the front lines. We often get the credit and they do the work. Robbie Jackson at CURE DR spends most of her working day doing things that I get credit for. I also owe thanks to Steve Bostian, Phil Hudson, and Andrew Haglund our administrative directors in the DR and Haiti who have made big sacrifices to facilitate the ultimate goal of caring for patients. There are hundreds more who deserve accolades, including the many donors who have given money towards this cause.

Dr. Dror Paley and Team

2010-03-19T20:10:00.000-07:00

It has been truly a privilege to have Dr. Dror Paley and his team visit our hospital this week. The Haiti relief efforts have been a constantly evolving process. Doctors and nurses have come and gone, injuries have continued to evolve in various ways, and supplies have waxed and waned. Dr. Paley's visit came at a key time in the chronology of the relief efforts. We are now 9 weeks after the earthquake and the evolution of the injured victims is becoming increasingly complex. There are still people with untreated injuries and many others that were operated on who require secondary procedures. This week we were able to take advantage of Dr. Paley's expertise in limb reconstruction and trauma surgery in the treatment of these extremely challenging cases.

Dr. Paley wrote the authoritative reference on limb deformity correction and is recognized worldwide for his pioneering in these concepts. I have been to his course on limb deformity many times and was also able to spend one summer with him and his partners in Baltimore doing a mini fellowship. The concepts learned have revolutionized my thinking and abilities to treat some of the challenging and exotic problems faced in the developing world. His work here this week not only benefited the patients operated but the many that will continue to be treated with the new principles that I always learn from him.

My well used copy of Dr. Paley's book

This week we did more than 30 orthopaedic cases at Adventist Hospital. Maybe not that impressive until one realizes that we were also seeing 30-50 patients a day in our clinic, rounding on all of our post op cases, organizing and refilling all of our instrument trays, transporting patients, cleaning operating rooms and participating in other aspects of the overall hospital management which goes far beyond orthopaedics. The credit for all this work must be given to his entire team as well as the other volunteers at the hospital who are working day and night to make this all possible. The Paley team consisted of:

Servando - Ortho PA
Jennifer - Ortho PA
Mark - Ortho Technician
Terry - Operating Rm RN
Keith Dowell - General Surgery MD
Aviva - Instrumentation Coordinator
Jonathan - Public Relations

I have been threatening to hire a few local hit men to kidnap various members of this team, and I can assure you that the ransom will be very high. Their expertise, hard work and caring attitude has enabled us to provide the loving and quality care that we strive for at Adventist Hospital.

Dr. Paley with the electric fly swatter - one of our most valued OR devices

Some of the difficult cases we treated this week included:

R hip traumatic dislocation (Injury 12 Jan)
Comminuted L subtrochanteric femur fracture
R radius and ulna fracture (Injury 12 Jan)
L femur fracture (Injury 12 Jan)
Revision external fixation and bone grafting tibia fracture
Reduction and fixation of ankle malunions (Injury 12 Jan)

When I saw a mother bring her infant child to the clinic with a congenital short femur it was inspiring to see Dr. Paley talk to this mother. She ironically had no idea that she was talking to a world expert who has innovated the most advanced lengthening techniques for treating this rare disorder. Ultimately Dr. Paley had to ask me what we should do about this problem since the normal infrastructure for providing limb lengthening does not exist in Port au Prince. Without letting the logistical challenges limit our thinking we recorded her contact information, made her a follow up appointment and will make future plans to give her the appropriate treatment.

Dr. Paley's Jewish heritage convened well with the Adventist observation of a Sabbath rest. After a busy and rigorous week of work it was much welcomed by all. Dr. Paley and his children Jonathan and Aviva led out in a ceremonial Sabbath blessing on Friday night to remind us of this special time. Because restoration of life is always a priority in the work God has given us we still have some urgent operations to do today, but feel refreshed and blessed as we conclude another week at Hopital Adventiste d'Haiti.

Special thank you to CURE International for providing the logistics and support for these surgical teams and other volunteers helping at the Adventist Hospital that enable top quality reconstructive surgery options for victims of the Haiti earthquake.

For more information on this past week's events and the Paley surgical team please see http://www.limblengtheningdoc.org/paley_blog.html

CURE Nurses

2010-03-16T04:25:00.000-07:00

Since our entry into Haiti on January 14 our CURE Dominicana nurses have played a vital role in the CURE relief efforts in Haiti. These nurses are a very special group of dedicated people that have a wide variety of skills. In North America our nurses are much more specialized and typically a scrub nurse does not necessarily know about central supply organization, sterilization processes, or how to take care of pre and post op patients. These Dominican nurses don’t even require union mandated coffee breaks, overtime pay, or political correctness. They typically take up nicknames amongst each other describing various physical characteristics like old, young, fat, skinny, black, brown, or ugly. Whether complementary or derogatory they all indicate endearment.

Their sacrifices and hard work should be truly commended. We entered an environment with no infrastructure, no equipment, and an overwhelming workload. While caring for the patients in a variety of ways, these nurses found time in between cases to assemble instrument trays, mop floors, wash instruments, and organize the storage room amongst many other things. Many caring nurses have come and gone and their work has not been unappreciated but special recognition is warranted to these CURE nurses who have been here with me since day 2 after the earthquake working day and night. Those who have seen them in action can truly appreciate this.

Lucia AKA "Vieja"

The Donor's Dollar

2010-03-11T18:08:00.000-08:00

Disaster relief is typically one of the most inefficient uses of the donor’s dollar. Think about it. Premiums are paid to purchase last minute items, overnight deliveries are made, volunteers are buying last minute air tickets, and extra funds are used for security and support of volunteers in a situation where there is no infrastructure. Due to lack of communication, urgency, and constantly changing needs, heaps of materials arrive that are not always needed. We experienced all of this. (BTW the breast implants and total knee replacement parts that were sent down were not needed at any point during the disaster relief) When the relief efforts are over many of the expensive pieces of donated equipment sit idle, deteriorate or are scavenged. This is not to be critical, many of these factors are uncontrollable and the job has got to be done. It is just the nature of the situation.

At the Hopital Adventiste we are doing a lot more than just disaster relief and because of this, your donations will have much more than just a transient effect. For a short period of time we were buried under the heaps of stuff that was generously provided. But, thanks to Dan and Marilyn Patchin from Portland, OR as well as many other Haitian and American volunteers it is now well organized and we are working efficiently with the needed supplies to offer a top quality level of care to those we serve. The donor’s dollar is also multiplying as we take advantage of synergistic collaborations with other organizations who are interested in our vision for a long term program with the highest of standards. We were very fortunate to receive an autoclave from Hope Force International as well as a portable digital x-ray machine from Americares (see photos).

We thank these organizations for their generosity as well as each and every one of our donors who have generously given. Some of the ongoing weekly expenses that we are currently supporting are:

Diesel $3000 for electricity
Oxygen $600
Transport of equipment and supplies $500
X-ray film and envelopes $750
Housekeeping, maintenance, & repair supplies $1000
Lab supplies $500

One time capital expenses include:

Water main $4000
Translator honorarium (30 people x 6 weeks) $2700
Shelving $5000
Generator parts $1000
Repair of perimeter wall $5000

In addition, payroll is about $42,000USD per month. All our services are currently offered for free. Without an income source this is not easy to come by, but we must pay our employees as they re integrate back into the workforce.

We want to again thank all of you who have contributed. The challenges ahead are great. But with God’s guidance and power we continue to give our all and not get discouraged.

We're making progress

2010-03-09T18:24:00.000-08:00

Welcome to the Hopital

Greetings on a beautiful bright and sunny morning here in Haiti. After a quiet weekend of overcast skies, fog, and rain, Monday morning has brought us a cloudless sky and beautiful sunshine. While we continue to face many challenges around the hospital, significant progress is being made and I would like to highlight a few of those areas with some pics.

Patients waiting in the main hallway on a not so mad Monday

Depot Central d'Haiti

Pharmacy stock room

Tent distribution for discharged patients

Thank you all for your prayers and support.

Posted by Andrew Haglund at 8:29 AM

C-arm Arrives

2010-03-01T19:02:00.000-08:00

It was an emotional moment when our OEC 9600 C-arm arrived today at the Hopital Adventist d'Haiti. It was on the night of Jan 14 just after my arrival in Port au Prince, less than 48 h after the earthquake that I sent Dr. Jim Matiko a brief message that he should start looking for a C-arm and get it down here as quickly as possible. For those of you who do not know - this is a machine that can give us instantaneous radiographic images. Since their inception in the 1970's they have revolutionized orthopaedic surgery. Seeing the magnitude of the orthopaedic problems, and knowing the time involved in making a transaction of this nature I knew it would be important to initiate the process ASAP. Now less than 7 weeks after the 7.0 we will be able to greatly expand our surgical spectrum. We have a 75 year old man named Albert who was admitted 2 days ago with an intertrochanteric hip fracture who will be the first beneficiary of this new technology tomorrow morning. Even before the arrival of this machine we have been able to do procedures available at few other hospitals in Port au Prince. Because of our long history, our current operations and stability as well as our long term vision we are increasingly becoming a center for advanced orthopaedic procedures. Thanks to the Arrowhead Orthopaedic Group and other donors we have now taken a major step towards fulfilling our vision as a center of excellence.

It was quite a task unloading this monolith. The first image taken was a thumbs up of my right hand. The Haitians were amazed by the technology and one said "where ever the Americans are people will live". We also have a beautiful printer to print the images which the patients keep with their medical record for follow up care.

From Mike Howard MD - Visiting Plastic Surgeon 25 Feb 2010

2010-03-01T09:37:00.000-08:00

Dr. Mike Howard is a plastic surgeon volunteering with the LEAP foundation who provides reconstructive plastic surgery and is collaborating with us providing their services at our hospital. His report follows.

During our drive across PAP to Adventist - it was again obvious that the downtown was harder hit; more destruction in the more densly pop areas; or was it the poorer construction? Unconsciously found myself holding my breath as we drove by flattened buildings. The stench of death is still everywhere.

Our route to took us by the harbor. The US Comfort is out there. Pretty cool looking. Rumor has it that the only functional CT scanner in PAP is on the ship. Rumor also has it that they are pulling out soon.

In fact, there are lots of rumors here in Port au Prince. We hear Aristid (sp?) Is coming back. Others swear they will kill him if he does. (That is fact, not rumor). One rumor, broadcast on major radio, blames the French for the quake. ("They got us again." and "It may have been a nuclear bomb from France").

We walked in to Adventist and found a line of patients down the hall waiting to see the plastic surgeon, having been told that they may need surgery. And in fact, most did.

The consistent presence there is by Scott Nelson, an orthopedic surgeon from CURE/loma linda, who's been in Santo Domingo for the several years. He's been doing some monthly work in Cape Haitian, a town a few hours from PaP. They moved their whole operation to PaP shortly after the quake. Having been at Adventist for a few weeks, he is the default International Medical Director there. Overhearing conversations between cases, it appears he too is doing a lot of good, building relations and supporting the existing Haitian admin. The pre-quake relationship between Loma Linda and Adventist has helped tons. They have med students and residents rotating here! Impressive.

A 4th year medical student named Matt took me down the hallway for post-op clinic/wound rounds/pre-op clinic. In a matter of minutes he had my day's OR schedule filled. Matt is awaiting match day, going in to ortho. Here, he has been functioning at much higher of a level than a student. We joked about the 80 hour work week concept here... Internship will be a chip shot for him. Maybe even a buzzkill.

A Canadian fireman then grabbed me and took me out to the hospital's tent city - site of the minor uprising earlier this week. There he had several more surgical cases for me, including a cleft lip and several more wounds for flaps or grafting. We put one more wound on our schedule for the day and gave the rest the name and number of our clinic at HCH. Scott and I coordinated another day of OR time next week for the LEAP team. Easiest OR block time ever negotiated with the OR committee:
Scott, "You guys want a room on Tuesday or Wednesday?"
Mike, " Sure."
Scott: "See you then"

The tents are crazy. There must be over a hundred ranging in size from a Coleman pup tent to a giant white one with a huge red Canadian maple leaf on it. It is almost as magestic looking as the Comfort in the harbor. The tents are packed with cots and matresses. And patients. And family members.

Out in the Canadian tent, between cases, I found my hand patient from earlier this week. I changed his dressing. Several more members of God's Little Cleaning Crew had shown up and been busy over the past 3-4 days. The wound was quite clean. I didn't have time to close him today; hopefully next weeks LEAP team or the ortho guys will be able to do so.

The cases went well. Wendy and Jim did a great job of showing up to a hospital they've never stepped foot in and putting toether an OR room and anaesthsia. Uneventful is good.

All of the patients, save 2, will spend the night in the PACU and then tomorrow get sent outside to the tents.

2 patients with rather complex wounds of an amputation stump and a wrist got VAC'd. Scott had "acquired" 2 VAC machines that were brand new. These were the first VACs placed on patients in this hospital. When they showed up in PACU, the machines created quite a stir. Lots of excited Creole. I told them to trust me, we do this all the time over at HCH (3 times does count as 'all the time', right?). More excited Creole. Then smiles and hugs. Then pictures of Scott, me, a machine and an amp wound vac.

One patient I operated on today really has captured the heart of the Adventist volunteer staff. Scott's wife has written it up in detail and I will forward it when he sends it to me. In short, Rochelle is a 26yo law student who was in class when the quake struck. Her brother, Eddy, dug her out of the school building a day later. Her left arm had to ultimately be amputated below the elbow. Another plastic surgeon had covered the stump with tissue from her groin 3 weeks ago. It had healed well and today she was ready to divide the pedicle connection between her arm and groin. When I get home, I am going to google the surgeon who did her flap to give him some followup on how well she's doing. Tomorrow or Sunday, Matt will discharge her to the tents. Her brother kept hugging everyone.

This case, among many others, really get me thinking about DVT prophylaxis. There is none. All we have is early ambulation and prayer. Have several physical therapy teams here helping with the first. But, as with everything, they need more of both.

A lot of Rochelles story came from a nurse named Brooke. After the quake, she felt a calling to go, so she sold her house and furniture and jumped on Loma Linda train heading south. She's an ER nurse and will be here until May. Maybe longer. She and several others were heading out to a local club tonight for some r&r. "Not everything was destroyed...". Brooke's remaining US possession is a 2009 Subaru outback. Its for sale too. Anyone interested?

The cases went a little longer than we had planned, so our trip back was after dark. I could sense that Jackson wasn't too pleased. I thought it was a security/safety thing, but midway home realized that probably was not it. Rather, with no streetlights, the driving juju was a bit more tense. Same number, if not more pedestrians and motorcycles. Same agressive Jackson driving.

In fact, driving back through downtown felt very big-city comfortable. In the dark, without street lights, all you could see were the people and tent fronts, illuminated by candles and small lights powered by small generators. Rows and rows of port-a-potties. Plenty of little metal grill carts with delicious smelling barbeque. People everywhere, milling about, smiling and laughing. Tents. We all agreed that it felt like camping out for superbowl tickets in NYC. Or Mardi Gras, minus the beads and parades. Until we passed another illuminated pancacked building front and I found myself holding my breath.

We got back to HCH. They had had a good day. The OB pt was extubated in the ICU. Her skin color looked much more appropriate for a Haitian. Chris was very happy.

We collected the rest of the crew, less Jesse and Liz, who were still in the OR w the Haitian OB doing yet another c-section. Not sure how the case would have gotten done without our anesthesia team here...

Over pizza at a nearby resturaunt, we all swapped stories from the day and began processing the past week.

Liz and Jesse joined us late. Spent an hour talking to Liz. She passed on a very big "thank you" to the rest of the team from the Haitian OB doc for the help last night. "She is alive thanks to your team". Quite interesting to get the Hatian-American perspective and hear about her and her husbands interest in returning to live in Haiti. With her nursing skills, the opportunity is endless. I think her eyes were opened as much, if not more, than mine by the the trip.

As we were getting ready to leave, another American team from 2 tables over came over and asked if there was a general/trauma surgeon in our group? They had just been called about 2 gunshot wound patients brought to their hospital. They don't have a general surgeon there. While we made some calls to help locate a general surgeon, I spoke with a nurse on their team, Julie, who quit her job as a news anchor in Duluth to come down. When she goes back, she is headed to NP school.

The stories from this place are amazing and the craziness just does not stop...

CURE Drill System

2010-02-21T21:24:00.000-08:00

This drill system was designed out of the need for a safe and sterile low cost solution for an orthopaedic power system in the developing world. Many local surgeons in this environment are using overpowered hardware store type drills that are used with marginal sterile technique and because they often function at over 2000 revolutions per minute, tissue necrosis is created with a host of secondary ill effects.

While the demonstrated system can be created by any adventurous orthopaedic surgeon, considerable effort has gone into researching the appropriate model drill, removing the commercial chuck to allow use of the stainless steel surgical chuck, and creating a cover that is safe and functional.

The components consist of the 9.6v DeWalt cordless drill which is a variable speed drill that has two different gears. The low gear is appropriate for reaming and power driving screws and fixator pins while the high gear is best for drilling. Of all the consumer drills researched the specifications and weight of the DeWalt 9.6v drill most closely matches that of the available orthopaedic surgical drills (for a fraction of the cost). This drill is comfortable for hand surgery as well as for performing ORIF and IMR's of the long bones. The 3 1/2" shaft is canulated up to a certain point allowing the surgeon to safely choke up on K wires.

Directions for use
The nonsterile drill is placed into a sterile cover which is carefully closed by a scrubbed member of the surgical team without touching the drill. The sterile surgical chuck is then threaded onto the 3/8" bolt (clockwise) and the cover is closed. The sleeve covers approximately 2" of the shaft proximal to the Jacob's chuck which provides an adequate sterile margin. At the end of the case the surgical chuck and cover are removed, washed, and sterilized in the autoclave. An ideal set up would include at least 2 surgical chucks and several covers in order to do multiple back to back cases.

Sets are available through Jerry Daly at www.lluglobal.org and are sold for the cost of the materials and shipping. Or you can create your own if you have the patience and time to work out the details.

Haiti Relief Volunteer Information

2010-02-10T17:44:00.000-08:00

Thanks to the many volunteers interested in helping with the efforts in Haiti, it has become impossible to answer all the individual email inquiries. Planning weeks into the future is also difficult as the situation and needs are dynamic and changing by the day. If you are interested in volunteering or donating please go to www.lluglobal.com or www.cureinternational.org to find out the latest information and sign up. The volunteer teams are scheduled through the Loma Linda Global Health Institute in collaboration with CURE International at the above sites. Our efforts are currently focused at the Hopital Adventiste d'Haiti and include plans to provide ongoing care to earthquake victims while establishing a functional hospital and creating an orthopaedic and rehab focused long term teaching program.

Currently we have had ample surgeons, however nursing and ancillary staff has been in short supply. Many of the employees have lost immediate family members in the quake and have yet to come back to work. As time evolves local workers will fill in some of the workforce needs. However due to the high patient load and current lack of staff, RN, MD, and other ancillary volunteers are needed in the emergency department, pediatrics, OB, and rehab as well as surgery.

Surgical disposables (gowns, gloves, drapes, and dressings) are needed items and will continue to be in short supply. We are currently depending on donations for these items as a functional supply chain has yet to be established. Other needed items can be coordinated through Jerry Daly jdaly@llu.edu (LLU Global Health Institute) or Heather Hunter hhunter@cureinternational.org (CURE International).

Rebuilding

2010-02-10T17:21:00.001-08:00

“Haiti doesn't need anything today that it didn't already need before the quake” - previous ambassador to Haiti.

Destroyed church

The challenges continue as we work for the past, present and future… We work for the past - to repair an infrastructure that was broken long before the earthquake. We work for the present – treating our many patients, some presenting with new injuries, babies being born, and Jan 12 trauma that is becoming increasingly difficult to operate now 4 weeks out. We work for the future – laying the foundation for a long term top quality orthopaedic and rehab program at Hôpital Adventiste d’Haiti.

Past

Hôpital Adventiste d’Haiti (HAH) has a strong reputation in the community and is known throughout Haiti. Its previous days of glory can be imagined as one looks at the well designed structures, the sizable grounds, and the devotion of the workers. The hospital was unscathed in the recent earthquake, however, it is evident that in recent years the hospital had all but quit functioning as a hospital and things had deteriorated significantly. Broken, rusty and dirty equipment occupy every room and every corner. Peeling paint and broken fixtures are the norm. Plumbing fixtures are clogged and rusted. And deteriorated “gifts in kind” are piled up everywhere. And the laundry service is using buckets instead of the relatively new commercial washing machine that needed only minor repairs.

Previous condition of patient rooms

Renovated post operative area

Organized anesthesia equipment

Present

We continue to treat orthopaedic injuries some new, some now 4 weeks old. In addition to orthopaedics the emergency department, pediatric and OB ward continue to keep volunteers busy as well. We now have most of the hospital reopened for patient care, rooms have been painted, furniture repaired, and toilets cleaned and recanulated. Some of the most exciting events of the past week were the addition of running water to the building and the inauguration of our pre and post op ward which is now providing reliable, caring and quality service to our patients. We continue to have over 200 patients living in our front yard with more than 1000 friends and family members. This is largely due to the volunteers from the “supreme master of ching hai” who have been making excellent vegetarian meals 3x per day for more than 1200 people.

Boys in front of Hopital Adventiste d'Haiti

Patient awaiting prostheses

Future

The orthopaedic needs of this country were great before the quake and now they are even greater. Thousands of people will be suffering for years into the future from the injuries that occurred last month. This represents an opportunity and responsibility to lead the way with a quality orthopaedic and rehab program which will provide services otherwise not available in this country. This will likely involve some additional construction with extra OR space, orthotics and prosthetics lab, rehab center and inpatient and outpatient areas. The key factor however, for a long term program is having long term professionals who are willing to make a life sacrifice to teach, build relationships and be here on the ground for more than a few weeks or months at a time. The human and economic resources may seem great, but the sacrifices of our forefathers years ago in establishing this institution were no less significant. And we should not let our minds be limited to what can only be accomplished by menial sacrifice, but hold forth a vision that involves giving our best to these deserving people.

Port au Prince – The Initial Days

2010-01-29T13:12:00.000-08:00

To see more images click here (some may be graphic)

Perhaps this disaster represents the greatest accumulation of orthopaedic injuries to ever occur in one place at one time. Here in Santo Domingo it felt just like another California earthquake, but soon word arrived that it was far worse. Having made 19 previous trips to operate in Haiti over recent years we were able to rapidly prepare our armamentarium and make plans to mobilize to Port au Prince, 160 miles to the west. By the time we departed on Thursday afternoon less than 48 hours after the earthquake, the chaos of early response teams was just beginning. We lifted off without knowing if we would be able to land in PAP or if there would be anyone to receive us. It was like going into a black hole as we had no information aside from what we were all seeing on CNN. We were prepared with food and water to survive for 2 days and no return ticket.

Team members were:

Steve Bostian – Executive Director CURE DR

Dielika Charlier MD – Pediatrician

Lucia Hernandez RN

Scott Nelson MD - Orthopaedic Surgery

Susan Beemer RN – anesthetist

Dielika grew up in PAP and was able to get a single text message through to Johnny Boulos a friend of her brother. After circling the airstrip 20 times we were able to get clearance to land the plane for 3 minutes. We made a steep descent and dumped our equipment onto the airfield and our pilot quickly returned to the air. Fortunately, Johnny had waited for us all afternoon and was there to greet us. To make a long story short we are indebted to the entire Boulos family for their hospitality and generosity in facilitating everything that we were able to accomplish during the last 2 weeks.

We initially made some brief visits to assess the operating facilities at approximately 6 different hospitals. 48-72 hours after the quake there was still not a single operation going on at any of the hospitals that we visited except for Hopital Adventiste d’Haiti where the innovative local medical director had created an operating room tent out of surgical drapes and was performing life saving amputations in front of the hospital. His nurse in the yellow short sleeve dress had just returned to work. She had been comforting her 10 year old son for who was trapped under a cement girder for 36 hours after the quake. A UN crane finally had come to free him and as the heavy cement girder was lifted it slipped from the grip of the crane… Another worker was at the hospital looking for 8 body bags for her family members. At every facility there were hundreds of languishing patients, most of whom were laying outside due to fear of aftershocks. Many of them were developing gangrene, some dying, and others already dead. It was utter chaos and no help was in sight. Where should we start…

With promises to return and help Dr. Archer, the medical director at Adventist Hospital, I returned to the Hopital de la Communaute Haitien where our team had already begun setting up. Here we had earlier discovered two operating rooms with electricity, running, water and even air conditioning a luxury in Haiti under normal circumstances. Due to our timely arrival and preparedness we were able to establish a leadership role at this facility and coordinate subsequent surgical teams who arrived to help. I began operating on Friday afternoon – 3 days had now passed since the quake. For the first several days operations consisted of life saving amputations and debridements. Injuries were far worse than they appeared due to the extensive soft tissue damage from crush injuries. This caused compartment syndromes (uncontrolled swelling which leads to vascular compromise) and then to gangrene. Patients were dehydrated, decompensated, and anemic. There was no mechanism or time to get labs, nor anything we could do differently had we been able to accurately assess their status. Patients were dying in the hallway outside the OR while waiting for surgery. Some who were operated died as well, as they were already too critical to save. This presented another difficulty in deciding whether to operate the most serious patients first or concentrate on slightly less critical patients who had a better chance of survival.

After 24 hours of operating, a team from the Hospital for Special Surgery in New York City arrived. They had flown down on the Synthes plane fully loaded with an extensive array of donated implants and materials. Their expertise and equipment combined with the momentum we had already established allowed us to continue operating in both rooms day and night for the next 3 days catching only a couple hours of sleep here and there. We are deeply indebted to the Synthes company and the timely arrival of this team which allowed us to salvage many severe injuries that would have otherwise been amputated. It was an operative marathon like none other and as the hours passed periods of daylight and nighttime melted into one long day. Emotions were high and fatigue was intense. I worked day and night for 6 days until I felt like I was starting to loose my focus and was able to escape the hospital and get a full 6 hours of sleep.

During the first few days the situation went from bad to worse. The many injured patients were developing infections and gangrenous limbs faster than we could operate. A couple days after we began operating the stench of death strengthened and permeated the hallways and courtyards of the hospital. Dead limbs still attached to patients, dead bodies, and amputated parts all contributed. Slowly we were able to overcome this and each day the hospital seemed to metamorphose. Patients were operated, volunteers showed up with bleach, halls were cleaned and chaos was organized little by little. An entire hospital infrastructure was to be created in the ensuing days. Masking tape was used on the foreheads of the victims to delineate OR 1 – emergent cases, or OR 2 – operative but less emergent cases. The first 4 days were spent operating only on OR 1’s which consisted of open fractures, compartment syndromes, and treating severe open wounds and infections.

Wednesday morning one week after the quake the 6.1 aftershock hit and all the patients rapidly cleared the hospital building. We took advantage of the situation by mopping the halls and slowly bringing all the patients back in to the building one by one in an organized fashion. Luckily we had arisen 15 minutes before the shock as part of the cement wall above our heads had collapsed where we had been lying.

Over a period of one week we were able to convert several adjacent rooms into operating rooms and the 2 room OR suite became a 6 room operating facility where we coordinated surgical volunteers from all over the US, Sweden, Jamaica, and Korea and other countries. The arrival of the Dallas team on a chartered 737 with several tons of equipment was a great boost our dwindling operating room supplies and fatigued OR crew. We had to stop surgery for several hours to organize, but in short order we were almost equipped like an American style operating room. During the subsequent 24 hours we treated more than a dozen femur fractures using the SIGN intramedulary nail system. The SIGN nail is a state of the art implant system design for use in resource challenged environments where intraoperative x-ray is not available. We were privileged to be operating with the founder and inventor of the system, Dr. Lew Zirkle who had previously treated a record number of 5 patients in a single day using the implant. In most cases these severely injured patients with femur fractures could immediately begin unrestricted ambulation.

We continue in collaboration with the Hopital Adventiste d’Haiti where the situation is very similar to the Hopital de la Communaute Haitien. The arrival of Dr. Brad Walters from Georgia and Andrew Haglund from Loma Linda University established coordination efforts at that facility. Initial plans are being made to create a large scale ongoing project to treat the generations of people that will be affected with orthopaedic needs for years to come at this facility.

It did become necessary to place armed security at the entrance of the hospital and other strategic locations to provide crowd control and resolve some looting that began to take place as food and supplies arrived on site. However, I personally never felt unsafe and would dare to say that with the additional military and NGO presence, most parts of Port au Prince may be more secure now than they have been in a long time. Of course many render my opinions on security as worthless as they consider me to have a lack of risk aversion.

It was a trip of physical endurance, emotional intensity, and spiritual contemplation. It brought my mind back to a scene several years ago of one of our Haitian patients who fell asleep with her Bible open to Psalm 46.

God is our refuge and strength,

an ever present help in trouble.

Therefore we will not fear, though the earth give way and the mountains fall into the heart of the sea, though its waters roar and foam and the mountains quake with their surging.

Ps 46:1-3

On January 25 I returned to Santo Domingo for several days to be with family and attend to my responsibilities. On Saturday January 30 Marni and I will be driving back to Port au Prince to continue the work and relieve those that are on the scene at the moment. We are living day by day and will focus our efforts where we are most needed during the ensuing months.

I would like to acknowledge the efforts of our team members not mentioned above who were also working day and night to support the efficiency of our operation both in Port au Prince and around the world. These in include my wife Marni in Santo Domingo, Robbie Jackson - Cure DR, Erin Card - Cure US, Jeff Douglas and Andrew Haglund in Port au Prince and the many other medical personnel who rapidly activated the delivery of their expertise and medical supplies.

To see more images click here (some may be graphic)

CURE Team Leaves for Port au Prince

2010-01-14T01:53:00.000-08:00

National Palace Jan 2005

Thursday morning a CURE team from the Dominican Republic including our medical and executive directors will be flying to Port au Prince with relief medical supplies, prepared to offer emergency surgery for trauma victims. We will plan to establish a secure base to receive victims, supplies, and collaborate with volunteers. There are still many unknowns about the situation and survival even for our team may be a challenge as even the most basic necessities are not available. We will keep our readers and those who have inquired about ways to help up to date on the situation there as information becomes available.

Trip 19 Cap Haitien, December 2009

2009-12-14T02:51:00.001-08:00

Once again we return from another busy week at the Justinien University Hospital in Cap Haitien. As usual we had a busy clinic on Monday evaluating all types of problems many of which are rare and challenging. The following 4 days and nights are filled with operations. We come prepared to treat just about anything in spite of the relatively primitive conditions. Most of the patients we treat have no other options and would often be left to a life of disability. Even after many experiences in Haiti the people and the conditions encountered leave one in awe of the human suffering and motivate each one of us to try and do more.

Due to the regularity of our trips every 3 months we are able to provide relatively reliable follow up care in addition to what the local doctors help us with. It was exciting to see Chantale the 6 year old girl who previously was unable to stand up straight due to severe burns that she suffered after sitting on a kerosene lantern when she was 4 years old. During our last trip she was operated and her hip flexion contractures are resolved. She awaits release of her right shoulder and elbow on our next trip March 8, 2010.

A special thanks to Dr. Wade Faerber (orthopaedic surgeon), Dr. Matt Klima (orthopaedic resident), Dave Tunon (Synthes) and Andy Magan (anesthetist) who came from California to participate in this trip along with Dr. Scott Nelson and the CURE Dominicana team.

Spinal Deformity CURED

2009-12-14T02:41:00.001-08:00

In order to provide the state of the art care to our patients who suffer from scoliosis and other spinal deformities an entire team is orchestrated consisting of experienced surgeons and nurses, experts in anesthesia, a neuromonitoring technician, an implant vendor, and pediatric intensive care doctor. Each plays an important role in the overall process and the quality results that are obtained. Thanks to the generosity of Biomet Spine and several people who have donated their time for children in the Dominican Republic we were able to again realize a successful week of spinal deformity surgery. Our goal is to give even the most economically challenged patients the opportunity to have a surgery that is equivalent to what is performed in the best medical centers in the United States. Thank you to Dr. Ray Woo, Dr. Henri Acosta and each of the important team members that helped make these life changing surgeries possible.

Limb Deformity Course CURE Dominicana

2009-12-14T02:05:00.000-08:00

Date: 25 January 2010
Time 8am -6pm

Course Directors:
Scott Nelson MD
Medical Director CURE Dominicana
Santo Domingo, Dominican Republic

Shawn Standard MD
Rubin Institute for Advanced Orthopaedics
Baltimore, Maryland USA

Sponsored by CURE Dominicana with participation of Dr. Micaias Perez, Dra. Honna Silfa, Dr. Cesar Coradin

Cost: 3000DOP (discounts available for residents)

Preliminary Agenda:
Basic Limb Alignment
Basic Deformity Analysis
Blounts Disease
Bone Transport
Knee Contractures
External Fixation Workshop

Please call 809-682-5022 for more information or email Robbie Jackson at j_robbie@hotmail.com

Trip 18 Cap Haitien 21-26 Sept 2009

2009-10-24T19:28:00.000-07:00

Chantale is a 6 year old girl who was badly burned last year when she sat on a kerosene lantern. Our hearts were saddened when we saw her for the first time last February. Due to the scarring she was unable to stand up, separate her legs or move her right shoulder and elbow. Her caring mother brought her again in June I promised that I would do something when I returned in September, not knowing if I would have the help I needed to do the case. Fortunately we were joined by Dr. Duncan Miles a plastic surgeon from Loma Linda University. After 5 hours of surgery we were able to excise the scars around the hip joints and rotate some normal tissue into place allowing her once again the freedom to stand up. The following morning I asked her how she felt and from under her mosquito net she replied “Sa va bien et toi monsieur?” In one of our future trips we will plan to release her shoulder and elbow contractures allowing her the use of her right hand.

We were joined on this trip by Dr. Brian Yost one of my orthopaedic surgery partners from Riverside County Regional Medical Center. He also brought with him Louise O’Rourke RN director of operative services and “Dr. Sagoo 2” one of our excellent ortho residents training at RCRMC. Their expertise, help and donations greatly added to our efficiency, quality of care, and international comraderie. As usual our Dominican anesthesiologist and 2 nurses were on fire from early in the morning until the late hours of the night.

We are progressing with plans to transition our quarterly trips into a more sustainable program that will involve several surgeons who are committed to making regular trips to Cap Haitien which will continue with the same frequency. We are planning the construction of some extra operating and storage space which will facilitate volunteers to provide services independent of our Dominican team and the armamentarium of equipment that we haul back and forth from Santo Domingo for each of these trips.

Our next trip will be Nov 29-Dec 12, 2009.

Announcing Release of Tolerances 3rd Ed.

2009-10-22T20:22:00.000-07:00

This 100 page orthopaedic pocket book that offers invaluable information for orthopaedic residents and practicing orthopaedic surgeons. It is a comprehensive collection of acceptable ‘tolerances’ for fracture alignment as well as other essential numeric data that should be at the fingertips of orthopaedic surgeons. As Einstein said “don’t memorize anything that you can look up”. It is concisely referenced to major orthopaedic textbooks and landmark articles. Click the cover images to order your copy on amazon.com. This publication is not affiliated with CURE International and all proceeds benefit the Loma Linda University orthopaedic residency program.

Haiti Trip June 1-5 2009

2009-06-07T19:23:00.000-07:00

Trip 17. We return every 3 months to Justinien University Hospital in Cap Haitien. As the major referral center for all of northern Haiti there is never a lack of work. The only orthopaedist in the region is planning to retire in the near future and many languishing patients are accumulating without resources or hope for urgent operations. Because of our commitment to quarterly visits we are able to provide adequate follow up for much of the work that we do. In spite of seeing many suffering patients we were encouraged to see some of our patients whose lives have been changed one by one due to our efforts, our supporters, and most of all God's healing touch.

Elena a 4 year old girl before and after surgery for severe clubfoot performed Dec 2008

Loudwige (R) with her sister after having an 85 degree scoliosis curve operated at CURE Santo Dominogo

Mirana a 12 year old girl with cerebral palsy walking for the first time after having severe knee flexion contractures corrected during our last trip.

A 5 year old Haitian boy after having bilateral "ulnarization" procedures performed for radial clubhand.

A mother with her baby cured of his clubfoot after serial Ponseti cast treatment and a minor operation

Dr. Ed O'Laughlin (Baltimore, MD) teaches Haitian resident anesthesia techniques as he puts another patient to sleep.

41 patients were operated during this trip. In spite of operating day and night, unfortunately many patients still had to be turned away.

Subsequent 2009 trips are scheduled for Sept 21 and Dec 7.

Haiti Trip Feb 15-21, 2009

2009-02-25T02:57:00.000-08:00

For more images see http://www.pbase.com/scottnelson/haiti_recent

In spite of 16 trips to Haiti the needs are not declining… This trip we were privileged to have the expertise of Dr. Jim Matiko one of my previous professors from residency at Loma Linda University as well as Geordy a senior orthopaedic resident from New York City. Even more noteworthy than us 3 “gringos” are the 3 Dominicanas – two nurses and anesthesiologist that can worked tirelessly into the morning hours on multiple occasions this past week. Their unwavering devotion, loving attitude and efficiency are an inspiration to all.

Working with other surgeons is a rare privilege in the states, but in the DR and during these trips to Haiti it has been a great opportunity for me to join with colleagues continue my quest for learning. It is especially a privilege to work with a former professor. He always taught all of us residents to be “lazy surgeons”. In reality “lazy surgeons” are perfectionists. The principle is that you must do it right the first time so you don’t have a complication that will create extra work. In Haiti this is especially important as many of our patients get very little follow up. Thus, each case is started with a prayer and with God’s helping hand we consider each operation a sacred event and don’t compromise on anything.

There are few experiences in life that are more gratifying, however, that is not why we do it. The gratification I simply pass on to the donors, our CURE support staff, and my family for the great privilege of helping these people. More importantly, the exchange of love in this environment of raw suffering is a call to action. The old man in bed 17 who called out to us to fix his femur every time we walked by, the little boy with the elbow fracture who smiled and thanked us as he awoke from anesthesia are just a couple of the reasons that we continue into working into the late hours of the night on these trips. Hopefully this call to action will continue remind all of us of the importance of serving those less fortunate, no matter where we are in our walk of life.

A New Required Rotation? Matt Hiersche LLUSM4

2009-02-02T18:16:00.000-08:00

I’m currently a 4^th year medical student at Loma Linda University with a rich history of overseas medical missionary work and an extensive international network of hospitals that accept visiting students. Why then, did I choose CURE International for my first away rotation in my senior year? I think that a statement one of my friends made in a recent email summarizes my motivation well. She said, ‘I’d love to work internationally, but as an anesthesiologist, I wouldn’t want to spend five years abroad using halothane and ketamine, watching my skills deteriorate in an international setting. How can I come back to the States later and feel comfortable working at our level again?’ Unfortunately, these doubts seem to permeate certain segments of the medical community. But might there be a cure?

Upon my return to the States and my regular studies, I continually found myself explaining my experience in the DR in one emphatic command. “If you’re interested in medical mission work, particularly surgical,” I kept exclaiming, “Then my month in the DR with the Nelsons should be a required rotation!” I, along with many of my friends, had long suffered under the false impression that following God’s command to serve His children abroad would simultaneously mandate that we regress in our level of medical care. What kind of vision of God is that, though? In finding CURE, I found an institution that believed in the God given directive of “providing the best care in the world for the least of the world.” In keeping with this vision, the CURE for my friends and me suddenly became clear. No longer would a first rate education generate a second rate level of care. No longer is it necessary to languish with only halothane and ketamine, while our skills deteriorate in “God’s service.” It is not our expectations or our level of care that needs to change when considering medical mission work as a future. It is our vision of God that needs to change. When we feel the call to serve, we must believe that God will provide a means by which we might serve at the level of His desire – that is at our best.

Haiti Trip December 8-12, 2008

2008-12-15T02:10:00.000-08:00

Once again we return from another Haiti trip with feelings that words cannot exactly describe. The problems are often overwhelming. In spite of the fact that we are not even making a dent in the overall situation, the lives we do touch are often changed forever. I am always reminded of Thoreau's words "One is not born into the world to do everything, but to do something". Our team is in a very unique situation to provide a service that no one else is able to do. Because of our proximity and ability to transport large amounts of equipment we are always prepared operate on a huge variety of problems. Our Dominican anesthesiologist Dra. Adrian and our nurse Lucia work tirelessly, efficiently and adapt themselves to any situation without complaint. In addition to providing the best in patient care, their work ethic, attitude, and energy always provide a positive experience and inspiration for the rest of us. When one of our children needed a blood transfusion Dra. Adrian donated her A+ blood while giving anesthesia to another patient and then paid for the post transfusion lab test out of her personal money.

This trip we were also privileged to have the expertise of Dr. Wade Faerber Chief of Orthopaedics at Riverside County Regional Medical Center, Dr. Cris Sherman ortho resident and Ralph Burney OR nurse also from Riverside County. It was great to work once again with my old colleagues. Even though we go with the intent of giving we always receive a much larger blessing. Seeing the love of the Haitian people, their raw suffering, and their tolerance of discomfort is a life changing experience for us soft Americans.

For more images see http://www.pbase.com/scottnelson/haiti_recent

K2 Medical

2008-11-09T17:58:00.000-08:00

When a gift is given from one human being to another a special feeling is created within both the receiver and the giver. Dr. Ray Woo and his team have now just completed their 5^th trip to CURE DR. This miraculous feeling from transactions driven by love is one that was felt by all of us including our patients. Because of Dr. Woo and his nurse Ana’s long term commitment to our hospital we have been able to greatly improved our spinal deformity program. Both in terms of equipment and patient safety we have advanced dramatically. Repeat visits by short term teams as well as a local organized infrastructure is the key to success for performing such sophisticated operations in the developing world.

We owe special thanks to K2 Medical for the hundreds of thousands of dollars worth of implants that were used this week. Each member of the team is vitally important to the success of the work. Paul Caron and Autumn Sutterlin of K2 Medical, Larry Daly (anesthesia), and Carrie Bower (neuromonitoring) as well as our Dominican doctors and nurses all worked hard for the success of this trip.

Both in the United States and the Dominican Republic the work for these trips starts many months before the trip takes place, gathering equipment and planning for cases. This past week we had the privilege of using the Nuvasive thoracotomy retractor system, Aquamantys coagulator, FloSeal, Grafton and the other products only available in the most advanced centers in the modern world. On the behalf or our patients and also myself I would like to thank all those who gave and spent their time preparing these products.

Arne 16 came to the CURE clinic with her sister in Cap Haitian, Haiti. Both of their parents are dead. With the help of Cross International they were able to travel to CURE Santo Domingo to have surgery for her 85 degree scoliosis.

Katherin 13 with her mother on post op day 5 is ready to go home after having surgery for her 95 degree R thoracic curve.

Click here for more pictures of CURE Hospital DR and the spinal deformity program

Depuy Spine USA

2008-10-27T02:29:00.000-07:00

Alam 17, Maryfel 16, Damaris 10, Mario 20, William 17, Roselbia 17, Ana 12, Emelyn 16, Franklin 17, Massiel 15, Dariana 16, Pamela 21, Yanil 15, Juleisy 15, Mideline 18, Wilson 19, Phillip 15, Ana 16, Eunice 17, Lusahidily 12, Mercedes 37, Flor 20, Cynthia 16, Yesica 17, Jose 16, Sheryll 14, Yerolanny 17, Youseline 12, Miguel 17, Esteanny 14, Winifer 12, Andritson 16, Alberto 42, Felix 18, Victor 20, Jose 18, Ruth 13, Miranda 16, Daysi 37, Gernelys 14, Santa 17, Perla 11.

42 patients

4 trips

18 months

On behalf of CURE and the patients we serve I would like to express my sincere appreciation to Depuy Spine on the behalf of the 42 patients that have had life changing surgery because of their generous support. Only 18 months after their first visit they have sponsored a total of 4 trips, inspiring many, educating, forming relationships and changing lives. At CURE we are all about giving our patients loving state of the art care and providing long term follow up for those that we treat making it possible to safely do such complex operations in the developing world.

Todd Spiegel of Depuy Spine and Dr. Howard Place and team from St. Louis University have repeatedly devoted their personal time and expertise to make these last 4 trips possible. Their sincerity and commitment to these children and to our hospital has enabled unparalleled care. Since this October 6-10 trip - Omar 16, Abigail 11, Orlando 18, and Katherin 15 have already been added to our waiting list for scoliosis surgery. We will hopefully be setting dates soon for a return trip.

Esteanny 14 and Andritson 16 @ 2 week post op visit

Click on any of the photos above to take you more photos of spinal deformity surgery at CURE Santo Domingo

September 2008 Haiti Trip 14

2008-10-04T21:41:00.000-07:00

With needs more desperate than ever, the Haitian people once again inspired us to set our own corporal desires aside. We worked day night to relieve just a small portion of their pain and suffering. Making a difference one life at a time we operated on 46 patients with a variety of complex problems. In spite of a broken down infrastructure, lack of electricity, and fuel we were able work around these obstacles and treat more patients than on any previous trip. I was privileged to have along with me two of my mentors Dr. Terry Dietrich a devoted mission doctor responsible for my original introduction to the Dominican Republic and also Dr. Doug Benson from northern California.

Each and every one of these patients came with a special story. There was the man with an external fixator on his leg which had become infected after having navigated the floodwaters of Gonaive. He was accompanied only by his 7 year old son. There was the 11 year old boy who had lost most of his leg due to the brutaine traction methods used by the local doctors for a simple femur fracture. Then there was Presler (pictured) a sweet natured 16 year old boy intentionally burned 3 months ago by his father, for not listening to him. His neck shoulder and elbow had all become severely contracted leaving him with a monster like appearance. Due to providential circumstance, Dr. Duncan Miles (Loma Linda University Plastic Surgeon) was able to come to Haiti for one day to help us with this case. Tuesday night he performed a sophisticated latisimus dorsi rotational flap and z-plasty to complete the first stage of several reconstructive procedures that will be needed. In spite of a painful operation the next day Presler smiled at us from under his mosquito net and said “thank you”. After doing several more cases the following morning, Dr. Miles flew home to Los Angeles leaving us an extra $200 to buy some more diesel for the generator so we could continue operating without delay.

Jean Role director of clubfoot Haiti was also able to join us after riding 4 buses and wading through 3 rivers to get to Cap Haitien coming from the capital. Nonetheless he showed up the next morning dressed for business with his shirt ironed and pants clean. We made significant progress with the Ponseti clubfoot program casting more than 25 feet and doing percutaneous tenotomies on 9 cases. With the help of Robbie Jackson significant strides were also made on the administration and documentation necessary for the success of this program.

There will be 2 new Haitian orthopaedic residents joining the Cap Haitien residency program. We have been asked to become an integral part of their training and possibly increase the frequency of our visits. Both of them have worked with us in the past and are motivated and responsible which is very encouraging as it will allow us to enhance our training program as well as the efficiency and quality of our work for the patients.

Click photo above to see more pictures from this trip.

Orthofix

2008-09-29T03:52:00.000-07:00

The generous donation of Orthofix to CURE International is revolutionizing deformity correction, limb lengthening and trauma care at our Dominican Republic and Haiti sites. Some of the common uses for these devices are bowlegs, other angular deformities of the lower extremities, lengthening for congenital short femur, osteomyelitis, fractures, nonunions, and bone transport for bone deficiency after trauma.

Pictured is a 12 year old boy named Laudy who lives in a destitute part of the Dominican Republic about 4 hours from the capital. When he came to CURE he was diagnosed with pseudoachondroplasia a type of dwarfism with this typical “windswept” deformity of the lower extremities. The angular deformities were analyzed and 6 osteotomies were performed along with the application of 4 Orthofix Paediatric LRS rails. Prior to this 4 hour operation Laudy was hardly able to walk. Today he is elated to be running for the first time in his life. Now he has brought the first of several cousins who are also affected by this rare type of dwarfism. Click here to see pictures of his cousin Yini along with some other patients treated at our center.

Because of the hundreds of thousands of dollars worth of Orthofix equipment that has been donated to CURE International we are able to provide our patients care that is equal to the best centers in the United States and Europe. Because of this type of generosity, our personal sacrifices, and economization we perform these many complex operations at a fraction of the cost that they would cost in the developed world. Also, relatively unique to CURE is our permanent or long term presence in the countries in which we serve making possible these operations that involve a process of close follow-up for procedures such as limb lengthening, bone transport, and deformity correction.

Thank you and congratulations to Orthofix and those of you who work for this generous company which is making a positive difference in this world.

Small Country Church - Big Hearts

2008-09-17T19:26:00.000-07:00

“The church is in Philadelphia, MS, my hometown. It's a small country church, with mostly country people, but they have big hearts” describes Terry Winstead a recent visitor to CURE International Dominican Republic. After visiting our hospital, Terry, an occupational therapist from Mississippi returned home inspired to make a difference. He presented the Bethsaida Baptist Church with a report of his trip and a challenge to donate for surgical care of disabled children in the Dominican Republic. In addition he promised to make a matching donation for whatever was placed in the offering plate. After doubling their Sunday morning offering the amount reached over $3500. Each and every one of those dollars will be again multiplied as the lives of the children and families that we serve are changed through medical and spiritual healing. By personal sacrifice, corporate equipment donations, and harvesting wasted excess of medical supplies in the United States we are able to provide state of the art surgical care for our patients at a fraction of the cost normally required. Not everyone is called to leave the shores of their comfort zone to serve, but these simple folk from Mississippi have stepped forward as an example of what Christ has repeatedly asked us to do. Call it an investment, moral obligation, or Biblical principle, the rewards of sacrifice are great.

Give and it will be given to you... Luke 6:38

Roynelis, a 4 year old girl born with a nonfunctional thumb on the left hand underwent reconstructive surgery to create a thumb by transplantation of her index finger. In addition to a wrist repositioning surgery a similar operation will be performed on the right side where she was born missing a thumb and one of her forearm bones. Thanks to support from people like the members of the Bethsaida Baptist Church CURE surgeons and staff are able to transform the lives of children around the world. Click here to see pictures of similar operations performed at CURE Dominican Republic.

Arrowhead Orthopaedics Sponsors Rotation in the Dominican Republic

2008-07-28T04:36:00.000-07:00

On behalf of Loma Linda University and CURE International I would like to thank Arrowhead Orthopaedics for their generous financial support of the international pediatric and limb deformity rotation in the Dominican Republic. To our knowledge this is the only ACGME approved orthopaedic elective rotation in the developing world making it a unique feature of the Loma Linda orthopaedic residency program and CURE International. Because of the financial support of Arrowhead Orthopaedics and the administrative support of Loma Linda University and the orthopaedic department an important part of the mission of LLU has been reintegrated into the residency program and placed us at the forefront of modern humanitarian and outreach efforts in orthopaedic education.

Over the past several years there has been a growing interest amongst medical students and young physicians in medical missions and social responsibility. This has spread throughout secular universities throughout the modern world. In contrast to years past, most of these efforts are purely humanitarian as opposed to previous years where the large majority of this work was carried out by religious groups. Loma Linda University was established with the unique charter to train physicians for this type of work long before the secular world became interested. At LLU there is a resurgence of interest in this work as well as strong administrative support which has made possible the success of this orthopaedic rotation amongst other similar endeavors.

The rotation at CURE International in the Dominican Republic and Haiti is a unique opportunity to provide first world orthopaedic care for the challenging problems of the developing world. Due to consanguinity, environmental contaminants, and public health and safety issues we treat a wide variety of rare congenital deformities, developmental problems, post-traumatic disorders as well as other diseases such as polio and TB which are rarely seen in the US. As if many of these problems were not challenging enough, they often do not present themselves in a timely fashion and often have been mistreated at other centers making the challenge even more difficult.

Over the past 3 years a number of top quality visiting professors have greatly added to the resident education and quality of services we offer. This has given the opportunity for the residents to work and develop relationships with surgeons from other programs in the United States. (We are still awaiting a promised visit from Maestro Jim Matiko – possibly this will be realized in 2009.) In addition the armamentarium of equipment has substantially increased over the last several years. Spinal deformity corrections are commonly performed with the latest pedicle screw systems. As well, we have developed an in depth experience with external fixation and limb deformity correction and limb lengthening reconstruction. Residents are getting extensive experience with Orthofix external fixation, Ilizarov, and with the Taylor Spatial Frame which is a computer assisted six axis deformity correction device recently placed on the orthopaedic market.

Sam Chen MD quotes “Thanks to the sponsorship by Arrowhead Orthopaedics, I was given training not obtainable in my home program. I was able to see the effect of untreated pathology and the suffering it can cause. More importantly, I was also able to see the gratitude of people when they are provided with help from outside organizations.”

At CURE International Dominican Republic we have hosted residents from New York, St. Louis, Mayo Clinic, Riverside County Regional Medical Center and Loma Linda. We also have become a regular part of the curriculum for residents from two of the Dominican orthopaedic surgery residency programs. Although the rotation for US residents is ACGME approved, administrative support and financial support has been lacking at other institutions (aside from LLU) inhibiting the ability to formalize the elective for the residents from other programs many of whom have used vacation time for their visits. For this reason we owe a great degree of gratitude to Arrowhead Orthopaedics for financially supporting this endeavor and appreciating the importance of this educational experience and our heritage as educators and students at Loma Linda University.

Biomet Donation Saves a Leg in the Dominican Republic

2008-07-13T07:21:00.000-07:00

Multiple surgeons in Santo Domingo had recommended amputation, but when 43 year old Marineris came to CURE International’s hospital she was given a new hope. She had been diagnosed with an advanced giant cell tumor which had completely destroyed the bone just above her knee. In spite of working in an environment of limited resources I very seldom compromise my surgical indications. But in this case I knew it would be difficult to provide state of the art limb salvage reconstruction surgery for this patient whose resources were already exhausted with a few simple preoperative imaging studies.

The first step was to confirm the ambiguous pathology report with Dr. Craig Zuppan at Loma Linda University a ‘virtual missionary’ who gives his time and expertise for people he never meets. Thanks to FedEx and email, one day later, Dr. Zuppan had received the specimen in southern California and confirmed the diagnosis. Lung metastasis were ruled out and with a marginal resection her prognosis would be good. I presented the situation to some of my contacts at Biomet who had helped one of our patients a couple of years ago. Not much hope was initially given due to new government restrictions on any donations that could be construed as physician enticement. After a month long approval process government monitors determined that my practice does not represent any lucrative incentives for corporate donations and Biomet approved the donation. When I announced the news to Marinerys and her husband, tears came to their eyes and hope of living a relatively normal life was restored.

Multiple emails were exchanged with Mark Bollinger and Troy Hershberger of Biomet, Warsaw, IN. Final preoperative planning was wrapped up with a meeting at Starbucks Santa Monica, CA between myself and Tyler Jolley the Los Angeles Biomet limb salvage specialist. I returned from my trip to California loaded with instruments and implants.

After maximal preparation and a prayer… the operation was initiated. The absence of a vascular surgeon, vessel clips and a Biomet rep added to the difficulty of the case. But after 3 hours of surgery the tumor was resected and the prosthetic reconstruction begun. The innovative Biomet Compress prosthesis addresses the problem of loosening at the implant bone interface by loading the bone with up to 800 lbs of continuous spring loaded force to invoke an incredibly strong biologic bond between the metal and bone. We released the spring loaded force and placed the $20,000 implant without difficulty. Her recuperation phase was begun.

It does not matter that Marineris knows nothing about Warsaw, Biomet, Loma Linda, Lemoyne, bone ingrowth, or all the work and resources that multiple people around the world have invested to make this operation a success. She appreciates her leg and her life. Worth more than a insurance reimbursement are the two mangos and a hug that I pass on to all who have given unselfishly to make this possible.

June 2008 Haiti Trip 13

2008-06-30T18:48:00.000-07:00

Ou ban-m lespua You give me hope

Every 3 months we go to Cap Haitien and work at the regional government hospital – Hopital Justinien Universitaire with the intention of treating children with deformities, injuries and infections. This was our 13^th trip in just over 3 years of providing this consistent service to the people of northern Haiti. In just 5 days we saw nearly 200 patients and operated 36 people with various orthopaedic problems.

This trip I was privileged to be working with Dr. Howard Place (Spine surgeon, St. Louis University) and Dr. Sam Chen (ortho resident Loma Linda University) along with our hard working Dominican CURE staff and several other visitors. Dr. Place has worked in Haiti before and also come to CURE Dominicana twice to perform spinal deformity surgery. His technical abilities and compassionate service are a great asset to the mission of CURE and our work on Isla Hispaniola. We also owe a big thanks to Jim Forbes photographer from the St. Louis Post Dispatch newspaper who was with us on this trip as well. Not only will you notice some professional photos from this trip but he also mopped floors, operated the x-ray machine, and transferred patients amongst other things.

At the beginning of the week I often times feel overwhelmed and apprehensive about the magnitude and difficulty of problems that are likely to present themselves during the week. After finishing our 36^th operation in 5 days, Jim asked me how I felt. Always a bit shell shocked from the experience, I can only liken it to all the emotions a soldier must have when he is returning home from war. In spite of long work hours and little sleep we don’t feel tired until the last case is done. The suffering of the people and the love created by the giving and acceptance of acts of kindness fills the team with emotion that provokes deep thought and leaves one changed forever.

The urgencies and case volume leaves little time for personal interaction with the patients, making one of my favorite times of the week Saturday morning rounds when we visit with our patients and review their post operative care plan before heading home. The 67 year old man in bed 24 Monseur Luime said to me “Ou ban-m lespua” You give me hope. During our last trip in April this same man had been in bed 24. In fact he had been suffering for 10 months with a severe segmental open tibia fracture. Because of the severe infection and little hope for salvage we had left his care to the local doctors. Since they had done nothing the bone was still exposed, although the infection had somewhat improved. This trip we saw him still sitting in bed 24 begging us to help him. With a 2 hour reconstructive surgery we placed an external fixator, removed the nonviable bone and covered the wound with a muscle flap and skin graft. Thanks to the companies and personal donors that support this work we are able to come prepared to take care of a wide variety of injuries and deformities. Often only a couple hours of our time along with the healing powers of our creator can make a life changing difference in those that we serve.

March April 2008 Trip 12

2008-04-08T20:19:00.000-07:00

Every time I return from Haiti I feel like reporting that it was our best trip ever. I am not sure if it is because each trip gets better or if it is just the ever present inspiration and excitement of working in Haiti. It is probably a combination of the two. Although in the big picture we are only making a small difference, we are making a big difference in many of the lives we touch. For us it may be only a one or two hour operation but for our patient it is a life changing event that affects them for their whole lifetime and hopefully beyond.

This trip was exceptional in that we had 12 team members which is the largest ever. Prior to the trip I feared that keeping everyone organized and busy in the chaotic work environment would be difficult. To the contrary each one of the following self-activated people played a special role, making it one of the easiest and most efficient trips ever. And most importantly the quality of our patient interactions and whole person care was unsurpassed.

Janet Castillo (RN CURE Santo Domingo)
Lucia Hernandez (RN CURE Santo Domingo)
Dra. Maria Adrian (MD anesthesia CURE Santo Domingo)
Dr. Scott Nelson (MD CURE Santo Domingo)
Dr. Dan Ruggles (DO Orthopaedic Resident, Riverside, CA)
Dra. Dielika Charlier (MD pediatrics, CURE Santo Domingo)
Dale Brantner (VP Spiritual Life CURE Home office)
Mike Wilson (Dir. Special Projects, Cross International, FL)
Robbie Jackson (CURE Clubfoot Worldwide, Dallas TX)
Jean Role (CURE Clubfoot Haiti)
Arpy Soo (Plumber, San Luis Obispo, CA)
Bernhard Ahrens (Architect, Santo Domingo)

No trip to Haiti begins or ends without some special stories to tell. Before we even reached Cap Haitian we were presented with our first patient. We typically stop for a late lunch at an elementary school run by the Bruno family before driving the last hour into Cap Haitien. It was there that several boys brought over there 3 month old injured puppy to see if we could do anything. The puppy had been attacked by a larger dog and broken her left hindleg. A local “veterinarian” had come and splinted the leg with some yucca leaves and wrapped a constrictive dressing. The leg lost its blood supply and eventually had fallen off leaving a stump of infected exposed bone. Anyone working in primitive countries knows that often times the treatments rendered are worse than the injuries. At least this time it was not a child and the pup had 3 other legs to run on. Nonetheless an operation needed to be done. I told Dra. Adrian that we had a 3 month old around the corner that needed an operation and to prepare some anesthesia. When she saw the furry little creature she was slightly surprised but did not bat an eye. The operation was successfully performed and 6 days later on our way home we made a post op visit. The pup was running around and the children were delighted that she was no longer suffering.

We operated an additional 31 human patients on this trip as well. Many of them just as sweet and innocent as the canine. We only worked until 4:30 am one night and finished by 9 or 10 pm on the other days leaving, us less fatigued than some of our previous trips.

One notorious case was Rosebeline. She is a 10 year old girl crippled by severe bowlegs caused by a poorly understood growth disturbance in the legs called Blount’s disease. Some short term missionaries from California had met her on one of their previous trips and had been trying for a long time to find someone that could correct this. They heard about us and brought her. The next day after a two hour operation her legs were straight. Thanks to the coordinated efforts of people like David Bell inventorying donated Orthofix clamps in Lemoyne, our donors, our founders, Haitians, Dominicans, and Americans we were able to offer this girl a standard only available in some of the most advanced centers in the world.

Thanks to Dra. Charlier, Mike, and Dale we were able to have much more interaction and better communication with our patients. Dra. Charlier is our new pediatrician in Santo Domingo and is fluent in English, Spanish, Creole, and French. She worked tirelessly during this trip and made sure that all the pre and post op care was rendered as intended. Robbie and Jean Role were able to launch the northern Haiti clubfoot center and coordinate solutions to a number of the challenges facing the clubfoot program in Haiti. Berni and Arpy worked on the physical plant around the OR building. These challenges equally as great as those required to perform quality orthopaedic operations, but significant progress was made. Not only does this enhance our work there, but also leaves something behind that enhances the work of the local people.

Although our patients were still suffering pain from their injuries and operations, they expressed an impressive gratitude and love for us and for God, saying that God had sent us and thanking us for helping them.

January 2008 Trip 11

2008-01-12T21:06:00.000-08:00

For most outsiders, Haiti typifies a failed state of insurrections, poverty and social malaise. It has always stood out in the media as the dark side of Hispaniola, the island Haiti shares with the more laid-back Dominican Republic. But a look beyond the headlines reveals a kind and deeply spiritual people, who reach back to their African roots more than any other Caribbean nation.

Haiti’s difference lies in its history: after independence in 1804 the country was isolated from the full brunt of European colonial influences. Art, influenced by the fascinating Vodou culture, has dominated life ever since.

Although Haiti’s lack of infrastructure, grinding poverty and ravaged environment may leave even the most hardened traveler somewhat shell-shocked, it is still a very rewarding place to visit.

Lonely Planet – Caribbean Islands 2007

It took me several days to recover from this last trip. The week usually ends in physical fatigue and emotional overload. If the mere traveler is “somewhat shell-shocked” then visitors to northern Haiti’s government hospital have reason to be extremely shell-shocked. Fortunately all the patients and crew members of the voyage survived the record breaking trip, both parties being tested to the physical limits of the human body. Mentally and spiritually we were all transformed by the events of the week.

Several new team members accompanied us on the trip:

Cris Sherman DO – orthopaedic resident, Riverside, CA
Ed O’laughlin MD – anesthesiologist, Baltimore, MD
Terry Piper MD – orthopaedic surgeon, St. Louis, MO
Christy Piper – pre-med student, St. Louis, MO
Chuck McDonald – physical therapist, St. Louis, MO

In addition to myself the returning members were:

Maria Adrian MD – anesthesiologist, CURE Santo Domingo, DR
Lucia Hernandez – nurse, CURE Santo Domingo, DR
Bernhard Ahrens – architect and hotel owner, Santo Domingo, DR

A mob of Haitians on strike at the border caused some delays en route to Cap Haitian, but after some negotiations with group leaders we were able to convince them to let us pass. We had to leave our vehicle behind but were able to load ourselves and our equipment onto a truck on the other side of the border and complete the trip. Some of the new team members seemed to be somewhere between amusement and fear during the whole process.

Not until we arrived at Hospital Justinien did it become clear to our first time teammates what the motivation was behind the perseverance it took to transact the border crossing, assimilate our medical team, equipment, and travel the distance to Cap Haitian. The first day of the trip we saw over 140 patients including some follow up visits on some of our previous patients. We operated 37 patients some of whom had bilateral or multiple procedures. In between each case during the entire week we would evaluate more patients, change casts, and transfer patients amongst other things. Dr. Sherman commented that the time we were working least hard was when we were scrubbed in and operating. Although many of the traumatic injuries we saw had occurred in the weeks and months prior, we treat them as orthopaedic emergencies knowing that if we do not take care of them nobody will. Two nights during the week we operated until 4 am. Fortunately the inverter we installed last year gave us uninterrupted power throughout the week and allowed us to operate late into the night without delays and additional risk to our patients.

Another encouraging aspect of the trip was the progress made with our Ponseti clubfoot casting program. Our Haitian technician “Mano” has progressed very nicely with his techniques. He was able to participate in a refresher course in Port au Prince in November that was organized by Andy Mayo and Kaye Wilkins. His reputation is spreading and many children are now coming at earlier ages and the results have improved dramatically.

The week also allowed for a bit of time to meet with the hospital administration and some of the surgeons to better understand their needs and formalize some of our goals for the future of these trips. Bernhard played an essential role in these meetings. Not only is he a great help in improving the physical plant – water, electricity etc. but also is an expert at international communications, empowering the people, and breaking down the some of the barriers to progression.

We go to serve – without pay, but inevitably return with more than we give.

The angels of heaven join us in helping others. They are sent to minister to all who need and choose to be saved, and when we open our doors to help the poor and suffering, they join us, bringing a holy atmosphere of joy and peace. Every helpful act of mercy makes music in heaven.

Jerry D. Thomas, Messiah, Pacific Press 2005

CURE Haiti

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Reconstructive surgery is being performed at the Hopital Adventiste d'Haiti for victims of the earthquake. We also continue our commitment to serving the children of Haiti who have surgically treatable deformities and disabilities.

Clinics run M-F 8 am-3pm.

Contact info:
Scott Nelson MD
Hopital Adventiste d'Haiti
Diquini 63 Carrefour
Port au Prince

For further questions email scottnelson@mail.com or call 011 509 3492 1054

Purpose

2008-01-01T16:50:00.000-08:00

Keeping in mind Christ's words in Matthew 6:1-4

"Be careful not to do your acts of righteousness before men, to be seen by them...when you give to the needy, do not let your left hand know what your right hand is doing, so that your giving may be in secret.

it was with careful deliberation and intentions to avoid self-glorification that I decided to create this blogspot for the following purposes:

To express gratitude to the donors who so generously have supported CURE and our work in the Dominican Republic and Haiti
To repay the encouragement and support given to us by our CURE home office family who deserve to see the images and read the stories of the lives being changed by their efforts in a nondescript Pennsylvania warehouse
To inspire others to understand the benefits of sacrifice and engage themselves in caring for those less fortunate
To give information for visitors planning long or short term work with CURE International in the Dominican Republic and Haiti
To provide contact information for patients and organizations seeking high quality orthopaedic treatment in the Dominican Republic and Haiti

As the Medical Director of CURE International Dominican Republic and Haiti this site is authored by myself and other authorized persons but is not an official publication of CURE International and although it is written with discretion it does not strictly adhere to HIPAA regulations.

Contact Information

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CURE International
Centro de Ortopedia y Especialidades
Francia esq Leopoldo Navarro 129
Santo Domingo, Republica Dominicana
809-682-5022

We are located "en frente el Palacio de la Policia" in Gazcue. For those arriving from outside the capital this is just across Av. 27 Febrero from the Caribe Tours bus terminal.

Orthopedic clinics are Monday, Wednesday and Friday 9-3.
Neurosurgery clinic is on Wednesday afternoons.
General Surgery clinic is on Tuesday.
Pediatrician is available Monday, Tuesday, Wednesday and Friday.

Initial consultation is $150 RD for children and $500 RD for adults. X-rays and lab are extra. No appointment is necessary and patients are seen in the order of arrival time.

If a private appointment is desired with Dr. Nelson the charge is $1500 RD (plus x-ray and lab if needed). Please call to schedule.

For further questions please call 809-682-5022 or email scottnelson@mail.com.