Jan 15 - 16
Today was a very restful Sabbath. I really needed it. I was able to make leisurely rounds on the inpatients and all are doing very well. I have no help other than Jeannie on Sabbath. I guess everyone else thinks that the patients don’t need to be seen. I had made tentative arrangements to go to a Project HOPE storage area yesterday to evaluate a large donation of orthopedic implants. The cases lasted too long so I decided to go this afternoon and spend a bit of time there. There is a lot of stuff but most looks unusable, especially the implants. I couldn’t find any instrument trays that are necessary to actually implant them. They might be there, but weren’t apparent on the inventory sheets nor was there physical evidence. I didn’t make an effort to go through the mountain of boxes to find what I was pretty sure wasn’t there. I did meet Dr Charles Prospere. He directs Project HOPE in Haiti. He sounded very enthusiastic about the fundraising project of our coffee table book and agreed to help with an introduction as well as editing the text. He also wants to help me get good pictures of Haiti and Haitians. He has a connection to Haitian American organizations as well.
Jay Neil came in today. He is a med school classmate of mine who has practiced orthopedics in Vermont for many years. He fully retired last month after being half time for the last four years.
We made rounds with Jeannie and changed all the dressings. The patients continue to do well. Jay had arranged for a friend, Henry Perry CRNA, to come for the week to give anesthesia. He arrived today. We look forward to a productive week. I spend at least 6 hours on the internet today on the fund raising project and general communications. Jeannie and I also took Jay and Henry on a big outing to the delimart just around the corner.
I hadn’t scheduled any surgery today so that Jay and I could concentrate on the clinic. It was a good thing, too. We didn’t finish with the last patients until after 5 pm. One of the last patients was the lady that Scott and I had done the pelvic fixation on the night before we were evacuated last month. She is doing very well. I had spoken earlier to Madame Clotier about the hospital billing the patient for the surgeons services as well as for anesthesia and for the hospitalization. The patient is not actually married to the man who lives in West Palm Beach Florida. They are engaged to be married. She lost her home and her place of work(large pharmacy downtown) on Jan 12. She hasn’t worked since. Her fiancé was with her today. He has moved to PAP in the last few days and plans to look for work here. He had been selling multimillion dollar homes in Florida. The recent housing market is so bad in Florida that he decided to move here to save money. I doubt that either the patient or her fiancé will pay much if anything. I told Madame Clotier that she should give them a bill for at least $2000 for the surgeons’ work.
I saw a patient with a pelvic fracture today who checked herself out of a hospital in Cap Haitien and rode in a public car 9 hours to get here. It is just amazing what comes here for orthopedic care.
Even though Tuesday is supposed to be our big surgery day, there was a good sized clinic. Jay stayed in the OR and did cases while I took care of the clinic. I slipped in an arthroscopy after clinic. We finished off the day doing a hip hemiarthroplasty together. It went well. We finished work after 9 pm and Jeannie and I were both pretty bushed. I opened up a can of tomato basil soup and microwaved it. It was pretty tasty and it saved Jeannie from more work. The local “French” bread is very tasty and we had some balsamic vinegar with olive oil for a bit of dipping sauce. A pretty simple meal but it hit the spot.
We got some terrific news today. There is a team here to completely rehabilitate the lab. They plan to add bacteriology and upgrade virtually everything else. There is even a good chance that we will be able to have a blood bank. Hallelujah!
The clinic looked like it was bursting at the seams today. Of course, the clubfoot patients are there all morning. A couple of them needed Achilles tendon lengthenings so that added to the work load. Jay did an AK (above knee) amputation and some smaller cases and I came over for the Achilles tendons and then did another arthroscopy. I had another interesting experience today. Bryan Denhartog came to HAH to meet with me and check out the hospital. He represents the American Orthopedic Foot and Ankle Society. They are considering starting a program here. It would involve periodic teams of surgeons coming to perform surgery and be involved in teaching. I would certainly welcome any arrangement that would improve our academic credibility. It might even improve our chances of having a regular orthopedic resident rotation here. Brian is from Rapid City, South Dakota and knows my classmate, Dale Anderson well. He seemed favorably impressed with the facility and with our equipment and implants and with the work we are doing. I had an arthroscopy while he was here so he came in to the OR and observed. Our setup is pretty basic but it gives a nice view in the knee. The patient had a classic tear of the lateral meniscus and the case went well. I think he was favorably impressed. Today was only a 10 ½ hr work day but, of course, that doesn’t include the two hours or more of emailing and journaling this evening.
I discovered today that 2 of the Haitian ortho techs that work for CBM also play tennis. There are apparently several courts that aren’t too far away. I might be able to get in some court time this weekend.
Jay and I operated on a very muscular young man who had a humeral nonunion for 5 years. He had a very large amount of callus at the fracture site. The deformity presented a challenge to identify and protect the radial nerve. It took some time and we were able to find and protect it. It was still very difficult to remove enough of the callus to adequately reduce the fragments without over stressing the nerve. We were able to get an 8 hole plate on with 8 screws. The post op xray shows residual angulation but I believe it is satisfactory.
I spent most of the rest of the day in the clinic and Jay handled the OR. I saw an amazing 8 year old patient in the clinic with congenital deformities of both legs. He has never been to a doctor before. He has normal hips but deformed femurs. His knees, tibias and feet are nonfunctional. He scoots around everywhere basically sitting. He has a mischievious smile and seems totally happy. I asked both him and his mother if he would like to have legs that were normal in length so he would be normal height. They both answered “yes,” without hesitation. The only real option, given the severity of the deformities would be bilateral amputations and good prostheses. They want to go ahead.
We had a comminuted midshaft femur fx (a fracture of the mid portion of the femur-thigh- bone into multiple pieces) that had been fixed in Santo Domingo with a small diameter Kuntscher nail(old school – can’t be locked) The patient had fallen a few days ago and the rod was fairly prominent above the greater trochanter (up by the hip area) and the rod looked a little bent. The fracture occurred just two months ago so we thought we could get it out even though we don’t have a Kuntscher rod extractor. It wasn’t easy but Jay got it out after a bit of a struggle. He then put in a nice sized SIGN nail and locked it. This job would be virtually impossible by myself. I wouldn’t be able to see many patients in the clinic at all if I were tied up continually in the OR. Of course, I wouldn’t schedule many elective cases without sufficient help. Jay is really a great help. He has so many years of experience that he isn’t stymied by a problem. He just keeps at it. He is getting acquainted with all of the instrument/implant sets and the power equipment. I would love to have him here more. He is going to cover for me when I am gone in February. Henry is an excellent anesthetist. He is calm, cool and collected. He is fun to work with, too. He has a good sense of humor. His best quality is his work ethic. He never complains and seems to be happy getting in another case in the evening even after working all day long. I wish he could take two or three months off and spend them here with us. I hadn’t realized that Henry was going to leave tomorrow until later this afternoon after I had scheduled several elective cases. I decided to pay the fee for getting his ticket changed so we would be able to do cases tomorrow. I’m not sure why that scheduling glitch didn’t get passed on to me. We really need to have the volunteers staying at least through Friday and even through Saturday if possible. We never know what urgent cases may present.
The work just keeps flowing in. A patient was transferred from MSF (Médicins Sans Frontières-- Doctors without Borders) yesterday with a comminuted patellar (kneecap) fracture associated with a displaced lateral femoral condyle fracture (the outside of the knee). He also has a displaced clavicle (collarbone) fracture and a mandibular/maxillary (jaw) fracture. Jay and I did the knee fracture together then I went to the clinic and spent much of the day there. The first half of the clinic was pretty uninteresting with several patients with back pain. A little 6 month old was sent from one of the other hospitals with fever and a swollen knee. I got her ready for the OR and aspirated her knee and femoral metaphysis. I didn’t find any pus fortunately. I hope the pediatricians watch her closely, she is so tiny.
I had just finished clinic and was doing some emailingwhen I was told that the ambulance had just arrived with an 8 year old with a femur fracture. The boy had been hit by a motorcycle. We decided to do him tonight since Henry is leaving early tomorrow. That meant postponing an arthroscopy and a femoral nonunion that were waiting. Things can get somewhat hectic in a hurry here. The case went well with me serving as a component of the fracture table. We used a sheet between his legs and tied it to the top of the radiolucent table (table that you can shoot x-rays through). Then I had on sterile gloves and gave traction to help reduce the fracture. Jay did a very nice job of sliding the flexible nails up the canal after we got the fracture reduced. It was a fun case. Again, Henry was his usual chipper self even though we didn’t finish until after nine o’clock. It’s really a good thing that we changed his flight to tomorrow.
This case again highlights the generous donation the Synthes company made to Haiti in the aftermath of the earthquake. The flexible rod tray is a Synthes product. It worked beautifully last night to fix that child’s fracture. The tray is complete with all of the instruments necessary to complete the job in state of the art fashion. Much of the equipment and implants that we use day in and day out to manage both straightforward cases as well as very difficult and challenging cases here is equipment and implants supplied by Synthes. Our sterile supply room is stocked with two Large Fragment and two Small Fragment sets as well as an external fixation set and two full sets of Synthes battery powered drills, reamers and saws. We also have pelvic fixation plates and screws. In addition in our non- sterile resupply room, we have a Synthes Hybrid External Fixation set and a 4.5 Cannulated Screw set and two very full bins of carbon connecting rods and Synthes external fixation connectors. I am sure we are better equipped with Synthes implants here at Haiti Adventist Hospital than many larger hospitals in the US. It is almost mind boggling to find this remarkable array of sophisticated devices and tools in a small hospital in post-earthquake Haiti. I cannot thank the Synthes company enough for their generosity. The patients, I am sure, have no idea of the magnitude of what this really allows us to do here. We do face the challenge of resupply of the implants that are used. I am hopeful that a workable solution will be found.