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.