Wednesday, May 18, 2011

The Reality of Haiti

April 29

Thanks to Dave giving anesthesia, we were able to do several cases today. I spent most of my time in clinic and we were able to finish with both clinic and surgery by mid afternoon.
Long time friends Ed Miller and Terry Dietrich
Michel's blood pressure is still high so we will wait for the antihypertensives to take effect. Hopefully we will be able to do him the first of next week. It has been really great having Phil and his team here as well as Shane. The unexpected anesthesia help was wonderful.

April 30

Shane and I made early rounds then Jeannie and I went to church. It was a very restful Sabbath. I finished reading the book THE HOLE IN OUR GOSPEL. It has really challenged me to rethink my entire decision making process and reassess my value system and priorities. It has also given me some good ideas about how to approach potential donors for our indigent patient program. Ed Miller arrived today. He is an orthopedist who lives in Northern California. He has been a good friend of mine since college days. We were orthopedic residents at the same time at LLU back in the 70's. Ed sent me the "hillbilly" traction that we can attach to our C-arm fluoro table. His wife, Nancy, was going to come down with him but had to go take care of her elderly mother who was recently hospitalized. Ed is a mechanical genius. He has a lot of interests including flying aerobatics. I'm looking forward to this week with him.

I learned something very interesting about the 12 y/o girl who was transferred here with the femur fracture a few days ago. Apparently she was in the employment of a Haitian man as a sex slave at the time she was injured. I had heard that this sort of thing goes on here in Haiti. If her family was responsible for her being in this situation, she won't be able to go back to them. It is hard for me to imagine that this can actually happen. The grave reality of Haiti for so many children is sobering.

May 1

Jake Ricks, anesthetist extraordinaire with his sister
Shane left early this morning. He has been a really big help this week. We have had a good time working together. He plans to come back in a few months. I hope he can bring a team. John Herzenberg just emailed me a good suggestion. He advertised in the national anesthesia website and got a bunch of responses and could only accept two. Jake Ricks, our expatriate anesthesia provider for this week came this afternoon. He is a young anesthetist from Maine. He is FLUENT in Creole! He was a missionary for his church for two years here in Haiti about 8 or 9 years ago. He brought his sister who is a recent college graduate. We had a case to do so we put him right to work. Michel's BP came down enough so Ed and I did his surgery this evening. It went well. We first positioned him prone to harvest the ICBG then turned him over to do the antero-lateral approach for the tibio-fibular synostosis. This was the first time Ed and I have been in the OR together in more than 35 years. We both really enjoyed doing the cases together. Jake is a very good anesthetist. He likes to do blocks and is smooth as can be. Obviously, his language skills add hugely. Another volunteer is Dr Matt Jenkins. He is a third year general surgery resident from Temple. He came at the recommendation of Dr Tony Coletta. It will be fun to have him here to work with and teach and share the work load.

May 2

Dr Miller fixed this with a hybrid ex-fix
A patient came in early this morning with an open fracture of his tibia (see photo to the left). Ed took him to the OR and I helped him get the case started before going to see patients in our very large monday clinic. The fracture was extremely comminuted but stopped short of the ankle joint. Ed set up the traction and put in a calcaneal traction pin. This was a very high energy injury. Many of the fracture fragments had no soft tissue attachments and were removed. Ed put on a hybrid external fixator after fixing the fibula and then put a wound vac on the open wound. The patient now has a significant bone defect. It may either require tibial shortening or bone transport. We finished with the big clinic by late afternoon and saw all of our patients. Roosevelt and I threw the football back and forth a bit after clinic. I admitted two patients for surgery tomorrow to add to our full schedule of elective cases. One is a diabetic with a foot ulcer that needs to be debrided. The second is a man with a dead foot. He must have lost his circulation a week or so ago. He will have to have at least a BK. I just had laid down and put my legs up when I was notified that there was a patient in the ER with a femur fracture. The patient had been injured playing soccer. He had a quite distal oblique fracture of the distal femur. He hadn't eaten so we took him to surgery and put in a SIGN nail. We didn't want to interfere with our big surgery schedule for tomorrow. I finally got to lay down again just before midnight and promptly fell asleep.

May 3

All of our elective patients came in this morning. I told them that we might not be able to do them all because of the urgent cases that had come in. Ed and I worked on the cases together and got them all done except for one. We will do that one tomorrow. Our long case was a bilateral clubfoot for posteromedial releases. I did one side with Ed helping me and then I helped him do the other side. It was fun working with him. He is a very good careful surgeon. We have also been having to deal with a problem related to our generators. The two generators are being alternated to avoid overheating. Our third generator blew up a few weeks ago from overheating and now precautions are being taken to avoid that happening to the other two. Unfortunately, the decision is being made to randomly rest the generators which means that the power goes off in the ORs unexpectedly. We have the inverter in two of the ORs which will run everything except the air-conditioning. If we are doing a big case, it becomes insufferably hot especially if the C-arm is being used and we are wearing lead aprons. Randy our electrician finally helped convince the people making the decisions that the generators could be used continuously by alternating them during the working day and letting them rest if necessary at night while we are sleeping. The powerhouse people were ordered by administration to not turn off the power while we were still working in the OR. They are to come and ask when we will be done so that they can plan how to rest the generators as necessary. I hope the administrative order is followed so that we can provide proper care to our patients.

We got more information about the 12 y/o girl with the femur fracture. Apparently the family has more children than the parents are able to care for. She was "given" to the other family to be cared for. No money apparently exchanged hands. Whether the family knew what was going on or not is not clear. A cousin of the girl's mother has been by her bedside almost continuously. She is willing to take the girl and care for her.

May 4

This may have been our biggest clinic ever. I worked steadily through the day with ZJ and Matt helping. Ed was busy with cases much of the day but was able to come to the clinic and help for a few cases in the mid afternoon. I had hoped to finish before 5 pm but finally finished taking care of the last patient well after 6 o'clock. It seemed like there were an inordinate number of patients who
Matt Jenkins a Temple general surgery resident with the Ricks, Ed Miller, and the Dietrichs
were earthquake casualties. We are still seeing malunions, nonunions, painful joints, stiff joints and infections.

A team led by Ernie Schwab is here from the School of Allied Health of Loma Linda University. They are exploring the possibility of settling up a formal degree program for areas of therapy. This presents a great opportunity to perhaps formalize our Ortho Tech training program. Ernie and I arranged to take his group and our orthopedic team to the Auberge for pizza. Several of our translators came with us. I fired up the 'tap-tap to be' pickup and the whole crowd of 13 jumped in or on and we bumped our way to the hotel. The fried plantains and pizza and peekleez were outstanding as usual. Ernie and I got acquainted and had a good talk about the teaching program and how it might be accredited. It was a delightful evening.

No comments:

Post a Comment