Today was club foot clinic with large general clinic. We had a half dozen surgeries ending with a TSF on older child with neglected clubfoot. Ben and I also did a tendon transfer for severe spastic wrist flexion deformity. We had a difficult reduction in a 7 y/o with a fractured distal radius. Jeannie is extremely tired and not feeling well. I hope she isn’t getting sick. She has been trying to make our bare little room look ‘pretty with a nice mirror over the sink and a couple of very nice Haitian paintings that she got framed. All in preparation for Tim and Summer(our youngest daughter and her husband) arriving tomorrow. We inflated the air mattress and put up a mosquito net with Randy and Sam’s help. We have a makeshift table with a hotplate.
Scott and I are anxious to get out and do some exploring with the pickup/taptap to be. It may not happen since we have 13 cases on the schedule for tomorrow. We probably won’t finish until 2 or 3 in the morning. It has been great having the C-arm working again. We used it a lot today. Jeannie tried to come down and work but after a few minutes had to go back and lay down. It is a virus that has pretty well got her number. I hope it doesn’t last long, especially with Summer and Tim coming tomorrow.
My prediction was off by a few hours. We started by working on the spine case. I needed to reposition the upper screws since I had put them in without C-arm and missed the pedicles with all four. The bottom four were good. Scott also wanted to try to get a better reduction. It wound up nearly perfect! I am anxious to do more of them now. We kept cranking out the cases as the day and evening went on. Scott and Ben did a CP with bilateral femoral and pelvic osteotomies. Scott and Ben also did the case of the 7 year old orphan boy with the severe burn and knee flexion contracture and foot equinovarus. It is one of the most complex frame cases he has ever done. It involves an Ilizaroff frame for the knee connected to a TSF for the foot. They started by excising the web scar and full thickness grafting the defect taking the graft from the opposite leg. The flexion decreased from 110 degrees to 70 degrees. It really looks good. I continue to be amazed at what can be done at this hospital with all of the equipment, implants and specialists coming on a regular basis. I gave up the effort at 2 am while Scott and Ben did one last case and finished about 4:30. It was an exhausting day for most of us. Summer and Tim got in with out problems. It is so great to see them. They brought the Doppler as well as a mountain of other things including some of our favorite food items. It is a Godsend that they came today. They were able to recover our patients through the night. Tim normally works nights so it was no problem for him. Scott leaves tomorrow. No, we didn’t get to use the pickup again. Nathan will try to get it registered and insured as soon as possible.
I was so bushed most of the day yesterday. I had a fairly long meeting with Nathan and Dr Simeone over the girl that died. The parents came to the clinic area and wanted to know about the autopsy. It is not possible in Haiti at this time to get autopsies. They wanted to know if we were going to help them with the cost of the funeral(upwards of $2500 US). A simple yes or no would have sufficed but Dr Simeone wanted to ask me about the details of the case and as typical, it took way longer than necessary. The answer was 'no.'
We concentrated on the clinic in the morning and for some reason, the femur case didn’t get going until mid-afternoon. Ben really enjoyed the case even though it was an infection. He thought that we had really helped the patient by debriding the infection and removing the infected rod and then making and inserting an antibiotic coated IM nail. He is so enthusiastic about everything in orthopedics. Then we had the below knee amputation that needed revision to an AK (above knee amputation). Ben had never done an AK. Then we had the infected toe case. We finished at nearly 9pm. I certainly enjoyed going to bed a bit early. Both Tim and Summer have already been a big help. The AC finally got fixed in OR room 2. We are now back in pretty much full operation.
Another Sabbath is here. What a wonderful experience! No clinics or elective surgery. Jeannie is feeling much better although I am sure is very weak. We all took our time getting ready to go up the street to the English church service at the Adventist university. Ben and I made rounds and the patients seem to be doing fine.
Steve, Ben, Tim and I decided to try out the pickup and see if we could get some pictures of the countryside. We went up Diquini 63 which starts out paved but soon turns into a rutted rocky road worthy of a 4 wheel vehicle. We had to stop several times as we climb steadily up the hill to let oncoming taptaps pass on the very narrow road. We eventually arrived at a spot that Steve thought he recognized as an orphanage that he had been to on a previous trip. It was a very steep climb to the tiny structure where Mary Lou keeps 15 of the cutest kids. They are all clean and seem well fed. They have bright smiles and shyly respond to ‘como ou reley’(what is your name) and ‘ke la zhou’(how old are you?)
It is a difficult thing for me to say ‘au revoire’ and turn and slowly pick my way down the steep hill and leave kids like this. We have so much and they have so little. The pickup continued to manage the “going up” just fine but the “down” had its challenges. The brakes definitely need some serious attention. We were led by Wilson from the first orphanage to a spot on a hillside overlooking the hospital and the bay. There was a nice breeze blowing. We went on to one of the springs where there were dozens of people getting water for home use, washing clothes and bathing. It was very interesting. We went on to Wilson’s orphanage and met about 25 of his 45 charges. They were all lined up on the roof and sang a song for us about how they had been waiting and why did it take us so long to get there. It took a bit of coaxing but got most of them to interact. They loved taking pictures with our cameras. I got some good pictures of them drinking fresh coconut milk out of a freshly cut coconut. I also got some pictures of several kids flying their kites.