Haiti trip report: January 2012 from Tim Gerke

Front Gates of Hopital Adventiste d'Haiti

Typical street scene in Port au Prince.

I spent the final week of January at my home away from home; Port-au-Prince, Haiti. If you would have asked me a year ago where I most enjoy spending my free time, the last place I would suggest would have been post-earthquake Haiti. Yet after each subsequent trip to Haiti I find it more difficult to leave and often feel a sense of loss for my Haitian friends I leave behind. Haiti and its beautiful people have a way of changing ones outlook on life. While it’s true that Haiti has needs beyond needs, the people of Haiti are blessed with a kind, loving and caring spirit unlike any group of people I have come across. I often say I get more out my trips to Haiti than I provide to those whom I serve, and this trip was no exception. I left for Haiti with a heavy heart, traveling for the first time without my amazing wife and without Terry and Jeannie Dietrich, as Terry recovers from a back injury. But together with eight new friends, I had another incredible to trip to Haiti as I helped serve those in need.

Our trip consisted of nine members; I was joined by Bill and Sue Shawler (an ER physician and recovery room nurse from Portland), Randy and Carrie Goethke (anesthesiologist and family practice physician from Appleton), Chris Jobe (orthopedist from Loma Linda), Kenny Jahng  third year orthopedic resident from Loma Linda) and Maria and Lucia (anesthesiologist and nurse from the Dominican Republic). In many ways our time there was like two trips in one with time split between working in the hospital and visiting orphanages around the city.

After a jolting awakening each morning around 6am by a cold shower, our team had a quick worship service and then it was on to the clinic. Dr.’s Jobe, Shawler and Jahng ran the orthopedic clinic with Dr. Francel Alexis. Dr. Alexis graduated in 2004 from the Medical School of Haiti State University and divides his time between very busy clinics and the OR. He now serves in the position of Director of Orthopedics, which Terry had served as last year. We had general orthopedic clinics Monday and Friday and a clubfoot clinic Wednesday.

We had a variety of cases in the OR during our week. One of our first cases was a teenage boy who had an elbow dislocation around Christmas. Unfortunately we missed in the translation that it was Christmas of last year, 2010, which made the case much more difficult. We planned for a three hour case and spent closer to seven on it. Due to the long duration during which the elbow remained dislocated and not used, the ligaments and nerves were injured, and a large amount of scar tissue and calcification had formed around the joint. Hours were spent trying every trick in the book until we finally had to put a pin in to fuse the elbow. The next morning the patient was doing well with limited pain and bleeding, so he was discharged home and will come back for a checkup.



Another surgeon (Dr. Bull Durham) transferred a patient from another hospital to ours to use the equipment we have to fix her hip fracture. Randy and I provided the anesthesia; I did my third spinal block, three for three so far this trip. The case went well. The head of the bone was completely broken off and floating free. To fix this we applied traction to her leg to realign the fracture, then three pins were placed to hold everything in place. Then three canulated screws (screws with hollow centers) were fed over the pins and screwed into place. Then the pins are removed and the screws hold everything together. After a few months
the bone will heal and the girl will be good as new.


We did several other cases during the week ranging from children as young as four years old to a hip replacement on a 70 year old woman. Thanks to many generous donors, every person who comes to Haiti Adventist Hospital, young or old, wealthy or poor, obtains the same high quality care. We also performed a few knee arthroscopies and various other surgeries. Sue and I really enjoyed recovering patients in the PACU and working side by side with the Haitian nurses. Bill and Carrie also stayed busy down in the pediatric clinic. Carrie’s French came in very handy when translators were not available. It was a great week and while the OR was not as busy as some prior trips, I feel we made an impactful difference in the lives of many people.

Hopital Adventiste d'Haiti

After our work was done in the hospital, many members of our team ventured out into the city to visit the local orphanages. With each trip to Haiti I find myself spending more time with these amazing children. Thanks to many of my friends and family, I was able to bring enough donated clothes to give over 140 children new outfits. Many children were wearing the same shirts from my other visits in March and July. Carrie and Sue also brought clothes, shoes, toys and toothbrushes for the children. We visited four orphanages over the week and saw so many amazing children. We also made time to go to local markets and buy each orphanage enough bulk food to last 4-6 weeks.

Our first trip included visits to two orphanages: Mr. Wilson’s and Mary Lou’s. Mr. Wilson has 25 children and they were out of food, so along the way we picked up enough bulk food for both orphanages and all the kids to last them for a month. Rice, pasta, cooking oil, spices and beans were on the menu. We toured their place and were surprised to see where they slept. They all had a bunk to sleep on but no mattresses. Instead they each had 1 or 2 layers of cardboard between them and the metal frame of the bed. That’s it. And yet they were the happiest kids I have ever met. I arranged to buy them each a mattress so hopefully by Monday they will each enjoy the “luxury” of sleeping on a mattress. We then spent a few hours playing with the kids and handing out the clothes, toys, shoes, toothbrushes, and the “Gerke Nutrition packs” we brought down for them. I gave out over 100 nutrition packs this week, I can only imagine how many of those were the only meal of the day for some of those kids.

Tim with some of the orphanage residents

Next we went to Mary Lou’s. She has 15 kids but her house is only 7 feet by 20 feet in size. All 15 kids, ranging from 4 years old to 11, had to squeeze and share only three twin mattresses. And they had no beds so they just put the mattresses right on the floor; dirt, bugs, rats and all. Dr. Bill Shawler and his wife Sue are arranging to buy them a few bunk beds to sleep on, and hopefully we can get them some clean, new mattresses as well.

Some of the bulk food we purchased earlier was brought over for them. Only in Haiti have I seen a child cry over receiving rice as a gift. What life must be like that food is so sparse that a 50 pound bag of rice brings an 11 year-old to tears.

The other orphanages all had more happy children. One of the orphanages had done some construction to build one additional building, however about half of their spaces are covered with tarp roofs, many of which have large holes in them. I am going to try and arrange to have metal roof built over some of them to keep them dry.

The final orphanage had ten children, all of which were all very sweet but very shy. They had a nice home with a small flat area to run and play. This was the first of all four orphanages to have somewhere for the children to get exercise and be near their home. There are four boys and six girls. The boys shared three beds and the six girls shared two beds. The boys did not have mattresses, only a single layer of carpet for padding. The girls only had cardboard to sleep on. I also found out that every child under 12 gets a free education in Haiti, however they must have their own uniform. The orphanage only had five uniforms so only half the kids went to school. The uniforms ended up only costing $10 each so we bought each child a new one and now all 10 children can get an education. $10 will allow a child to get years of otherwise free education in Haiti, not a bad return on that investment.

At each orphanage I asked how much it costs to provide for each child. On average it only costs about $1 per child, per day. For $100 a month you could clothe, feed, provide shelter and an education for 3 needy children and have some money left over.



We had a wonderful trip to Haiti and I was blessed in so many ways. You too can bless the needy by donating to the Haiti Indigent Patient Fund. By donating $50 you will receive a free copy of our book, “Haiti: Together We Move” and 100% of the money you donate will go on to provide life changing medical care to a needy Haitian.

Together we can move Haiti forward.
God bless the Haitians.

Tim Gerke

Haiti Never Ceases to Amaze

Nov 2
I felt like running when I woke up at 5 o’clock.  I started out on the uphill a bit faster(not quite as agonizingly slow?) as usual.  The gas was pretty well gone before even getting to the more level section at the top.  Pushing on was not fun but there was still some hope that today might be the day.  The more flat section decreased the negative sensations a lot and the timed spots seemed to come a bit sooner than usual.  The more flowing feeling on the descent turned the whole experience into something actually positive.  27’ 10” My best time yet.  To think that my goal after doing this run several times when I first started was to break 30 minutes.  Now I’m nearly 10% under that.  If I can keep up the improved times I will logically reach 0 minutes and 0 seconds.  Then time will begin to go backwards and every time I run I will get a little younger.  It took for me to spend a year in Haiti to discover the secret of eternal youth.  What an awesome year this has been.

Dr Alexander operating with Dr Nau

I concentrated on the clinic while both Ian and Mario got our cases going.  Several more patients with frames came in and they almost always take a while to make sure everything is going well.  One patient with bilateral PonseTaylor frames for severe clubfoot is doing quite well.  I checked all of her strut settings and a couple of them were way off.  The mom said the strut was hard to turn so she just stopped.  They live quite close by.  I don’t know why she didn’t come to get help before her appointment.  We got it straightened out and changed a couple of struts that needed it.  A patient of mine that I put a TSF on for a tibial malunion came in.  He looked a bit overcorrected and the xray confirmed he is in a bit of varus as well as more distraction than I had programmed.  I discovered that he has been adjusting his struts to try to get one of the rings way from his skin.  All of the struts but one were totally off. 

Huge cyst in the talus bone

I programmed a residual for him that will take a few days.  I’ll check it next week before we leave.  The orthopedist at Medishare called to ask if we could take a couple of hip fractures.  Apparently they have limited Carm capabilities.  His name is “Bull” Durham and he is from Tuscon Arizona.  He came over along with the neurosurgeon and I showed him around.  This is his 4th time working at Medishare.  He is getting to the point where he feels they are regressing in their capabilities.  He also feels frustrated that they are not allowed to get out in the community at all because of security concerns.  He wants to come here next time.

An ORIF of the ankle

A neurosurgeon at Medishare called and asked to bring a patient with a C6 spinal injury for surgical stabilization.  He had jumped facets and complete quadriplegia.  I told him it was fine to bring the patient and I would help him with the case.  We started it about 5:30 and finished before 8 pm.  I passed sublaminar wires and we bent a rod and wired C4 to L1 and fused him.   He was reduced and nicely stabilized when we finished.  Derek gave the anesthesia and was a pretty tired guy by the time I got him to the hotel.

Nov 3
Our surgery schedule was lighter than the usual Thursday.  That was ok because Ian had heard about the Hotel Olafson and the really good food there.  He wanted to take the whole team there because today was Mario’s last day.  We had several smaller cases, another diabetic foot that needed a transmetatarsal amputation and a 10 y/o with severe neglected clubfeet.  I assisted Mario with the clubfeet.  The first side was easier and he got a good correction.  The second side was limited by both medial skin contracture and the neurovascular bundle.  It will require a second stage procedure.  Dr Durham from Medishare called back to see if he could bring a case over to do tomorrow.  Their C-arm apparently quit working yesterday.  We have two cases for the C-arm tomorrow but it should be available in the afternoon.

With our cases wrapped up before 5 o’clock, we headed off to the Olafson in the pickup.  The traffic was absolutely terrible.  The jams appeared to be related to the road work that is being done on the main road through the city.  Roosevelt helped us find the hotel.  It is a decades old Victorian building and very photogenic.  The long  veranda wraps around the end of the three story building.  Overhead fans keep the air moving.  There was a classic looking hotel bar just inside the front door.  Many of the tables on the veranda had people sitting at them smoking cigarettes. It was much like a scene out of the movie “Casablanca.”  We had a really good time telling stories.  I toasted the whole team and especially Mario for all of their help and hard work.  Most of us had sandwiches for which the hotel is well known.   Derek really enjoyed the rum punch which is also a house specialty.   After several of them,  he decided to take a swim in the pool which he said was delightful.  We explored the rest of the old building before leaving.  The traffic was all gone by the time we returned home.

Nov 4
I expected the clinic might be larger than usual because of the holiday on Wednesday.  It was.  Quite a few new patients came in including one young man with a history of chronic infection in a distal femur fracture.  He was last operated on at the navy ship for a debridement.  He continues to have significant purulent drainage from just above the knee.  He has just a jog of motion in his knee.  I explained the options and recommended amputation.  He would need at least 3 more operations and likely more to clear up the infection.  If the process were successful, he would still be left with a short leg with virtually no knee motion.  He had already been thinking about this possibility and fairly quickly agreed.  We’ll try to work him in in a  timely fashion this coming week.  The power went off for quite a while during clinic.

The patient with the hip fracture from Medishare is 98 years old.  She was quite active and not demented before her fall a couple of weeks ago.  I had Ramon Rivera evaluate her when she got here yesterday and he cleared her for surgery.  We tried to get things going in the OR as quickly as possible hoping to finish in time to go back to Petionville to look for some paintings and carvings.  Ian wants to try to have a fund raiser in his church in Ohio with the Haitian art work.  Unfortunately, things went very slowly.  The hip fracture, using the hillbilly fracture table went nicely.  Lilly helped me and drilled several holes and put in screws and did some suturing.  She has been great to have here.  A patient with a tibial nonunion for a SIGN nail was supposed to be next but we had several smaller cases that each needed Derek.  That slowed the whole process down and we didn’t get the tibial case started until nearly 2 pm.  I helped Dr Durham from Medishare do that case and by the time we finished it was after 4 o’clock.  The power went out during the procedure and would only come on for a few seconds every half hour or so. It was very maddening.   After finishing the tibia the clinic was still going but almost done.  I couldn’t leave Dr Durham alone to do his distal radius fracture and Jeannie was the only one left to help circulate.  We eventually finished with everything by around 7 pm.  Petionville would have to wait.  Ian and Sue and Derek leave tomorrow morning so we’ll have to go to plan “B” with that one.  Jeannie and I will try to get what they want before we leave on Wednesday and take it with us.  We can ship a box to them when we get back to Appleton.  Ian is really excited to try this fund raising for Haiti.  If it works, he wants to come back and get more art and do it on a regular basis.  Jeannie and I took Lilly to the Auberge and we spent a couple of hours with them reprising some of our interesting times during the last two weeks.  Scott and team arrive tomorrow.