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.
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 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.
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.
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.
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.
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.
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.
"He was married twice, the second time to ranch hand and single mother Gwen Grant. 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.
"In 1956, they opened the Hôpital Albert Schweitzer Haiti in Deschapelles, Haiti.
"He died in Deschapelles at the age of 79 with cancer and Parkinson’s disease, on August 3, 1989."
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.
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.