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.

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