Sunday, December 19, 2010

Trip Recap from Scott Nelson

Saturday, December 18, 2010

Trip In Brief From Flight AA 816 – 17 December 2010 By Scott Nelson

We thought that it was over when we finished all of the urgent cases of the week about 6 o’clock last night. After returning to the hospital from a dinner with Dr. Hans Larsen president of Societe Haitien de Orthaedie et Traumatologie we were faced with another patient in our emergency room who had been in a car accident. She had a complex pelvic fracture that under normal circumstances could have waited another day or two prior to surgery, but since there are no other options in Haiti for injuries of this type we prepared our instruments and aroused the operative team. We had just enough time to complete the case prior to our 5:30am departure from the hospital. After finishing the case and washing our instruments we went upstairs to finish packing our bags just as the roosters began to crow. This operation represented a culmination of blessings and teamwork that occurred throughout our trip. 
Just a few of the trip highlights… 
  • Brent Scully, Sebastian, and Randy Tall installed an inverter system to protect our sensitive OR equipment against power surges and the frequent power failures that have inevitably caused our C-arm fluoroscope and monitoring equipment to fail. 
  • Terry and Jeannie Dietrich – are perhaps the biggest of all blessings during this week. They are now on site full time and will be able to maintain continuity of care for our patients and provide a system to increase the productivity of our highly skilled surgical volunteers. Terry is also starting an orthopaedic technician training program which will have a major impact on the services at HAH as well as other hospitals around the country. 
  • We spent a significant amount of time organizing and cleaning the operating room as this is an essential element to performing high quality operations and making the most out of our donated materials. Most all of the instrument and implant trays which were donated in the early days after the earthquake by Synthes, Smith & Nephew, KCI, Stryker and others are still in excellent condition and in regular use. 
  • We upgraded the air conditioning in the sterile supply room thanks to Sebastian who did the dirty work. 
  • Our electrical team also replaced the dangerously rusted out electrical outlets and switches in the OR and clinics 
  • The clinic and orthopaedic x-ray rooms were completely reorganized, painted and scrubbed from top to bottom, giving a whole new look which is more in line with the quality operations that we do. 
  • Patients from far and near, new and return, old and young came for evaluation, treatment and follow up. 
  • Many operations were done both simple and complex including thoracic pedicle screw instrumentation for a T3 burst fracture, Taylor Spatial Frames, hip fractures, femur fractures, and tibia fractures amongst others. 
  • Remediation from my former professor James Matiko who was able to refresh my surgical skills and improve upon the instrument organization process. His support and attention to detail goes well beyond the confines of the operating room. 
  • Adventist Hospital in partnership with Cure International is now recognized as the premier center in Haiti for the treatment of clubfoot. 
  • We were blessed by the cancelled flights of American Airlines and political manifestations which prolonged the stay of Dr. Matiko, Greg Bonner (biomed tech), Jere Chrispens (IT) and others. This honeymoon of productivity was ended with the decision of our Adventist leaders to evacuate expatriate workers in a police escorted motorcade early one morning due to the political instability and airport closures. 
  • Jere Chrispens worked tirelessly with the technicians at Fuji to help develop an x-ray archival system for our digital x-ray machine. 
  • Greg Bonner worked longer hours than the surgery team to resolve the fatal error messages that were preventing the C-arm from functioning. Finally at about 3am on the third day of work he wheeled the machine into the OR with signs of victory. Unfortunately the day after he left it failed again due to an unrelated problem and was again repaired by some diligent orthopaedic surgeons. 
  • Even the little things count - like new x-ray gowns (thanks to Jerry Daly) that we are now able to hang on some hooks in the OR made by Brent. 
Although many other people and events deserve mention, I will end by thanking Marni and the boys who constantly encourage service, risk, and hard work. They encouraged me in my efforts to prioritize patient care over evacuation orders and when she found out that I was operating until the last hour of my stay, Marni even suggested that maybe I should stay longer. 
For the first time since January 12 the hospital is void of surgeons, but the patients just keep coming…

Saturday, December 18, 2010


Dec 9

Today was another day of rioting and burning, shooting and general violence in the city.  It is quiet on the hospital compound, but we can see smoke a few blocks away and occasionally hear what sounds like the odd gunshot.  Needless to say, we continue to be confined to the compound.   Several of my patients came for their elective surgery.  We  have virtually no empty hospital beds since hardly anyone wants to be discharged and leave the hospital compound.  That means that we can only do same day surgery.  I wound up doing an arthroscopy, a foot/ankle procedure and a skin graft with the resident.  The TSF case required C-arm so that had to be postponed since the machine is STILL not working.  Since we had some extra time, we cleaned out the ortho clinic rooms and got the painter to come in and repaint them.  That is a job that has needed to be done for a long time.

Jim Matiko emailed the Linvatec rep who works with them.  Jim’s group recently switched to Linvatec for their equipment.  Jim told him that I needed more and newer arthroscopy equipment.  He responded right away and said he could get us nearly anything we need.  He is interested in coming down as well.  I sent him a nice long wish list and apologized for it looking like I was greedy.  I am starting to run low on the 3 liter irrigation bags.  Lucia is trying to work out some irrigation system that will work that will not be so expensive.  I am really glad that Jim came down.  He spent a long time today teaching Jean Joel how to suture and what are the names of many of the instruments we use in surgery.  Jean Joel is a quick learner.

Dec 10

Terrific news!  The C-arm is fixed.  Greg is a volunteer biomed tech specialist who came several days ago from the Pacific Northwest. He had been working on it all week.  Thurs night he prayed for Divine assistance and at 3 am he awakened and felt inspired to once again test some circuit boards.  He discovered a small etched area on the mother board.  Then by trial and error he tried soldering from different points and after 7 or 8 hours he found the right combination. Luck? Cosmic karma?  I prefer to think that God had a major part in the whole process.  Maybe it was something that we needed to learn.  Did I learn something?  Maybe to be more patient and depend more on Him.  For sure, my prejudging the tech guy that did the repair as incompetent was totally wrong.  Clearly, God can use people to accomplish important things even though they may SEEM and perhaps even BE incompetent.  Needless to say, he fixed the machine and I didn't.  Maybe someone else needed to learn something.

I am having a great time doing cases with Scott and his friend, Jim Matiko.  Scott and I are hoping that Jim might be the person to replace me.  I think he would do a great job here.  In spite of the unrest in the streets many of our patients for elective surgery continue to show up.  We did a raft of good cases today including  a CP with severe planovalgus feet.  We did calcaneal-cuboid-med cuneiform osteotomies.  Lat column lengthening/medial shortening with Gastroc lengthening.  Also hamstring lengthening.  Very elegant surgery.  We've done 5 TSFs and have another tomorrow.  The trauma cases continue to come in.  Scott brought a resident with him from LLU.  It has been great having him.  How I wish I could have a resident here to help with the work load on a regular basis.  I believe the experience would be invaluable for him as would the help for me. Scott did a T spine fracture and I assisted him.  It went well.  I then had a hip fracture that the resident assisted me on.  It also went well.  We used the C-arm on a femur fracture and on a major bilateral foot reconstruction.  Now if things settle down in the streets, we can get really rolling.  Many nurses and other hospital staff are still unable to make it in to work.  The tap-taps are not running yet either and many of our patients use them to get here and back home again.  The airport remains virtually closed.  Several more volunteers have had to delay their returns home and several who were coming on Sunday are now unable to come.

Dec 11

Today was not a good day even though it was the Sabbath.  We did several cases that Scott and I considered urgent and they all went well including another TSF.  However, during the day we started getting word that we were going to be asked to evacuate the country.  Indeed, when we finished surgery after 8pm we met with Nathan and he informed us that the SDA church leaders had asked that all expatriots be out of Haiti before the government announces their decision about the election recount on Dec 20.  Nathan would like for all of us to leave by this coming Wednesday, Dec 15.  He is planning a convoy with several other organizations that will be leaving then. There are rumors that violence will increase this coming week in anticipation of the announcement.  This will mean that the surgeries that Scott and I were planning to do so that I could get more familiar with the instruments and types of cases will not get done.  We are still going to try to do a few cases tomorrow and Monday, but since nurses and therapists will not be here to give necessary care to our post-op patients, many will have to be postponed.  I will try my best to give good care to everyone who comes here.  I may have to be less aggressive in doing certain types of cases given my lack of experience.  Jeannie and I decided to watch a movie last night.  Scott and I also met with Brian, the architect who is here for several months.  We went over the plans he has developed for the new addition to the hospital and other structures that will be added in the future.  There is so much more that could be done here if the structure and infrastructure could be improved.  I am confident that the necessary changes will occur and I am going to do my best to help it happen.  I hope that some of the important changes can be made in the next few months so that we can attract more paying patients and improve the hospital’s financial situation.

Dec 12 – 13

I write these words with a heavy heart.  It is 2:30 am and a patient of mine just died. He was 19 years old.  He crashed his motorcycle 4 days ago and was taken to the hospital in Petit Goave where he was kept for 2 days.  He had very comminuted fractures of his femur.  I operated on him with the resident and Dr Matiko yesterday.  He apparently had a massive pulmonary embolism just after we finished fixing his femur fractures.  His pressure dropped to 60/30 and his respiratory rate went to almost 50 and stayed there until a little while ago.  We lost a lot of blood during the case but were able to transfuse him 3 units postoperatively.  Scott and I even went to the blood bank downtown to procure more blood in case it might help him improve.  He very slowly deteriorated with his O2 saturations slowly dropping from the 90s down to the low 70s.  He finally had a cardiac arrest at 1 am.  In spite of prompt intubation and resuscitation, I pronounced him dead at 1:30.  He was a nice young man and a perfect physical specimen.   I can hear the wailing chants of the mother downstairs even now.  She wailed to God for her loss and repeatedly asked ‘why did he ride the motorcycle when I told him not to.’  How I long for the day when sickness and death will be a thing of the past.  As much as I love orthopedic surgery, this kind of experience robs my work of much of its specialness.  I have gone over in my mind several times the sequence of care that I gave this patient.  I have talked with both Scott and Jim Matiko about it.  Should I have done something differently?  It is a tough call when resources are limited.  I tried to get through to the University of Miami field hospital in the hour before he died.   They have an intensive care unit and specialists in treating these kinds of problems.  I got no answer from them  before my patient died.  Perhaps I should have tried sooner.  I feel so sorry for the family.  It has been almost 2 years since I have had a patient death.  They happen so infrequently in my practice that each one hits me hard.

Dec 13 – 14

We had a huge clinic on Monday.  I couldn’t help as much as I wanted to because I had a long meeting with Nathan about the volunteer situation.  He has been directed by church leaders to evacuate all the ex-patriots by Wednesday Dec 15.    Even though there are no demonstrations at this time, they  believe that there will be more when the election council announces its final decision next Monday Dec 20.  American Airlines has resumed flying and all is quiet everywhere.  A couple of the volunteers want to keep their original travel plans and not leave early.  That is a problem for Nathan and he wanted my opinion.  I told him that I have patients in the hospital that wouldn’t be adequately cared for by Wednesday and I would need to delay my departure until at least Friday.   He understands that patients cannot be abandoned by their doctors and has granted me permission to stay the extra 2 days.  Even if the violent demonstrations resume, the hospital compound will undoubtedly be a safe place.  It is really only dangerous to try to get to the airport or bus station if there is violence.  If need be, I can stay here through the holidays until it is safe for everyone to return.  There is a possibility that might not be until after the runoff election the middle of January.  The really bad news today is that BOTH c-arms won’t work.  Our elation when Greg got them both running has now turned to distressful feelings.  So many of the cases we do can be done so much better and faster with intra-operative fluoroscopy.   Scott is going to call a c-arm technician that has helped him in the past.  The man lives in Puerto Rico.  He might even be able to come here and work on the machines.   We had several cases as well on Monday including another TSF.   It would have been nice to have c-arm for aligning things perfectly.  I learned some more on that case.  I calculated the deformity and the mounting parameters without Scott’s assistance and he checked them and found them correct.  It’s great to know that I am making some progress on that front.  I wish that he could stay for another week or two.  He has decided to keep his original travel plans and leave on Friday.  Of course, that doesn’t fit with Nathan’s mandate from the church leaders to evacuate all ex-patriots.  I hope that bit of friction doesn’t create problems for Scott back at Loma Linda.  I am grateful for the extra two days I will have with him to learn as much as possible so that I can be more effective in caring for the Haitians.  After all, that is why I am here.

Jim Matiko left today after changing his flight to Delta. He is a really great surgeon to work with.  I am fortunate to have him for a friend and supporter. He has been extremely generous with his financial support of this project.  I wish he could stay here also since many of the upper extremity cases are complex and well beyond my capabilities.  I am confident that he will be able to help recruit other upper extremity specialists to come down periodically.  I can save the tough cases for them.  Most aren’t urgent.  I just hate to put things off and let them pile up.  It is VERY inconvenient for patients as well since some come from hours or even days away.

I saw 2 patients today that need total hips and have the resources to go to the Dominican Republic.  I contacted Dave Mehne and will try to work it out so that they can get their hip replacements there on the next trip to Los Alcarrizos.   That will probably be in March.  I’ll try to go over to the DR for a couple of days and do some cases with the young Dominican orthopedist that I am teaching to do arthroscopy.

Today, Tuesday, we had a bunch of cases and another huge clinic.  Everybody is returning now that the violence has subsided.  One interesting case was a little girl with congenital band syndrome of the leg.  The tibia and fibula were rotated at the band and her foot pointed almost straight backward.  She walked and ran with hardly a limp.  I assisted Scott as he did three osteotomies of the tibia and fibula and then pinned the fragments in shish kebob style.  Her foot now is correctly oriented in her cast..  The biggest concern is for the circulation of the foot.  It has looked very good so far.  We’ll do a cast change in a couple of days before she goes home.  Several cases that I had scheduled for Matiko showed up.   Scott and I will try to do them tomorrow.  A patient with a fresh dislocation of the lunate came in also.  Scott and I studied up for that case until about midnight tonight so we hopefully can do a good job on it tomorrow.  The pathology here is just amazing!  We have seven cases on for tomorrow.  Tomorrow is clubfoot clinic as well.  Scott had arranged for several clubfoot patients that he had taken care of to come in.  Tomorrow could be the mother of all work days here.  The ortho resident, Ray, was able to help us a lot today but he will be leaving early tomorrow with the rest of the expats.

Wed Dec 15

The ex-patriots including my precious Jeannie left at 6:00 this morning to meet with two other groups to caravan to Santo Domingo per orders of the church leaders.  I hope and pray they will have no difficulties on the way. .  There have been no reports of any violence in the entire country for several days and all seems very quiet this morning.  Of course, when the official results of the election are announced next Monday there will probably be ‘unrest.’

 Staying behind until Friday are Scott and Dr Adrian, anesthesiologist, and Lucia.], OR nurse specialist.   Both of them are from Santo Domingo and have been with Scott on many of his trips to Haiti in the past.  I first met them when I went with Scott to Cap Haitian 2 years ago.  They are both extremely good at what they do.  Jeannie has learned a lot from Lucia in the past 11 days.  She is VERY organized and a very hard worker.   She believes that Scott walks on water.  His surgical skills are truly enormous.

  We had an even bigger clinic as well as seven surgical cases today including the upper extremity cases I mentioned above.  A displaced fracture of the distal radius that occurred 3 weeks ago in a 22 y/o was supposed to come in last week for Jim to do.  He was my biggest challenge since he had lots of callus.  It took time to free it up and get it reduced out to length and then fixed with a volar plate and multiple screws. I am certain that Jim could have done it much better and would probably have made it look easy in the process.  I helped Scott with the dislocated lunate.  It went well.  We put in several pins after reducing the bone.  We didn’t have c-arm but did bring in the portable x-ray unit.  Our educated guesses on pin positions and angles turned out to be close to perfect.  They required very little adjusting.  We also took out a large submuscular lipoma from the forearm.  After talking to the c-arm tech in Puerto Rico, Scott went to work on the unit.  I hung around to see if I might learn something.  After working on things for a while, we were clearly stymied so we hung it up for the night and headed off to bed about midnight.  Scott wants to talk to the guy in Puerto Rico again before throwing in the towel.  We would really like to get it working again.  We have the 69 y/o blind man with the subtrochanteric fracture that should be surgically fixed.  Jessica was finally able to get an echocardiogram done per Dr Spendey’s recommendation.  She had to take him out of traction and put him on a stretcher and taken him to the cardiologist’s office.  He has a normal ejection fraction so no one can say he isn’t a reasonable surgical risk.  The risks are actually greater if surgery is not performed.  The team that admitted him prior to my arrival decided that he was too high a surgical risk.  They placed a tibial traction pin and wanted him to be placed in a body cast after 6 weeks.  I don’t think he would survive that kind of treatment.  He would be impossible to manage with a cast.  In addition, it would be a horribly uncomfortable existence even if he did survive.  Scott and I will fix his fracture tomorrow even if we have to do it in the old style using the portable x-ray machine in the OR.  The fluorscope would make it much easier and more accurate and less risky by decreasing operative time.

Thursday Dec 16

Once again the clinic was very busy although a bit less so than the last several days.  Scott went to work there after rounds and I began with the surgical cases.  They were all smaller cases except for the last one.  They all went well including Clodia.  She is the little girl with the leg infection from her cholera treatment.  We were able to take her wound vac off and place wet to dry dressings without anesthesia.  That means that Jean Joel will be able to do here dressing changes while I am gone and she should do well. While I was doing a case, I heard a yelp of joy from the next room.   Scott had gotten the c-arm working.  Given the error code that the machine was giving us, he followed the advice of the technician from Puerto Rico and took the cover off the collimeter.  He found some screws that were very loose and the collimeter was not being held in place properly.  Tightening the screws and adjusting the collimeter got it going again.  What a miracle!  I put everything back together with his direction so that I might be able to work on it if the need arises.  I don’t have Scott’s boldness nor confidence that I can trouble shoot this kind of equipment.  If the tech from Puerto Rico is available to give me guidance, it might work.

 I saw an amazing patient in the clinic in the afternoon.  He is a 53 y/o farmer with a wife and children ages 5 to 15.  He came from 3 hours away by vehicle.  He grows rice and beans on his little farm.  He has no mechanical or animal assistance to till the ground.  He produces just enough to feed his family.  There is no surplus to sell.  He has terribly problematic knees.  He has severe knock knees that are also very unstable.  The lateral compartments are completely worn of articular cartilage and very painful.  He walks very hunched.  He has thick calluses on his knees apparently from working a lot on his knees.  It could also possibly be from spending a lot of time in prayer but I doubt it.  It will be a major challenge to solve the deformity/instability problem and give him good durable knees that will be satisfactory for his farm work.  I took a video of him walking.  Perhaps it can be used to help raise funds for the care of patients like him with virtually no financial margin.

 The old man with the femur fracture was our last case and it went well.  He finally has the fracture fixed and we can start getting him out of bed.  He and his family are so grateful.  Scott and I had a good meeting with Madam Clotaire.  We discussed the training program for orthopedic technicians and some hospital plant/grounds issues.

We were able to finally get together with Hans Larsen, the president of the Haitian Orthopedic Society.  He suggested we meet for dinner at a restaurant in Petionville.  He was a half hour late.  The food was tasty and was a nice change from our daily hospital food.  We talked about his experiences taking care of earthquake victims in the hours and days after Jan 12.  We discussed the state of orthopedics in Haiti and the role that I might be able to play in training programs.  He was especially interested in the ortho tech program that we are starting.  He is a likable, engaging person.  He invited me to call him to play tennis when I return in January.

Scott and I got stopped by hospital personnel as we returned to the hospital at 10 pm to see a patient in x-ray.  She had been in an MVA and had an unstable pelvic fracture.  She is moderately obese.  Scott thought she should be fixed surgically so we woke up Lucia and Maria and started the case after 1:30 am.  Three hours later she had an anatomically fixed parasacral iliac fracture with 2 long iliac wing screws and a contoured iliac plate with multiple screws and two fluoroscopic-ally placed SI screws that were in perfect position.  Scott gets more amazing all the time.   He made it look quite easy.  The lady had a head on collision on her way to the airport to go see her husband in Palm Beach Florida.  The hospital could certainly bill her the going stateside rate for the terrific care she received in the middle of the night.  She initially was taken to Medicin Sans Frontier hospital and was told she would have to stay at bedrest for 3 months.

Now as I write these words, I am leaving Haiti per orders of leadership.  What will happen if any of these patients have complications during their recovery?  The patients who have fractures and dislocations will either be taken care of at MSF, Medishare or General Hospital or will get no treatment.  We will probably be faced with patient complications from treatment or from no treatment.

Thursday, December 16, 2010

Updates from Jim through

Update From Scott Nelson

I received the following update from Dr Nelson this evening.  I also had the opportunity to speak with him by phone earlier today.  Both he and Terry are safe and in good spirits.  
Scott Nelson writes, "The day was kicked off by the evacuation of nearly all the expatriate employees and volunteers who fled the country in a police escorted convoy just before dawn. A core team of essential medical volunteers consisting of Terry Dietrich, Scott Nelson and our Dominican anesthesiologist and nurse stayed behind to take care of the patients that had been waiting for urgent surgeries and provide post operative care for the recently operated cases. As day broke the patients began to line the hallways. There were more patients than usual since many had not been able to come last week due to lack of public transportation during the riots that broke out across Port au Prince. We operated on seven patients today consisting of several severe fractures of the upper extremity which would have almost certainly gone without proper treatment had we not been there. In spite of the fact that we have closed ourselves down to new trauma referrals, seven more urgent cases are already scheduled for tomorrow. Fortunately there has been no civil unrest at the hospital or immediate area surrounding the property and we hope and pray for peace and God’s guidance as we continue our work."

Thursday, December 9, 2010

Terry does his first solo TSF and begins training a local Haitian man.

Dec 5

My first foray away from the security of our walled compound took Nathan and me to an isolated clinic just outside the small town of Croix des Bouquets to the north of Port au Prince. Tony Coletto is a general surgeon who works at that clinic periodically. He told me in April that there was an unused C-arm at their clinic that we could have. He reaffirmed that last week so we went there to check it out since our “good” C-arm continues to be nonfunctional. I felt totally safe with our driver, Richard. It was about 2 hours each way. We talked much of the time and it went by quickly. The town is on the main road leading to the Dominican Republic. There were lots of large trucks sharing the road with us. The C-arm looks like it will be a good backup for us. Tony says it was working perfectly when it was checked just before it was shipped here several months ago. They have a lot of other supplies that are occupying space in their storeroom and are going to donate them to us. Nathan sent a truck the next day to pick it up along with the supplies. I cranked it up when it got her and it worked nicely. I have some cases that we can use it on when Scott and Jim Matiko and team get here on Sunday. Friday afternoon I was asked by Dr. Spendey to go with her to translate and help transfer a patient to another hospital. The patient was having a difficult time breathing with a respiratory rate of 40. Richard drove the ambulance like a man possessed. With lights flashing and siren howling we careened down the left side of the divider into oncoming traffic as if it didn’t exist. There were several heart-stopping moments. Richard really is a great driver and the only significant damage happened to my nerves. I would love to watch Richard take that ambulance to Monte Carlo and go up against the Formula 1 cars. He would no doubt put them to shame. On our way back, we stopped at the airport and picked up Tim Downey. He is a nurse anesthetist who works with me in Appleton. It is great to have him here. I’ll finally be able to get things done in a normal time frame. Saturday I was able to get several cases done that couldn’t be delayed. That wouldn’t have been possible with only the local anesthesiologists.

Seven new volunteers arrived on Saturday including orthopedists Scott Nelson and Jim Matiko. An orthopedic resident, Ray Grijalva accompanied them from Loma Linda. Lucia, OR nurse, and Adriana, an anesthesiologist from Dominican Republic also came. We should be able to run 2 rooms regularly now. I scheduled several cases in anticipation of their arrival. Brent Scully came from Walla Walla. He is a builder and is going to help with a lot of projects. He might also come back to help with the completion of the new wing and the OR remodel. He thinks he might be able to get a group of builders to come with him from Walla Walla and help with the new wing/OR remodel project. Randy is an electrician from Washington State. He will be here for perhaps a year helping with all of the electrical needs. Scott Nelson needs no more introduction other than to say that he is an orthopedic hero. What he did here in Haiti during the chaotic months after January 12 is the stuff of great reading material. I would love to have the time to research accurately the details and put them in print for all to know and appreciate. If any one reading this journal would be so inclined, please do it. I am sure it would be a best seller. Jim Matiko is an orthopedic colleague and LLU graduate. He has had a very successful orthopedic upper extremity practice for many years in Southern California. He is also integrally involved in the orthopedic teaching program at LLU. He and Scott have been close friends ever since Jim mentored Scott during residency. Jim has had a strong interest in international orthopedics for many years. I am SO glad they are here to help with the volume of cases.

Sunday had some highs and some lows. We were able to run 2 rooms for surgery much of the day, but the c-arm was a disappointment. It worked great for Dr Matiko and the resident on their first case but Scott and I couldn’t make it work on our case. An illuminated flashing button warned us that the disk was ‘full’. We tried every trick we could think of to empty the disk to no avail. The case went well even without the c-arm but only because of Scott’s expertise. I did my first arthroscopy here and it went very well. Jean Joel assisted me and he is great.. The Linvatec equipment is working beautifully. The company and their representative, Ed Mueller, are to be congratulated for their generosity. Their willingness to help the Haitians is emblematic of a big-hearted unselfish spirit. We spent a lot of time today organizing the orthopedic trays and equipment. It is a big job. Many of the trays and sets hadn’t been properly restocked after being used. I assisted Scott today on a complex tibial nonunion that required two Taylor Spatial Frames. Tomorrow we have a simple one scheduled that I will be able to do myself.

Dec 7

The last two days have been a somewhat of a blur with nearly nonstop surgery and clinics. I also spent what seemed like hours trying to email and then talk with the biomedical technology people in California who were supposedly familiar with the C-arm that we just got from the little clinic in Croix des Bouquets. Even though I gave them all of the model numbers from the machine, they can’t seem to find any correct information to give me to get workable again. The unit was made in 1988 and I imagine there is no one alive from that ancient period of technological history who would have an idea of how a machine of that vintage would be able to be repaired. Another negative issue that presented itself yesterday was regarding my orthopedic physicians assistant trainee, Jean Joel. The OR director, Madame Jordan, let it be known that she was totally upset at discovering that we were allowing a “translator” with no training to scrub in “her” ORs and that was why there were so many complications and that she was going to quit if it continued. I wish she had come directly to me with her concerns. I certainly do not want to have an adversarial relationship with anyone here in the hospital let alone the director of the OR.

The Taylor Frame went nicely. Of course, Scott was in the room quite a bit of the time so I certainly can’t take credit for the work. He wasn’t scrubbed in though so I can say that I put the entire frame on by myself. Scott is really great to work with. He is a very patient teacher. The patients and staff here at the hospital all love him. I am fortunate to have him for a friend and teacher. The TSF wasn’t a very difficult case since there was not a large deformity. The ring/pin/wire construct in the OR is only the first step. The second step is to immediately restock the dizzying array of rings , bolts, nuts, wires, bone pins and adjustable bars in three different large instrument trays. All of the used instruments that are case specific also need to need cleaned and placed in the proper trays. Then everything will be ready for the next TSF. The third step is taking an xray immediately after surgery. The TSF program then calls for entering a set of numbers that define the deformity and the mounting parameters. Those numbers are obtained by measuring specific points and distances and angles on that AP and Lat xray. The fourth step is to go online and actually enter those parameters as well as the “structure at risk” and the rate at which you want the deformity corrected. The program then immediately gives me a program which tells us and the patient exactly how to adjust the bars every day to reach the desired correction. The fifth step is teaching the patient or a family member or friend how to make those adjustments. It is challenging to get it all done especially when trying to work through a big clinic, get the rest of the surgical cases done for the day, make rounds on 20 or more inpatients, some of whom are complex cases, have meetings with administration, learn more Creole, try to maintain some level of personal fitness, train Jean Joel, teach the CBM physical therapists who are so anxious to learn, email and call biomed specialists with the hope that someone might be able to get our c-arms working again, answer emails from orthopedists who would like to participate or who are already on the schedule to come, recruit anesthesiologists, raise funds for the necessary equipment and implants and the indigent patient fund and now try to restore a relationship with the director of the OR. Needless to say, this entry in my journal is taking place at 4:30 am. A couple of things give me a great deal of comfort. First is that I have Jeannie with me. She is wonderful to work with. She is an unbelievably hard worker and has such a desire to learn everything as quickly as possible. I am unbelievably fortunate and blessed to have such a terrific person in my life. Secondly, I have the Sabbath to look forward to every week. Even though I have to make rounds and if necessary do an urgent surgical case, I am sure that I will be able to get at least some of the rest that God knows I will need for the upcoming six days. Having that one day out of every seven to let the multitude of daily challenges lie dormant and allow God’s Spirit to refresh my body and soul is a great delight.

Terry having completed his first solo TSF!

Jim working with Jean Joel who is studying to become an Orthopedic assistant.

Guest Blogger Amy Lindsey from Beauty in the Mess

Wednesday, December 8, 2010
Lock Down Again
Around the 28th of November we were on lock down in the hospital compound, now we are again due to the election results being announced last night. To say the least people are upset and there is potential for some major problems. There is no clear winner since nobody got over 50% of the votes so there will be another election in Jan for the 2 people with the most votes. People are unhappy with the announcement of the 2 leading candidates because it definitely looks like there is fraud. There are going to be problems as long as the current president's candidate gets through. It seems like people don't really care who goes on to win, as long as its not Preval's candidate. Read more...

Saturday, December 4, 2010

Smiling Pretty before Thanksgiving dinner.
Starting from front left is Jessica, Me, Marc, Brian, Sam, Sarah, Terry,
Jeannie, Lynn, Audra, Junior, Azariah

In my last post on my rundown of what happened during November I forgot to mention some of the good things that have happened as well. Of course there was Thanksgiving and we actually took the afternoon off in order to celebrate. At that time we only had long term volunteers (about 11 of us) and so it was a little bit quieter and relaxing. I had the opportunity to try out my cooking skills by making pumpkin pancakes for all of us for breakfast and they seemd to be a hit. It gave us a little flavor of fall time in spite of it being 90 degrees. Read more...

Wednesday, December 1, 2010

Where did November go?

Wow, it is already December and I never even posted a single thing in November. Here is a quick rundown of November. In the beginning of the month we had Hurricane Thomas, then we started seeing cholera patients at the hospital, ending the month with the presidential elections. Throw in all the regular daily crisis and you get a pretty busy month...which is not too out of the ordinary for Haiti. We keep thinking that there couldn't possibly be more hardship, but then the next thing comes up. You never know what to expect and our hearts just cry out for relief for the people of Haiti. Through it all they are strong and resilient, but it makes me wonder how much more they can really take. Read more...

Guest Blogger Jim Matiko, MD from

Thursday, December 9, 2010
C-Arm Down And Out
The biggest negative to the trip so far has been the fact that the image intensifier has been down for the count since we've been here. The C-arm is a critical piece of equipment for an orthopaedic service and its absence sorely missed. Read more...

Wednesday, December 8, 2010
Hopital Adventiste On Lockdown
Last night the Haitian presidential election results were posted and the citizens reacted negatively. In the image below by Damon Winter, Haitians burned tires, trash and earthquake rubble and blocked streets in the capital, Port su Prince. Read more...

Tuesday, December 7, 2010
Hopital Adventiste Redux, Part 1
I had good intentions of posting at least a couple of progress reports by now but a combination of a busy schedule, tiredness and a little laziness have foiled my efforts so far. Scott Nelson and I took the red eye out of LA this past Friday night and flew to Miami by jet then hopped on a small prop plane for the 2 hour flight to Port au Prince. Read more...