Wednesday, October 26, 2011

Outing to Furcy

Oct 7
I saw several more patients in the clinic today in followup of their frames.  I also saw a new patient with severe Blounts for a TSF.  We had several smaller surgical cases that Ed did while I concentrated on seeing clinic patients.  We finished with surgery and clinic by 5 pm. Wilfredo Perez arrived this  morning from Puerto Rico.  He brought manuals and tools and kits to go over our anesthesia  machines.  He started to work right away on the machine in room 3 and after several hours we  concluded that it would be better to test the machine in storage downstairs for leaks. We brought the other machine up from downstairs and he began working on it.  It didn’t take him more than an hour or so of testing it and checking all the hoses and connections to conclude that it is in better shape than the room 3 unit.  It doesn’t have any significant leaks and we decided to concentrate on getting it in good shape rather than waste energy and time and resources on the older machine that may be more  problematic.  Dr Adrian tested both machines and she agreed.   He has really gotten a lot accomplished since he got here this morning.  About then, the Sabbath had begun so Freddy put his tools down.  It is once again a delight to have a day apart from the business of the week.   Jeannie made a great meal of savory beans and rice that everyone really enjoyed.

Haitian Countryside
Oct 8
Our patients are doing fine.  I planned to take Ed, Andy and Josh away from the campus so they could see some of the Haitian countryside. Freddy wanted to come as well.  They all wanted to go up to the cooler high country.  I  had missed seeing Ft Jacques the last time we were up there.  It is a fairly well preserved fort built just after independence in 1804.  Our four main translaters wanted to go as well. Jeannie decided she needed the rest and stayed at the hospital. Emmanuel did a nice job of directing me to Petionville and then on up the narrow, winding road to Fermathe where the Baptist mission and hospital is located.  The group all looked through the mission and then we headed out on a very bumpy, never paved road to the fort. There was some very nice scenery on the way so we stopped a couple of times to take pictures.  One spot was a rock wall along the road with several different types and colors of hibiscus hanging over.  I love flower photography so took a few minutes to compose about a dozen images.

Ed & Terry at the fort

The fort’s small parking lot had several people selling fresh fruit as well as cooked food.  There were French fries, whole vegetables thatlooked like a potato, and some other veggies as well as ‘peekleez.’ I got a plate full of a variety and it was very tasty.  Most everyone except the translators were a bit reluctant at first but once they tasted it, it was “Katy bar the door.”    Two more platefuls were bought and devoured.  Everyone really liked the peekleez. We paid admission to the fort and a young guide started the tour.  His heavily accented English was fun to listen to.  The earthquake had caused a lot of damage and the cannons had been taken off the wall
At the Fort
s and placed on the ground in front of the fort.  We all enjoyed poking into various rooms and areas and taking pictures.  I set up a groupphoto and the guide did a nice job of working everybody's  camera.  The small central “plaza” has a cistern nearly filled with water and lily pads.  The flowers were beautiful.  We got more pictures at the end of the tour on the cannons as well as of the Haitian flag on the flagpole in front of the fort.  I paid the guide very well for the group but he continued to hang around and started asking the others for money also. I don’t have patience for that sort of thing and he quickly got the message.  Back in the parking lot, four more plates of food with peekleez were purchased.  It all disappeared quickly. We continued on our outing through the town of Kenscoff.  It continued to get cooler.  The Lonely Planet guide book describes the little town  of Furcy as “picturesque” so that was our destination.  We continued on the road that became more and more “rustic.”  It seemed as though we travelled quite a bit farther than the guide book had indicated before we finally got there.  I got a couple of relatively uninspiring photos and we put the pickup in 4 wheel drive for the trip back to Kenscoff.  It runs very well in 4x4 and felt very solid.  The whole trip back to Delmas took about 2 hours.
Welcome to Furcy

Stephanie Bryce’s family had invited us to their house on Saturday again.  I had told Emanuel that we were going to Kenscoff and beyond and weren’t sure how long it would take and when we would return. Freddy also planned to spend the
In Furcy
evening working on the anesthesia machines.  I told Emanuel that we wouldn’t have much time and for them to not make us a meal.  We got to the Bryce’s around 6 pm and they had a whole meal ready.  We all had a great time with the family.  Stephanie is doing really well.  I had JJ take some pictures of me dancing with Stephanie.  Everybody got a kick out of it.  We didn’t stay late.  Freddy worked late into the evening on the machines.  He is unbelievably knowledgeable.  He plans to get up early in the morning to get as much done as possible.

Oct 9
Pt with femur fixation last week by previous team had some persistent serous drainage so I took him back to the OR.  I only found a hematoma/seroma.  I washed him out thoroughly and closed him so he hopefully can
Freddy working his magic
seal and not drain any more.  I spent a lot of time on the computer also catching up with my journal and sending emails. Freddy worked all day long with only a short lunch break.  He finally wrapped it up after 11 pm.  All of the machines are now functioning and have been serviced.  He services each of his machines every 6 months.  I hope we can arrange with Bella Vista Hospital for him to come every 6 months.  Even better would be for us to have Freddy train a Haitian to be our Biomedical technician and have our own department. Roosevelt spent almost the whole time with Freddy. I will have to get some feedback now from Freddy to see if he thinks Roosevelt has the aptitude to do the job.

Wisconsin September, Haitian October

Oct 2
Arrived back in Haiti.  Ed Miller is back for his second stint helping me.
Wisconsin September
He will be here for 10 days.  There are two students from DO school in Colorado here for three weeks.  Dr Pat Yoon’s team covered the last two weeks while we were gone.  They left earlier today. Francel is also gone.  He will be spending most of the month of October with Dr Karl Rathjen in Dallas.  I accepted a young teenager with fractures of both of his tibias.  Apparently a stack of bags of cement fell over on him this morning.   We won’t have any anesthesia until Maria gets here from the DR Tuesday afternoon.  The fractures are closed so we will just have to wait until Tuesday or perhaps Wednesday.  We checked out the anesthesia machines and then called Freddy again.  He wants me to take pictures of them and email him with more information.

Oct 3
The Monday clinic only had about 40 patients but it took a long time.
I think I saw at least a half dozen patients with TSF and Ilizaroff
frames.  Each one took quite a bit of time to study and sort out
potential issues.  I also saw a 57 y/o man with a huge fluid filled
cyst that fills his entire popliteal fosso(area behind the knee) and
extends out around the lateral side of the knee and welll up the thigh
behind the back of the knee.  He has had the cyst for several months
but in the past few days noted that now he can no longer dorsiflex his
foot and ankle.   The cyst was very tense and filled with what felt
like fluid.  We put in a needle and drained a lot of dark colored
fluid.  I suspect Pigmented Villonodular synovitis.  At most we were
able to only get about 20% of the fluid out by aspirating with a
needle.  I emailed  the clinical data and pictures of his knee to Dr
Bibiloni in Puerto Rico.  He is an orthopedic oncologist who teaches
at the University of Puerto Rico in the orthopedic department.  He is
helping organize the team from Puerto Rico that will be here next
week.  I would prefer to wait for Dr Bibiloni to do the definitive
surgical treatment since that is his specialty.  Perhaps keeping the
cyst partially decompressed will relieve enough of the pressure on the
peroneal nerve that it might have a chance to recover.  We still don’t
have an x-ray machine working in the clinic and there may be an issue
with the Ministry of Health questioning our use of the C-arm for
clinic patients.  We are encouraging patients to go to the xray
department for permanent films.  Many of the patients seem to be able
to pay the fee involved.  Ed did a couple of cases in the OR with
local anesthesia and also helped in clinic.  Clinic lasted until
nearly 6 pm.  Jeannie made a really nice meal for us and we invited Ed
and both of the students to join us.  We had a good time talking for a
couple of hours.  I called Freddy again tonight and he has gotten
permission to come.  I’m really excited!  I hope this will be the
beginning of a good working relationship with Bella Vista Hospital.

Oct 4
There were 7 cases scheduled for today in anticipation of Dr Adrian
and Lucia arriving early this afternoon from the DR.  They didn’t get
in as early as we had hoped and we didn’t get started until after 4
pm.  A patient with a calcaneal fracture came into the ER last night.
His fracture is displaced and should have a surgical reduction and
fixation.  We should have time to do his surgery on Friday.  That will
give the swelling time to go down a bit.  We postponed one case until
tomorrow.  Ed and the students did the hip hemiarthroplasty with JJ
assisting.  ZJ and I did the rest of the cases in the other room
including an arthroscopy on a patient with an AK amputation.  We
finished all of the cases and got everythingcleaned up just before
midnight.  Dr Adrian did her usual terrific job.  It was even more
impressive given the fact that she had hardly had any sleep the night
before because of a neurosurgical emergency that she gave anesthesia
for until 5 am.  ZJ  did very well with the arthroscopy.  He has very
good hands.

Oct 5
Apparently the patient with the calcaneal fracture knows Dr Hans
Larson, the president of the Haitian Orthopedic Society.  He wants Dr
Larson to do his surgery.  He has been admitted as a private patient.
The clinic including the clubfeet patients was large as usual.
Several more patients with frames came in and took quite a bit of
time.  We had three cases including the boy with the bilateral tibia
fractures.  Ed did his usual very careful, well thought out, precise
surgical management of a difficult case.  The entire medial tibal
plateau, half of the entire growth plate of the proximal tibia was
extruded medially.  The ACL was shredded as well.  The students, Josh
and Andy, are getting totally inundated with amazing orthopedic
pathology.  Jean Sondy, the boy who was an inpatient for so long last
year with the infection in his tibia, finally got his Ilizaroff frame
removed today.  He has no infection and the tibia is healed although
it is a bit short yet.  He is really happy and expressed his
appreciation for all we have done.  His father did likewise.  I
continue to be impressed with the Haitian people.  Another case was a
4 y/o orphan boy who is being treated for neglected clubfeet.  Dr
Nelson put Taylor Spatial frames on both feet and legs in August.
Using the TSFs for these deformed feet is considerably more difficult
than a straightforward frame for a long bone deformity.  If I could
have a few more weeks doing these kinds of cases with Dr Nelson,
perhaps I could even do them myself.  The reality is that they can
easily wait for a few weeks until an expert can do them and then I can
follow them.  This boy’s followup has been a little more complicated
than usual and I had to spend some time on the phone with Scott last
night and again today to get everything right.  These cases need two
separate treatment programs.  The first is to correct the forefoot and
midfoot so that the navicular bone is reduced on the talus.  Then the
wire that is stabilizing the talus is changed from its attachment to
the proximal ring and attached to the distal ring.  The new program
then corrects the remaining equinus deformity(foot pointing down
toward the floor).  Of course, it requires a completely new
prescription.  The data is again entered into the computer including
the amount of deformity(equinus).  The patient and the caregivers then
adjust the 6 struts over a period of several weeks to get the foot
straight.  It is fairly common for patients to have infections around
pins or wires during the several months that they have the frames.
The simpler infections respond almost always to oral antibiotics.  I
have had a couple of patients with infections that were significant
enough to take to the OR for debridement and IV antibiotic treatment.
So far, I haven’t had to take any frames off before finishing with the
full treatment because of infection.
The clinic and surgical cases were all done by 7:30.  I admit that the
12 hour days are preferable to the16 hour days.

Oct 6
Seven cases were on the board for today including a 17 y/o girl with
severe Blounts for TSF and osteotomies of the tibia and fibula.  About
10:00 I was told that Dr Hans Larson was coming at noon to do the
surgery on the patient with the calcaneal fracture and was going to
start at noon.  That left us in a bit of limbo since we were planning
to use the C-arm for two cases that could each take up to 3 hours.  We
certainly want the Haitian orthopedists to want to come here and do
surgery without having to wait for a room or equipment.  We waited
until nearly 2 pm and didn’t have any word from him so we went ahead
with our shorter case.  Then we followed with the TSF.  Ed helped me
with it and it went very well.  He had never seen one done before.  We
had a really good time doing it together.   Of course, we had to clean
up all of the instruments and trays and restock  all of the trays with
the bone screws, rings, struts, connectors and bolts.  We finished
everything by about 8:30.  Dr Larson did the calcaneal fracture in the
other room while we were busy in Room 2.  I guess he didn’t need the

Wednesday, October 19, 2011


Sept 12
We had another quite large clinic today.  In addition, we had a couple of cases including a hip hemiarthroplasty that I did with ZJ.  It turned out to be another fairly long day.  Nathan and Amy came back today.  He still has the symptoms of dizziness when he stands.  I asked about the xray machine getting fixed.  The Fuji rep apparently needs to come here to deal with the problem.  He is going to try to get that arranged in a timely fashion.

Sept 13
7 cases were scheduled today.  We canceled one and did 5.  One patient didn’t show

There were some smaller cases.  One was the bilateral clubfoot patient that Bill and I did last week.  The feet look really good.  We recasted them in neutral.  The next cast change should let us get to 10 degrees of dorsiflexion or more.  The biggest case was the obese lady with the pathological fracture of the femur and many metastatic lesions throughout her femur and pathological humerus fracture.   We fixed her femur with a SIGN nail and methylmethacrylate.  She bled significantly and since we only had one unit of blood decided to not fix the humerus.  The case took quite a long time.   I also did another arthroscopy with Francel. The patient is morbidly obese and Francel had difficulty getting visualization.  I took over and the case was not easy for me either.  It may not have been the best learning experience for Francel.  Our last case was an elderly gentleman with an intertrochanteric hip fracture.  We set up the fracture table and the case went well.  We finished at nearly 2 am.  Irma was a real trooper all day long and until we finished.  I offered to watch the patient in recovery but she insisted that it was her responsibility.

I talked with Francel earlier in the day and he told me he will be here til end of year and would like to stay on afterward.  That is great news for us and the program here.  I am sure there will be some financial issues and probably a need for us to be involved in subsidizing his practice in some way.  I’ll talk with Scott and others about that.

I had an interesting encounter with an expatriate today also.  Anthony Kilbride  is a friend of Brooke Beck.  He is from England and works here on water project.  He has had an ongoing problem with a knee for about a year.  He suspected it was a meniscal injury.  He had a prior meniscal lesion in the other knee several years previously and had an arthroscopy.  I assessed  him and his findings are consistent with a torn meniscus.  He was very surprised that we do arthroscopy here at HAH.  He thought he would have to go home to England to have it taken care of.   I talked about HAH, the work being done here and the need for fund raising for this program to have long term stability and success.  He must be a fairly important person in his program because he told me he meets with Bill Clinton on October 8.   He said he would like to talk to Clinton about our work here.  I plan to scope his knee before that.  I gave him a book to give to Clinton.

Ernie Schwab from the LLU School of Allied Health was here for a few days.  I talked to him about the possibility of getting some type of certificate for JJ as an Orthopedic Technician.  He believes it shouldn’t  be very hard to do.

Sept 14
Clinic went well.  I left for the airport at 2 pm for Santo Domingo.  Jeannie and Cameron picked me up and we drove to Cabarete.  It is so nice to be back here again.   It’s great to be with Jeannie after nearly a week.

Sept 15 -17
Just two days in one of my favorite places is hardly enough.  A couple of good windsurfing sessions and a nice round of golf made the short trip worth it.  Tim and Summer were there also.  Tim got out on the windsurfer and did really well.  He is making steady progress.

Sept 18 – 29
Pat Yoon from Minnesota is bringing a team to cover for me in Haiti while I am gone.  He has been very involved in the project and his commitment  to the work there is remarkable.  This is his third or fourth trip there.  I cannot thank him enough for what he and his teams have done to keep the work going.  He is fellowship trained in foot and ankle and does a lot of trauma in the Twin Cities.

This was our last return trip to Appleton to work during our Year in Haiti.  I was again on call for 9 of the 11 days.  I once again enjoyed being “home” with Jeannie even though we are staying in our neighbor’s downstairs apartment.  This trip back was fairly similar to the others with office hours and several elective cases including total joints and one Oxford.  I got several cases in while on call also.  We ate out several times and made it to the tennis center several times.  I had several meetings in New London to work on getting things ready for my work beginning there in November.  Jeannie and I also attended a Foundation banquet  in New London and had a good time meeting and talking to several of the people that I will be working with.  We took some time to look at houses with a real estate agent and found one that was a really good price that we like a lot.  It has been on the market for two years so perhaps we will have time to sell our house and buy it.  It has a main floor and basement – NO upstairs which I like.  The kitchen is perfectly functional but some changes will need to be made.  There is no fireplace in the master bedroom either.  There is a three car attached garage and a two car detached one.  That will be perfect for a tractor to deal with the acre lot.  The landscaping in the front is bad and will need to be redone.  It is less than 5 minutes from the hospital and office.  I would favor moving to New London mainly because of the winter road conditions.

Something very special occurred also.  We were able to meet with Joan Malchowski, the director of publicity for the Packers.  Jeannie and I had about an hour with her.  I explained the work being done and the amazing opportunity it presented.  I gave her a signed copy of the book as well as two others to give to whoever in the Packers organization she wanted.  She is very interested and supportive and will try to spread the word to Packers fans.

Sept 29
I got an email from Haiti that we have only one functioning anesthesia machine.  The large team coming from Puerto Rico is wondering if they should even come.  I am sure we can solve this issue with a good biomedical technician.  I have offered several times to bring the head of the biomedical technology department at our sister Adventist hospital in Puerto Rico to help us develop this area at HAH.  Now will be a good time to bring him over to solve this “crisis.”  It might be the start to developing our own program with their assistance.  The young man, Wilfredo Perez, who heads their department is a good friend of ours.  When we first moved to Puerto Rico more than 40 years ago, his family lived two houses down from us.  His mother did medical transcription for me.  He was about 3 years old.  A few years later, I taught him to windsurf.  He still practices it avidly today.  When he decided to study biomedical technology, he came to Walla Walla, Washington where we were living to study.   He spent many weekends at our home during the years he was studying there.

Sept 30
Last day of work in Appleton.  We leave tomorrow morning to return to Port au Prince.  I called Freddy Perez today and told him about our needs.  He is very interested in knowing more about the types of anesthesia machines that we have at HAH.  He will have to check with administration to see if they will give him the time off to come and check things out.

Oct 1
Left Appleton.  No problems with the trip to Miami.

Saturday, October 15, 2011

Touring Haiti

Sept 1 - 4

We got up at 5 am so we could leave by the 5:30 pickup time.  The driver didn’t come until 5:50.  The traffic was heavy and when we arrived at the airport at 7 am there was a very long line.  Fortunately, it moved along and not too many people cut in line in front of us.  Our flight was already boarding by the time we made it through the 3 security screenings.  We were able to go right on the plane since we now have priority access on American.  Our flights to Miami and then on to Los Angeles were uneventful.  We thoroughly enjoyed 2 days with Jeannie’s brother, Bob, and his family.  Shelle and Summer, our two daughters both came to spend the time with us.  Bob and Carolyn are such generous and gracious hosts and always make us feel so welcome in their comfortable Laguna home.  Their three children all came to spend time with us as well.  We had a very restful Sabbath first listening to a young Christian physician present a sermon that had been recorded and then taking a long walk on the beach.  I was able to take several excellent beach pictures with umbrellas for my collection.  The surf was really big.  I would have never tried going out in it.  Ben Chen and Sarah’s wedding was really nice.  Scott and Marni were there as well as several members of the LLU orthopedic department.  The chairman of the orthopedic department, Gary Botimer, again invited me to join the faculty at Loma Linda.  Ben was here in Haiti with us several months ago.  We did the first ACL reconstruction together here at HAH.  I have hopes that he and Sarah will be willing to return and work at HAH.  Our trip back was an all night flight.  We had hoped for upgraded seats so we could stretch out and sleep but the good seats were all taken.  I was able to get some sleep.

Sept 5.

Our plane landed in Port au Prince at 10:30 am and we made it back to the hospital in time to help finish the Monday clinic.  The large Bill DeMuth team was already comfortably working.  They had several vac changes going in the OR.  It was a fairly large clinic but they had already seen many of the patients.  A couple of patients with TSFs needed some strut changes and I took care of those as well as a few other patients. Jeannie isn’t feeling well and hardly slept at all on the overnight flight so she spent the afternoon sleeping.  I hope she isn’t down for the count for several days.

The DeMuth team
The De Muth team is good sized.  Bill and his wife Cindy, a pediatrician, were both here exactly one year ago.  Bill had also done a mission trip to a CURE hospital in Central America a couple of years ago.  He knows Scott Harrison, the founder of CURE.  They were actually associates when Bill first started his practice in Pennsylvania.  He is in a large group of about 20 orthopedists.  He does the children’s ortho as well as 2 or 3 spine cases a week and then general ortho for his group.  He brought a young partner, Brett Himmelwright, who also does some spine as well as general ortho, including arthroscopy.  Matt Willsey, a fifth year ortho resident came with them for the week.  A surgeon, John Judson is also with them.  He has spent a lot of time in Haiti including nearly two years at Albert Schweitzer Hospital more than 10 years ago.  I was surprised to see a general surgeon on the team since we haven’t been allowed to have them in the past.  They also have several nurses and assistants on the team.

The AC guy came this afternoon and connected our unit to the condenser on the roof.  It works like a charm.  It’s almost magical to feel the cool air when we go in our room now.  Sleeping should be much easier for both of us.  At times during the last few weeks especially, I have had to get up once or even twice in the middle of the night and take a cool shower to be able to get back to sleep.  Needless to say, the quality of sleep has not been high many nights the last couple of months.

Sept 6
Sleep came almost simultaneously with my feet hitting the bed.  It was sweet.  The surgery lineup had 8 cases.  The first was a child with bilateral clubfeet from arthrogryposis.  Brett helped with that case.  Several cases came in to the clinic that needed attention so he did the suturing and casting after the posteromedial releases and talectomies were done.  There were some hardware removal cases.  Brett did an arthroscopy on a patient with a torn meniscus.  It went well.  Bill was challenged by the 10 y/o boy with the dislocated elbow that had occurred nearly two months ago.  He said it took nearly everything out of him.  The last case was a tibial nonunion that Brett and Matt did with a bit of my assistance.  They had never seen a SIGN nail before.  The patient had a significant deformity that required a fair amount of dissection.  The nail went in well and Matt put in the distal locking screws as if he had done a bunch before.  We have another one tomorrow.  This team is really great to work with.  The cases all finished before 8 pm.  Jeannie stayed in bed almost the entire day with a bad headache and congestion.  I hope she is feeling better tomorrow.  The air conditioning is working extremely well.  We have had to turn it way down or it is too cold.

Sept 7
Somewhat after midnight, we were awakened by pounding on our door.  A flood of water was coming from under our door into the hall.  I was raining when I went to sleep at a bout 11 pm and the rain had intensified into a tropical monsoon.  The water that normally collects on the roof during a rain was now running down the holes that I had made over the balconies of our rooms for the air conditioning to be connected.  The AC guy was supposed to have sealed them when he finished hooking them up.   Clearly that had not happened.   The water was accumulating on the balcony floor and not draining our fast enough through the one small drain.  It was coming in under the door in significant amounts.  Some water was also draining down along the wall and into the window and inside our room.  I used towels and clothes from the dirty clothes basket to create a dam at the doorway, then started mopping the water up.   Once I got most of the water off the floor, I started out on the balcony.  After about an hour of work, the rain slowed down noticeably and I started making headway.  Others were also working on their rooms that were also flooding.  The floor was still wet in spots but I was pretty tired and laid back down to get some sleep.  So much for sleeping in the arms of Morpheus.  I’m REALLY glad we have air conditioning in our room!!

I wasn’t totally excited about an early wake up for my run after the middle of the night excitement.  Knowing that advancing age needs to be actively challenged, I forced it to happen.  It never really cooled off much at all last night and the heavy rain left the atmosphere thick with humidity.  It felt almost like it needed to be cut with a machete to get through it.  Needless to say, my performance was pathetic.  I’m glad I was running(slow jogging) by myself.  I only had to deal with my own ego.   In spite of my lethargy, my time was only about 20 seconds slower than my best so far.  Bill told me today that he would like to try going out with me later in the week.  He has run several marathons and even an ultramarathon.  I’m planning on having serious cramps when I try to run with him.

Jeannie still wasn’t feeling very well today.   She tried to get up but that only lasted a short time and she went back and laid down and stayed there the rest of the day.  She was feeling a bit better this evening so I’m optimistic tomorrow will be better.  The clinic was not huge.  Matt, the resident, and I spent the morning seeing the patients while Bill and Brett did the paraplegic with the L1 fracture.  They put in 8 pedicle screws and two rods.  I slipped in a couple of times to see how it was going.  The blood loss was minimal. They did a superior job.  They both hustled down to the clinic as soon as they finished to help us see patients.   They are all really hard workers.  With everyone working so diligently, the clinic was over by 2 pm and then we could concentrate on the surgical cases.   The second case was another patient with a tibial nonunion for a SIGN nail.  Bill and Matt did the case and again Matt put in the distal locking screws effortlessly.  The last case was a  child with severe arthrogryposis and clubfeet that I did with Bill.  The cases were done again before 8 pm.  There are 8 or 9 cases on the schedule for tomorrow including a TSF on a patient with Blounts disease.  There is also another tibial nonunion and a child with bilateral clubfeet.

Our room is so much more enjoyable now that we have air conditioning.  The hole in the ceiling was sealed today so hopefully we won’t have another repeat of the middle of the night flood.

Sept 8
Jeannie was feeling much better today.  She seems to be her usual self except for a cough.  She worked the whole day getting cases into the OR and facilitating room turnover.  There were nine cases on the schedule for the OR today.  One patient didn’t show which really disappointed me.  It was the patient for the TSF.  However, three more cases came in with papers that indicated they had been scheduled for today.  One was a child that was transferred from Medishare - University of Miami hospital with a femur fracture.  The phone call from them indicated that they do not have an orthopedic surgeon this week.

We had 3 cases for 8 plates, 2 hardware removals, bilateral club feet for posteromedial releases, an arthroscopy, ORIF of displaced clavicle, cast change under anesthesia and tibial nonunion for SIGN nail.  We did a closed redustion and spica cast for the child with the femur fracture.   Matt and Bill did the SIGN nail and everything went well except for the distal interlocking screws.  We finally had to break out the C-arm to get them in.  Matt was a bit disappointed especially after getting the first two in so quickly without needing C-arm.  The general surgeon with the team also had 5 cases on the list.  We finally ran out of inpatient hospital beds with one case to go.  We’ll do the case tomorrow.  Everything was done by 6 pm.  Another case came in to the ER apparently transferred from a “clinic” downtown.  There wasn’t even a warning phone call.  She has clear pathologic fractures  of both her humerus and femur.  The general surgeon evaluated her and found a very large breast lesion.  We’ll work her up and stabilize the fractures.

Jeannie is going to the Dominican Republic tomorrow.  Lucia is going home also.  I had her come specifically for the spine case on Wednesday.  She was a big help with all of the other cases that we did especially with Jeannie not feeling well.  Brett is also leaving tomorrow.

Sept 9
Jeannie left early to catch the bus to the DR.  Bill had wanted to run with me this morning so I went to the Auberge at 5:30 and picked him up.  Matt was also up for the run.  We stopped a couple of times to admire the view high above the hospital.  We still managed to do the run in about the same time as usual.  I was surprised to see Francel back this morning.  I didn’t think he would return until next week.  I am glad now that we postponed the arthroscopy until today.  I did it with him and he continues to learn.  I hope we can do several more before I leave next Wednesday.  I did the clinic with Matt while Bill did several cases that we had scheduled.  General surgery had an urgent case that occupied one room so we again had to postpone another of our cases.  We were finished with both the clinic and surgery before 5 pm.  The DeMuth team is planning to go on an excursion planned by Dr Judson, the general surgeon over the weekend.  They invited me to come along.  They have to be back at the airport by 9 am on Sunday so I am planning to drive the newer pickup that we got last week.  That way I don’t have to be back to the hospital until Sunday afternoon.  I am going to take Emmanuel, JJ and Roosevelt with me.  I ate dinner at the Auberge with the team and once again they wouldn’t allow me to pay.  We had a really good time talking.  Matt is a really committed Christian.  He would really like to do this type of work on a regular basis once his medical school debt is paid off.

Sept 10
We  took off in the morning in the pickup following the van with most of the group.  JJ was with me and one of the group from Pennsylvania.  Emmanuel and Roosevelt left last night to spend some time with Emmanuel’s family in the country not far away.  They planned to meet us at the beach resort later in the day.  The road to Mirebalais is really nice.   It is fairly new and has virtually no bad spots.  It is a very steep grade to the top of the hills and then fairly steep back down to the valley on the other side.  Paul Farmer’s organization (Partners in Health) has a small medical facility on the outskirts of the city.  They are currently building a VERY large hospital to help relieve the overcrowding and centralization of medical care in Port au Prince.  We went by the construction site and took some pictures.  The cholera epidemic started here in Mirabalais.  There is ample evidence, according to Farmer’s new book, Haiti After the Earthquake, that the UN troops that were stationed very near the Artibonite River just outside of town had inadequate facilities and sewage was inadvertently discharged into the river.

We followed the river down the valley on a road that was not nearly as nice as the one from Port au Prince to Mirabalais.  It was nearly 2 hours of intermittent slow going to get to Albert Schweitzer Hospital.  John Judson had spent 2 years there in 1998-1999 as the general surgeon.  We thoroughly enjoyed the tour of the hospital and grounds.  They had a tasty lunch for us also.  The director of the hospital is from Switzerland.  She has served also at the first Albert Schweitzer Hospital in Gabon, Africa. .  She said they have an orthopedic team there 7 weeks each year.  No local Haitian Orthopedists work there.  They have a budget open for an expatriate orthopedist.  They have a fair amount of equipment as well as a C-arm.  The story behind the founding of the hospital by Larry Mellon is quite fascinating.  Wikipedia summarizes it with the following:

"William Larimer “Larry” Mellon (1910–1989) was an American philanthropist and physician.

"He was born in Pittsburgh June 26, 1910, the son of financier William Larimer Mellon, Sr. and a grandnephew of U.S. Treasury Secretary Andrew W. Mellon. His family fortune derived from Gulf Oil, Westinghouse, BNY Mellon, Koppers, Alcoa and others.[citation needed]

"He was married twice,[1] the second time to ranch hand and single mother Gwen Grant.[citation needed] He attended Princeton University for one year, worked for his family’s Mellon Financial and served in the OSS during World War II.

"He owned and operated a cattle ranch in Arizona until, at the age of 37, he read about, and then studied, Albert Schweitzer’s medical missionary work in Gabon, and resolved with Schweitzer’s encouragement and guidance to create a similar third-world hospital. He and Gwen Grant Mellon enrolled at Tulane University; he received his medical degree in 1954 at the age of 44, and she became qualified as a medical-laboratory technician.[1]

"In 1956, they opened the Hôpital Albert Schweitzer Haiti in Deschapelles, Haiti.[1]

"He died in Deschapelles at the age of 79 with cancer and Parkinson’s disease, on August 3, 1989.[1]"

We continued on through the coastal town of St Marc to our destination, the beach resort of Moulin sur Mer.  It is somewhat similar to the Resort at Wahoo Bay but a bit nicer.  The beach is wider and prettier.

Manuel and Roosevelt met us up there when we checked in.  They had gone friday night to be with Manuel’s family and came by taptap.  I paid for 2 rooms.  All 3 of the guys had a terrific time.  They had never done anything like that and they were all so appreciative.  They thought that they had died and gone to heaven.  Roosevelt said he wishes that he could live there.  We had a great time at dinner with the whole team.  I toasted them as the best team so far and I toasted the three translators and of course I toasted Jeannie and how much she means to me.  I told them how sorry she was that she hadn’t been feeling her best and hadn’t been able to get to know them better and work with them more.  I shared a room with Manuel and Roosevelt.  

Sept 11
Who could forget that today was the 10th anniversery of the Twin towers attacks.

The DeMuth team left early for the airport.  That left me with JJ, Emmanuel and Roosevelt to enjoy the resort.  We had a great breakfast.  There was a lot of tropical fruit, pancakes, cereal, juice, scrambled eggs and hot drinks.  We all kind of overdid it.  There were very few other overnight guests.  As the day went on, quite a few more people came to enjoy the place.  The guys challenged me to play basketball when they found out that I had played quite a bit in a former life.  I was able to crank my 65 year old body around enough to come away with a “W.”  I think the translators were a little disappointed.  JJ has a lot of natural athletic ability but in this case, craftiness dominated.  We spent a good share of the morning playing in the pool.  I gave all of the guys some swimming lessons and they all had a really good time.  We played miniature golf a bit also.  There was a big float out on the water so we went out there and played around.  Alex snorkeled some.  There is a small pier over the water and there is a fairly large circular end that they play nice music on.  It was good for dancing.  I saw a young Haitian couple with their arms around each other and I told JJ to tell them I was a dance instructor and to ask them if they wanted me to teach them to dance. They did, so I showed them the rumba box step and under arm turn.  It was fun.  They seemed to enjoy it as did the 8 or 10 Haitians that were watching.  I took a lot of pictures of the flowers and the beach.  A sailboat came by fairly close to shore and I got a lot of nice pictures of it.  All of the translators repeatedly thanked me for bringing them.  They really had a good time. The new pickup runs well and we made it back in about an hour and a quarter.  The whole trip only took a half tank of gas.  Emmanuel knows a couple of guys who live near him who have car wash and he wanted to wash the pickup so we went there and they did a great job.  They are two friends who grew up in New York City and lived there for more than 20 years and then were deported about 5 years ago.  They seem very nice.

Thursday, October 6, 2011

"Bonjour, Haitien!"

Aug 28
It has been two weeks since I made the hole in the roof over the small
balcony outside our room for the AC and it still hasn’t been hooked
up.  At least a third of the nights are hot enough that it makes
sleeping somewhat difficult.  Sometimes I will read for an hour or two
in the middle of the night until sleep finally becomes inevitable.
Most nights do eventually cool off a bit by 3 or 4 in the morning.
The green duplexes have finally been emptied of the occupants who have
no relationship with the hospital.  They aren’t very large but are a
bit bigger than our current unfinished hospital room.  They have a
very small bedroom and tiny kitchen area and bathroom.  There is a
fair sized living room and another small room that could accommodate a
bunk bed and serve as a second small bedroom.  They are in awful
condition.  Besides some obvious earthquake damage, they are dingy and
dark.  The doors and windows need to be replaced. The electrical and
plumbing is nonfunctional and there are no working sinks or commode.
AC will be needed and then a complete paint job done.  Jeannie thinks
it could be made “charming.”  Obviously a fair investment will be
needed.  The four units could probably accommodate all of the long
term volunteers for a few months.  That would then allow the
unfinished wing where we are all currently staying to be emptied and
finished.  The lost revenue from the hospital not being able to use
them for patient care has been significant.

Our little balcony really needed some greenery.  A banana plant from
down behind the peds clinic building was about the right size.  It
needed to be dug up with roots and all but now is nicely decorating
one end of the balcony.  There are at least two or three dozen more in
the area it came from.  The balcony gets a lot of direct sun in the
morning.  This will provide some nice natural shade.  Randy gets to
harvest any bananas that grow over onto his side of the balcony.
Emmanuel had told me that Stephanie’s father had found a reasonably
priced lot about “twenty” minutes away.  It took nearly an hour to get
there and then the traffic on the way back made the return a half hour
longer.  It is in a nice place on a hill overlooking a small pretty
valley as well as a view of the sea iin the distance.  A very nice
breeze was blowing.  An American organization is building a fair sized
school about a block away.  It is definitely much too far away from
the hospital for us to be interested.

There was a concert at Emmanuel’s church this evening that he had
invited us to attend.  It was an interesting eclectic mixture of
music, poetry and choreographed movement.

There was another very heavy rain tonight.  We were prepared and able
to fend off the water that wanted to come in from the balcony.
I dug up another banana plant and brought it up on our little balcony
to add some more greenery.  It is about nine feet tall and I had to
lean it over so it wouldn’t rub against the ceiling.  I’d really like
to get a couple of other plants including a hibiscus to add some

Orthopedist, Mark Slovenkai, unable to make it today d/t Hurricane
Irene.  He will arrive on Tuesday.  Edith Newberry our anesthesia
provider for the week made it fine from Nashville.

Aug 29
My early morning run took 28’ 20” .  That is  15 sec slower    than my
fastest time so far.
1.    my calf is still bothering a bit.:)
2.    It has rained heavily the last two days and the roads/trails are
slippery and there are big puddles to negotiate.
3.    A big dump truck slid partway off the trail near the top and I had
to go in the mud to get around it.
4.    I got a “Bonjou Haitien” from a man that I greeted with “bonjou”.
It caused me to lose focus.  (it is the first time I have been called
a Haitian)
5.    I still detest running uphill and refuse to do it(my SLOW jog is
hardly running).
6.    I ate too many Hot Tamales last night while Jeannie and I were
watching an episode of “The Guardian.”
7.    I ran by myself so had no one to spur me on.

Big Clinic(>50) for just ZJ and me.  I also had 4 cases to do.   They
all went fine but kept pulling me away from the clinic.  I was on the
home stretch in the clinic at about 6:30 pm when I suddenly got
sweaty, dizzy and nauseated.  I had to stop in the middle of a patient
evaluation and go upstairs and lay down.  The symptoms lasted for
about 4 hours.  7 Up seemed to help settle my stomach.  I hope it
isn’t a relapse of whatever organism invaded my system a few months
back.  We’ll see what tomorrow holds.

Aug 30
Jeannie and I had to go to the US Embassy to get more pages for our
passports.  We have been warned a couple of times now as we pass
through immigration that we have very little space left to stamp.  We
got up and left the hospital shortly after 6 am.  We dropped a person
off at the airport and then went to the Embassy for our 7:30
appointment.  After two levels of security, we finally made it in
nearly 15 minutes late.  It took them almost 2 hours to do the job.
Maybe that was really speedy.  It just seems like it would only take a
few minutes to look over the applications that we had filled out and
then add the pages in.  There must be many important details that have
to be looked at and thoroughly checked out.  After waiting about a
half hour, I was called to a window and asked if the Social Security
number I had given on the form was my actual number.   I checked the
number written on the form and I assured the person with the skeptical
look on her face that, yes, indeed, it was my correct number.  Then
she read it out loud over the intercom so the 6 or 8 people including
the Haitian guard could hear it clearly and asked again if it was my
correct number.  I found it odd that such a thing should happen and
wonder if perhaps someone there has some type of scam going to steal
identity.  The traffic was very congested coming back but finally made
it around 10:30 to start our first surgical case of the day.

The cases all went well including the 83 y/o with the hip fracture.
We set up the fracture table again and it worked like a charm.  Dr
Slovenkai and his 17 y/o daughter arrived part way through the case.

Our last case was the man with the lateral tibial plateau fracture. Mark helped me.  I was very glad for his help.  It was a difficult one.  The lateral tibial articular surface had a coronal split.  The anterior 2/3 had partially buttonholed through the anterolateral capsule and was just under the skin.  The part of this fairly large fragment still in the joint had already started to heal to the underlying intact tibia.  There was a second free fragment with the remainder of the lateral articular surface.  The lateral meniscus had a complete radial tear out to the rim and the entire tibial spine was in many fragments with the ACL nothing but mush.  The articular fragments went back together and held well with two threaded K-wires. A lateral buttress plate and screws held well sandwiching it to the intact medial side.  Everything was solid and I could flex it to past 90 degrees.  I put him in the CPM  for immediate range of motion.  I’m glad he was only 3 weeks post injury.  It seems that so many of these types of injuries are delayed in coming here for a month or more.  It makes it so much more challenging when the fragments have already healed and started to remodel.

A few days ago, I had asked Randy to see if he could find a newer pickup to replace the “taptap.”  I have come to the conclusion that putting more money into the old one is just going to be throwing good money after bad.  He  found a Chinese pickup that has the same size box.  It is a 2010 model and is 4WD and diesel.  The make is JMC(GMC?) and there is a dealer here in Port au Prince.  We had a mechanic check it thoroughly.  It seems to be in excellent condition.   The price the owner was asking seemed reasonable.  We would really like the hospital to have a vehicle that can serve several purposes.  Picking up groups  at the airport, transportation for groups on outings, hauling items
for the hospital, and a vehicle for the orthopedic director to use at his discretion are all important uses.  The front and back seats can carry 4 or 5 passengers and another 6 or 8 could ride in the back. Most importantly, the taptap cover that I made will fit.  We finalized with the man selling it yesterday.  It should be a fairly good vehicle for trips to the Dominican Republic from time to time.

There were no more of the odd symptoms today that laid me out yesterday for a bit.

Haitian Sunrise
Aug 31
The run this morning went well.  There were still some obstacles including the dump truck which had been pulled back up onto the road but was clearly not working since it was just at an angle sitting there.  It made progress slow to get around it  without falling off the hillside.  The road is just dirt at that spot and fairly muddy still.  The bothersome calf has healed and wasn’t an impediment. Overall, it was my best time ever by 20 seconds.  The uphill part definitely presents a major psychological effort but the flatter section at the top is ok and the downhill part is even kind of fun. Surely there are health benefits that make the negative parts of the run worth it.

Malignant Melanoma
The clinic wasn’t as big as the one on Monday and of course, Mark was here to do the cases in the OR.  There were a couple of smaller cases and then the below knee amputation on the man with the large malignant melanoma.  It was an option to do a much wider excision with margins. That would have involved removing about the lateral ¼ of his midfoot with some of the forefoot and the heel.  Getting coverage of such a large defect would have been a big challenge.  The patient and his family decided to have the amputation which I think was a good decision.   Mark did a very nice job with both JJ and Jeanty assisting him.  Edith said that he spent time teaching both of them and letting them suture as well.  The clinic finished before 5 pm thanks to ZJ’s strong help.  The C-arm still needs to be used for x-rays.  It isn’t ideal but the clinic unit is still not functioning.  Nathan continues to try to get the Fuji techs to try for an online fix.  Patients do have the option of paying for their xrays in the radiology department. At least 20% have the money.  Perhaps those patients should also be paying something for their surgical care.

Jeannie and I wanted to have more time with Mark and his daughter so we walked with Edith and
Irma to the Auberge where they are staying.  We ate dinner together and Mark generously offered to pay for the meal.  They wanted to know all about how the program started and of course, about Scott.  It was a very good evening together.  He seems very interested in continuing to periodically come and help with the work at HAH.  Edith has been a great anesthesia provider.  She comes from Nashville and knows several of the people who came and worked with Dr Lovejoy earlier this year.  Mark was anxious to do plenty of cases and we put 7 on the schedule for him.  Some are small but one is a bit of a challenge.  She is a patient I put a TSF on about 2 months ago for a malunited tibia fracture that occurred in the earthquake.  She hasn’t followed up well and has developed a significant plantar flexion contracture.  Her correction is quite good and she only has a few days left on her strut
adjustments to finish the prescription.  The plan is for Mark to do the final strut adjustments under anesthesia and then do a TAL and then put an Ilizaroff frame to hold the foot/ankle in neutral while
the tendon heals.  I built the frame for him and it is being sterilized tonight.  I wish I could be there for the case but tomorrow, Jeannie and I leave early to go to Ben and Sarah’s wedding in Southern California.  They are a great couple and we think it is important for us to be there.  Ben is an outstanding resident.  He really made an impression on everyone during his time here in March.
Sarah is doing an OBGYN residency.  She is a member of the LLU School of Medicine Class of 20010 that adopted Haiti Adventist Hospital.  I think they would be a great team to work here at HAH.   We fly back Sunday pm/Monday am on an overnight flight.  I should be back for a good share of the clinic on Monday.  The DeMuth team arrives on Sunday.  ZJ and Lynne can get them started with rounds and then seeing patients in the clinic.  I haven’t scheduled any patients for surgery for Monday.  A patient or two may show up for cast changes or something may come in tomorrow to clinic or over the weekend that might need to be done on Monday.  We have a fairly full schedule of surgical cases for the week and I am sure that more will come in during the week.

A Tour on the USNS Comfort

Aug 22
The big Monday clinic went fairly well in spite of our xray machine
not booting up.  We brought the C-arm out to the front of the OR and
kept it plugged in to the invertor and used it for most of the films
we needed.  It worked reasonably well.  I saw another 4 y/o old boy
with severe knock knees.  He should do well with 8 plates for
correction.  We have a lot of cases besides the tumors for Dr
Zuckerman so we arranged for Dr Adrian to come over from the DR to
give anesthesia.  Francel was able to arrange Haitian
anesthesiologists for only Tuesday and Wednesday.

Jeannie and I had another distraction today – Hurricane Irene!  The
initial trajectory had it hitting the DR on the southeast and then
becoming a tropical storm as its strength was diminished by the hills
and high mountains.  The storm changed course a little bit as it
crossed over the Virgin Islands and headed just a bit farther north.
It just touched the north coast of Puerto Rico and headed for the DR.
It stayed slightly offshore as it continued WNW.  It became a Category
2 hurricane as it honed in on Cabarete.  100+mph winds can do a lot of
damage and carry heavy objects through windows.  Then the horizontal
rain floods the interior.  Of course, the storm surge with that sized
hurricane can be 10-15 feet.  Hurricane Katrina’s was 27 feet.  Our
place on the beach is only about 8-10 feet above sea level.  The math
is easy.  LOTS OF DAMAGE!!  Fortunately, the surge was only about 4-5
feet and the wind didn’t carry any heavy objects through our windows.
I tracked the storm for 2 or 3 hours during the night.  Cameron was
somehow able to sleep through the worst of it.  Another bullet dodged
by the grace of God.

Aug 23
We had 10 cases scheduled and did almost all of them.  Doctor
Zuckerman worked with Adam most of the day on the tumor cases.
Everything went well.  I helped Francel with a hip hemiarthroplasty.
Dr Adrian came over on the bus from Santo Domingo.  It is a good thing
we arranged that since the Haitian anesthesiologist told us today that
she wouldn’t be able to come tomorrow.  We have another 8 or 9 cases
on the board for tomorrow as well as Wednesday clinic.

Aug 24
We had more than 50 patients in the general ortho clinic.  Then there
was the club foot clinic as well.  Francel and I did most of the
clinic while Lee and Adam stayed in the OR most of the day.  I saw a
12 y/o boy with severe knock knees.  Each side measures 40 degrees.
He will need femoral and tibial osteotomies.  A 17 y/o girl came to
the clinic with marked bowleg on one side only from Blount’s disease.  I’ll be able to put on a TSF and osteotomize the tibia and fibula. She won’t be ready to have her TSF taken off before I leave in November but it should work out for when I come back for a week in January.   I evaluated a man with a large knee effusion.  He has moderate degenerative arthritis.  I aspirated 60 cc’s of joint fluid then injected the joint with steroid.  I showed him the fluid I took out and told him it was a very good lubricant.  I jokingly offered to go into business with him selling lubricant.  He got a great big smile.

 The orthopedic pathology continues to stream in.  The surgical
schedule was interrupted by a general surgery emergency.  It just
helped us to be able to focus on the big clinic better.  The clinic
xray machine still isn’t working.  We are hoping that Fuji can fix it
remotely but haven’t been able to reach critical mass yet with the
people that need to give input.  We again used the C-arm for a few
clinic xrays.  Of course, we keep it plugged in with an extension cord
to the invertor to avoid voltage fluctuations which could take out a
circuit board.  Several of the patients had enough money to pay to
have their xrays taken in the xray department on permanent films.  I
did another arthroscopy with Francel.  He still has a ways to go
before he can start doing them on his own but he is making progress.
We also did an above knee amputation.  The clinic finished a few
minutes before 5 pm and we finished the cases before 8:30 pm.

Aug 25
Our surgical schedule looked good until we were informed as we were
starting our first tumor case that there were two emergency C –
sections.  The first one may have been somewhat urgent but the second
looked suspiciously as if it was being done to follow the first for
the convenience of the doctor.  C’est la vie!  I wasn’t able to start
my first case with Francel until after 1 pm.

Meanwhile Lee did the case of the week if not the year with Adam.  The patient has a grapefruit sized mass in his wrist.  He had some type of unknown tumor removed and the wrist fused with a plate and screws about five years ago.  The mass has been steadily increasing in size for the last year or more.  Hours of meticulous dissection were necessary to identify the tendons and neurovascular structures and separate them from the tumor.  Lee is unbelievably patient.  It is hard to believe that he is a surgeon.  Most surgeons don’t have even a fraction of the patience that he has.  Adam kind of zoned out a bit periodically during the case.  I was able to close the BK amputation stump over a couple of drains.  We then lost water to the hospital – something about the pumps not surviving the brownout in the middle of the night last night.  We had to cancel two SIGN nails.  We hope to do at least one tomorrow.  I also have a patient tomorrow with a large herniated lumbar disk.  Hopefully the water will be back on.

Aug 26
Randy actually got the water on late last night.  He activated the old system.  It doesn’t have great pressure but it is way better than nothing.  Lee did a tumor case and then I did the spine case.  The
patient fell 8 months ago and has had back and leg symptoms since. His foot is numb and then 3 weeks ago he lost control of urination. He actually came in with a  CT scan that Francel had ordered which showed a large disk herniation at L4-L5.  I found an extruded disk the size of a large grape.  I got several more good sized fragments out of
the disk space.  He was moving his toes and feet nicely after he woke
up.  It will be interesting to see if he gets bladder function back.
I did one of the SIGN nails with Adam, the resident.  It was an
antibiotic cement coated job that went well.  The patient had had
several prior operations and drained for a period of time after at
least one of them.   Both Dr Zuckerman and Adam leave early tomorrow.
Lucia and Dr Adrian also leave in the morning.

Arrangements have been made by Ron Anderson for us to tour the USNS
Comfort tomorrow.  Ron is part of a church group that is doing
surgical cases on the ship this week and next.  The ship was here
about a week after the earthquake last year and stayed for nearly 3
weeks.  We have seen several patients that had surgery on the ship
last year.

Aug 27
We got up early to see everybody off then went down the street with Emmanuel and caught a taptap.  We had to change taptaps in the middle of town and that took a while.  I was getting a little nervous because we were supposed to be at the terminal for the boat pick up at 8:30. The second taptap dropped us off on the road near Cite Soliel.  The walk to the terminal and then to where the boat came in was over a mile.  We had to go through 3 checkpoints.  We got there at a fewminutes after 8:30 and found a fairly large crowd of Haitians waiting to go out to the boat for medical care.  The boat came about 15 minutes later and loaded all of the patients and a few navy personnel and there wasn’t room for us.  The Petty Officer in charge apologized for us having to wait for the boat to come back. Meanwhile, who should come to wait also but Bernard Nau.  He is a prominent Haitian orthopedic surgeon.  He has been coming to work on the ship nearly every day.  Several patients on the boat with us are his.  I had a nice long talk with him.  Emmanuel had never been on a boat before and was a bit apprehensive.  His life jacket gave him comfort and the trip only took about 15 minutes.  The Comfort  is huge – nearly 900 ft long! We were met by Amanda Dolittle who has been in the Navy 19 years.
She started us on the tour and then Ron came out of surgery and joined us.  We also met Bill Todd who is the chief medical officer and a pediatric orthopedic surgeon.  I was disappointed that Dr Tim Mickel and Dr Mark Swiontkowski were still in the OR doing a case.  The tour was fascinating.  The ship has 1000 hospital beds and 80 ICU beds. There are 10 operating rooms including an  angiography suite.  They have a very nice CT scanner and the lab and pharmacy are very complete.  There is a nice rehab area as well.  We met the lady pathologist who has been working on our specimens.  The dental clinic is nicely equipped.  They even have veterinarians as part of the staff. They do all of their work on shore.  After the tour we were unexpectedly invited to join all of the orthopedists for lunch.  Both Mark and Tim had finished with their cases and were able to join us. We had a great time getting to know each other.  I had taken a book with me in the hopes I could share it with Tim Mickel or someone else who might be interested.  I showed it to all of them and told them about the opportunity we have to really establish excellent orthopedic care for the indigent.  I signed it and presented it to Dr Todd.  The others all plan to get at least one book.  I hope they spread the word. They are all interested in coming here and helping with the work.  Bill then gave us a personal and quite emotional Powerpoint presentation of his experience being the only orthopedic surgeon on the ship when it arrived one week after the earthquake.  He worked nearly nonstop for about five days.  The whole day was a really neat experience.  I got a lot of pictures.