Hillbilly Traction

April 24

I'm certainly glad to see Shane Williams.  He is a young orthopedic surgeon from southern California.  Unfortunately, the anesthesia provider that was going to come with him had to cancel at the last moment. 

Phil Hurley and his team, Shane Williams, Jeannie & Terry

Nathan has arranged for a local Haitian anesthesiologist to provide service for us on Tuesday and Thursday.  It is great to have an orthopedist to help with the work after the last two weeks by myself.  I have several elective cases scheduled.  One is a teenager with severe Blounts disease on one side.  We'll do a TSF with osteotomies.  Today was totally quiet and I got in some reading.  I finished a book named "BORN TO RUN".  It is a must read for anyone interested in exercise and nutrition.  Every orthopedist should read it to be able to give sound advice to runners.  It is highly entertaining.  It is not flattering to Nike and Phil Knight.

I was finally able to to some exercising in the room today.  I can't do nearly as many repetitions of sit-ups and pushups as I could 6 weeks ago but it is a start.  I'm definitely on the road back.

April 25

Shane and I had a big Monday clinic.  It is great to have someone to help see all of those patients.  Several more new patients came in.  One nine year old has a 70 degree scoliosis.  I am reluctant to schedule much elective surgery with the anesthesia situation as it is.  I was told late tonight that the Haitian anesthesiologist that was contracted to give anesthesia tomorrow and Thursday will not be arriving tomorrow until 11 am.  There are 5 cases scheduled. 

April 26

We somewhat impatiently waited until 11 o'clock but still no anesthesiologist nor any word either.  I decided to try to lessen my negative feelings about the whole situation and went to our room and read several chapters of the book, "THE HOLE IN OUR GOSPEL."  I don't know if it was the book or something else, but when the anesthesiologist came a bit after one o'clock, I was able to be surprisingly pleasant.  That is not my usual state of interaction when anesthesia is so tardy.  I had already cancelled one baby and wound up canceling a second case.  Some of my positive feelings where related to the fact that I got a call from an expat orthopedist at a  hospital about 2 hours away.  He wanted to transfer two patients with fractures for surgery.  I asked if he wanted to come along with the patients and help with the work here.  He had told me that the ORs were not functioning at his hospital and he couldn't do any surgery and was getting itchy.  His team included an anesthesiologist who also was frustrated at not being able to do what he came here to Haiti to do.  The whole team came including 2 OR nurses and an ortho tech.  Nathan cleared all of their credentials and they came this evening anxious to go to work.  Phil Hurley, the orthopedist, is from Kentucky.  This is his fourth trip to Haiti since the earthquake.  He and his team are planning to stay through Friday.  What an answer to prayer!

The big case today was our patient with the hip and femur fracture on one side and the tibia fracture on the other.  Shane and I fixed the hip first with multiple cannulated screws and then put in a SIGN nail to fix the femur.  Shane did a nice job for his first SIGN nail.  We put it in retrograde and had a bit of trouble getting in the proximal locking screws and wound up using the Carm.  I also manipulated his stiff knee again.

April 27

Today was a full throttle situation.  The monster clinic seemed to never end.  Shane and Zj  and I just kept seeing one after the next after the next.  For some odd reason, Frantz came early and took 4 X-rays then disappeared for several hours.  A huge clot of patients formed around the X-ray room door waiting some not so patiently.  Meanwhile, Phil Hurley and team got the first patient into the OR.  She is a 12 y/o with a comminuted midshaft femur fracture so we set up the "hillbilly" traction.

The Hillbilly traction set-up

It worked very nicely.  Phil did a nice job of putting on an Orthofix external fixator.  Her hemoglobin was only a bit over 6.  I split my time between the clinic and the OR.  I wanted to make sure that Phil and team didn't have any questions or problems.  Phil's second case was a patient with a segmental tibia fracture.  He did a nice job on the SIGN nail.  He got both distal and proximal locking screws in with ease.  He is a very good surgeon and a fun guy to be around.  I had hoped to do an elective case also but the generator needed a rest so we didn't have AC in the OR.  We postponed her until tomorrow.  We got in another transfer from Phil's hospital with a  femur fracture.  We'll try to do him tomorrow.  I hope our anesthesiologist comes earlier tomorrow so we can get all of our cases done.

The whole group went to the Auberge for pizza.  A downpour struck on our way over and the pickup couldn't make it up the steep hill.  We parked at the bottom of the hill and walked up through the rain.  We had a great time stuffing ourselves and getting better acquainted.  The rain had stopped by the time we were finished.  It was a good end to a day full of a lot of work.

We have a lot of cases tomorrow.  It should go well if we can run two rooms.

April 28

We got a fairly early start in one room.  Unfortunately,  the local anesthesiologist didn't arrive until noon.  We were able to do one case with her.  Shane and Phil did the SIGN nail on the femur fracture that came in yesterday.  It went really well.  Shane did the case with Phil assisting.  Shane is an outstanding surgeon.  He had a bit of difficulty getting in the locking screws but it was mainly because of the very dull drill bits.  Shane helped me with the girl with Bounts.  The TSF went very well as did the tibial and fibular osteotomies.  We cancelled our last case because the patient had such high blood pressure.  Hopefully we can get a medicine consult and get his pressure controlled so we can do him in the next day or two.  I've been enjoying reading the book that Andrew Haglund gave me, "THE HOLE IN OUR GOSPEL."  It certainly very clearly lays out the Christian's responsibility in a world with so many poverty stricken people.