Tuesday, November 30, 2010

Update from Terry, 30 Nov 2010

Nov 30 Hopital Adventiste D'Haiti

The last week has seen a major preoccupation with the presidential election. Administration pushed hard to get the new front gate installed before Sunday. The crew worked late into the night to get the job done. Even with the compound ‘secured’ we were notified that the UN was prepared to evacuate us should things get really rowdy. I could envision 'Saigon II' with me hanging onto the skid of an overloaded helicopter straining to lift off from the top of the hospital while taking on sniper fire and RPGs and such. That’s what an overactive imagination will do. The evening passed about as quiet as a typical Sunday night in Appleton. I wasn’t disappointed. My golf and tennis this summer didn’t get me in great shape for dodging Stinger missiles. Being confined to the campus for four days was no change for me. I haven’t been anywhere since my arrival on the 19th. I haven’t worn through the tile floor yet on my path from our room to the clinic and OR but it is probably imminent.

The epidemic seems to have subsided, at least for us. At last count we had zero cholera patients except for my little girl who is still getting IV antibiotics and has a wound vac in place for her leg infection. She is doing great. She might be discharged in a few days.

Fortunately, we haven’t been slammed with trauma, especially since the Haitian anesthesiologist informed me last Wednesday that she wouldn’t be back until Monday. I got in a little 4 year old with a displaced supracondylar humerus fracture on Friday and wasn’t able to do her for 4 days. They are so much easier to do right away. It was a struggle, but it went well even though I didn’t have a C-arm. I had a new experience today. I accepted a transfer of a patient with an open tibia fracture from a hospital more than 2 hours away. By the time he got here, the anesthesiologist had left and would not return. The fracture was 8 hours old so I took him to the OR and did the debridement and washout under ‘conscious” sedation. Titrated Fentanyl and Valium(no Versed available) worked great along with Marcaine at the fracture site. He slept through most of it and of course remembers nothing of the event. I didn’t think I could put in an interlocking rod given the circumstances, so I splinted him and will take him back for the fixation tomorrow(assuming I have anesthesia.) I also had a partial thumb tip amputation to clean up and repair. There was a bit of damage since he did it with a hammer.

I am thoroughly enjoying teaching Jean Joel Boyer to be my orthopedic assistant. He has been one of the OR translators and was the unanimous recommendation of all who had worked in patient care in orthopedics. He is enthusiastic and a quick learner. I am optimistic that he will be able to relieve Jeannie of the heavy burden that she feels to keep things going smoothly for me.

All the translators are doing their best to help me learn Creole “pad kwah”* It’s fun to see them shake their heads as I butcher the phrases time after time. The patients, without exception, seem to appreciate my efforts and smile as I try. The translators have different and interesting personalities. Their enthusiastic greetings every morning are music to me and their smiles are infectious. Emmanuel is my main guy in the clinic, but Roosevelt, Junior, Jeanty, Dorgil, Calvin, and even Frantz supplement as necessary.

Harold works in Central Supply. He is an art teacher. He lost all of his paints and brushes in the earthquake. He had several paintings in the national cathedral which was destroyed as well. I am going to have him paint us a picture of Haitians dancing as soon as I can get him some paints and brushes. We need a little something on a wall in our unfinished hospital room to make it a bit more homey.

I am delighted to watch the You-tube video of Staille that Karen posted on Sunday. She will be coming in next week to remove the external fixators from her tibias (the devices seen attached to her legs in the video). I’ll get some more video of her then. I really hope that the video of her changed life will help raise funds for the indigent care here.

Enough for now *You’re welcome

Terry Dietrich

Sunday, November 28, 2010

New You Tube channel-- CaribbeanOrtho

We have started a new Youtube channel for Orthopedic Ministries of the Caribbean. The channel is called CaribbeanOrtho and our first video up!  Please take a minute and twenty seconds to watch and share with your friends and family.  We are praying for God to spread the word of His work at HAH and raise money for our Indigent Patient funds.

Anesthesia providers needed desperately!

I got a quick note from Jeannie this morning.

"We are really hard up for anesthesia here until a team comes. There were several cases that Terry needed to do on Thur. and Fri. but was unable to do because we had no anesthesia. The local people would not come in."

Today, the national presidential elections will take place, and the country is bracing for severe unrest with cries of fraud already beginning. Because of the potential for such danger of rioting on the streets, it sounds like the local staff is not able to come to the hospital for work reliably.  Please pray for the elections, for peace, and protection at the hospital for everyone there.  We know of some medical providers traveling to Haiti today to go to a different site, and are very nervous about their arrival. One of whom is Stacy, a CRNA who was with us on our April trip to HAH.

Jeannie says her shoulder is improving but slowly, so please continue to keep her recovery in your prayers as you think of Haiti, HAH, and all that is going on there today.

Tuesday, November 23, 2010

HAITI Nov 19

Sent by Terry 23 Nov 2010

Our year in Haiti Adventist Hospital (HAH) has begun.  It brings delight to see some of the changes that have happened at the hospital since we were here in August.  Many of the tents are gone from the hospital compound.  Three new concrete slabs have been poured and one already has part of a small building constructed on it.  This is the PROJECT HOPE donation.  I’m told it will take three or four days to finish each building.  The third is designated for volunteers(us) to live in.  The reality however is that a Haitian day could last anywhere from a week to a month.  Jeannie and I are going to stay wherever there is a place to rest comfortably and have a bit of privacy from time to time.  The hospital room that we are currently using is in the new unfinished wing.  We have two hospital beds with comfortable mattresses and ceiling fans.  The sink has no mirror.  The shower/commode area has no light.  It is extremely convenient to just walk a few feet to see our patients and do surgery.

The progress at the hospital continues to contrast with the lack thereof in the city.  Perhaps a bit of the rubble has been cleaned up and there is some evidence of some new building since we were here in August, but it is a pathetic effort given the magnitude of the damage and the needs.  What might happen after the presidential elections this weekend is anybodies guess.  Mine is that not much will change.

We have 20+ orthopedic patients in the hospital.  Many have wound vacs and require a lot of attention. One has an acetabular fracture that I haven't been able to find the xrays on yet.  She has been in tx now for 3 weeks.  I have another man with a pelvic fx (fracture) and femur fx.  The femur fx was fixed and the pelvis has an exfix (external fixator).  I reduced a very comminuted unstable intraarticular fracture of the  distal radius and ulna in an elderly lady this afternoon.  She might require surgery.  I'll keep her on ice until Jim Matiko gets here in a couple of weeks.  He is an upper extremity subspecialist and has been here 2 or 3 times.  He started the website haitibones.org to help organize the orthopedic communication from the quake recovery effort.  The Haitian workers here in the hospital are all happy to see us back.  They are such warm people.

Our departure from Appleton was a bit less organized than anticipated.  Jeannie had to go to deal with a family emergency in Arizona the 5 days before we left.  My organizational abilities are several standard deviations lower than hers.  Needless to say several things did not get included that she had planned on.  We are managing fine and she has already forgiven me.  It is great what a couple of lengthy back rubs do for her.  The word is that HAH is very close to finalizing the purchase of the house across the street for the use of the long term volunteers.  Work could begin in a week or two on the clean-up and other necessary work so that we might be able to move in.  The Project HOPE housing is being installed as well.  It may be ready for the short term volunteers in a couple of weeks.  Then when all of the volunteers are out of the hospital, work can begin to finish the unfinished new wing.  We are hoping this will make it possible to attract paying patients in bigger numbers to increase the hospital's revenue stream.

I'm told the clinics have gotten steadily bigger in recent weeks.  They now are cutting off the number at 65.  I'm here by myself for the next 2 weeks so I'll be ready for a breather when Scott Nelson and crew get here.  I'm not going to be scheduling any elective stuff.  I hope I don't get too slammed with femur, pelvic ,ankle, knee and other urgent trauma and infections.  The team that was coming from New York canceled due to their fears of violence during the presidential elections this coming week.  It included 3 orthopedists, one a traumatologist and 2 orthopedic residents, one a Haitian.  Oh well, what happens, happens.  I'm fortunate to still have an energy level that most guys half my age envy.  Having Jeannie by my side makes all of the difference.  She is really amazing.  I am a really really lucky guy.  I tell her that a lot.

The first weekend was spent rounding on the patients.  I changed all of the wound vacs and the dressings on the other patients.  They all are making satisfactory progress.  Two new patients came in.  One is a 14 y/o boy with a subtrochanteric femur fracture transferred from a hospital a couple of hours away.  The other is a 10 y/o cholera patient transferred from Medicins Sans Frontieres (Doctors Without Borders) here in Port au Prince.  She had an intraosseous infusion to rehydrate her.  Apparently an IV couldn’t be placed. The tibial line was left in more than twice as long as it should have.  48 hours later she had pain and swelling in her leg and they asked me to take her because of the possibility of infection in the bone.  The I and D showed pus around but fortunately not IN the bone.  I put a wound vac on her as a precaution.

Mondays clinic wasn’t huge but it took me 6 ½ hours.  By then I was kind of hungry and my bladder was crying for relief.  I wolfed down my lunch so I could get a case going in the OR.  Tuesday was a similar sized clinic interrupted by an ORIF of the 14 y/o with the subtroch femur fracture, then a BK amputation in a 56 y/o diabetic then an I and D.  Two more traumas came in while all this was going on.  One patient has bilateral wrist and forearm fractures and the other has a depressed lateral tibial plateau fracture.  If the clubfoot clinic tomorrow has enough people to do the work, I will do both of those cases.  I saw many patients in the clinic that will need surgery.  Because of the cholera epidemic and the scarcity of anesthesia, I am not going to do any elective cases until we know for sure we won’t be inundated with patients needing rapid hydration to stave off death.  Experts are saying that this week and next should see the epidemic reach its peak.  We are not a “cholera treatment center” per se but patients do come here when they get sick.  At last count we had 18 cases being treated here with one death.

Saturday, November 20, 2010

Terry and Jeannie Arrive at HAH

Sent from Jeannie Dietrich, 19 November 2010

"We arrived today and the city seemed cleaner at least in some of the places.  The market place was still quite dirty with rotten food, and dirty clothes on the ground in front of the market place.  But they are starting to clean up the rubble and trash.  You even see trucks being loaded with the rubble of the concrete.  We were put into a room in the new wing of the hospital down where Scott and Brook had their rooms.  We have two hospital beds pushed together with mattress on them.  We are glad for the hospital beds.  Our room has a small bathroom and two oscillating fans above our bed.  A sink is attached to one of the walls of the bedroom.  Our rooms back door over looks the laundry area and maintenance area.

They have had about 5 cholera  patients come through the ER each day.  Other hospitals in the area have had many more then this.  They are thinking that the peak of the cholera epidemic here in Port au Prince will be mid December.

I dislocated my right shoulder kiting so am somewhat limited with what I can do with my right arm right now.  But hopefully it will get stronger every day.  By the time Terry could be called off the water to help me, my muscles has spasmed quite a bit and he could not pop the should back into place.  So I had to go into the hospital in Sousa and be put under before he could get it back into place.  I fractured several areas of the bone and Terry sent the x-rays and CAT scan to one of his partner's in Wisconsin, but they both thought that I did not need surgery and I am glad of that.  Hope that I get full range of motion back soon."

Please keep Jeannie in your prayers as she heals from her injury, and that both Jeannie and Terry would stay healthy with the cholera outbreak starting to make its way to Port Au Prince and to them in Carrefour.  Our web page (www.caribbeanortho.com) is growing and will continue to add pictures, stories, and ways to partner with Terry and Jeannie and Hopital Adventiste d'Haiti (HAH) in the upcoming year. The best way to partner are your prayers for them and their patients.

Sunday, November 7, 2010

Orthopedic Ministries of the Caribbean Rolls Out a New Webpage!

Thanks to everyone who followed the trip in August and offered prayers and support to the team. Terry and Jeannie are preparing to return to Haiti this month to begin their yearlong commitment to serve at Hopital Adventiste d'Haiti.  In preparation for their service, a new webpage is under development where you can follow their mission, their work in Haiti, and support them in their medical ministry to the people in Carrefour Haiti.

Please take a look and visit often for the latest updates from Terry and Jeannie: