Bowlegs

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

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

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

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

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.