Saturday, January 15, 2011

Another Leg and Life Changed at HAH!

 Jan 9

A very quiet day.  Lucia, Jerry and Dave all left this morning.  The patients are doing well.  I spent much of the day on the internet networking with orthopedists that have been here or will be coming.  The work on the Coffee table book to be was also time consuming.  I did follow the Packers some as they won their wild card game with Philadelphia.  I finished carving my little Haitian Santa during the game

Jan 10

A HUGE day.  Monster clinic worked around an ORIF (open reduction and internal fixation-- plates and screws) of BB of the forearm (both bone forearm fracture).  Dr Hans Larsen came during the clinic and we talked a bit.  He is the president of the Haitian Orthopedic Society.  Then towards the end of the afternoon there was the screech of tires and the sounds of a collision with breaking glass from out in front of the hospital.  A few minutes later the ER was very active with two patients with multiple long bone fractures.  The open tibia fracture was very actively bleeding.  One patient had no recollection of what had happened or how he got to the hospital.  He also had neck pain so the C spine needed clearing (making sure there were no fractures of the neck).  I finished washing him out and fixing him with an ex-fix after 9 pm.  I also put in a cannulated 6.5 screw for an undisplaced vertical split to the joint line that I found with the C-arm.  We had to clean up all the instruments and restock the implant trays so finally got to eat a little supper at 10pm.  We’ll do the other patient’s femur fracture and both bone forearm fracture tomorrow.  I scheduled about a dozen cases from the clinic today and saw several others that I put on the list for upper extremity and peds teams.

Jan 11 

I kept the clinic as small as possible today.  I had 4 cases scheduled since Craig Tingey and his anesthesiologist would be arriving in the late morning.  I hoped to be through with clinic by then so I could orient him to everything and do the cases.  There were hundreds of flight delays going through Miami because of the big snowstorm (where is “global warming” when we need it) on the East Coast.  They didn’t make it here until quite late in the afternoon.  Fortunately, one of the Haitian anesthesiologists offered to do 2 “short cases.”   I did them both after having to wait a bit because they weren’t quite ready. The wait created some anxiety on my part and, shame on me, I got upset at Jeannie.  Can you believe it?  She works at least as hard as I do if not harder and is trying to do her best to learn to do many things she has never done before, and I have the gall to take out my frustrations on her.  I am not sure exactly what type of punishment I should have for that but I am sure if there are any Tonton Macoutes (‘Uncle Gunnysack’ – see Wikipedia) still on the area, they would delight in taking care of it.  Fortunately, she is a wonderful forgiving person and I am pretty sure she won’t leave me over it.  I am such a lucky guy to have her in my life.  She is an unbelievable collection of beautiful things.  She is lovely to behold.  She is thoughtful and kind and hard working and intelligent.  She has a heart bigger than you can imagine.

We did the last 2 cases with local and sedation.  There has been an unbelievable flurry of activity all around us with painters painting and carpenters carpentering and cleaners cleaning and scrubbers scrubbing.  All this in preparation for the big day tomorrow – the one year anniversary of the EARTHQUAKE.  A large area in the parking lot has been covered with a  huge tarp and a platform set up and many chairs set out.  There will be dignitaries here to participate in giving homage to those who died and pay tribute to those, like Scott Nelson, who responded and heroically gave of themselves under unbelievable circumstances.  There is a planned emphasis on all of the good things that have happened since that event filled day.  Leading that list, in my opinion is the fact that HAH is now providing a world class orthopedic service to the indigent Haitians who have lived with their disfiguring and/or disabling limb or spine for years and even decades.  I am privileged to now be a part of that service.

Jan 12 – 13 – 14

This has been a good week with Craig  from Las Vegas with his physician assistant (PA) and an excellent anesthesiologist, Jenny Geracci.  I have known Craig for several years since he first came to the DR on our mission work there as a resident from LLU (Loma Linda Univ).    He has come to the DR several times since.  They were only here for wed and thurs but the timing was great.  I got in a big lady with a BB forearm and midshaft femur at the same time as a second  pt with a pilon fx (fracture of the tibia just above the ankle).  I had several big elective cases scheduled as well.  Craig did the BB forearm and followed with the retrograde SIGN nail on the femur while I did a below knee amputation in the next room.  Craig had never seen a SIGN done before.  Before starting the cases, I went through the surgical technique with him and Neil, his PA.  I thought I would be finished with the BK in plenty of time to help him do the distal interlock screw.  When I walked in the room, they were putting the dressings on.  Jeannie said it was the slickest one she had seen done.  Eat your heart out Scott.  It certainly doesn't say much either for how my surgical skills have impressed my own wife.  The pilon got a TSF (Taylor Spatial Frame).  It was a treat for me to show Craig something so sophisticated.  Only at HAH!

My meeting on Wednesday with Elie Honoré went fairly well.  He is the chairman of the board of HAH.  We talked for more than an hour.  I emphasized the importance of satisfactory comfortable sleeping quarters with at least a bit of privacy for the volunteers.   He instructed Madame Clotaire and Nathan to make it happen without delay.  Now we will see if it really will happen.  When I told him about the indigent patient fund and the coffee table book fund raiser, he immediately said that I should put it in writing as a request.  I told him that I had no intention of doing that.  The fund raising started 8 months ago.  I envision an independent, board controlled endowment that will provide necessary subsidies through a contract with the hospital.  I was very clear that the funds would be specifically to subsidize orthopedic care for indigent Haitians and that those funds could be used in any hospital.  My strong preference is HAH.  I believe an independent program is the only way that the endowment can function for its specific intended purpose.  There would be just too much opportunity for diversion of the funds for other needy areas.  During the meeting Dr Honoré used such descriptive terms as “maverick’ and ‘loose cannon.’  I reminded him of the situation 20 years ago when we were involved with a high level decision while I was a full time missionary in Puerto Rico and he was on the board of Hospital Bella Vista.  I had envisioned a program for reimbursing specialists so that we might have hopes of stemming the tide of returning missionaries who were difficult to replace.  That idea had been agreed upon by all of the leaders involved for the approval process.  Unexpectedly, an authority at a higher church level intervened and prohibited the approval of the program.  When reminded of this incident, Dr Honoré looked a bit taken aback and somewhat sheepishly nodded his head and said, ”I remember.”  I am unwilling to allow church leadership to have “control” over this endowment fund.  If being a ‘maverick’ or ‘loose cannon’ applies to me and is too much to be tolerated, perhaps I will be asked to leave.  I certainly hope not.

We did elective cases all day yesterday and then got in a 4 year old cutie with a displaced supracondylar fracture of the humerus about 9pm (elbow fracture).  Jenny got him to sleep quickly, we fired up the C-arm and got an anatomic reduction and 2 K-wires in by 10 o'clock.  I would wager to say that there are precious few hospitals in the US that could even come close to that time frame.  I wish they could have stayed longer but left this morning.  Jenny is a fearless anesthesiologist.  She dove right in doing cases here as if this was her home turf.  She was not bothered by lack of her usual medications and monitoring devices including end tidal CO2.  She fit in perfectly and I would love for here to come back as often as possible.  It was a quick hitter as teams go but helped me enormously.  Craig had a great suggestion for organizing anesthesia coverage.  Get state anesthesia societies to each take responsibility for a month here at HAH.  He and Jennie are going to work on Nevada.

Her leg can be straightened at HAH!
I saw another incredibly precious little girl in the clinic.  She has a major deformity of her leg.The tibia is very bowed in a fairly sharp angle above the ankle   She bopped in with her wrap around shades up on her forehead like she owned the place.  I held her in my lap and she was totally mine.  It gives me unbelievable pleasure to know that this little girl can be given a nice straight leg and I can be a part of that process.  I am very proud to say that it can be done at Haiti Adventist Hospital.   If not for the disaster of one year ago, she very well may have lived her live limping on a deformed short leg.  I want to see that little girl to grow to become a young lady with perfect posture, a ladylike gait and loads of self esteem. 
(note the normal left leg compared with the right. On X-Rays, left and right are reversed as though you are looking at the person).

I had an interesting interaction toward the end of my day Friday.  As I was doing an arthroscopy on a PAYING patient, Dr Hans Larsen walked into my OR.  He is the president of the Haitian Orthopedic Society.  We talked about several things including arthroscopy.  He has done some arthroscopy in the past at HAH.  He currently does an occasional case at a different hospital.  I told him of my interest in teaching local orthopedists and he suggested that the residents from the university program should rotate with me.  I asked him if he did ACL reconstructions and he said "no."  I told him I would be happy to help him with his cases either here at HAH or at his hospital.  He said he would bring them here.

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