Tuesday, August 30, 2011

41 years

July 26-29
It has been a good week.  I had plenty of interesting work but also
time to enjoy getting out a bit.  I got some trimming done on the
trees in our yard as well as a start on the work of redoing the
peeling paint job on the pergola that I built last summer.  To look at
the thing you would think that I must be one of the worst painters in
the world.  I think it had something to do with some paint that I used
that has a lot of texture.  No matter the cause, it needs to be
redone.   I am so glad that Jeannie is back.  Her return was delayed
by some nasty weather in Chicago.  She was able to make it the next
day by getting a standby seat.  It was the last one on the flight.
She had to go from Chicago to Minneapolis and then to Green Bay.  Kind
of crazy.

The call every night has been fairly light.  I have it this weekend
also.  The OshKosh Air Show has been all this week and continues this
weekend.  There has been a lot of overhead activity.  Some of the
planes have been vintage.  It is certainly nice to have the Sabbath
here again even though I am on call.

July 30
I wasn’t able to make it to church until the very end.  I had a
patient in the hospital that required my attention.  The church had a
potluck for pilots attending the Air Show.  It was interesting to talk
with many of them.

I also got a very interesting email today.  It was from the director
of publicity for the Green Bay Packers.  She thanked me for the
composition I had sent her entitled “ A Packer Fan in Haiti.”  She
included her telephone number so I called her and we talked briefly.
I hope this Haiti project might be the beneficiary of this contact.  I
plan to meet with her when we are back in September to give her one of
the coffee table books.

July 31
My partner, Todd Smith and his wife, Carrie, had a backyard cookout
and book signing event for the people who came to Haiti in August last
year.  It was a lot of fun.  He is a great partner.  Both he and Eric
have been totally supportive of me taking this year to work in Haiti.
I couldn’t ask for better partners.

Aug 1
This week is scheduled to be a bit lighter than last week except for
being on call until Thursday.  Several patients came in that are
followups from my ER call this weekend.  None are surgical cases.  I
had some time to work in the back yard and that was good.  We got
together with Randy and Carri Goethke at their house for pizza.  They
really had a good time in Haiti with us in April.  They would really
like to come back again after the first of the year.  We are
tentatively planning that for January.

Aug 2
41 years ago today Jeannie and I were married in a ceremony at the Hill Seventh Day Adventist Church in Loma Linda.  It was a double wedding with her identical twin sister, Jane.  I was still in medical school and she was starting her last year of nursing school.  We have had many amazing things happen in our lives during these 41 years. Our children continue to be a source of great joy to us.  We love getting together with them.  We were last together in December in SanDiego after we were evacuated from Haiti because of the election related violence in the streets.  We have an incredible group of people that are our good friends and enrich our lives.  Our first 8 years in Loma Linda gave us an opportunity to really enjoy getting toknow each other and do fun things together without the added stress of dealing with the challenges of raising children.  We both finished our training and continued working at Loma Linda in the University medical center.  Shelle was our first child and was born in the med center. She was a year old when we moved to Puerto Rico and began our 12 years of service as full time missionaries at Bella Vista Adventist Hospital.  Cameron was born 2 years later and Summer a year and a half later, a bit unexpectedly.  Those years living on a tropical island were a wonderful experience.  We learned to speak Spanish and made many lifelong friends.  Many of those great people, missionaries and Puerto Ricans and other  Hispanics, are our best friends today. Today, we and our children love warm tropical beaches.   Snorkelling is one of our favorite activities.  Other watersports are a big part of our activities.  Our son even became a professional kiteboarder. 21 years ago, we moved to the little town of Walla Walla, Washington where we lived for 16 years.  My parents moved there also a few months later.  We all loved spending time with them.  My dad had a legendary garden every year.  He also loved to play golf and I was able to enjoy many rounds with him.  Our children’s school activities largely dominated our lives during that decade and a half.  Jeannie and I also started going on orthopedic medical mission trips to the Dominican Republic.  We found the people of the DR to have many more needs than the average Puerto Rican.  Our children as well as many other students commonly came on those mission trips with us.  A number of orthopedic surgeons and anesthesiologists also have worked with us in the DR. More than 12 years ago, I had an experience that brought me to realize many of my inadequacies as a marriage partner.  It was a definite epiphany.  One of my colleagues was somewhat unexpectedly divorced. They had four children the youngest under two years of age.  We saw them all sitting together in church regularly and they seemed to be the All American family.  It shocked me that his wife had fallen out of love with him and I realized that the same could have easily have happened to me.  My ongoing relationship for many years with my wife had been based on me being the center of most everything.  My rational was based on my perception of the importance of my surgical practice.  I resolved to do everything to make sure that Jeannie would never find  another man who could make her even a fraction as happy as I could. The acts of service, words of affirmation, giving of gifts, especially  regular flowers, physical touch and quality time were elements commonly lacking on my part unless I had an ulterior motive or it was some special occasion.  Speaking all five of those love languages  regularly to Jeannie has made our relationship  unbelievably rich.  I consider myself one of the luckiest and blessed men imaginable.  The last five years in Wisconsin have been wonderful.  She and I have been  able to make many new friends and we thoroughly enjoy doing things with them.  We have a tandem bicycle that we enjoy a lot.  Learning ballroom dance has brought us a special closeness that enriches our relationship.  We continue to enjoy snowboarding, tennis and windsurfing as well.  We both enjoy music a great deal.  Concerts and other programs at the Appleton Performing Arts Center help to satisfy that interest.  Now we have this unexpected year in Haiti.  We feel very privileged to be part of this wonderful opportunity to help this work get more firmly established.

Aug 3
Jeannie left for California today.  I have nearly a week by myself
before she comes to Haiti.  She has been planning this time with some
of her best friends for several months.  I am glad she does these
things even though I get very lonely for her when she is gone for more
than a day or two.  My planning skills are certainly not legendary and
it makes things  a bit hectic for me when I have to get myself ready
for the return to Haiti.  I had some straightforward cases today in
the surgery center and they went well.

Aug 4
I had an early morning meeting related to the work I will be doing
when I return in November.  It is exciting to have a new project that
suits my background, training, and interests.  I also was able to meet
with Dr John Toussaint.  He and his wife have committed to be involved
with the fund raising project for the Haiti Indigent Patient Fund.  We
are planning a function with people that he and his wife know.  I will
present them with what is happening here at HAH and the opportunity we
have.  Then they will be able to decide if they want to be involved in
helping this program to be an ongoing success.  I will use much of the
material for a Powerpoint presentation that I used last Friday.  I
also talked to him about the coffee table book and the need to get
national media exposure.

Since today was my “day off”,  I spent much of the afternoon and into
the evening working in the backyard mostly on the pergola.  It is
pretty hard work scraping the peeling paint off the overhead beams and
ten holding a fairly heavy sander and creating dust and paint
particles that pretty much cover my head and neck and arms.  I imagine
I look more like a Haitian to anyone who would just glance at me.  I
have already repainted a couple of the posts and they look so much

Aug 5
Today was a pretty light work day.  I had a clinic in the afternoon
that finished fairly early.  I was able to get in a late round of golf
with Chris.  It was my best round so far.  It has been fun to have a
break from the concentrated work in Haiti and do some of the fun
things that help make life interesting.  I also was able to get in my
last licks working on the pergola.  I now have all of the 6 posts and
two of the three large overhead beams repainted.  The final beam will
have to wait until I come back in September.  It needs scraping and
sanding first then painting.  I hope there is some nice weather for
doing that when I come back to Appleton.

Aug 6
One of the members of our church, Dorothy, drove me to the airport in
Green Bay this morning.  We had a nice talk.  She has an idea of
trying to get the church approved by the proper authorities to be used
as a shelter.  She would like to use proceeds from the sale of her
house to help fund the project.

The flights to Chicago and Miami were essentially on time and
uneventful.  Staying overnight in Miami breaks up the LONG day of
travel and I arrive fairly rested instead of worn out and needing a
couple of days to get my energy back.  It is totally convenient to
stay in the airport hotel.  I don’t have to leave the building and it
is located immediately next to the TSA screening area for my flight
out tomorrow.

Sunday, August 28, 2011

Back in the US & DR

July 19
It hugged my sweetie goodbye this morning.  She is leaving a couple of
days before me to spend some time with her elderly mother and her two
sisters in Tennessee.  I’ll next be with her on Sunday in five days.

We had seven cases on the surgical schedule for today.  We had to
cancel one child who has an upper respiratory infection.  Two of the
cases were tentative pending clearance, including the man with the
subtrochanteric fracture.  His hemoglobin was only 8 and we had just one unit
of blood so we sent the family to look for more.  They finally were
able to obtain another unit but it wasn’t until evening.  We
rescheduled him for tomorrow.  The other patient with the ankle
fracture dislocation is also being worked up to be cleared.  We wound
up the day doing four cases and they all went well.  There is a young
anesthesiologist who first gave anesthesia at HAH last week under the
employment of a more experienced anesthesiologist.  Francel knows her
well.  She was an intern under him while he was doing his residency.
She gave the anesthesia and seems very good.  We had another
arthroscopy today that Francel had scheduled.  I let him choose and
establish the portals and put in the scope.  This was his third case
and he made some progress.  His is still quite a long ways away from
doing even simple arthroscopy by himself but I am optimistic.  The
patient had deep chondromalacia in the medial compartment with bone
exposed on the medial tibial plateau.  I helped him do the
chondroplasty.   Perhaps 3 or 4 more with me and then he can try one
by himself with me next door.  Rick came in to the OR and observed the
teaching.  He had never seen an arthroscopy.  He even helped put up an
irrigation bag when our circulator was indisposed for a bit.  One of
the cases was a patient with a high above knee amputation who has had
several attempts to cure a chronic draining sinus.  ZJ has a somewhat
personal interest in the case.  The patient is young lady who is very
pretty and has an engaging personality.  She lost her leg as a result
of an injury in the earthquake.  She has a prosthesis but has hardly
used it.  Z J thinks that some of the problem is related to the high
energy cost of ambulation associated with the short stump.  He has
done some research and wants to know if it might be possible to
lengthen her short remaining femur and try to improve her ability to
use a prosthesis.  She doesn’t have a lot to lose since she isn’t
using her prosthesis now anyway.  I ran the idea by Scott and he
thinks it could be done once she heals the chronic drainage problem.
I let ZJ do the case and we found a definite piece of dead bone where
the sinus terminated.  The end of the femur itself looked clean.  ZJ
is on cloud nine after being able to do the whole case.  I am
convinced that Z J will make an outstanding orthopedic surgeon.  I
will do everything I can to help him get a residency and perhaps even
some credit for  this year.  He has a desire to serve the underserved.
His personal lifestyle and needs are modest.  He periodically gives
worship talks and is a committed Christian.

July 20
This was kind of a bizarre day.  I am now in the DR after a 40+ minute
flight.  I was planning to come to the DR by bus so I could at last do
some more work on my project here.  It has been nine months since I
have been able to do any cases and, in particular, continue teaching
Yunior Herrera to do arthroscopy.  The bus costs only $40 one way but
it takes about 6 hours.  I had tried to find someone who would like to
come to the DR with me for a few days that would rent a car so we
could drive here.  Then they could leave me here to work at the
hospital, do some cases with Yunior then have some time with Cameron
before going on to Wisconsin.  Since no one was able to come, I
decided to ride the bus.  That plan changed.  Our patient with the
subtrochanteric femur fracture was finally ready for surgery by
Tuesday evening.  The family had obtained 2 units of blood.  Francel
wanted me to do the surgery so he arranged for anesthesia to be there
early for the case.  That meant I wouldn’t be done in time to catch
the bus to the DR.  There were flights available on Tortug’ Air so
Rick helped me make a reservation and buy a ticket for the 4 pm
flight.  The commuter service flies into La Isabela International
Airport.  It is a fairly new airport north of Santo Domingo in a
largely agricultural area.  It took about 30 minutes and $30 dollars
to get here to the hospital by taxi.  We passed by the new US embassy
which is being built.  The case went well without undue blood loss.
Francel assisted me and we were able to get a good reduction.  The
fracture was very comminuted and displaced widely.  I used the Stryker
compression screw system that the Vitales brought and donated in
January.  I added a second posterior plate and screws to help fix and
stabilize the comminuted fragments and also help prevent failure of
fixation.  These fractures are somewhat notorious for not healing.  He
will have to be kept touchdown weight bearing for at least a month or
more.  It is so great to have such good equipment to help solve
difficult fractures like these.  I set up the “hillbilly traction”
with Francel helping and learning and it worked like a charm.  We had
excellent xray visualization of the fracture in both the AP and
Lateral views.  The C-arm continues to function perfectly since Scott
did the last repairs and adjustments to the potentiometer in March.
The orthopedic program at HAH has been very blessed and continues to
provide badly needed services to the people of Haiti.

July 21
I had hoped to do some arthroscopy with Dr Herrera and continue to
help him develop his skills as an arthroscopist.  Unfortunately he was
unable to get patients ready in time to do any cases today.  I’ll have
to give him more lead time when I try again.  I had plenty of
administrative work to do and was able to use the time well.  Our son,
Cameron, is now living in the Dominican Republic.  He came to the
hospital and we are going to be able to spend a couple of days
together.  It has been more than 6 months since I have been able to
spend time with him.  We plan to go east and perhaps play a round of
golf together at Casa de Campo.  I found a little hotel listed in the
Lonely Planet guidebook in the Boca Chica area.  It is modest but
clean and is close to the airport for when I leave for the US on
Saturday.  We walked down the beach into the little town.  It is a
pretty uninspiring beach town.  There were quite a number of ladies of
the night on the prowl.  Cam and I found a nice little Swiss
restaurant after a fair amount of walking and getting two very
misleading sets of directions.  It was actually only about a block
away from where we asked the first person if he knew where it was.
The salad and cheese fondue was very tasty.

July 22
We slept in late then took Cam’s van about an hour and a half drive to
Casa de Campo.  It is a high end resort on the Caribbean.  Jeannie and
I had been there for a short stay several years ago.  It has several
highly regarded golf courses designed by one of the best golf course
architects living.  The course we were able to get a tee time on is
called Dye Fore.  It is located in an area called Altos de Chavon.
This area is an artists colony that was built by the resort 3 plus
decades ago.  It looks like a Mediterranean village that is several
hundred years old.  It is very picturesque sitting on high bluffs over
the Chavon River.  I have a special picture of Jeannie at home.  I
took it of her when we were at this place more than 10 years ago.  I
cropped it and had it enlarged and framed nicely.  It hangs in a
special spot in our home.  We walked around a bit and took pictures
and had a bite of lunch before playing golf.  The golf course is a
really great layout and we were thoroughly challenged.  Afterwards we
found a nice restaurant in one of the centuries old looking buildings
and got a table on an outside area.  We had a nice soft breeze cooling
us off.  As we finished our meal, a trio of musicians appeared and
played some very pleasant music.  The older gentleman of the three
played the accordion expertly, accompanied by the others on guitars.
They also sang very well.  They came to our table and I asked them to
first do EN MI VIEJO SAN JUAN.  I sang along a bit.  That song has a
great deal of meaning for our family since we lived in Puerto Rico for
12  years and some of our best friends are Puerto Ricans.  I also
asked them to do YELLOW BIRD and MALAGUENA.   Cam and I enjoyed the
good music especially given the special spot in Altos de Chavon.
Their tip was well worth the entertainment.  It was a memorable day.
Spending it with my son made it exceptional.  Jeannie is spending
these days with her mother and two sisters so it is only right that
Cameron and I have been able to have a couple of very special days

July 23

It’s off to Wisconsin for the next two weeks.  The flight left early
this morning.  Paul and Ethyl Conner met me at the airport in Green
Bay and I am staying with them tonight.  It’s Paul’s birthday

July 24
Paul and Ethyl asked me to play golf with them to celebrate his
birthday.  It didn’t take much arm twisting on their part to get me to
agree.  My game was a bit rusty but I had fun.  I also hit some tennis
balls later in the day.

July 25
Jeannie is having a good time with her mom and sisters in Tennessee.
I wish I could be there with her.  I have very little time in my
schedule though during this year we have committed to working in
Haiti.  Clinics, elective surgeries, taking call and organizational
meetings will keep me busy for the next two weeks.  I hope to have a
bit of time to relax as well.  I’m looking forward to Jeannie coming
in two days.

Friday, August 26, 2011

Arthroscopy Lessons

July 14

We finally got some blood for the man with the comminuted displaced
proximal femur fracture but we don’t have anesthesia so all surgeries
were canceled.  I took advantage of the time and went downtown with
Randy and Sam to look for a spare wheel and tire for the pickup.  I
came back with Jimmy and Joe on a tap tap.  I got a lot of
administrative work done which I hardly ever have enough time for.  I
am now working on the spine week that Dr Howard Place is setting up.
We were told that we will “probably” have anesthesia for a part of the
day tomorrow.

July 15
The week ended on a high note.  We got anesthesia for “two” cases and
wound up doing four.  For some unknown reason, the clinic was smaller
than usual.  Adeel did a hemiarthroplasty that I chiefed him on and
Francel scrubbed on.  Then I did another arthroscopy with Francel
assisting.  It was straightforward and Francel did well.  He held the
scope steady a good share of the time and was able to put in the probe
and even the shaver and do some shaving.  I am optimistic that he can
learn to be a good arthroscopist.  We’ll see how the next 4 or 5 go.
He was totally excited afterward and expressed his thanks to me very
deeply.  I told him that HAH presents a very good opportunity for him
to develop a private orthopedic practice.  I told him I would help him
to learn as much as possible and then when he is ready we can find
another young Haitian orthopedist and he and I can train him in
arthroscopy and in this way he can develop a nice group practice.  He seemed to be very
interested.  It might take some subsidizing on our parts to help him
get established.  Our patient with the proximal femur fracture and the
low hgb is still not ready for surgery.  His hemoglobin is 7.8.  Adeel was
very upbeat after we finished the cases today.  He thanked me
effusively for the great experience here.  He is really looking
forward to the time here in a couple of weeks with Scott.  I think he
could very likely decide to return here and spend significant time.
The first year med student Jonathan Mills told me this was a life
changing experience for him and he has definitely decided to take
orthopedic surgery.  I am happy that they have felt so positive about
the experience here.

Altogether, we did a total of 29 cases this week even without any
anesthesia on Thursday.  Once again, I am so happy for the arrival of
the Sabbath.  I’m looking forward to Rick Williams coming for a few
days.  He is a VP at Loma Linda University.  He is a close friend.
His son, Shane is an orthopedist who was here a couple of months ago
and was a big help.

July 16
Sabbath was once again a restful delight.  Jeannie and I went to the
English speaking church at the University up the street.  We both
rested and read and got caught up with emailing family and friends.

July 17
I went to the airport with Richard to pick up Rick.  We had to go 2 ½
hours early to drop off Brittany at the bus stop in Petionville.  I
used the time to work on my pictures.  It’s great to have Rick here.
We usually stay with he and his wife, Linda, when we are in Loma
Linda.  The last time was in March during APC.  We have so many common
interests and think a lot alike.  He thinks the taptap is pretty
awesome.  I took him out for a walk up the street to experience the
environment.  There were all of the usual street vendors as well as
guys playing dominoes and taptaps everywhere.  There were no surgeries
that need to be done and, of course, there are no anesthesia providers
anyway.  I am hoping that administration can arrange for anesthesia
help this week.  We do have several cases that should not be put off.
Adeel and Jonathan left today.  Adeel has been a really big help for
me.  He felt his time here was really worthwhile so it was mutually
beneficial.  Jonathan really blossomed here during these weeks.  He
has found what he wants to do and that is orthopedic surgery.  He was
a big help once he got in the rhythm of the situation here.  He is a
quick read and will be an outstanding ortho resident and orthopedic

July 18
The Monday clinic was big as usual.  Francel, ZJ and I worked our way
through the patients without any problems.  We didn’t see any new
patients that needed urgent surgical care.  That was good since we
still don’t know what anesthesia services will be available.  Nathan
was able to get coverage for at least part of the day tomorrow.  Rick
and I had a good time getting caught up with our respective lives.

Monday, August 22, 2011

Tap-Tap, Go Pack!

July 9

Today was an extremely restful Sabbath.  Jeannie and I tried getting church services on the internet and finally succeeded getting a Karl Haffner sermon.  I went through some of my pictures also and did some emails.  I made rounds and all of the patients are doing well.  I got some good pictures of the hospital and the grounds then Jeannie and I went for a long walk later in the afternoon.  We walked up the hill past the university where I go jogging.  On the way back we did some exploring.
Instead of coming back through the university, we continued on down the street and took the first left.  We eventually found the street narrowing into nothing more than a very narrow walkway.  It continued for quit a ways and eventually we found a street for vehicles and followed it until it came to the main street in Carrefour, not far from the DiQuini 63 turnoff.  The foot and ankle team has plans to see some of the sights in the country this weekend.

July 10

Jeannie and I had some projects to work on and got most of them done. I drilled a bunch of holes in the taptap top to mount the paintings that the artist promised me for tomorrow.  I also finished the little computer table to help organize our room a bit more.  I dug up some small banana plants to pot so we can have a bit of greenery on our balcony.  I glued some more concrete pieces on the compound wall
behind the prosthetika area and tested some of the holds that I had glued on last week.  Most were ok but I have to add some more in a few spots for it to work.  A patient came in to the ER with a subtrochanteric femur fracture.  He was riding his donkey when a rock rolled down from somewhere and the donkey spooked and the patient fell off.  It’s my first femur fracture from a fall from a donkey – only in Haiti.

July 11

Monday’s clinic was full but went very well with all of the manpower we have here.  Francel is a big help with his Creole skills.  Another patient with a hip fracture came in.  It is a displaced femoral neck
fracture and is more than a month old.  We’ll get her worked up for a hemiarthroplasty. The other patient with the subtrochanteric fracture has a hgb of 4.8.  Needless to say, his surgery will be delayed until enough blood is available to get him ready.  It turns out that he wasn’t riding a donkey.  He was chasing a goat and the rock caused him to fall from a height. The artist brought the paintings of Jeannie, Emmanuel and Stephanie, Aaron Rogers and the Haitian dancers.  I really like his work.  I’m
Tap-tap Packer Style
anxious to get them mounted on the pickup. The day started with 3 cases but we ended up doing seven.  Bryan, Steve and Dean did a 6 y/o child with recurrent clubfoot deformity.  I then did a case with Adeel and Bryan of 8-plates in a twelve year old girl with knock knees.  She is fairly mature and needed them on both the femur and tibia on both legs.  Adeel did a very nice job.  Once again we used the new tourniquet that Dr Frykman arranged to have donated.  It is really nice.  We also got a transfer from MSF with an untreated femoral neck fracture who had a treated midshaft femur fracture and a patellar fracture on the same side as the hip fracture. Her injuries were more than three months old.  She is a large lady and would need blood ready for a major open reduction.  We had a conference on the alternatives and decided to use the fracture table to help reduce the hip fracture(it was in varus).  Bryan , Dean and I teamed up and addressed the challenges.  We were able to get the head and neck out of varus with an extended incision proximally using osteotomes.  The C-arm was absolutely essential as was the hillbilly traction and it all worked perfectly.  We had very nice visualization
of the entire head and neck.  It wasn’t easy getting in the guide pins because of her size but we eventually got three good screws in with washers and let the traction off to compress the fracture.  If she develops AVN or a nonunion, then she will need a total hip once her midshaft femur fracture is healed.  We finished with all of the cases after dark so I took the whole team to the Auberge in the taptap.

July 12

We had 12 cases on the scheduling board for today including a 33 y/o lady with bilateral neglected clubfeet.  She had undergone attempted surgical correction before she was two but the deformity was either incompletely corrected or recurred.  We had two cases of hardware removal and some postop clubfeet for cast changes and pin removals.  A very large lady with an ununited humerus fracture needed her plate and screws removed and then refixed with another plate and then bone grafted.  Another case was ankle arthroscopy for impingement.  Another 10 y/o child with tibial osteomyelitis needed debridement and antibiotic beads.  This is the last day for Steve and the team members from New York.  Bryan and the group from South Dakota will stay one more day.  All of the cases came in and we did them all as well as an add on.  Steve and Bryan did really nice jobs on the lady with the
bilateral clubfeet.  They just kept enlarging the lateral wedge and the anterolaterl/dorsal wedge until the foot was plantigrade.  They each did a side and made the surgery look easy.  They used multiple
cannulated screws as well as a small plate on one side.  It is great to have such talented surgeons willing to volunteer their time in this project.  My life has certainly been enriched personally and professionally by being able to meet and work with them. I chiefed Adeel on the humerus nonunion.  He did a very nice careful exposure of the plate and screws, including protecting the radial nerve very nicely.  All seven of the screws were loose.  There was no evidence of infection.  We put on two plates and 15 screws.  One plate needed a bit of contouring.  I harvested some bone graft from the proximal tibia while Adeel was putting in screws.  It was a very satisfying case for all of us.  I have seen Adeel’s confidence improve during the weeks that he has been here.  He is a hard worker and has such a positive attitude.  I really enjoy working with him.  He has a very nice way with the patients also.

The ankle arthroscopy case also went well.  We had a small glitch at the beginning but once the loose cable was found and properly inserted, everything worked perfectly.  Both Steve and Bryan were very
happy with the equipment and set up.  They trimmed some impingement and then Bryan removed a neuroma in continuity and buried it in a drill hole in the fibula.  Steve, Toni and Shirley leave tomorrow morning.  It was raining extremely hard when we finished at about 7 pm.  Nathan arranged for transportation in the ambulance for the team to the Auberge and they all talked Jeannie and me to come with them for pizza.  The main street in Carrefour was nearly a river but we made it without stalling out.  Afterwards, Jeannie and I walked back to the hospital.  It was still sprinkling a bit but the water in the street was much less and we had no difficulty in getting back.

July 13

The combined clubfoot/general ortho clinic was about average in size. With so many of us evaluating patients, it was over by early afternoon.  The surgical cases went well.  We only had Dean left to
give anesthesia so we didn’t schedule a lot of cases especially with a  big clinic.  I spent a little time putting paintings on the pickup and mounting the wooden femur that Exhume carved for it.  I also mounted the exfix on the femur.  Jeannie’s picture looks really good on the back.  We took it over to the Auberge so that the team could get pictures of it in the daylight.  They talked us into staying for pizza again.  Then we played table games with them for a little while.  This was the South Dakota portion of the team.  They are all so easy to get along with.  They all leave early tomorrow morning.  I got back and talked with Nathan and he told me that he and Dr Simeone have been trying their best to arrange for anesthesia for tomorrow but it doesn’t look promising at all.  We have about a half dozen elective cases scheduled as well as two hip fractures that need doing.

Wednesday, August 17, 2011

July 3
Many of the members of the Foot and Ankle Society team arrived today. They are staying at the Auberge and most went directly there.  Brian
DenHartog is the leader of the team.  He practices in Rapid City, South Dakota.  He has several partners who are all subspecialists.  He brought an ortho PA, Dan, a nurse anesthetist, Dean Gibson  and Karrie a scrub tech and Sue, a nurse to help recover patients.  Steve Weinfeld does exclusively foot and ankle surgery in an academic practice in New York City.  He has a lot of experience putting on Ilizaroff frames.  He brought an OR nurse, Shirley, and Toni, an anesthesiologist from Syracuse, New York.  A third foot and ankle surgeon, Dean Jameson from Arkansas is part of the team as well.
Bryan and Steve know each other quite well from being on teaching panels for the Foot and Ankle Society.

July 4
We got off to a very good start with the foot and ankle team.  Most of the patients we had on the list came in for their evaluations and we scheduled them for the next several days.  The clinic was very large. Francel began today as well and he is a big help.  I saw a 7 y/o with symptoms and physical findings of discoid lateral meniscus.  I scheduled him for Wednesday to do with Francel.  I am hoping that teaching Francel arthroscopy will be part of an arrangement that will keep him at HAH for the long term. Adeel, our ortho resident and Jonathon the med student from LLU and ZJ and Lynn complete the entireortho team.  We had already scheduled some cases for today and they all went well. One case was an ankle fracture that the team took care of nicely.  I did a PMrelease in a child and Bryan, Steve and Dean did a case of chronic infection in the fibula. Scott and I have major hopes that Francel will decide to stay here at HAH after he finishes this peds ortho fellowship.  He could help keep all of the equipment organized and implants restocked and be the bridge between visiting teams of orthopedists.  He could be involved with teaching residents at the university as well as eventually being the core of the orthopedic practice at HAH.

July 5
We had a total of 8 cases today and they went well.  The man with the banana plantation for correction/stabilization of foot and ankle was the biggest case.  The team did an elegant job of correcting the deformity and stabilizing the foot and ankle.  I chiefed Adeel on a wrist fracture and it went well.  We have enough manpower to see all of the clinic patients in a timely fashion as well as do a lot of cases.  All of the nurses and techs are very hard working.  It takes a lot of work off Jeannie’s shoulders to have a team that is so well planned out.  Brian has really done a great job of putting this entire team together.  Steve is an accomplished very assured surgeon.  He is really great to work with.  Dean is the quietest of the group.  He did a sportsmedicine fellowship but then got into foot and ankle and does that almost exclusively for his large group.

July 6
I did the child’s knee arthroscopy and found a discoid lateral meniscus just as I had expected.  The case went well with Francel helping me.  I recontoured the meniscus to make it as normal as possible.  All of the clicking with flexion/extension was gone.  I had Francel hold the scope and look and probe the structures, then had him take everything out and start over several times.  He has watched some arthroscopies but hasn’t had the chance to actually do much.  It will take a number of cases for him to  start feeling comfortable just getting good visualization.  The Wednesday clinic was big but went very well with all of the clinicians seeing patients.  Steve did a revision of Stevenson Dorsainvilles Ilizaroff frame while I was doing the arthroscopy. It turned into a pretty big job.  I am going to review it again with Scott to make certain it is going to do what he wants.

July 7
One of the most interesting patients I have seen here is a young lady who sustained a femur fracture in the earthquake.  She had an open reduction and internal fixation with a SIGN nail that was locked on both ends.  The fracture healed and she had no pain.  She came into the clinic a few days ago with a complaint that her foot turns out to the side when she walks.  Examination showed a 60 degree malunion with external rotation of the healed femur.  I did her surgery today with Francel helping.  I first removed the single distal locking screw.  Then I did an osteotomy of the femur about 3 centimeters proximal with the Gigli saw.  The Gigli saw is like a piece of wire with sharp teeth.  Once the bone was cut through, I rotated the bone internally so that the foot would point straight forward.  Then I put two locking screws back in holding the bone in the correct rotation and alignment.  We put some bone graft around the osteotomy site as well.  Cases like that are very gratifying.  The team did another case of Tibial osteomyelitis with debridement and antibiotic beads.  Adeel did a ganglion cyst and assisted on other cases including Maxi.  He is the patient from Cap Haitien with the tibia fracture that we shortened with Pat Yoon.  Steve did a very nice job of putting on an Ilizaroff. I certainly hope he will be able to heal this fracture and get his life back again.  Bryan, Steve and Dean also did a difficult tibio/talar/calcaneal fusion.  It went well as have all of their cases.

July 8
We had more tough cases today.  The patient from Jeremie was one.  He has a midshaft femur fracture which is very shortened as well as an infected ankle/distal tibia post attempted ORIF.  Adeel and I put on an Orthofix distracter on the femur and then the foot-ankle team cleaned up the ankle and put on an Ilizaroff.  The entire week has gone by very fast.  We have gotten a lot of cases done.  Toni is an outstanding anesthesiologist and likes to do lots of blocks.  She is very thorough.  Dean does a great job of getting patients in and ready for surgery.  The team has until Wednesday of next week.  We have a lot scheduled already.  The weekend off will be welcome for everyone.

Saturday, August 13, 2011

Sailing in Wahoo Bay

July 1
We all worked together in the clinic and then did cases again until we finished this afternoon.  It has been a joy to have Anthony here even for just 3 days.  He has really enjoyed the experience.  His team came into town late today and we got to meet his wife and two children and the others working on the building project.  Anthony plans to get some of his friends together to make a team and come back this fall before we leave in November.  The generators continues to run poorly and cause brownouts.  We have to keep our little refrigerator unplugged unless we have Haiti power.  I am afraid the fluctuating voltage will burn out the motor.

July 2
Jeannie and I  took Tim and Summer today away from the hospital.  They all wanted to go to a beach.  I thought it might be interesting to try to arrange to go out on one of the old fashioned looking sailboats that Jeannie and I had seen when we were at Wahoo Bay back in early February.  I arranged to use a hospital vehicle and Roosevelt agreed to come along and help. Neither he nor Emmanuel know how to swim but he isn’t afraid to go out on a boat like Emmanuel.   We drove up the highway to the north and west of Port au Prince.  We stopped at a couple of places and tried to find out where we could talk to someone who knew about the sailboats that we had seen.  We weren’t having much success when a young fellow randomly heard us asking and came up and told us he could take us there.  He led us to a small town called Luly.  We turned down toward the water and eventually stopped behind some houses that were on the beachfront.  He led us through a fence and past a  bunch of drying sea cucumbers to the beach.  It was rocky and pebbly and strewn with many broken seashells.  It had about a half dozen boats on it.  Several more boats we coming toward us.  Roosevelt talked to the guy who seemed to be in charge about taking us out on one of the boats and putting up the sails for us.  He agreed to do it for a price.  There are three small islands offshore called the Acardins.  There is a lighthouse on one of them.  Two young guys and an older gentleman loaded on the oars and mast with homemade sails wrapped around it.  Then they attached a small outboard motor to the transom and we all got on board. It took about 45 minutes to get to the islands.  We had a good conversation with the Haitian crew utilizing Roosevelt’s translation skills.  The more mature of the three told us that he had used the boat to successfully transport a group of more than 30 refuges to Florida.  He did it as a favor for the group.  On the way to the island today, the swells were pretty big at times and Tim got a bit sick.  The island we stopped on has a nice beach that has a lot of flotsam.  We started finding shells right away, especially hawk wing conchs.  There were also lots of small pieces of polished coral.  We spent at least an hour beach combing and having a great time.  Roosevelt loved rolling in the shallow water and the beach.  We enjoyed the sandwiches and snacks that we brought and then got back in the boat for the return trip.  The crew stepped the mast and put up and adjusted the sails.  The mast is in two pieces.  The first section is fastened to the mid-line near the front of the boat.  The second is a long piece of heavy duty bamboo that is attached to the top of the sail and is hoisted as high as possible until the sail is tight.  Then a line ties it near the bottom of the main section of mast.  The boom is secured also near the base of the mast and a front triangular part of the sail is secured at the very front of the boat. It was fascinating to watch the process.  It seemed like we had gone back centuries as we rode in the homemade wooden boat with the rigging made of locally grown materials and sails clearly hand sewn.  It was a priceless experience for all four of us.