Preliminary Report

Due to the efforts of Elaine Lewis (surgical tech), Dan Brown (facilities manager) and Ed Martin (administrator) major progress is being made.  When we arrived yesterday on campus there was a noticeable difference.  The wires and tubes hanging all over the front of the building have been consolidated and cleaned up, the old ambulance parked in the backyard has been relocated, the nonfunctioning rusty water tank that was “gifted” to us after the earthquake has been removed, and the makeshift dilapidated kitchen built by the supreme masters in 2010 has been destroyed.

Rose and Elaine

Thanks to Elaine the operating room is in impeccable condition.  I have never seen it so organized.  Not a single item is out of place in the sterilization room, the table is not piled up with a bunch of disorganized instruments, the sinks are clean and the shelves are labeled and neatly stacked.  Although the new operating room is still awaiting some final touches the current operating area is more than adequate to accommodate whatever cases need to be done.  A big part of doing safe surgery is being organized, having what you need when you need it, keeping equipment clean and in good working condition, and effectively using what you have.  More important than Elaine’s organizational skills is her diplomacy.  She has not done all this work herself.  She has motivated the staff, built relationships, taught them what needs to be done and shown appreciation for quality work.  They are now doing it on their own.

Before Elaine

After Elaine and Staff

I have not yet seen the progress inside the new operating room but I expect that my report will be good.  Two massive medical air/suction pumps have been installed downstairs as well as a huge circuit board.  These pumps look large enough to run the 16 operating rooms at Loma Linda University much less the 3 at HAH.  The front entrance to the operating rooms has been remodeled and looks modern and clean. 

Suction and Medical Air Compressors

This week in addition to the cases that we have to operate we plan to accomplish some administrative goals regarding the sustainability of the orthopaedic program.  Although all of us have the common goal of continuing to offer top quality services to all, it is challenging to find ways to increase revenues, make a budget, transact donations and continue to host volunteers without burdening the precarious financial situation of the hospital.

5 Years Later

It was a balmy January afternoon 5 years ago (January 12) when the world lost contact with Port au Prince.  For me it started out as just another day in Santo Domingo with a seemingly unremarkable earthquake on my way home from work. 

Yesterday in the late afternoon as I looked over the peaceful parking lot in front of Hôpital Adventiste I thought back on the hundreds of injured victims who poured through the front gate of the hospital with life threatening injuries.  People were laying everywhere interspersed with a few dead bodies.  Some had mattresses pulled off of beds in the hospital but most were just on cardboard or nothing at all.  A tent was created out of some tarps in the front yard where wound debridements and amputations were performed while aftershocks continued to shake the building.  Both local and international volunteers soon began to arrive and do what they could to help.  Initially it was difficult to triage, organize and prioritize, but in reality it was not long before this hospital became a veritable beehive of activity and developed a strong national reputation for orthopaedic surgery.  An unprecedented amount of donor support brought in the materials and expertise needed to maintain the hospital.  Patients were coming from near and far.  Many with medical issues long pre dating the earthquake.  Operations were offered for free to all comers. 

This was the honeymoon of a mission hospital program - the beginning of a long-term relationship. It was not just a one-night stand of volunteer passion that would leave Haiti in a lurch and justify the American dream for those who came to help.  As with any relationship it has not always been smooth sailing, but in spite of its struggles the romance continues to motivate us.  We are committed for the long term and great effort is required in order to successfully face the realities of financial viability, communication, and oneness of purpose.

It can be discouraging to face the literal and figurative piles of stuff and issues around here but it is all worth it when we remember the real reasons we are here.

Chadme a 15 year old girl who was in a wheelchair due to severe knock knees caused by rickets

Julie a 15 year old girl with post traumatic deformity from earthquake fracture before and after correction with TSF

Kenn a 8 year old boy with L tibia bone deficit due to osteomyelitis.  He has had a bone transport procedure to grow 2 inches of new bone and dock the nonunion site while correcting the deformity. 

Nelson operating in the provisional operating room.  Yes we spent Saturday night cleaning up the mess in the foreground.

Elaine Lewis surgical tech and mother of 7 from Redlands who will be living at HAH with her husband for the next 6 months and organizing our operating room.

The new operating room.  Finish date TBD.  Container with equipment is still in the port

Recovery room

New lab

Interview with Dr. Nancy Snyderman medical correspondent for NBC

From NBCNews.com...

Haiti 5 Years After Deadly Earthquake
http://www.nbcnews.com/nightly-news/haiti-5-years-after-deadly-earthquake-n284141

Our host Patrick

Hôpital Adventiste September 2014

Dr. Francel Alexis Chief of Orthopaedics at HAH pauses with patient before surgery

Islande is an 8 year old girl with an enlarged left upper extremity.  She has macrodactyly that caused her middle and ring finger to be grotesquely enlarged  requiring amputation of these digits at a young age.  She came to Adventist Hospital with her mother for further treatment of the deformity because they heard that there were some doctors that may be able to help her.  She said the first surgery was done in Cap Haitien by a surgeon named Nelson in 2009.  At first I did not recognize her but after a brief search of my database I found her pre operative images.  This again was a reminder of how sparse the resources are for these patients, how diligent they are in travelling to various parts of the country to look for help, and how important it is for us to make long term commitments in order to build a reputation worthy of the God we serve.

Islande 2009 in Cap Haitien

Islande 2014 HAH

A brief update on the hospital and construction is warranted:

• Edward Martin was inaugurated last week as the hospital CEO after the resignation of Mdme. Clotaire.  He is taking on the daunting responsibility of creating a financially solvent institution, which requires a major downsizing of staff and the development of some new and innovative business plans.  While paradoxically not loosing the priority of providing top quality care to those who cannot afford it. 
• Operating room construction is progressing well and the new facility looks beautiful.  Staff will scarcely recognize the layout of the new operating rooms, recovery room and ancillary areas.
• The new lab is also well on its way to completion and will drastically elevate the level of services offered at the hospital and the perceptions that build our reputation.
• We were able to perform the same quality and complexity of operations in the provisional operating room in spite of power outages, C-arm malfunctions and an occasional stray fly.

Operating by flashlight in the provisional operating room

There were many dramatic cases this week – each with stories to tell.  Kenn a crippled 7 year old boy with part of his tibia missing from infection was sent by a 16 year old American girl who raised $3000 to have his leg fixed.  Julie who is a 13 year old girl had her right leg injured in the 2010 earthquake causing a partial growth arrest and subsequent development of a severe knock knee deformity.  Marie is a 28 year old women who had a developmental bowed leg since a very young age.  And Phanord a 10 year old boy with a type of dwarfism that causes knock knees.  Each of these people who took just a few hours of our time this week have started down a dramatic pathway of healing that will change their lives. We must remember that it is not our own power that is creating this miracle of healing.  A common thread to all major world religions is the importance of compassion to our fellow man and the acknowledgement of something greater than self.   It is a privilege to be a part of something much greater than ourselves – the God of our fathers and Creator of the universe.  It is also a privilege to be part of a group of people that have contributed so generously to this work in Haiti.  This trip was largely funded by the Foundation for Orthopaedic Trauma www.fotnorthamerica.org.  We are grateful for the generosity of this group which makes a huge difference in the lives of each of these children that have been operated.  It also helps us to direct additional funds into the much needed capital expense projects. 

Kenn before and after surgery.  This bone transport procedure will take 47 days to correct the deformity and begin filling in bone which will then consolidate over the next several months.

Icons on the computer programmed prescription show before and after images

Marie before and after surgery for her L tibia Blount's. This case not amenable to acute corrections is treated with Taylor Spatial Frames which operate on the principle of gradual distraction.  This device is adjusted on a daily basis by the patients which allows for extremely precise corrections and less operative morbidity due to minimally invasive surgery.  It will take 44 days to straighten her leg.

Julie prior to surgery

Dra. Adrian giving anesthesia

Genu valgus seen with Ellis Van Creveld Syndrome

Phanord before and after acute correction of B leg deformity

The team (L to R):

Patrick (local host)

Philip McClure MD Orthopaedic Surgeon Brown University RI (planning pediatric orthopaedic fellowship)

Alex Nelson and Austin Thompson (students and carpenters – building furniture for Haitian schools)

Djuro Petkovic MD Orthopaedic Resident PGY-4 Loma Linda University

Robin Kamal MD Hand and upper extremity surgeon, Stanford University

Maria Adrian MD Anesthesia

Scott Nelson MD Team leader

Francel Alexis MD Chief of Orthopaedics HAH (not pictured)

Richard Michel MD Anesthesiologist (not pictured)

Lisa Hwang PT Physical Therapist Loma Linda University (not pictured)

Alex and Charles with one of the desks they built out of recycled pallet wood for a local school

Renovation Update 23 March 2014

Major changes are taking place at HAH with renovation of the operating room suite and installation of a new laboratory.  I travelled this past weekend with Ken Breyer, Assistant VP for Construction and Planning at LLU to assess the progress of the project.  We arrived at 9 am on Friday morning after an all night voyage from Los Angeles.  The progress that has been made is remarkable and the quality of workmanship is impressive.  We spent the entire day going over each detail of the plans with the construction foreman.   A multi faceted team coordinated by Ken has lent expertise in the design and engineering of every detail.  Although the complexity of the project has progressively increased, as well as the time and resources required to complete it; the final results will be worth the extra efforts.

Originally I had envisioned moving a wall or two, repainting and resurfacing the floor.  With the intention to create a first rate facility some additional expertise was consulted and it became evident that a more sophisticated plan would be worthwhile.  Additional storage, larger operating rooms, replacement of entire electrical system, too much to list new pieces of equipment, HVAC design with positive pressure airflow, plumbing changes, new lighting, shelving, new doors, central distribution of medical gases and other details have been added.

Francel and the workers have created a provisional OR suite in the previous emergency room which is quite adequate to handle a variety of cases.

Volunteer surgical teams are anxious to know when the project will be completed.  I won’t guarantee any completion dates but the first construction phase will likely be wrapping up in about one month.  At least two months will be required for the remaining acquisition and shipping of equipment in a container from Loma Linda.  Installation of fixtures, furnishings and special equipment will then likely require another two months.  Best case scenario currently puts us well into July.

Pictured below is a photographic update the progress.

Front Entrance - Desk will be resurfaced and modified

Main hallway inside OR suite - all flooring removed

Ken in front of existing OR 2.  OR 1 on the R is being renamed OR 3

Pile of rubble from tile removal with 8 inches of lime rock

The new OR 1 (was old small OR on the L, now twice as big)

OR 2 showing removal of med room in between OR's

OR 3 also bigger without intervening med room

Ken going over details with foreman Alfredo

Enlarged storage room (only partially shown)

Break room/Kitchen

Plans

Workers take a break

Corbels with rebar designed to withstand major quake

View down hallway from near scrub sinks

Central sterilization

Recovery room (inside OR suite)

Provisional OR - central sterile

Provisional OR

Additional provisional OR

Laboratory area under renovation.