Monday, August 30, 2010

Returning Home

From Terry Dietrich, MD
We are on our way home from Haiti.  Our week was filled with memorable experiences.  Nearly half of the 200 patients we attended in the orthopedic clinics this past week were injured on January 12.  Of those patients, nearly 50 surgical procedures were performed.  These included wrist, knee and ankle fusions, bone grafting of ununited fractures, fixation of fractures, skin grafting, removal of tumors, correction of club foot  and other congenital deformities, and knee arthroscopy.  The sophisticated Taylor Spatial Frame was placed on several patients.  This device is used to realign bones that have become deformed from poor fracture treatment or from conditions such as Blount’s Disease that cause bones to deform during growth.

Port au Prince continues to be a major disaster zone. The recovery from the fourth most deadly earthquake in the history of the world is agonizingly slow.   Of the estimated 230,000 people who died, nearly half are still entombed in the rubble.  I was told that only 2 % of the rubble has been removed.  Of course, that means that the people who lived and worked in those buildings are still without a place to live and have no livelihood.  There are people and organizations making efforts to help with the recovery but it is a seemingly impossible task.  There is a bright spot in Port au Prince.  It seems to be the silver lining in the black cloud that enveloped the capitol city on Jan 12.  The development of Hopitale Adentiste d’Haiti into the major referral center for orthopedic surgery is nothing short of miraculous especially given the devastation and chaos created by the earthquake.  Before Jan 12, it was a struggling little clinic that had never done orthopedic surgery.  Now, mainly because of the dedication and vision of Dr Scott Nelson and the support of Loma Linda University, it is making a terrific impact in the entire country.  The sophisticated orthopedic procedures that are done routinely at HAH exceed what is done in many good hospitals in the United States.  Limb deformity corrections for severe congenital and posttraumatic limb deformities are done on a daily basis.  Joint arthroscopy has just been established and can now be done routinely.  Many volunteers continue to flock to HAH to provide services that had never been available to even the wealthy prior to the earthquake.  It appears to be one of the few projects that have been making a significant difference in Port au Prince since the earthquake.

There are many needs that still need to be addressed for HAH to realize its potential.  Volunteers still sleep on army cots or on the floor in unfinished parts of the hospital.   These volunteers are an important part of the treatment given to patients.  They include administrators, surgeons, nurses, x-ray specialists, anesthesiologists, therapists, physicians, plumbers, electricians, builders, surgical assistants, coordinators and students.   There will be needs for volunteers for many years as Haitians are slowly trained to assume these positions.  Housing needs to be acquired to accommodate the volunteers.   Funds need to be raised to finish the new patient wing.  This unfinished project began more than 5 years ago.  Finishing that wing will make it possible to attract patients that can pay for their medical care.  That income stream is vital to keep the hospital financially viable as it continues to care for the needs of the indigent.  A total joint replacement program would help bring paying patients.   The current operating rooms are not of adequate size.  The equipment necessary to perform joint replacement requires a large space to accommodate the array of tools, materials and equipment and reduce the risk of contaminating sterile areas.  An entire addition to the hospital with new operating rooms is planned.  That will be a project that will take 3 years or more.  The current operating rooms could be reconfigured to create a room of adequate size for joint replacement surgery.   That reconfiguration would involve updating the entire surgical theater area to improve traffic flow and provide more effective fly control.  These projects to provide volunteer housing, finishing the new patient wing and updating the operating rooms could be finished for approximately $200,000.   Another very important project to ensure continued access to high quality medical care for the indigent is a fund dedicated to subsidize their care.  The interest from $500k would be sufficient as a starting point.  There is still a relatively high awareness of the needs in Haiti.  Fund raising can still be done.  Identifying the institutions and organizations that can provide financial support is the starting point.

I am personally contributing a year of my life to this project.  I was impressed during my two weeks at HAH in April of the need to continue the work that Dr Nelson has started.  He cannot continue to live in Haiti due to family and professional responsibilities.  My wife and I will be moving to Port au Prince in November of this year and will stay for one year.  I will continue to coordinate the orthopedic services that have been established.  I plan to implement new programs such as joint replacement.  A training program for Haitians is a high priority.  Identifying my replacement will need to be done.  Fund raising for the above projects is key.

August 27th

From Terry Dietrich, MD
Today was really a fun day.  We had 8 cases scheduled and did them all.  Our first case was a lady with a grapefruit sized mass in her left shoulder.  It felt like a lipoma.  I had Ben do the incision and then he dissected the whole thing out.  It was a pretty amazing experience for a college student.  He then assisted me on my third ankle fusion this week.  It went well.  He put in a couple of the screws.  Our last case was a wrist fusion.  He put in most of the screws.  He did really well.  He has very steady hands.  Todd did 2 more arthroscopies and Ed scrubbed on them both and actually did the second one.  He is totally wired about the experience.  Our work here at the hospital is over for the week.  It has been a very worthwhile experience for all of us.

Scott’s wealthy Haitian friend, Jean Marc, came to HAH today and brought some construction people.  They looked at the new wing project and the OR and agree completely with Scott and me that it should be finished to appeal to the wealthy.  It would include putting in a more appealing tile.  They did all of the very nice work on Jean Marc’s home that Scott has visited.  It would be great to have it finished to really have high end appeal.  We can offer services to the well to do and the income could subsidize care for the poor.  Scott thinks that the necessary money would be relatively easy to raise.  They are going to give us an estimate by Monday.  I’m going to have Scott take them over to the house across the street and have them also give us some ideas about how to make it more livable

August 26th

From Terry Dietrich, MD
Still no C-arm.  Scott continues to make efforts to get it running.  His optimism hasn’t waned.  The portable unit is working very well now and we have used it in the OR for a couple of cases.  Todd did a second arthroscopy and then he and Scott put a Taylor Spatial frame on the patient and osteotomized his tibia.  Clinic was much smaller today.  Todd and I saw the patients and scheduled several cases for tomorrow including another arthroscopy.  Scott had a long case to start the day.  The child has fibular hemimelia – the small bone in the lower leg didn’t grow properly.  The leg is crooked and short.  He corrected everything and put on o TSF to lengthen the leg.  His surgical talents amaze me.  I did another ankle fusion.  Scott and I finished the day with a 15 y/o boy with spastic hemiplegia.  We corrected his foot and ankle with a lengthening of both the Achilles tendon and posterior tibial tendon and a split anterior tibial tendon transfer.  I finished it at nearly 10 pm.

I had a meeting with a representative of the University of California system.  They have a very strong interest in having extensive participation with HAH.  Professors, clinicians and students from UC San Diego, UC Davis, UCLA, and UC San Francisco want to rotate many surgical and medical specialties through here.  The possibilities here are seemingly limitless.  Dr Archer presented me yesterday with preliminary drawings for the reconfiguration of the OR so that we can have a large enough OR to be able to begin a total joint program.  He and the hospital administrator are very enthusiastic about the idea.  Tomorrow will be our last day.  It has been a tremendous week so far.

August 25th

From Terry Dietrich, MD
We had another very good day.  The clinic was huge with more than 40 clubfoot patients.  There were an additional 35 regular ortho patients.  Joseph Fritzner returned to the clinic.  I operated on him at least a half dozen times in April.  He had fractures of both arms, both femurs and left tibia into the knee.  He had an infection in the tibia fracture as well as a compartment syndrome.  I almost amputated his leg on 2 occasions.  His leg is doing well as are the other extremities.  He uses a brace on his left ankle and still walks with a cane.  He and his wife were happy to see us as we were to see him.    Scott has a good system set up for the clubfeet so it went smoothly.  The whole area of the hospital around the ortho clinic was massively packed all day.  Both rounds and surgery went very well.  All of our patients seem to be recovering from surgery nicely.  It was a great day in the OR.  Dr Smith did the first arthroscopy case ever in this hospital and maybe the first ever in the country.  It went very well.  The patient had a torn lateral meniscus as I had thought when I saw him in the clinic.  The new equipment worked very well.  It is exciting to be involved in a project like this.  I am very thankful to Ed Mueller and Linvatec for making such a generous contribution.  We have seen more than a half dozen patients in the clinic that need joint replacement.  The small ORs are inadequate.  The possibility of removing the wall between OR 3 and the storage room and then combining them into a large OR that would be suitable for Total joint surgery was discussed with Dr Archer and the hospital administrator.  They are very enthusiastic about the possibility.  Combining that with finishing the new wing would undoubtedly attract many paying patients.  All of our cases went well today including the ankle fusion that I did.  We were able to finally wash out the open femur fracture and then put in an interlocking SIGN nail as well as fix the tibia with another locked SIGN nail.  Fortunately he is thin and we were able to use a tourniquet and blood loss was negligible.  Nathan took Jeannie and me to the house across the street where we will probably be living when we come back.  We will be sharing it with about a half dozen other volunteers.  It is a large house that appears to have been unoccupied for a long time.  It has a very large yard surrounded by a high block wall.  I think it will work very well for us.  If we were going to be living here for several years, we would find our own house to live in.

August 24th

From Terry Dietrich, MD
Aug 24     The ortho clinic was even bigger today.  I saw a man with a clear cut torn lateral meniscus.  He will be the first Haitian arthroscopy case.  I put him on the schedule for tomorrow.  We have about 8 other cases on the list as well for tomorrow.  All of our cases went well today even though we don’t have a C-arm.  Todd helped Scott with a Taylor Spatial frame.  I did a knee fusion on a pt with post traumatic arthrosis.  Todd grafted a nonunion of a tibia with post ICBG.  I saw the mystery patient in clinic.  He has a healed incision on his buttock that looks like he had a hemiarthroplasty.  The staples were still in.  He said his surgery was done here at HAH 5 weeks ago.  His xray shows that he has an intertroch hip fracture with no evidence that the fracture was ever fixed.  His medical record is missing.  We may never find out what transpired.  The blood finally arrived for our trauma patient at 7:30 tonight.  We got 2 units so will get them in tonight then do his surgery early tomorrow.  I sure hope he makes it.  There is a nearby house that may be where we will be staying for the year.  We’re going to look at it tomorrow.  I spoke with Dr Archer today after he made rounds with us.  He was pleasant and very agreeable.

Tuesday, August 24, 2010

News from the Radiology Techs

Greetings from Haiti!  Everything is going great.  I never thought I would love a cold shower so much!  Hannan and I have been working with the x-ray tech here, his name is Franz.  He does not speak English, but we have a translator named Joseph helping us communicate.  We are actually having a blast.  They are great guys and we all enjoy working together.  Today Franz didn't show up, so it's Hannan, Joseph, and I.  We are using a portable CR machine in a small room.  BONUS is it's air conditioned- for the equipment.  At times we show Franz new things and we are also learning from him the way Dr. Scott likes x-rays for the Taylor spatial frames.  Unfortunately, the C-arm is not working so we haven't been in the OR yet.  They have a few cases lined up for when it is up and running. 

We have seen so many fractures and a large majority of them are from the earthquake and the patients are just now seeking treatment.  

Gotta get back to work! 


Team Haiti from ThedaCare is on the ground and at work!

From Terry Dietrich, MD  8/24/10 7AM CDT
Aug 20    The   Thedacare Orthopedics Plus Haiti Relief team from Appleton Wisconsin is locked and loaded.  The team:

1.  Todd Smith   orthopedic surgeon

2.  Terry Dietrich   Orthopedic surgeon

3.  Jeannie Dietrich  RN  Trip coordinator

4.  Jodi Zimmerman  RN

5.  Becky Czechanski RPT

6.  Kristen Daniels  RTRM

7.  Hannan  RTRM

8.  Trent Jerzinski  Health Care engineering/construction specialist

9.  Ed Mueller  Linvatec representative  arthroscopy equipment specialist

We have included a wound specialist, JanKlass,  from San Diego as well as an anesthesiologist, Karl Eckhardt, from Walla Walla, Washington.  Both are high priority for the types of patients that are cared for at the Hopitale Adventiste d’Haiti.

This team was formed to respond to the orthopedic needs of the people of Haiti in the aftermath of the devastating earthquake of January 12.  The site for our work will be the HAH.  This small mission hospital in a suburb of Port as Prince was developed in the weeks following the earthquake to care for the many patients with fractures and other orthopedic injuries.  Dr Scott Nelson was the first orthopedic surgeon to arrive in the city just 24 hours after the earthquake.  He decided after assessing the medical facilities to focus on HAH as the best site to provide orthopedic care.  No orthopedic surgery had ever been done at HAH before the earthquake.  In the past 7 months, he has done a remarkable job of developing the orthopedic capabilities of HAH.  It is now regarded as THE referral  hospital for orthopedics in the entire country.  Many of the patients that are cared for there are victims of the earthquake with residual infections and/or deformities that were unable to be treated in the chaos following the disaster.  Many patients with orthopedic injuries that have occurred since the earthquake are now also treated at HAH.

The goals of the team are:

1.     Provide orthopedic care for Haitians

2.     Develop an arthroscopy capability for HAH (the first such program in the country)

3.     Assess the physical needs of the hospital. 

4.     Develop strategies for raising funds to support costs of providing orthopedic care for indigents.

Dr Nelson and other volunteer orthopedists have been inundated with orthopedic cases especially in the indigent population.  There is a huge ongoing need for volunteers to continue to provide this care.  The government orthopedic hospital is largely limited to treating the patients with acute trauma.  Their resources are limited.  Arthroscopy will increase the range of orthopedic services and bring a modern orthopedic capability to the country.  The Hospital physical plant has major needs.  The operating rooms are very small making it difficult to accommodate the equipment necessary for modern orthopedics.  Storage space is hopelessly inadequate.

All team members plan to spend the night near the airport in Chicago.   We leave at 9:20 tomorrow.

Aug 21    The trip to Haiti had some anxious moments.  We arrived at the airport before 7 am.  We were informed that the maximum number of checked bags per person is 2.  The Website indicated 3.  We were able to repack and use the overweight allowance of 70# for 3 of our bags.  We had a very helpful AA desk agent named Eli Ortega.  Jan met us in Miami.  Karl arrived in Port au Prince yesterday.  There were 3 other AA planes on the tarmac when we touched down.  Baggage claim was near total chaos.  All of our luggage made it in good condition.  The hospital contact got us to the vehicles and secured the luggage.  It was a fairly long walk.  On our trip through the city, it appeared as if there has been virtually no work done to remove the rubble or rebuild.  It really leaves an impact to see the incredible amount of destruction in the city  and the piles of rubbish and the tens of thousands of tents.  We met with Nathan and Amy at the hospital and gave the group an orientation.  We are anxious to start seeing patients and putting our new equipment together and start using it.

Aug 22    The forecast was for a light day.  We started with morning report at 7:30.  We just finished our last case n the OR and it is 10 pm.  We have 6 cases on the schedule tomorrow including a man who came in to the ER with fractures of the tibia, femur and proximal humerus.  The C-arm gave us grief today and wouldn’t boot up.  We are hoping we can get it figured out by tomorrow.  Ed got all of the arthroscopy equipment unpacked and is anxious to start using it.  Ben scrubbed in on some cases and was a big help.  The whole team has jumped in with both feet.  It is a great team to be a part of.

Aug 23    As expected, the ortho clinic was huge.  Scott managed it pretty much by himself while Todd started the first case in the OR.  I made rounds with the rest of the team.  Our patients are doing well except for the patient with the multiple fractures.  His hemoglobin was 6.0.  We asked for blood and are still waiting.   Meanwhile, his Hgb has dropped to 4.7.Since malunions and nonunions are treatable, we have decided to not operate until blood is available.  We did a lot of cases today and finished by 8:30.  They all went well even though we don’t have a C-arm to check our reductions.  We might have to make some adjustments to some of the fractures.  We ran 2 rooms a good share of the day.  It is great to have 2 anesthesiologists.  Jeannie has been spending a lot of time with Lucia learning how to set up the OR and how everything is organized.  We used the new drill/pin driver on 2 cases today and it works great.  Ed scrubbed in and assisted Todd on an ORIF of an elbow fracture. Ben helped me on several cases.  It is really fun working with these guys.  Trent made contact today with the Haitian student.  I don’t know what happened with that yet.  I am sure that tomorrow will bring more new challenges.

Thursday, August 19, 2010

Team Haiti-- August 2010

Welcome to the blog for Team Haiti from Wisconsin! The team departs on August 20 for the first part of their journey to Chicago, and then will fly to Miami and Port Au Prince (PAP) on Saturday August 21. Their destination? Hopital Adventiste d'Haiti (HAH).

For current happenings at HAH, check in with the Haitibones blog at for more blogs and trip reports.

Check back here for posts from the team on the ground or subscribe in the box on the left for daily emails containing any/all blog posts from the previous day.

Thanks to the team for their willingness to travel to an under-served, undeveloped, and unstable country and give of their time, talents, and even tears for the next 10 days. Blessings on everyone and the families supporting them.