Sunday, September 11, 2011

A Weeeknd in Paradise

Aug 15
The clinic went well with Francel back from his club foot meeting and
Ron going right to work.  Francel was able to arrange the same young
anesthesiologist as before for our cases tomorrow.  I rearranged the
schedule a bit and postponed a couple of cases that I didn’t feel
comfortable doing. I started coming down with some GI virus and took it kind of easy.

Aug 16
I did the first case today of a Cerebral palsy child for hip, knee and
ankle surgery on both legs.  It went well.  The GI problem started
becoming more of a problem so I turned things over to Ron and Francel.
Later today Ron came up to the room and said he had the cure for my
diarrhea.  He said the Haitians recommend mango nectar so he had gone
to the store and got some for me.  My mango allergy is only to the sap
in the tree and the peel of the fruit so I gave it a try.   It tasted
pretty good and it seemed to do the job.  I continued to drink 7-Up to
settle my stomach.  I don’t know if it was the mango juice, the
carbonated stuff or just time but I definitely started feeling better.

Aug 17
I had meetings almost the whole day today.  Leadership planned a
brainstorming session with the hospital department leaders.  Our goal
is to identify and make plans for dealing with the challenges of
maintaining the success of this orthopedic program.  The biggest issue
is the successful recruitment of my replacement.  The first meeting
lasted until after 1 pm.  I grabbed a bite to eat and then went to the
clinic and saw a few patients that Ron and Francel weren’t sure what
to do with.  I then had another meeting that lasted nearly an hour.
Everyone is optimistic that things are going to work out.  There is an
orthopedic surgeon currently working at a small Adventist hospital in
Central America.  He doesn’t have a lot of orthopedic equipment and
isn’t able to do very many cases.  We plan to see if he might have an
interest in coming here.

We received a call from Medishare today asking if we would accept a
patient with a hip fracture if they would send an anesthesia provider.
We accepted the patient.

Aug 18
This really turned out to be a crazy day.  The patient with the hip
fracture came fairly early this morning along with a nurse
anesthetist.  No xrays came with the patient.  We got a small case
done while we were getting the films.  We actually had three rooms
running simultaneously since Francel had arranged for two local
anesthesiologists.  I did the wide excision of the mass on the
patient’s foot even though he was very anemic.  The xray showed a
displaced femoral neck fracture so Ron chiefed Adam the resident on
the hemiarthroplasty which went well.  I started the femoral nonunion
with Francel and was able to remove the old plate and screws but then
had to leave for the airport.  Ron took my place and finished the
double plating and bone grafting.  Meanwhile, Jeannie and I hustled
off to the airport.  We tried to get tickets on Tortug’Air for Santo
Domingo but were told we would have to go standby.  The flight left at
4 pm.  When we got there, we were told we would have to wait until
3:20.  People kept streaming in to check in and my heart continued to
sink.  I was sure we weren’t going to make it to the DR and have a
couple of days in Cabarete with Cameron.  At 3:15 another passenger
ran up to check in which doubled my anxiety.  My concerns were for
naught.  There were 3 seats left when we finally checked in.  Then we
had to notify someone that we were actually going to be arriving in
the smaller international airport just north of Santo Domingo in about
an hour.  We couldn’t get anyone but left messages with 3 people and
hoped for the best.  We thought we might have a really long wait or
maybe a very expensive taxi ride.  The flight went fine.  As we exited
the terminal, I asked Jeannie what she thought the chances were that
someone would be waiting for us.  She answered, “zero!”  As we were
fishing for some Dominican coins to try to call Cameron, up drove Dan
and Sue Ruggles!   Amazing!!  They took us into Santo Domingo to a
nice little hotel near their house.  Tomorrow we plan to get up early
and drive with them to Cabarete.  Scott and Marni Nelson and their
kids have spent this week there with Cameron.

Aug 19
Cabarete is a lovely as ever.  It was fun driving up with Dan and Sue
and getting better acquainted with them.  We made it before noon.
There was a nice breeze already which definitely got my juices
flowing.  Cam had been surfing in some good sized surf at Encuentro
for several hours and he was starved so we got some lunch with him.  I
headed directly down to Vela to try to satisfy my windsurfing
addiction.  After almost 30 years, my passion for the sport is as
strong as ever.  Within an hour the wind had built enough and was
steady.  I chose a medium sized sail and a floaty board and went out.
It was the perfect combination for the conditions.  I sailed hard for
an hour or more, including catching about a dozen nice waves on the
reef.  Some of them were overhead.  What a thrill to ride down the
face of a wave that is breaking at your head and throw in some nice
bottom turns and then laugh at it as you outrun it.  I came in with a
major thirst and talked with Jens for a while then went out for
another session.  After making some nice power jibes and a duck jibe I
sensed the wind was easing off some.  There were some pretty dark
clouds over the hills behind Cabarete which commonly mean rain.  When
that happens the wind can stop abruptly and that means a swim back to
the beach.  My session was over but it was sublime while it lasted.
Getting to do that every week or two would be just perfect.

Jeannie and I took Cam out to eat at our favorite restauant in
Cabarete.  Maraja is probably our favorite restaurant anywhere.  It is
a short walk down the beach from our place.  There are about 10
restaurants on the beach in Cabarete.  They have tables on the sand
under the palm trees.  It is such a unique place, unlike anywhere else
we have been.  Enjoying a really good meal with the sand between your
toes is an experience that everyone should have.  Jeannie and I were
celebrating our 41st anniversary a couple of weeks late.  We didn’t
have the chance to do that when we were in Appleton.

Aug 20
Jeannie and I love waking up in Cabarete and going for a long walk on
the beach together.  It is just about the best way to start the
Sabbath that I know.  Today was totally restful.  The wind was blowing
a bit stronger than yesterday making it a perfect day for windsurfing
and kiting.  Jeannie and I choose to not winsurf or kite on the
Sabbath.  We feel that God gave us a special day each week to rest and
recuperate from the activities of the week.  That break helps us to
recharge ourselves physically, emotionally and spiritually.  God asks
us to keep the Sabbath holy and doesn’t specify a list of do’s and
don’ts.  I have found that I don’t even have a desire to windsurf on
Sabbath even though on any other day, it is a totally strong
addiction.  Every person has to decide for themselves what “keeping
the Sabbath holy” means.
Jeannie enjoying a restful weekend in Cabarete

Our 30 hours in Cabarete ended with Cameron taking us to the bus forour trip back to Santo Domingo and then tomorrow our return to Haiti.
It was great to be with Cameron again if even for only a short time. Cabarete is such a special place for us.  We feel that God has given us a small slice of Heaven to enjoy from time to time.  Retirement in a few more years will give us a lot more opportunity to spend months
at a time there.

Aug 21
We had to come and spend the night in Santo Domingo in order to get the 8 am bus to Port au Prince.  Lucia got our bus tickets for us yesterday which was a good thing.  They were the last ones left.  She came with us today to help us this week.  It took 4 ½  hours to get to the border and then about a half hour on each side dealing with immigration, etc.  The 20 miles from the border to Port au Prince took about 2 hours.  The roads are incredibly bad in places.  The bus is very comfortable although the seats are every bit as close together as airplane seats in coach.  We were able to sleep and read nearly the whole time.  The bus terminal is next door to the US embassy which is not far from the airport.  It took more than an hour to get from the terminal to the hospital.  Our orthopedist of the week, Dr Lee Zuckerman, is here.  He is a musculoskeletal tumor specialist from Loma Linda.  We have several cases for him this week.

Sunday, September 4, 2011

Appleton and NC Teams Are Great Blessings to HAH!

Aug 10
There are several runners in these two teams and they wanted to go out with me so we headed up the hill a bit after 6 am.   It wasn’t long before they all were ahead of me when I stopped to get a breather and walk.  Jerry King and Robert waited for me to catch up and then we ran back down the hill together.  It’s nice to have some company on the runs.

The clinic was really big since it included many of the patients from Monday.  Two more patients with hip fractures came in today.  They both need blood so we will have to put them off until the family is able to get that arranged.  There is a third hip fracture that the family was able to get the blood for and we will need to work into the schedule.  Since we have a lot of horsepower with both of these teams, we were able to start with surgery also before noon.  I did the TSF and Jay and Errol helped me.  It went well.

Aug 11
Having two full rooms to run all day meant we were able to get a lot done.  Dave gave anesthesia for Jerry and Adam, the resident.  They did 7 cases including the revision of the BK amputation.  Jay and Errol worked together on several cases in the second room with Steve giving anesthesia.  We finished with the cases around 8 pm and decided to celebrate with pizza at the Auberge.  The tap tap lights   
Errol Springer and Jay Minorik operate in room 2
weren’t working so we used another hospital vehicle.  I lost count but there were about a dozen of us crammed in the Montero.   I took it slowly up the bumpy road to the hotel.  We were disappointed that the restaurant only had one small pizza left.  It took them a while to get our table since the tables on the balcony were mostly taken already.  The service was even slower than their already legendary slowness.  We didn’t get our food until well after 10 pm.  A couple of us were able to get in a bit of nap time.

Aug 12
Steve was down for the count today with a serious dizzy problem.  He couldn’t sit or stand without getting extremely dizzy.  He stayed in bed and we tried to get medications that might help but it lasted the entire day.  Dave discovered an oxygen leak in the anesthesia machine in room one and couldn’t use that room anyway.  We did all of our cases in room 2.  The clinic was again very manageable with so many providers seeing patients.  Francel left yesterday for a CURE clubfoot seminar but even without him we worked through the clinic and finished by early afternoon.

Aug 13
Most of the members of both teams wanted to go on an outing so Manuel arranged for the same driver that took us to Kenscoff.   Steve Dungar had already started feeling better last night and was feeling well enough to go on the outing.  Dr Brannon and Robert stayed with Jeannie and me.  They didn’t go as far as we did but stopped at the Baptist mission in the little community above Petionville.  There is also a historical fort nearby that I managed to overlook when we went to that area.  Fort Jacques was built by Alexander Petion in 1804.  It was restored in 1992.  They all enjoyed the scenery and the cooler temperatures.  On the return, they went to Franz’ orphanage and left the children several bags of clothes.  The new team of Ron Anderson and his family arrived this morning.  Ron has been here before.  He and I took care of the American fellow with the open tibia fracture several months ago.  He was unable to bring an anesthesiologist with him.  He did bring his wife for the specific purpose of exposing her to the situation her to see if perhaps she might be interested in coming and staying for a longer period of time.  His college aged daughter and son-in-law and his high school daughter are also with him.  Ron will be here through Thursday then will be joining the staff of the hospital ship for a two week stint out in the bay.  His church sponsors several people who are staff on the ship.

Jeannie and I went to the English speaking church at the University up the hill.  Dave also attended.  After lunch, we did the lady with the femoral neck fracture.  It was clearly a month old fracture if not more.  It went well.   The rest of the crew got back as I was finishing.  We brought down the patient with the external fixator that Scott had placed for her dislocated hip.  Scott had recommended fusion with a cancellous screw and continuing the fixator.  We found the proximal pins all loose so took the fixator off.  We used the C-arm and studied the hip and found that the acetabulum appeared intact, including the posterior wall.  The head had a shear fracture.  We all agreed at her age, 43, that a hemiarthroplasty might work better for her.  We might even wait until we can do total joints and then do a total hip.  She and her husband were in agreement with the recommendations.  It wasn’t my ideal way to spend the Sabbath but we needed to do both of those cases.

Aug 14
Both teams left before 6 am.  It has been a really good week with them here.  Ashley is an excellent scrub tech.  She has such a positive attitude and is a joy to work with.  Robert really was able to make things happen in the OR.  He took ownership and moved things along.  It didn’t take him much time at all to get familiar with the OR and where things were located.  I hope they will come back again.  It goes without saying that Jerry and David are a huge help.  Having been here before means a great deal.  They are familiar with how the clinics and the OR work and can go to work with no orientation.  Jerry has a very good understanding of how to manage cases that are out of our capability for whatever reason.  David continues to provide very high quality anesthesia.  He refuses to compromise in any way which I thoroughly appreciate.

The Appleton team was really great.  They all adapted quickly to the situation and were a big help.  Being able to run two rooms and get a lot of cases done is so important.  It allows us to schedule a lot more elective cases.  It was a lot of fun watching and listening to them “rip” each other with put down after putdown.  They would go after each other as well as the anesthesiologist.  He was actually their biggest target.  They even got me to throw in a little bit of my own sarcasm and a couple of putdowns.  Their nurse, Eric Bowen, especially has a heart for the Haitian people and this work.  I certainly would like for this team to come back.  Steve is planning to encourage his partners to come.  We really have a big need for anesthesiology here.

I went for my morning run after they left.  Going up the hill is still a negative experience but coming down is even getting to be somewhat pleasurable.  I then spent a couple of hours with a jackhammer making holes in the roof over the balconies of the four rooms on our side of the hospital.  The air conditioners that have been installed in our rooms for about a year can now be connected to the condensers on the roof.  Randy says we might even be able to have them connected by tomorrow.  Sleeping the last couple of months has been somewhat less than refreshing many nights because of the humidity combined with higher evening and night temperatures.

Tonight we had one of the most incredible lightning storms yet.  The thunder and lightning were almost simultaneous as the storm passed immediately overhead.  The rain started to flood into our room from the balcony.  Fortunately, Jeannie noticed it and we put several of our towels in the doorway to keep the water on the balcony.  The balconies all have drains but they aren’t leveled properly and tend to direct the rain water towards the door rather than the drain.  The break room next door got totally flooded with water more than an inch deep even out into the hallway.  The electricity stayed on through the whole storm and then when it passed the lights, water and fans went off.  They were off for several hours and then finally came back on in time to take a shower before falling asleep.   

Appleton and North Carolina Teams Arrive

Aug 7
I had no travel glitches and arrived around noon.  Scott was just finishing a case.  Jerry King’s team was delayed out of Miami today and won’t be getting in until tomorrow.  It’s great to see Scott again.  He has done a large number of cases in the week he has been here.  More than 80 patients came to the clinic last Monday.  Both Dr Adrian(anesthesiologist) and Lucia are here from the Dominican Republic.  Scott always arranges for them to be here when he comes down.   They were part of his team that went to Cap Haitien  four times a year for several years.  They also came with him 2 days after the earthquake and stayed for an extended period of time.  They have been operating until after midnight nearly every night during the week.  Jerry King and the anesthesiologist, Dave Brannon, were supposed to arrive this afternoon.  There was a problem in Miami and their flight was canceled so they will be arriving tomorrow.  They have several other team members including OR nurse, scrub tech and recovery nurse.  Jerry and Dave came here in January and were a big help.

Aug 8
Scott and I went for a 30 minute jog/run early this morning.  We had a big clinic today but unfortunately, the generator gave out on us and we had no power to take xrays.  We had to send many of the patients away and tell them to return either Wednesday or Friday.  Welcome back to Haiti, Dietrich.  It took about 5 hours to get the power back on.  What a relief that was to get air conditioning again in the OR.  We had a lot of cases and were just about to curtail the schedule for fear of running out of power from the inverter.  We were able to continue doing cases.  The King/Brannon team made it in well rested after their unexpected night of rest in Miami and started to work right away. The Appleton team finally made it in by late afternoon.   Their travel started in the wee hours of the morning with a three hour drive to Chicago and then flights to Ft Lauderdale then on to Port au Prince,  They were all pretty exhausted after traveling since very early in the morning.

An older man came in to clinic with a terribly foul smelling leg.  He was initially injured in the earthquake and apparently has had an open wound ever since.  It got a lot worse in the past several weeks.  His hgb is less than 8 so we need to get blood ready and then do an amputation.  Welcome back to Haiti, Dietrich.

I finished my last case at 11:30 pm and then went in to watch Scott do his last case – a complex TSF that involved the foot.  It went well and I learned some more.  I still don’t feel comfortable doing those cases though.  I am happy to follow them and deal with any issues that come up in their post op care.  Scott finished it about 2 am.

Aug 9
The Appleton team was up and raring to go.  I had an early morning administrative meeting while Scott got two ORs running.  Jeannie arrived fairly early this morning.  It is so good to have her back with me again.  I really miss her when she goes without me.  Scott did some more TSFs today including another fibular hemimelia.  It was even more complicated than the one he did late last night.  By the time he finished at 6:30 this evening he was ready to throw in the towel even though there was one more patient that needed a TSF.  Adam had also pretty much reached his limit and was zoned out.  We had the 75 y/o man with the terribly smelly infected leg that needed an amputation.  We were able to get one unit of blood for him which was really important since he had a hgb of less than 8.  He certainly was higher priority than the remaining elective case.  The patient for the TSF was very understanding and agreed to come back tomorrow.  He is a straightforward TSF that I can do.  Errol helped me do a guillotine BK amputation that we finished before 10 pm.

The team from Wisconsin consists of Errol Springer and his partner Jay Minorik.  They brought Eric Bowen, orthopedic RN who has been to Haiti before.  Steve Dungar is their anesthesiologist.  Steve’s son, Ben, came here with the Wisconsin team last August.  Ben is a pre-med student.  Dr Springer brought his son, Evan, who is also a premed student.