Wednesday, November 30, 2011

Haiti is Beautiful!

Haitian Metalwork, a local folk art form
Oct 29
The Alexander/Adames team all wanted to do something this weekend.  Some wanted to go to the mountains and others to the beach.  Some wanted to do both.  We decided on the mountains today and the beach tomorrow.  The group was ten strong and we filled both the cab and the back of the pickup.  We stopped on the road to Petionville and looked for souvenirs.  We also found some great citrus that was very sweet and juicy.  We also got a large watermelon for lunch.  The paintings, metalwork small decorative boxes, and wood and stone carvings were even better in Fermathe, the little town where Ft Jacques is located.  We all thoroughly enjoyed the fort.  It is very picturesque and has such a great view of Port au Prince and the bay far below.  We got lots of pictures sitting on the cannons and climbing around.  A woman in the parking lot was selling some just picked raspberries.  We bought a bag full of them and Jeannie plans to have them with waffles.  It was a very relaxing day for everyone to get away from the intensity at the hospital.  Ian and Sue found some nice metal work and a couple of paintings that they liked.

Oct 30
Jeannie and I made rounds early.  We changed all of the dressings that needed it.  All of the patients seem to be doing well.  They lady with the bilateral femur fractures that rode here on a motorcycle for several hours is all smiles whenever we come in.  Her right side was definitely the most painful and now that it has been fixed with a SIGN nail, she is able to get out of bed with no pain.  The left side is now nealy healed even though it is malunited.  She is several centimeters short on that side.  Her hemoglobin remains too low to do any further surgery right now.  She would have to be transfused first as well as have more blood ready for an open reduction and fixation.  She has no resources and all of the volunteers that are able have already donated.

Mario Negotiating
We had only one translater with us today so the back of the pickup wasn’t quite so crowded on the way to the beach.  Kaliko Beach resort is quite nice.  The beach itself is smooth pebbles and rocks but there is a wide sandy area between the beach and the buildings.  Some small sea grape trees provide shade for much of the area.  There was a small rowboat hanging out just off the beach.  It said “taxi # 13” on the side.  I asked Ian and Mario and Derek if they were interested in going out for a ride.  Only Ian wanted to go so we negociated with the guy, Fritzner, and out we went along with Roosevelt.   The guy is a fisherman who fishes three days a week.  On good days he can make more than $50 US.  He keeps all four of his kids in school even though he says the fees are high.  I tried rowing on the way back but was pretty much a failure.  I don’t think I made any headway into the breeze.  The oars as well as the boat were handmade.  They were quite heavy and I struggled.  Fritzner took over again and we made it back in short order.

Lunch was next on the agenda.  It costs $30 US per person to access the resort for the day but that includes a great buffet lunch as well as 5 tickets for drinks.  The salads were very fresh and there was a lot of rice, beans, chicken, meat, potatoes and other vegetables.  We were all thoroughly stuffed.  The rest of the afternoon was a total enjoyment in the pool and looking for shells on the beach.  I had a great time talking with both Ian and Lilly.  We started out for home later than we should have and it got dark about halfway back.  I am very reluctant to drive at night because bicyclists and many motorcycles have no lights or reflective devices.  It  is also way harder to identify the potholes.  Thankfully it was an uneventful return.  We will have another big clinic tomorrow I am sure.

When we got back to the hospital, we found our good friend, Ramon  Rivera.  He is an internist who lives and practices in Puerto Rico.  He and I worked together at Hospital Bella Vista more than 30 years ago.  He has a real heart for Haiti and has been here on two different occasions.  The first was before the earthquake.  He came and worked in Cite Soliel for 2 weeks.  After the earthquake, he responded and rented a pickup in Santo Domingo and drove here, caravanning with another vehicle.  He would like for the Adventist hospital in Puerto Rico to be involved as a sister institution with HAH.  He will be able to help us a lot the next week and a half.  We have a lot of patients with comorbidities, especially the diabetics.

Oct 31
The Monday clinic was a typical large one.  I got taken away for part of it by a fairly long phone call from an orthopedic surgeon at Medishare.  His name is John Durham and has been called “Bull” since he was a child.  He has been to Medishare 3 times previously.  He practices in Flagstaff, Arizona.  He doesn’t have a fracture table and doesn’t want to try to do intertrochanteric hip fractures without one.  He also has a patient with a femoral neck fracture and has no hemiarthroplasty implants.  He also wants to borrow some plates and screws to fix a distal radius fracture.  With all three of us seeing patients steadily we finished by about 2 pm.  We had 4 smaller cases to do and finished with everything by about 6 pm.  Our last case of the day was the lady that I had treated for a malunited tibia with a TSF and osteotomy.  She had been lost to followup for a while and developed an equinus contracture of her ankle.  We treated it surgically with a gastroc slide and then immobilized it by extending her frame to her foot and putting in metatarsal wires.  She had healed well and her foot was plantigrade when we removed the lower part of the frame and the metatarsal wires two weeks ago.  Upon going home, she apparently made no effort to prevent another equinus contracture.  She came in to the clinic today with the same fixed equinus she had before.  I was sure we could do a manipulation and get her foot plantigrade.  Ian suggested making a foot plate orthosis to attach to her TSF so Jamison did that while we were waiting for her stomach to empty.(she ate spaghetti at 9 am)  Sure enough, the manipulation was successful.  She is now in a little bit of dosiflexion, held by her custom foot plate tied up to her TSF.  During a break in the afternoon, we celebrated Mario’s 41st birthday.  Jeannie made brownies and we had ice cream and the fresh raspberries that we bought up at Ft Jacques on Sunday.
Lunch with a hopeful Haitian Dog, a common occurrence

We had a tremendous thunder and lightning storm that hit suddenly.  The wind blew very hard and I heard a loud crash outside.  I carefully opened the door to our balcony and found my cool banana plant laying on the floor as though someone had shot and killed it.  It was still raining hard.  I’ll try to resuscitate it tomorrow.

Nov 1
We had a big day scheduled – 4 cases for the c-arm.  Two of them were cases that Dr Bernard Nau had sent.  One was a lady with a SIGN nail and femoral nonunion.  The other was the patient he sent a few days ago with a painful swollen ankle.  The joint crunched a lot when it moved.  The xray showed the talus(ankle bone) was riddled with cysts.  There was hardly any bone left.  Dr Nau had arranged to come for both of the cases.  Ian did the case with Ben assisting.  The huge cysts in the talus were impressive.  Meanwhile, Derek was already next door getting a 3 year old ready for a bilateral posteromedial clubfoot release.  I assisted Mario on them and they went well.  Ian finished the tibio-talar-calcaneal fusion with a large distal femoral locking plate.  Ben then came in and watched while we finished the second clubfoot.  Ben and I then did the lady he had sent me with the femoral nonunion.  We took out the distal locking screws and a third “blocking”? screw.  The knee was very arthrofibrotic and required a big incision to mobilize the
Terry at the Fort with Derek, Ian, & Mario
patella to get the retrograde SIGN nail out.  We reamed her to 11 mm and then put in a larger 9mm SIGN nail that was 20 mm longer and locked it both proximally and distally after impacting it.  Ben got bone graft from the iliac crest and I exposed the nonunion and cleaned it up and made a good bed for the graft.  The case went very well.  It was a pleasure working with Ben.  We were able to give the patient an additional 30 degrees of knee flexion as well.  The last case was really interesting.  The patient had a history of a fracture dislocation of the ankle that got infected after surgery.  Eventually the infection got cleared up but the patient was left with a very painful ankle.  Ian decided to fuse her tibia, talus and calcaneus with a SIGN nail.  He did the case with both Mario and Bernard assisting.  He did a beautiful job.  He is really a master surgeon.  He had never seen a SIGN nail before coming here.

Monday, November 28, 2011

Alexander Team Arrives

The Alexander Team with Jeannie & Terry

Oct 24
The Ian Alexander team arrived yesterday.  He is a foot and ankle subspecialist from Ohio.  He is sponsored by the Foot and Ankle Society.  His trip here is to help the leadership of the Society decide if their involvement here will be an ongoing program.  They want it to be a teaching program as well as a help for the local orthopedic surgeons.  He has his wife, Sue, with him.  She is a pediatrician.  He also has a peds foot and ankle specialist from Brazil.  Mario Adames practices in the Southern Brazilian city of Florianopolis.    It is largely on an island and has 42 beaches.  It is well known for its surfing.  He says they do a lot of windsurfing and kiting also.  Sue is an OR tech with them.   She is extremely good at orthopedics.  She sets up the room as if she has been working at HAH for years.  Derek is a great anesthesiologist.  He is from Ohio but will be moving to Virginia in a few months.  He grew up in Lake Tahoe, Nevada and studied in Arizona.  We are lucky to have him.  He loves to do blocks.

The clinic  was made all the more challenging by three diabetics with foot infections.  One had an entirely infected and dead foot.  Another had a dead fourth toe.  Everyone in the hall was wearing a mask to deal with the odor.  We  were able to take the patient with just the toe involved and debride her foot.  The other patient had a very low hematocrit and needed transfusion first.  I hope we can get blood so we can do her surgery tomorrow.

I was able to schedule several cases.  The little boy with the TSF being treated for short tibia came in again with infection around several of his pins.  He has had several trips to the OR already for similar problems.  He still needs his frame since the new bone still isn’t strong enough.  I’ll take him back again tomorrow for revision of his frame.

The final path result finally came back today on Katiana Paul.  It is a fibrosarcoma.  I emailed Dr Bibiloni and Dr Mehne with the results to see if they might have any connections that can get her adequate treatment.  Dr Larson answered that the only possibility in Haiti would be a hip disarticulation.  That wouldn’t address the pelvis that appears to be locally invaded.

Both teams enjoyed a pizza dinner at the Auberge hosted by Frank and Kaye.  I got to know Ian better during the meal.  He has been a business man also, developing and selling software.  The “peekleez” was a hit with most everyone, especially Steve.

Oct 25
We had a big list of cases on the board and didn’t finish until after 9 pm.  Ian and I did a takedown of a malunited tibia and placement of SIGN nail.  Ian enjoyed learning the nuances of the SIGN system.  The case went well.  A 20 y/o came into the ER after being hit by a car.  He had a puncture compound very comminuted distal femur fracture as well as an unstable fracture of L2 without neurologic deficit and a deep abrasion on the back of his hand.  Frank put in a SIGN nail and then cleaned up the wrist abrasion.  We’ll have to plan the spine surgery.  He will need to have blood available.  Mario did some of the peds cases.  I showed Ian the book while we had a bit of time in between cases.  He was very impressed with the quality and the content.  I explained the opportunity that we have to establish this program with satisfactory funding.  He immediately mentioned that he has a very wealthy patient that he is sure would give a large donation and that he is going to give her that opportunity.  I’ll sign a book for her that Ian can give her.

The Whitney/Mulder team leaves tomorrow.  Jeannie made a great spaghetti and salad meal for their team and we had a late dinner.

Oct 26
Jeannie and I bid the team goodbye.  Frank said that he and Kaye were seriously considering taking over for me.  After working with him for the last week and a half, I am sure that he would do a great job.  After they left, I went for my run.  I had my best run yet 27’ 40”  even though I was still a bit stuffed up with a cold.  We made rounds and after finishing, Ian was very excited to tell me some ideas.  He said that he had been brainstorming about getting exposure for the book.  He wants to arrange for a booth at the American Academy of Orthopedic Surgeons annual meeting in San Francisco in February.  For more than two months I have been trying to figure out how I could make the right contacts to see about having a display there.  Ian has done it many times and has all of the equipment.  He wants to arrange a schedule of times for Scott and me to alternate being at the display for book signings.  I sure hope we can work out the details and that it isn’t too late.

The clinic didn’t look all that big so I tried to get some important administrative work done.  Scott had developed a proposal for keeping Francel here at HAH.  He is being courted by MSF where he worked for a while before starting his peds ortho fellowship.  I gave him my input on that important issue.  Arrangements have been made for the orthopedic surgeon from Curacao to come the day before we are scheduled to leave.  It is not nearly enough time for him to become familiar with the multitude of different areas that he will need to learn on his own.  Dr Nau emailed me about a case that I had scheduled for surgery next week.  He wants to come and help.  He apparently knows the patient.

I helped out with the last half of the clinic and meanwhile, Mario went to the OR and started a case.  I really enjoy working with Ian.  Unfortunately, many of the foot and ankle cases we had saved up were operated on by Dr Perez when he was here just 2 weeks ago.  Ian did the BK amputation on the diabetic  today.

Oct 27
The surgery schedule was full.  Dr Bernard Nau, a well known Haitian orthopedic surgeon arranged to have a patient of his evaluated this morning.  Dr Alexander did the evaluation and felt that he was a very good candidate for a fusion of his ankle and subtalar joints.  The patient has very large cysts throughout his talus(ankle bone.)  He injured his ankle playing basketball 2 years ago and has had progressively worsening ankle pain since.  He walks with a noticeable limp now.  This type of problem is an area of expertise for Dr Alexander.  We scheduled him for surgery next Tuesday.  Dr Nau is planning to assist.
Out for some sightseeing with the Alexander team

I did an arthroscopy with Lily assisting.  She is very good with her hands and handled the instruments very well.  She has a very good knowledge of anatomy as well.  Mario did more children’s feet and leg cases and he and Ian took out a SIGN nail and put in antibiotic beads and placed an external fixator on  a tibia.  ZJ and I revised an amputation stump on a young girl that he has been following closely and has gotten to know very well.  We tried giving her tetracycline and using a black light to try to identify dead bone.  I can’t say that it worked convincingly.  We put antibiotic beads in the stump.  I hope it finally clears up her infection.  We have another diabetic with a severe infection in her foot that we will try to take care of tomorrow.  This is our fourth case in 3 days.

The reply from the Academy was that it is NOT too late for a display.  In addition, it is complementary for nonprofits.  Ian and I are excited.  He is planning a ¼ page ad in the ORTHO NOW newspaper to raise awareness before the Academy.  It will be fun to hopefully interact with many of the attendees and share with them what is happening here at HAH and what a wonderful opportunity it is.

I received word via email from Frank and Kaye that they have decided to not take over here for us.  Of course, I am disappointed.  I know he would do a great job.  Perhaps they can be convinced to help this transition for a shorter period of time.  I know this is God’s project and have complete confidence that He will keep this project accomplishing what He wants it to do.

Oct 28
The clinics continue to be large and challenging.  Ian, Mario and I worked steadily through the morning.  We got in another diabetic patient with two dead toes and infection in the forefoot.  Ian took him to the OR and removed the dead tissue and packed the wound open.  Another patient with an Ilizaroff frame needed the foot wires and plate removed under anesthesia.  The big case was Felix and his ankle.  Felix had and open fracture of his ankle more than a year and a half ago.  He also had a femur fracture.  He first came to us several months ago with a nonunion of his femur and an infected failed ORIF of his ankle.  Drs Weinfeld and Den Hartog removed the hardware from his ankle and debrided it thoroughly and placed an Ilizaroff frame.  The infected wound was left open.  It finally completely healed about a week ago.  In the meantime, the ununited femur was treated with first an external fixator to get the bone out to length and then a SIGN nail was placed by Dr Yoon about 3 weeks ago.  Mario tackled his ankle today to do a formal ankle fusion with iliac crest bone graft that Ian helped Lily harvest.  We are all hopeful that this will be the last procedure that Felix will need.

I saw several patients in the clinic today in followup.  One was Stephanie Bryce, the nine year old with severe bilateral Blounts that was treated with TSFs and tib-fib osteotomies.  She and her family are so happy with her result.  She is back running and playing again and is very happy.  Her osteotomies are completely healed.  Her mom brought us another great meal for lunch.  I saw the ACL reconstruction that Anthony Feniston did four months ago.  He is likewise doing very well.  He is anxious to return to playing soccer.  I am going to let him start some light jogging and then gradually increase his activities.  Perhaps in 2 more months he will be able to play again.  The patient with the TSF that I did last week came in.  He has no problems.  I had Franz teach the family how to adjust the struts properly.  He will return next week to check on his progress.

Sunday, November 13, 2011

Sabbath at Jardin de Mer

Oct 21
The Friday clinic was somewhat helter skelter.  The CURE clubfoot
program has had a pediatric orthopedic surgeon here this week and she
has been here a couple of days including Tuesday and today.  She had
several TALs to do which she did in the clinic as well as castings.
That kept our cast room totally tied up all morning.  I did clinic in
the hall while Frank used our clinic room.  We also had several cases
today.  One was a dressing change on Franz.  I followed the email
advice of a hand surgeon from Ohio.  He recommended transferring the
lacerated tendons to the index finger to the adjacent extensor tendon
to the long finger.  I couldn’t find the proximal part of the extensor
tendon to the thumb so left it for a hand surgeon to deal with.  I
partially closed the wound and put on a wound vac.  I plan to skin
graft the defect in a few days.

Oct 22
Sabbath again – what a blessed relief.  I love the work here and the
interaction with all of the patients and their families, but it is
pretty intense and I really look forward to a day of rest.  Amy and
Nathan had arranged to take a group including the Whitney/Mulder team
and us to a small resort on the Caribbean.  It was a three hour drive.
We all went in a good sized van.  I had a great time talking with
Frank almost the whole way there.  The Jardin du Mer(Garden by the
Sea) is located on a hill which is on a small peninsula that protudes
a bit into the Caribbean.  The views are spectacular both directions.
We went exploring one of the beaches and came upon “The Sloop John B”.
It is a very small handmade wooden boat(cannot) with a handmade
wooden mast, boom and hand sewn sails.  It was much like the boat that
we went out on a few months ago but only about half the size.  It was
very photogenic.  There was a nice buffet dinner prepared for us in
the early evening.  We all had a good time.

Oct 23
I got up early to take advantage of the morning light to get photos of
the scenery. I hiked up the hill a ways and got some great shots of
one of the handmade sailboats coming in from an early morning outing
presumably for fishing.  Steve had also been up early and had gone
down across the road and climbed a different hill with a bunch of
kids.  The rest of the group was up and talking with Bob Anglade, the
owner of the resort.  He is a most interesting man.  He grew up in
Haiti and studied marine biology.  He spent 10 years working in
Africa, mainly in the Belgian Congo where he met Michelin, his wife.
Twenty five years ago he came back to Haiti and started an oyster
fishery where he now lives.  At the same time he acquired the property
where he has built his little resort.  The entire property was barren.
He has planted shrubs and trees on the entire property.  There is
extensive stonework made into retaining walls and patios and the open
air restaurant/bar.  There are 10 rooms that accommodate 18  visitors.
Unfortunately, the oyster business was a failure.  The locals all
harvested and consumed his product before he could get  to it.  He
throws up his hands in resignation and says,”What can you do?”  They
all believe the sea belongs to everyone.  He continues to fish and
that is how he makes his living.  His resort has a 10% occupancy.  His
brother, a well known Haitian author, died in the earthquake along
with a couple of other family members.  Bob told us of the experience
of the one surviving family member who had moments before left the
house to get something from the trunk of her car.  She felt the severe
movement of the earth and watched as the entire house which she had
just walked out of collapsed in a pile of rubble whith her husband and
brother and sister-in-law underneath.  No effort was made by the local
officials to recover the bodies.  Six weeks later, the Canadian
government brought heavy equipment and removed the bodies.  His
brother wrote this great book about Haitian laughter that Bob showed
us.  I hope I am able to get a copy of it.

After breakfast we followed Steve and the kids on the same hike up the
hill that Steve had done earlier.  The view was equally spectacular to
the ones I had earlier.  We had a great time taking lots of pictures
with the kids and each other.  We didn’t have time to try to get a
boat ride so decided to walk as far around the peninsula on the beach
as we could.  We got a lot of really good pictures.  The dozen kids
all came along.  There was a little dugout boat on the beach which had
a mast step.  I had never heard of a dugout sailboat but there it was.
It had fishing nets in it so is obviously still in use.
We presented the kids with a new soccer ball that I had taken with us.
They were delighted and wanted to use it so we headed back to their
soccer field/cow pasture.  It was a lot of fun watching them play.
Several of them were obviously more talented and skilled than the
others.  Steve and I got out with them for a bit and ran around.
Everyone took a lot more pictures.

After settling up with Bob, we piled in the van and headed back to the
hospital.  I spent the entire three hours talking with Steve about
mainly the origins of the universe.  He believes strongly in a literal
7 day creation week.  We discussed a lot of different viewpoints and
the arguments for and against.  The time really went by very quickly.
I really enjoy spending time with him.  He is a quality person.  We
plan to get together and enjoy our passion for windsurfing.

Saturday, November 12, 2011

New Renovations to Take Place at HAH!

Oct 18
Cam and Chris left early this morning.  It is exciting and very
gratifying for me to see them so interested and with such good ideas
for fundraising for this project.  I went for a run after they left
and had my best time ever by 5 seconds.  I continue to detest the
uphill part but the fairly level part in the middle gets easier and
less somewhat less detestable.  Then the downhill is even kind of
“fun.”  Having a nice set route gives me the opportunity to time
myself and makes it a game and new challenge each time I do it.
We had surgery all day.   We started with 8 plates on a 3 year old.
Mimi had never seen one done so I helped her with it.  It went fine.
Then we had a couple of smaller cases and a delayed ORIF of a wrist
fracture that Frank and Mimi did very nicely together.  Our last case
was actually two procedures.  A large teenager had a genu varum and
painful knee that he and his family said began when a wall fell on his
leg in the earthquake.  There were some mechanical symptoms in his
knee as well. He had an expensive looking knee brace and was well
dressed.  His xrays showed the nearly 15 degrees of varus that was all
in the femur.  There was no apparent old healed fracture.  His
epiphyses were closed.  Frank first did an arthroscopy and found some
unstable chondromalacia on his medial femoral condyle.  He did a nice
job and trimmed it.  We then switched to the radiolucent table and
Mimi and I put on an LRS femoral fixator and osteotomized his distal
femur and corrected his femoral deformity.  I really enjoyed the case
as did Mimi.  I continue to be amazed at all of the equipment we have
here for doing this type of surgery.  Virtually all of it is because
of the earthquake and Scott’s unbelievable hard work and vision.  That
this type of work is being done in post earthquake Haiti is pretty
mind boggling.  After the case I talked with Frank for quite a while
about how Jeannie and I made the decision to volunteer here for a
year, how it has been such a tremendous experience for us and how we
would like to stay longer if it weren’t for my contract back in
Wisconsin.  I am hoping that the circumstances with my work will allow
me enough flexibility in the next year to return(if I am needed) from
time to time.  If the practice in New London is able to attract a
younger orthopedist who would like to work full time, then I might be
able to reduce my time there significantly and be able to come here
for longer periods as necessary.

The internet finally came on here at the hospital.  I have a ton of
emails to answer and many others to send.  I have seen about a half
dozen patients that I need to run by Scott.

Jeannie made soup and salad and we ate dinner together with Frank and
Kaye.  We had a good time talking about our experiences with our
orthopedic practices through the years.  He was in solo practice in
Sonora, California until a year ago.  He had a same day surgery center
that he really enjoyed working in.  It was very efficient.  He sold it
to the hospital in town and “retired.”  He has been doing locum tenens
about half time since in the community where Scott grew up and where
his parents still live.  Steve Mulder gives anesthesia for him

Oct 19
Very busy day today.  Jeannie and I took Frank and Kaye out and showed
them the duplex that we want to upgrade for living quarters for the
orthopedic director.  The large clinic went well with the three of us
steadily working.  Several more patients with frames came in today for
adjustments and strut changes.  Franz, our xray tech here at HAH had a
motorcycle accident last night and injured the top of his left
hand/wrist badly.  He “sandpapered” off a large area of skin and two
tendons down to bone.  The tendons go to his thumb and index finger.
The wound was highly contaminated and required extensive debridement.
The tendons are missing a segment each and will require specialty care
and probable tendon grafts.  He may also need a pedicle flap to get
skin coverage over the area.

The Mulder/Whitney team provided an excellent meal of “haystacks” for
dinner.  They brought all of the ingredients with them.  It was
terrific.  All of the long and short term volunteers enjoyed it

Oct 20
We had a good sized surgery schedule today including an 8 y/o boy with
moderate Blounts for a TSF.  Frank helped me and it went nicely.  We
finished in well under 2 hours.  Passing the Gigli saw was
uncomplicated.  I helped Mimi do an ORIF of a proximal femur fracture
with a SIGN nail.  She hadn’t done one before.  The patient has
osteogenesis imperfecta and didn’t know for sure when she had
fractured her femur.  The fracture had begun to unite with the
proximal fragment flexed about 30 degrees or more.  We eventually got
it reduced after shortening it a bit and then the rod down and locked.
I spent time emailing to see if we can get a hand surgeon down to
work on Franz.  I sent out about a dozen emails.  I continue to apply
subtle(and occasionally not so subtle pressure) on both Frank and
Kaye.  They haven’t given us any indication of which way they are

Nathan announced today that funding is now available for building a
new kitchen that will apparently be a sit down facility as well as a
commercial laundry.  Both could be revenue centers for the hospital.
Jeannie made a tasty chili and salad dinner tonight for the two
medical students who are leaving in the morning.  It has been great
having Andy and Josh here the last three weeks.  Andy is totally
commited to orthopedic surgery at this point.  Josh really likes ortho
also but is going to wait to make his decision.  One of their
classmates arrives this weekend for a three week rotation.  Andy is
planning to arrange with his school for Jeannie and me to give them a
presentation about the work here and mission work in general.

Friday, November 11, 2011

All in the Family- A visit from Cameron Dietrich

Oct 14
The clinic was the usual size today.  I had a meeting with Nathan and we discussed a number of items. There is a possibility for another orthopedic surgeon that might be able to replace me.  He is from the Philipines and is currently working at the Adventist hospital in Curacao, apparently doing just administrative work.  The funding apparently wouldn’t be an issue.  Even if he doesn’t do much surgery, perhaps he could keep the program organized so that the specialty teams have good cases set up and there is satisfactory followup.  He and Francel could run the clinics and take care of the
Jeannie with son Cameron
everyday cases. It will be interesting to see where that possibility goes.  Of course, Dr Frank Whitney and his wife Kaye are coming on Sunday.  We have hopes that he will be willing to take over for me for at least six months or more.  The surgical cases were mostly foot today, but Dr Bibiloni did the tumor case.  I was busy in the clinic when he did it but he said the tumor was immediately on the vessels in the groin but not invading.  He again did an excellent job on a very difficult case. We have been hoping to get the report back on our teen age girl with the lesion in her hip that Dr Yoon biopsied especially with Dr Bibiloni here to help with the management.  Dr Perez and Dr Guzman have done a really great job on all of the foot and pediatric cases we have had. We arranged to have dinner together
this evening at the Auberge where the team is staying.  We had a really great time talking and telling jokes and getting better acquainted.  Juan told Jeannie and me about his 500 acre farm in central Puerto Rico.  He farms about 100 acres. He has Valencia oranges on most of it.  He also has limes and some plantains.  He has a foreman and 9 employees.  He has 3 children and loves his wife very much.  He  has a big concern about the drugs, crime and violence that seem to be more and more prevalent every  year in Puerto Rico.

Oct 15
Another Sabbath has come to give me the break that is so helpful in keeping balance in my life.  Having a special day each week that is set aside as God's day is one of the best gifts ever given to  mankind. I took an early morning long walk up the hill. We all wanted to go to the prosthetics program that the Puerto Rican team has developed so we took the pickup to Delmas with Emanuel leading us.   It took a while to find the site.  We even arrived before the Puerto Rican team who had to call us for directions.  We got a bunch of pictures especially of Cam and the younger amputees.  We had lunch at a nearby cafĂ© and talked with Cam and Chris about funding the project.  Chris has many connections with the media especially in England. On our way home, we took pictures of Haiti’s ruined nationalcathedral.  There were a number of beggars at the site.  It is hard for me to walk away from people who have so little but I have resolved to not encourage begging.  We also stopped at the ruined National Palace for more pictures. The internet went off today.  It won't be worked on until Tuesday since Monday is a holiday.

Oct 16
I was able to do my early morning run in 28’ 05” .  It was my best time yet. Whitney/Mulder team  arrived fairly early in the day.  I had an enthusiastic meeting with them sharing how I perceived the unprecedented opportunity here.  Of course, my hope that Frank will takeover for me had no influence on that at all.  Steve Mulder’s return is his first since the “Rocket Man” episode.  He calculates that he has spent 50 days here in Haiti since the earthquake.  Mimi Batin is a trauma subspecialty trained orthopedist who shares the ER work with Frank in his work in San Luis Obispo, California.  She has been here before not long after the earthquake.  She is very enthusiastic.
The students and Cam wanted to go to Petionville to check out the souvenirs and paintings.  Jeannie and I found one that we liked a lot. As we were leaving we had an interaction with a group of youth who were asking for money for "protecting" our vehicle while we were looking at paintings.  It was a somewhat threatening situation and required a hasty departure.

Oct 17
The clinic was much smaller than usual due to the National holiday in remembrance of the assassination of Haiti’s first president/emperor, Dessalines.  We were finished before 2 pm.  That gave us an opportunity to all go to Franz’ orphanage.  The kids put on a great program singing and dancing. We took a lot of gifts and clothes and candy.  Cameron really enjoyed having fun with the kids.  Josh and Andy did also.  The students and Cam and Chris all wanted to go to Leogane, the epicenter of the earthquake so we spent the rest of the day driving there and looking around and then coming back. Still no internet

Thursday, November 10, 2011

Haiti Stands Up

Oct 10
Freddy left very early for the airport. ZJ also left for the week to get some medical issues checked and treated in Miami. I went for my morning run and felt really good when I started. I was pretty sure I
Master Surgeon Juan Bibiloni
would have a good time for the run and I was able to do it more than a minute faster than my last run. (28’ 50”) I’m getting close to my best time ever. Ed and I started the big Monday clinic. The Puerto Rican team arrived mid morning. They immediately dove in and started working. Juan Bibiloni and Humberto Guzman are the two orthopedists leading the team. Dr Ramos is their anesthesiologist. They have 2 OR nurses/techs also, Ulisses and Julia. Juan is a subspecialist in both reconstruction and orthopedic oncology and teaches at the University of Puerto Rico orthopedic teaching program. He did his oncology training in Boston with Dr Mankin and also at the Instituto Ritzoli in Bologna, Italy. His joint reconstruction fellowship was also in Boston. Humberto did a fellowship in children’s orthopedics in San Diego, the same program where Scott did his fellowship. Humberto finished fairly recently and has never met Scott. They have both been very involved here in Haiti. They have been instrumental in starting a foundation called “Haiti Se Pone de Pie.”(Haiti stands up) or (Haiti gets back on its Feet). The emphasis is on providing prostheses for the many amputee victims of the earthquake. Humberto and others from Puerto Rico did many amputations starting three days after theearthquake. They brought an entire truck over from Puerto Rico on the Ferry from Mayaguez to the Dominican Republic. They made it as far as Jimani at the border and found a facility with many patients needing care (amputations, external fixators and fasciotomies for compartment syndrome.) Their experience was wrenching but also gratifying. They had an incredible experience in the aftermath of their week of nearlynonstop, heroic efforts to help injured Haitians. Several pictures were posted on Facebook by team members that were totally misinterpreted by some members of the press in not only Puerto Rico but also in the national media in the US. Such a negative light was shown on them all that they were even brought under threat of medical license revocation in Puerto Rico. They paid several thousand dollars to take out a full page ad in the Puerto Rican news media explaining the misinterpretation of the pictures. It clearly shows how the popular media can take information and without proper analysis, use it in an inflammatory manner that can discredit highly trained and qualified specialists who are donating their valuable skills to save peoples lives in a disaster situation. Of course, the motivation is to attract more viewers and readers to “sell” their product and improve the “bottom line.”

Two more orthopedists will be arriving on Wednesday. Juan and
Humberto started evaluating patients as if they were at home. I am
really impressed with them. Ed did a case of tibial 8 plates and I
did a couple of small cases. Dr Bibiloni then started the case of the
large popliteal cyst with the peroneal nerve palsy. He spent between
2 and 3 hours very carefully dissecting out the lesion and identifying
the peroneal nerve and the neurovascular bundle. The peroneal nerve
was located between two large lobes of the cyst and was flattened so
that it looked almost like a ribbon. Clearly it had been under
pressure for quite some time. The neurovascular bundle was displaced
significantly toward the medial side of the knee by the cyst. Juan is
certainly a skilled surgeon. He made what for many orthopedists would
be a sphincter puckering experience look fairly straightforward.
The cases as well as the clinic were all finished by about 5 pm. It
was a rainy day all day long so I chauffered the team to the Auberge
in the “new” tap tap to be. I also took JJ and Roosevelt home so they
wouldn’t have to find a taptap in the rain. The traffic was awful out
on the main street in Carrefour and what should have been a ten minute
event took more than half an hour. The evening was still young so
Jeannie and I took Ed and the two medical students to the Auberge for
pizza. The Puerto Rico team was just sitting down so we joined them
and had a great time talking and getting to know each other.

Oct 11
We had a good list of cases for today. Unfortunately, we had to
cancel a child because of a cold and two other patients didn’t come
including the patient with severe Blounts for a TSF. We were able to
call one of the patients scheduled for tomorrow and he agreed to come
in. It turned out to be a good day after all. Tomorrow the
foot/ankle specialist, Dr Perez, arrives as well as the sports
medicine specialist, Dr Mayol. Today was Ed’s last day. Jeannie made
dinner and we invited him to join us. We had a good time talking for
nearly 3 hours. Ed and I went to college together and he was one of
the more colorful students. He was involved in several pranks that
eventually led to him being asked to leave. The experience didn’t
embitter him and he finished premed at another school and ultimately
did orthopedics at Loma Linda. During residency we did socialize a
bit and have stayed in contact since, mostly through the Neufeld
Society of which he was a founder and our common interest in
supporting the orthopedic program at Loma Linda. Jeannie and I really
appreciate his support of the work here. Many of the orthopedists
that I know well and had hoped would be willing to donate a week of
their time during this year have not been able to come. Ed has come
TWICE and that puts him in a special category for us. He has been
extremely generous also with helping with resupply of implants. He
brought the 7.0 cannulated screws that he tested and then ordered and
payed for from the company in India. We now have a full set as well
as replacements that should last for quite a long time. The Zimmer
7.0 screws are much better than the Synthes 6.5 screws because the
guide wire used with them is much beefier and doesn’t deflect like the
thin one for the 6.5 Synthes one. The screws can be placed more
accurately especially in the hip.

Oct 12
Jeannie and I got up early and bid farewell to Ed. The clinic was big
as usual. Having two more orthopedists to help when they weren’t in
the OR helped us finish before 4 pm. An unexpected case came in for
Dr Perez, the foot specialist who arrived around 10 am along with Dr
Mayol, the shoulder specialist. Another tumor case came in to the
clinic. The lady has had a lesion growing in her groin for several
weeks. It is large and has eroded through the skin. Dr Bibiloni felt
it was something that he could remove. I would have never attempted
something like that. It was so intimately related to the
neurovascular bundle. We arranged for her to get blood ready and to
come back on Friday for surgery. We eventually did seven cases and
finished before 8 pm. Dr Bibiloni runs 2 or 3 times a week as well,
so we arranged to run together early tomorrow morning. Our son,
Cameron, has been having intermittent symptoms of pain in his ankle
that sound somewhat like a loose body. He would like to be evaluated
by Dr Perez to see if an arthroscopy might help him. He is going to
try to make arrangements to come here with a professional
photographer. He lives in Cabarete in the Dominican Republic and
could drive. I encouraged him to fly. The challenge of finding his
way across Port au Prince if he drives would be daunting, especially
never having been in the country before. The digital machine for the
ortho clinic has finally been repaired enough to be usable again. It
definitely makes the clinic go more smoothly.

Oct 13
Cam’s early email said he had decided to fly and would be in this
afternoon. Juan and I ran my route and had a good time. We stopped a
couple of times to enjoy the view from high above the hospital. There
were 12 cases on the surgery schedule today. There were three
arthroscopy cases including the Bankhart repair of the shoulder.
There was no clinic so we could use all three rooms for at least part
of the day. The fifth orthopedic member of the team, Artemio Torres,
arrived this morning from New York. He is also sportsmedicine and
does mostly knees. Five of the cases needed C-arm so we still didn’t
get done until after 7 pm. I did a talectomy case with Humberto and
that was a first for him. Dr Mayol is an extremely skilled surgeon.
He set up the shoulder arthroscopy as if he were operating in his home
hospital. Dr Torres assisted him. He made what for me would be a
challenging case look very simple. He put in three very accurately
placed anchors to repair the Bankhart lesion and the shoulder was very
stable. He has a great sense of humor as well. All of these guys,
except the serious one, Dr Bibiloni, are constantly “putting each
other down.” They make snide little comments about how slow one is
compared to the other. It is all in fun and they have a great time.
They obviously respect each other very much. Cameron arrived with
Chris Black, the professional photographer this afternoon. He had the
sportsmed guys and Dr Perez, the foot and ankle specialist, examine
him and the ultimate conclusion was that surgery wouldn’t be likely to
help him. Of course, the ankle isn’t bothering him right now. Chris
is an extreme water sports photographer. He mainly shoots surfing and
kiteboarding. He is from England. He has a lot of connections in the
movie industry. He and Cameron have planned to come here to get a lot
of photos of the project and then combine them with photos of a kiting
trip on the north of Haiti. They are sure that they can make a
several page spread in the kiting magazines that will help get media
exposure for HAITI: TOGETHER WE MOVE and the project here. I talked
with Chris about the possibility of getting national media exposure in
England for the book. He thinks there is a good possibility. With
the popularity of ‘reality shows’, he is going to work on getting one
done here to help publicize the opportunity and needs.