Port au Prince – The Initial Days

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

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.

September 2008 Haiti Trip 14

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.

June 2008 Haiti Trip 13

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

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.

CURE Haiti

Orthopaedic surgery is being performed at the Hopital Adventiste d'Haiti for post traumatic, congenital and developmental orthopaedic disorders.  Children and Adults of all ages are treated.


Clinics run MWF 8 am-3pm.

Contact info:
Francel Alexis MD
Hopital Adventiste d'Haiti
Diquini 63 Carrefour
Port au Prince
francelito001@yahoo.fr


For further questions email scottnelsonmd@gmail.com

Purpose

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.