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.

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