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.

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