As Time Goes By

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I am back sitting on my couch in my living room watching a warm summer rain fall here in Wisconsin. It has been hot and humid this week, not unlike the weather in Haiti. Here, the rain will likely cool the air and decrease the humidity. In Haiti, it continues to be hot and humid, with more mosquitos. I took my last chloroquine tablet a few nights ago signaling that it is now just shy of four weeks since my return from Haiti. While I would say I have readjusted to life of luxury I truly have here in the US, I am forever changed and impacted by my first trip to Haiti. I look in my kitchen pantry and see more food stocked there than most people in Haiti could imagine, and is certainly needed by most people there. I have clean, potable water running through my pipes. I have air conditioning and electricity, and a solid roof over my head and walls around me. I sleep in a bed in my house, not on the ground in a tent. People have told me I'm inspirational and amazing for going and working there. I feel none of those things. I believe that God has given me the ability to learn and practice medicine and has provided abundantly for me to do so. This is simply a way I feel I can serve Him through serving the people of Haiti and of the island of Hispaniola. When I got the call from Terry and Jeannie on January 15th asking if I wanted to go to help, there was no other answer than "yes." There have been so many instances of seeing God's Grace to us and to Hopital Adventiste d'Haiti, and to the people there in the amazing circumstances that have occurred before and since the earthquake. For instance, our teams over the past two months have saved lives that would not have gotten the care they needed had the earthquake not occurred. I was part of a couple of teams caring for a man who suffered life threatening injuries from a car vs. pedestrian accident in early April (see my post entitled Joseph). When the earthquake happened, teams of medical personnel from around the world began mobilizing to provide months worth of relief to Haiti so that when Joseph was struck by a car, we were all there to care for him. Here's another amazing story from the blog of a team who was at HAH for two weeks in May:

"On the way home from the orphanage Dale, Leanna and I were dropped off at the General Public Hospital with Gregory our interpreter. It turned out that Charlie had gone there to round in the TB ward with our own ER Doc who is volunteering there. There was not enough room in the car for everyone, so Dale, Leanna, Lynn and Gregory stayed behind at the hospital to wait for the driver to come back for us. Now this hospital is huge, many buildings, some cracked, many tents of patients and it was dark. There is a gate, like at a military base and the guards only let certain people through, they are constantly arguing with people who want to get in and and are not allowed through.

We were dressed in our scrubs sitting on a wall and a guy comes up and asks me in English if I will come help his grandmother who is over there bleeding to death. I told him I would not go unless Gregory told me it was OK. So Gregory goes off for a few minutes and comes back and says, "Yes his grandmother is over there bleeding, there is a lot of blood and yes I think you can help her. There are a lot of people around her so we might get mobbed, we have to be careful. I say, "I do not want to get mobbed". He says, "No, it will be OK". So off we go with gallant Dale ready to protect. So we go down this dark corridor around this corner and sure enough there are lots of people standing in this tight walkway and an old woman is sitting on the wall with her foot up, blood running down the wall into a pool and all over the wall. I am putting on gloves and getting some towels out of my pack and then this commotion begins and we all have to stop what we are doing and back up against the wall it is so tight with people. Suddenly a man emerges from the throng carrying a writhing 2 year old boy who is naked and crying in pain. First thing you see is his gigantic scrotum the size of a large orange, tense as it can be sticking up above his body. This is an emergency. The father asks me if I can help him, can I fix it, is there anything I can do. They have been waiting to get into the hospital and they won't let them in. I tell him he has to get in, this kid needs to go to surgery right now. He says they will not let him in. So I tell him to go to the Hopital Adventiste, we have a surgeon on duty. Gregory explains and they take of running. I find out later they did not have a car. I finally get to the bleeding woman and show the grandson how to put pressure on the wound and hold it until she can be seen in the hospital. I knew that the bleeding had stopped and she would be fine. He was afraid and I told him to pray for the healing power of God to come through his hand, to have faith that she would be healed. He smiled and beamed at me and thanked me profusely for praying with him. We took off running as more people started pressing forward to get to me.

Our driver showed up soon and we went back to the hospital. Sure enough our boy arrived at the same time. By this time he was vomiting, screaming and his scrotum was bigger. I took him to the ER and there was no doctor to be found. I ran upstairs and woke up Mohammad. He came down and said immediately it was an incarcerated hernia. The surgery team fell into place and the boy was healed!!! They saved him, his bowel was saved and he is resting downstairs." (read more at traumaqueen1.blogspot.com)

Another instance is in Scott Nelson, MD. Scott is a pretty amazing man, and would deny it vehemently, but what he has been able to do at HAH is amazing. A number of years ago, Scott was coming out his residency and was wanting to serve in Nepal. However, when that opportunity didn't pan out, he happened to hear Terry (the surgeon with whom I work in the US and traveled to Haiti) speaking at their alma mater on the work Terry has done in the Domincan Republic. To make a long story short, Scott accompanied Terry on some of his surgical mission trips to the DR and ended up taking a position in the DR in Santo Domingo for 5 years. Fast forward 5 years to January 2010. Scott had planned to leave the DR that December, but stayed on to transition the CURE hospital to the new medical director. Then comes January 12, the day of the quake. Two days after the quake, Scott has assembled a team of four from his Santo Domingo hospital and has a friend with a small plane who agrees to fly them and some supplied to PAP. When they left Santo Domingo, they didn't even have clearance to land at the airport in PAP which at that point was being operated by US troops with radios standing on the ground as their control tower was destroyed. As they are circling the airstrip, their pilot radios down that he has a surgeon and medical team in his plane and wants to land. They are cleared for a three minute window in which to land, unload, and get the plane off the ground again. It happens. Scott and team are able to get transport to some facilities and to start the process of looking at where they can set up a tent OR and start treating the wounded. For the first six days, they worked around the clock doing amputations without anesthesia and watching people die from sepsis and multi-organ failure from crush syndrome. Scott writes, "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." After a couple weeks into the relief effort, the team had set up some sleeping areas inside one of the hospitals. They arose in the mornings at 6am to start work. One morning, an aftershock hit at 6:15, crumbling the wall at the head of their sleeping bags. Had they slept in just 15 minutes, they would have all been dead.

See more of Scott's first few weeks in PAP including pictures here

After the initial Scott ended up setting up at HAH, a hospital that had never had an orthopedic service before. He began in a tent operating room (OR) and has now been able to run three functioning ORs. The largest company/maker of orthopedic trauma equipement and implants (plates, screws, nails, external fixators, etc) sent a charted jet to PAP with an estimated 10 million dollars of equipment, of which Scott estimates he has gotten about half and it is being used at HAH. Donations have come in the form of a used but excellent condition C-Arm fluroscopy unit and portable digital xray machine, items unheard of on the island in most hospitals and more than likely, the first C-Arm and portable digital xray machine to ever be used in Haiti. Because of Scott's work in the DR and connections through his training with world experts, he has brought world class orthopedic care to HAH, to Port Au Prince, and to the people of Haiti. His gifts of forward vision, abilities to organize and mobilize, knowledge and skill in medicine and orthopedics has saved lives, limbs, families, businesses, and hopefully souls as well.

Here is Scott and me operating on a limb deformity with the C-Arm unit in front of us (the black hefty garbage bag was sterilized and covered the top of the C-arm) and the monitor is seen in the far background.

Here is the same case with Terry, right, Scott, middle, and me, left.

Okay, last story for today. HAH is the closest hospital to the epicenter, a mere one mile. People have asked me why HAH was left undamaged by the quake. The simple answer is God's grace. Yesterday, Terry and I were talking in the OR here in the US about this amazing occurance. HAH (Hopital Adventiste d'Haiti) is an Adventist hospital, part of the international Adventist health system. When the hospital was being built, the lead administrator on the project was a man from southern California. With knowledge of PAP overlying one of the most active fault lines in the western hemisphere, the building must have been built with higher standards and codes than surrounding areas, leaving it less susceptible to quake damage and available for use when one of the worst humanitarian crises hit PAP. Amazing provisions by an amazing God.

As I flew out of PAP on April 29th, the hymn I chose to listen to on my iPod was This is My Father's World. I'll leave you with the words:

 This is my Father's world,
and to my listening ears
all nature sings, and round me rings
the music of the spheres.
This is my Father's world:
I rest me in the thought
of rocks and trees, of skies and seas;
his hand the wonders wrought.

This is my Father's world,
the birds their carols raise,
the morning light, the lily white,
declare their maker's praise.
This is my Father's world:
he shines in all that's fair;
in the rustling grass I hear him pass;
he speaks to me everywhere.

This is my Father's world.
O let me ne'er forget
that though the wrong seems oft so strong,
God is the ruler yet.
This is my Father's world:
the battle is not done-
Jesus who died shall be satisfied
and earth and heaven be one.

This a video filmed by a team that was in Haiti in mid-May. It is a minute and thirty seven seconds of video through the streets of Port Au Prince. It is the same sights I saw with my own eyes now almost a month after my return. It's worth the time to watch.

Want to read more about the happenings in Haiti and at HAH? Check out the blog Haitibones.org This is a blog of the trips of an Orthopedic attending from LLU but he also posts blogs, trip updates, pictures, and videos from other organizations, groups, and news outlets on the relief effort in Haiti.

Hopefully I'll be posting some more stories about our trip later. If you want to subscribe to my blog, there is a new subscription feature at the top of the right column. Just enter your email address and click submit. You'll be sent an email to confirm your subscription.

How To Volunteer in Haiti

I've had some readers inquire about opportunities to travel to Haiti, so tonight, I'm posting some information on the groups who are sending volunteers to Hopital Adventiste d'Haiti (HAH) in Carrefour, Haiti. I traveled with the Global Health Institute through Loma Linda University (LLU) in California. Also, groups of volunteers came through Cure International. Both groups coordinate transportation to and from the airport and housing arrangements. While the Orthopedic need is great, so are the needs for OB/Gyn with a very busy OB and NICU service, Emergency, General Surgery, Plastic surgery, Hospitalists, Infectious Disease and wound care, Pediatrics. PAs and NPs will definitely be put to good use. Even spouses with limited or no medical skills are welcome as there are huge needs for organization of central supply, pharmacy, meal distribution, and maintenance including plumbing and electrical amongst other things. While any single person cannot make a dent in the needs, together, great things are being accomplished and lives are being saved. The needs are great and will be ongoing for months and years to come, so consider giving a week of your time to the people of Haiti. It will impact you for life.

CURE International: Their main website is www.cureinternational.org However, if you have interest in volunteering at HAH in Haiti, contact Heather Hunter at hhunter@cureinternational.org

Since I personally did not travel with CURE, I do not have a lot of details about their arrangements. CURE arranged volunteer housing either in a nearby hotel or at the hospital and all transportation. LLU did provide volunteers with a travel insurance policy, housing at the hospital, transportation, and details for planning your travel and packing lists, vaccinations, etc.

LLU Global health institute:

http://www.lluglobal.com/site/c.msKRL6PNLrF/b.5767965/k.B2B8/Haiti.htm

AHI/LLU | Hopital Adventiste d'Haiti
Port-au-Prince, Haiti
Haiti Response

Loma Linda University (LLU) and our partners are working to support the Hopital Adventiste d'Haiti in Port-au-Prince. LLU is not alone in these efforts. Together we are pooling our resources and working closely with Park Ridge Adventist Hospital/AHS, Florida Hospital, CURE International, Life Enhancement Association for People (LEAP), and Adventist Development and Relief Agency (ADRA).

* The need for additional medical teams continues, but as we move forward the composition of these teams will change to reflect current needs at the hospital. Keep in mind the needs change almost daily.
* As of April 20, 2010, the "Dream Team" includes:
o 1-2 Orthopaedic Surgeons
o 1 General Surgeon
o 1-2 Anesthesiologists (MDs and CRNAs)
o 1-2 ER Physicians
o 1-2 Pediatricians
o 4-8 RNs of whom 2-4 with OR and ER experience
o 1-2 Physical Therapists and/or Occupational Therapists
o 2 Pharmacists
o 2+ Central Supply Personnel
o 2 Utilities and Maintenance Personnel
* We also welcome applications from OB-GYNs, PAs,NPs and other health care professionals. We would like to keep the number of our teams to about 25-30 people on any given week.
* The teams will work at the Adventist Hospital.
* The current strategy is to send in teams for at least a 9 day cycle (Teams arrive on Friday and leave on Sunday.) A longer term of service is preferred.
* LLU will maintain and manage the schedule of the various teams and provide them with information about their trip and tips about what to bring, etc.

The Children of HAH

Today, I thought I'd post some pictures of children. I actually had very little time to interact with the people and talk to them, which made me feel somewhat disconnected personally at times. We were so busy with clinic and operating (where patients are generally sleeping) that time to get to know some of the Haitian people was slim. One afternoon, though, I got a reprieve and got to go outside in the front of the hospital steps to the tent city on the hospital grounds. There was a large group of kids playing out front jumping rope and a lot of the adults had gathered around to watch. A group of volunteers who was waiting for their tap tap joined in to play as well. I got to talk to a couple kids that day, learn some names, give away some candy, and get lots of smiles, most of which I didn't capture in pixels. Here they are:

This is an 12 year old girl who had significant contractures of her knees. She underwent a procedure to lengthen the tendons so that she could eventually get her knees straight and be able to walk upright someday. She had casts on both her legs that we changed out one of the first few days I was there and she and her mom got to go home. These pictures were taken the morning she went home. She was a sweet girl and I loved the smiles and interaction between her and her mother.

One of the things you may notice is that children appear much younger than their stated age, often so much that we questioned if their recorded ages were correct! This girl was 12, but she really looked more like 8 or 9 by our US standard.

Here is one of the physical therapists working to help her walk with her walker so she could go home. Picture courtesy of Kaye Whitney, PT.

Kaye was pretty amazing. She rounded with the Ortho team every morning at 6 to keep all the day's therapists (who would arrive later in the morning) up to speed, she worked in the stock room sorting supplies, worked with a team to clean the kichen top to bottom one night after a full day of work, and also volunteered to pass out meals to the entire hospital during her last week, a job she said was so difficult to do because she just didn't have enough for everyone and had to turn away hungry family members.

Here is one of the new lives born during our time at HAH. She was born by emergency C-section and is a beautiful little girl. All the c-section babies I saw were girls. Average birth weights for the babies in Haiti are only about 5 or so pounds, a stark reminder of the malnutrition rampant in the country.

There are some of the kids outside the hospital living in tents on the grounds. This boy was playing with a little guy in a wheelchair and was pretty skeptical of having his picture taken, but sure liked popping the bubbles some of the volunteers were blowing at them.

Fun with bubbles

This little guy, Joseph, was one of our Ortho patients who had some infected wounds on his right leg. I didn't see him but once or twice, but our team took care of his wounds. He was a very sad boy and rarely smiled or interacted much, until the bubbles came out. Fred and Dianne who saw him regularly couldn't believe the smiles and joy he had playing that day.

This is Fred Liss, MD and his wife Dianne who brought bubbles with them to share with the kids. They were a hit! While we were playing, I saw a teenage boy sitting by himself just watching the interactions and the attention all the little kids were getting. You can barely see him sitting behind the lady in the wheelchair in the white dress. He looked pretty lonely to me.

I went over and talked to him through my interpreter friend, Jeanty, who had accompanied me outside. He told me that he had broken his leg when a wall fell on him during the earthquake. He had been showering when the quake hit and was with him mom in the house. He was able to get outside before his leg was injured. We talked a little bit more, and Jeanty told me Elizay asked for me the next day, but unfortunately, I didn't have a break again to go outside before I left HAH. I was very sad that I didn't get to see him again and talk to him one more time.

These are some of the girls jumping rope with some of the volunteers.

This young woman amazed me and demonstrated the resilience of the Haitian people after the quake. If you look carefully, you'll see she has an amputation of her left leg. You can just make out the ACE bandage around the end of her stump. Talk about amazing to see her jumping rope and having a good time with all the kids. I was flabbergasted and so moved by her. It still can bring tears to my eyes to see the pictures and remember her jumping rope.

This boy has an external fixator on his right leg and was outside watching all the activity from his wheelchair. He kept making signs at me, so I took his picture. He seemed upset by that until he got his sisters together with him and some artwork he had made and had me take a picture of them all together. Then he was happy!

She was one of the ones blowing bubbles and just looked so beautiful to me in her white lace dress, braided hair and smile. I dont' know her name.

This girl followed us around a lot. I forget her name right now, but she wrote it for me and I have the paper somewhere. She would join us for morning report on the steps and ask for our pens and notebooks to draw pictures and teach us words in Creole. She was the girl I met at the helipad our first Monday at HAH (see previous post and picture).

This young man was outside during report one morning. He is just one of the many patients living in a tent on the hospital grounds.

More kids at morning report hoping to make friends with volunteers. One day, they all wanted name tags like we wore, so someone took paper medical tape and made them all name tags. They were all really proud to wear them.

The boy closest to me (obscured some by the girl with the pink shirt) is Kervens. We were buddies my last week and would say hi and high five in the hospital halls. He remembered my name because I told him how close it sounded to his name, so we were buddies after that.

This boy has a condition called Arthrogyposis, a rare condition in which multiple joints suffer contractures. He came in for casting each Wednesday with him mother. He was a tough one to get to smile, but we got lucky a few times. He had very limited knee extension as well as clubfeet. With getting him help early in life, he has a chance to walk somewhat normally someday and may be spared the pain we saw in adults who never got the treatment they needed as babies and children. While Arthrogryposis is a rare condition, it is more common in Haiti and the DR as I have seen a number of children and adult patients with it in my few trips to the island.

This is Dayana. She was treated for a deformity of her right leg and had a Taylor Spatial Frame (TSF) on her tibia. A TSF is an amazing device, and Scott is probably one of the most experienced surgeon in the world in this technique. I had the privelege of assisting in a couple of TSF operations with him, which is more than most Orthopedic residents will see in their lifetime. Anyway, it's bascially an Ilazarov type external fixator "on steroids." It is used to correct deformities of long bones over a period of time. It has two rings that go around the leg, and then six adjustable struts that bridge between the two rings. The surgeon applies it very carefully to get the alignment of the rings right, and then takes some Xrays to make measurements on which the correction will be based. These measurements then get put into a computer program on a webpage, and it spits out a program of daily adjustments that the patient makes on their own at home over a number of subsequent weeks or months, depending on how severe the deformity is. This allows the adjustment to be made in very small increments and done slowly so there is less pain involved and the surgery is much less invasive than one where the the bones are cut to be realigned and then soft tissues have to be released and lengthened to correct the deformity.

Dayana was at the hospital almost the entire time we were there, going home on the Tuesday of our last week. Her surgery had been a couple weeks prior to our arrival, but she didn't have family who could help her with her adjustments to her TSF at home (see explanation below). Finally, our therapists were able to train an aunt how to do them so she could go home. Then, the family said they needed a tent, so our nurse coordinator went through the process to get her family a tent so they'd have some place to live. During her entire stay in the hospital, she had a cot in the hallway, never having a room to herself. During the days, I would see her in a wheelchair sitting at the end of the hall upstairs where there were some windows that overlooked the main hall below. From there she could watch the people come and go and have some way to pass the long days at the hospital by herself. I would often pass her sitting in her chair and slip her peppermints or butterscotch candies, and on the special days I had M&M packets in my bag, she was the glad recipient of some chocolate. She seemed pretty lonely, so I made a point to say Bonjour to her, to get her to smile and let her know she wasn't forgotten.

Wow, this little girl has a story!

Her story is told by Terry Dietrich (in quotations):

"She was brought from about 6 hours away by a neighbor. She has the most unbelievable case of bilateral Blount’s Disease I have ever seen.... "

Blount's disease is a condition affecting children where the tibia bows outwards at the knee. Here are her Xrays. Her right leg is pretty bad, but her left is much worse!

Basically, for those non-medical people, these xrays show horrible bowing of her tibia at her knee joint. Here's a normal knee to show the difference:
"....The neighbor speaks perfect English. He is married to a woman from Kansas. They live and work mainly in Kansas but come down periodically to their home here. When I told him that we could do an operation to straighten her legs he got tears in his eyes. The Taylor Spatial Frame will be perfect for her. I want to do her surgery with Scott."

It was amazing to see how all the pieces of her puzzle were put together to get her to HAH where she can have life changing surgery. She was neighbors with an American who cared for her and her family and had the means to get her to a center where the surgery could be performed. Because of the earthquake, Scott brought world class orthopedic care to Port Au Prince and will be able to operate on her legs with TSFs. Her surgeon is one of the most experienced TSF surgeons in the world. It's amazing to witness how God works all the pieces together to change this girl's life.

On a side note: I see Pierre and Stacey have found my blog now! It's great to have you guys in touch. Please say hi to Constantine, Gretchen, Mary, and Freeborn, too! I am not sure where my email addresses for you all are, so please drop me a line so we can exchange pictures and keep in touch.

More pictures: click on the pictures to enlarge

One of our anesthesiologists, Constantine, performing a spinal.

CRNAs Mary and Freeborn

Constantine at work

I&D of an infected wound and application of wound vac on Quito (From L-R Jan, Sharon, and Terry)

VAC placement around a Taylor Spatial Frame, thanks to Jan, our wound care RN specialist who helped us learn some advanced VAC techniques and wound care.

Rebuilding in town

Tough guy-- all the kids want to pose like tough guys and show hand signs. I saw this in the DR as well. It took a bit to get them to smile but showing them their picture on the camera screen usually helps get some smiles from kids and parents a like.

A view of the mountainside from our veranda sleeping quarters

A view of the back grounds of the hospital and laundry facilities. You can see the blue towels from surgery hanging out to dry in the lower right corner.

This was a sweet boy we met in clinic who was ready to learn to walk without his crutches.

One of our physical therapists during week one, Kaye, who worked some miracles.

This was the sterile processing room before reorganization. You can just make out the steel sink along the wall on the right that was used for cleaning the dirty instruments. So, the dirty, pussy, bloody instruments would be brought in and set down to be cleaned right next to the clean instruments waiting to be wrapped for sterilization. This sink was moved to it's own dirty processing room and new shelving set up for better organization.

Supplies to sort

Liz and Sylvia from LLU spending long hours sorting instruments and supplies.

Terry seeing a patient in clinic on our first morning. She had fallen and broken her wrist just that morning and we were able to reduce the fracture and splint her in our "after church" clinic.