Tuesday, August 21, 2012

Work at HAH and the Orphanages Continue

Aug 8

The Wednesday clinic looked huge.  Of course, the CURE clubfoot clinic helped fill the hallway.  We didn’t need to see any of those patients but it meant we had one less room in which to evaluate our general ortho patients.  Eric, Randy and Francel began seeing patients in the available rooms/hallway.  I took advantage of the opportunity to do some emailing.  I am hoping to arrange for Wilfredo Perez to come for a few days from the Adventist hospital in Puerto Rico to get the anesthesia machines all working properly again.  Hopefully he will be able to check and diagnose the problem with the Digital xray machine also.  I then met with the new medical director of the hospital, Dr Franck Geneous.  His medical training and masters degree in public health were done here in Haiti.  He has worked in several different countries for UNICEF, most recently here in Haiti.  He expressed deep appreciation to us for coming and working at HAH.  The board and administration have a strong desire for HAH to be a flagship hospital with orthopedic surgery the principal focus.  We discussed the importance of improving leadership in the area of surgical services.  The area of maintenance, especially biomedical technology, was also addressed.  The board recently voted to change leadership in the operating room and add additional responsibility for all perioperative care.  Marie Paul will have those responsibilities.  Some weak efforts have been made to have a person with some training in Biomedical Tech available to address problems in the hospital.  We talked about partnering with Bella Vista Hospital in Puerto Rico.  Wilfredo Perez spent 3 days with us last year mainly checking and restoring the anesthesia machines in all 3 rooms.  He is willing to participate in a training program and assist in developing a department.  The crucial items from an orthopedic standpoint are the anesthesia machines, the corresponding monitors, the C-arm image intensifier, the digital xray machine and the arthroscopy equipment.  The development of adequate laboratory facilities has been placed on hold.  There are plans to refocus on that important area beginning next week.

Daniel Williams is a new member of the administrative team at HAH.  He attended the meeting with Dr Geneous.  He came to the hospital via Johaniter but is now salaried by the hospital.  He is an experienced administrator from Grenada.  I was very impressed with his ability to quickly grasp the importance of the areas that need to be emphasized for the orthopedic program to flourish.  One idea of his is to develop a waste treatment incinerating capability.  It could serve the needs of the hospital as well as provide service to other companies.  It could be a revenue center for the hospital.

I explained to both of them the importance of continuing the orthopedic program for indigents.  Both Dr Nelson and I, as well as virtually all of the members of the orthopedic teams will continue to be involved as long as the program emphasizes providing care for the poor.  We discussed at length the challenges of covering the hospital costs.  Certainly a system needs to be developed that can adequately assess the financial resources of patients and their families.  Those that have resources should help cover the costs involved.  I also explained the money raising for the Haiti Indigent Patient Fund.  Both Dr Geneous and Daniel are very interested in cooperating to finish the project and start using the funds.  Dr Geneous put me in contact with Monty Jacobs at Florida Hospital.  Their foundation may be able to supply some matching funds.  They can supply us with financial expertise to develop the endowment and maximize the interest.

I felt the meeting was very worthwhile.  It will be interesting to see if decisions and actions will happen sooner rather than later.
Both bone forearm fracture repair

We had several smaller cases to do as well.  The last case was a patient with fractures both bones of the forearm.  I assisted Randy and he did a slick job.

All of the team members wanted to go out tonight so we loaded up and headed to the Hotel Oluffson.  The traffic was really bad.  It took more than an hour to get there.  It can take as little as 15 minutes.  We all enjoyed the evening.  The building is an old Victorian that has survived the disasters that have afflicted Haiti.  It makes me think of the movie “Casablanca.”  The traffic home was almost nonexistent and it took only 20 minutes.

9 August 2012

We had 13 cases on the board for today.  A couple didn’t show and we had to cancel another two.  We wound up doing 9 of them.  I started with a little boy with a spastic equinovarus foot.  I did a TAL and fractional lengthening of the Post Tibialis.  Francel and Eric planned to start with a child with genu varum and put in 8 plates.  The C-arm wouldn’t boot up so the patient had to be awakened from anesthesia.  I looked at the machine but it wasn’t giving an error code on the screen so I was stumped.  We carried on with other cases including 2 knee arthroscopies that Eric did with Francel.  The first had a classic bucket handle tear of the medial meniscus.  It was a great teaching case.  The second arthroscopy went well also.  Meanwhile, Samuel had managed to get the C-arm working.  Apparently, it was the same problem that had happened when Scott was here in June.  He had given Samuel a picture of the back of the monitor with exactly what to do.  It worked!  Francel proceeded with the 8 plate case.

All of the cases went well.  We were all pretty tired so just snacked for dinner and went to bed early.

10 Aug

The schedule was lighter today.  The clinics on Fridays are commonly smaller.  Eric went with Mary and Katie to the orphanage project so Francel, Randy and I made rounds then dove into the clinic.  We finished at 10 am and then had 2 cases in the OR.  The ORs were occupied with Gyn and general surgery cases to start the day.  Randy did a leg split thickness skin graft.   Francel and I did another knee arthroscopy.  It was great to see that Francel has made progress with his arthroscopic skill.  It took over an hour for him to get good visualization, inspect all of the intraarticular structures and then deal with the torn lateral meniscus and the unstable femoral chondromalacia.  If he had regular anesthesia, he could schedule a lot of cases and improve a lot faster.

 We all grabbed some lunch then got on the small bus that Emmanuel had arranged.  Our outing to the mountains was a lot of fun.   Four of the translators and Franz, the xray tech, came along.  Everybody had a good time.  We shopped for art in Fermathe.  I found a couple of really nice rock carvings.  Jeannie really likes the bust of a young Haitian lady.  My favorite, by far, is a very featured somewhat disfigured face of a Haitian man.  It tells me so much about what Haitians have experienced – the poverty, violence, pain and loss.

We spent another hour or more at Ft Jacques.  A nice young man gave us a tour.  He was very knowledgeable.  We enjoyed a watermelon in the parking lot also.  We hustled back down the mountain to Delmas for our dinner appointment with the Brice family.  This was either the 4th or 5th dinner they have made for us.  His daughter had severe bowlegs from Blounts disease.  We put on bilateral Taylor Spatial frames and corrected her.  She and her family are so grateful.  Her father told me on one of the times we went to her house for dinner that he would give me Haiti if he could.  They had the usual tremendous spread.  We all filled ourselves totally.

Returning to the hospital we encountered traffic at least as bad as we endured on Wednesday on our way to the Oluffsson hotel.  The 30 minute trip took an hour and a half.

11 August 2012

Our bus was scheduled to leave for the Dominican Republic at 8 am.  We got up at 5 so we could leave by 6.  Ericksons and Katie had a 10 am flight so we all went together.  The bus station isn’t far from the airport.  They filled us in on their eventful day yesterday.  The projects at Mary Lou’s orphanage were all successfully completed.

1.  New steps up the very steep hill from the street
2.  Dedicated clean sweet water supply with large storage tank including tap in the kitchen area
3.  Improved play area
4.  Improved cooking facility
5.  supply of rice and beans that should last a month or more
 6.  Porcelain toilet

They were so excited about the whole project.  When the water was turned on late in the afternoon they had a celebration and threw buckets of water over all of the kids.  It is an unbelievably satisfying experience to provide poor Haitians with these things that we take so for granted in the US.  It really brings one a level of personal happiness that cannot be obtained in virtually any other way.

Thursday, August 16, 2012

An Article from the NY Times on Haiti

Years After Haiti Quake, Safe Housing Is a Dream for Many

Today, the New York Times published the above article about the current state of housing for those displaced by the earthquake.  It is worth reading and sharing to continue to get word out about the tremendous needs in Haiti. 

Tuesday, August 14, 2012

The Dietrichs Return to Haiti

Another team embarked on a week long trip to Hopital Adventiste d'Haiti from August 6-10. Team members came from Utah, Minnesota, Wisconsin, Florida, Illinois and the Dominican Republic to Haiti Adventist Hospital on August 5, 2012.  The orthopedic medical team goals were evaluating and treating patients with orthopedic conditions and continue with advanced orthopedic training for Dr Francel Alexis.

Team Members
Orthopedic Surgeons
        Eric Erickson MD
        Randolph Knight MD
        Terry Dietrich MD

Anesthesia Providers
        Jacob Rick CRNA
        Karen Stagg CRNA

Nursing/OR specialists
         Jeannie Dietrich RN
         Lucia Hernandez RN
         Elinore Shank RN
         Taylor Drake

Orphanage program/ Support/ Photography
         Mary Erickson
         Katie Kaminsky
         Pam Knight

5 Aug
Team members found the assigned hospital accommodations.  The small building built by Project Hope next to the rehabilitation building has been equipped with air conditioning and 6 bunk beds.  There is a single bathroom in the building.  Other bathrooms are available in the nearby rehab building as well as in the hospital.  The “new wing” of the hospital that formerly accommodated the long term volunteers has been nicely remodeled and is nearly ready to be opened for patient care.  The mezzanine area formerly used as sleeping space for short term volunteers has been divided into four offices and is used for classes and training and office space.  Long term volunteers now are occupying the renovated duplexes.  A chain link fence with locking gate separates those two buildings from the remainder of the campus.  The only remaining long term volunteer from our year here is Marc.  She coordinates the different training programs.   Two long term volunteers from Germany are involved in the rehab program.  Jeannie and I arranged for the whole team to have pizza and salads at the Auberge.  Eric and I cooled off in the pool for a few minutes when I took them to check in.  I also ordered the food ahead of time so we wouldn’t have such a long wait.  It worked out great.  Emmanuel and JJ came with us to eat at the hotel.  It is great to see them again.

6 Aug
Dr Alexis met us after the morning worship/orientation and we began the workday.  Only 2 orthopedic patients were in the hospital.  One is an elderly patient with a pressure ulcer on her hip.  The other had a femoral neck fracture  and Dr Alexis did a hemiarthroplasty.  Francel had scheduled several smaller cases for a bit later so we all started seeing patients in the clinic.  It was a big clinic and we saw lots of good cases.  Both Eric and Randy had no problem evaluating and making decisions on patients.  We used both of our regular rooms for seeing patients as well as the xray room since the digital machine isn’t working.  Since there are four of us, I got a fan and some chairs and evaluated quite a few patients in the hallway.  We must have seen nearly 10 patients with frames of all types.  They were mainly done by superspecialists like John Herzenberg, Dror Paley and , of course, Scott Nelson in the last several months.   All of the patients with frames were doing very well.  We saw the usual mix of children with bowlegs, knockknees, clubfeet and adults with fractures both new and old.  There were several cases of infections as well, some of them post op.  The surgical cases were hardware removals and the decubitus ulcer debridement with wound vac.  Mary and Katie returned from the orphanage project very excited.  I’ll include Mary’s comments.

Jeannie and others exchanged their OR garb for chefs hats and whipped up a tasty spaghetti dinner for the whole team.

7 Aug
Francel and I did a recurrent clubfoot case to start the day. He seemed more self assured doing the case than I have seen in the past.  That is a very good sign.

Francel, Randy and I then did a 14 year old boy with bilateral Blounts.  I was impressed with Francel’s initiative in doing the case.  He was a fairly small child and we couldn’t do both sides simultaneously.  Francel did a very careful and thorough job on both sides.  The osteotomies went well.  We will have to get good orthogonal xrays and then measure the deformity as well as the mounting parameters for both frames then enter all the data on the internet.  I never cease to be amazed that this type of complex corrective surgery is being done on a regular basis here in Haiti.  The cost would be prohibitive if the frames would have to be purchased.



Eric and Francel do a shoulder arthroscopy
 Eric did a shoulder arthroscopy on a young man with recurrent shoulder dislocation.  The patient told me it had dislocated “a hundred times.”  Eric wasn’t intimidated in the least by our minimalist arthroscopy equipment and did his usual impressively efficient setup.  He found a large Hill-Sachs lesion and did the corresponding repair.  He made it look easy.  He is a good teacher and spent time explaining things to Francel.  We have at least two patients with knees that need to be scoped.  Francel can benefit a lot from Eric’s expertise and knowledge. We had a bilateral recurrent clubfoot case that Francel had scheduled for posterior medial release but I didn’t think we should do it.  He hadn’t done any preop casting and I was sure that the patient would need several cast changes with manipulations post op.  There won’t be anesthesia available for that.  We manipulated and casted her.  Francel will continue to cast in the clinic.  The feet are so rigid they almost seem like arthrogryposis but the child has no other joints involved.

Eric took off some frames today as well.  Our last case was a young man with an infected femur fracture.  He had an antibiotic coated SIGN nail that was put in last year.  He had 3 locking screws and the nail that all came out fairly easily.  We excised the fistulas and removed nonviable bone as well as infected tissue from the canal.  The tobramycin methacrylate beads were placed in and around the canal.  If the infection can be cleared up, he will need a bone graft and IM rodding again.

Jeannie made her famous vegeburgers tonight so we had a real feast.

Friday, June 15, 2012

Tim Gerke's Trip Report June 2012

Haiti Trip Report, June 2012

          After returning from my fourth trip to Haiti since the earthquake of 2010, I am again reminded how truly blessed and fortunate I am. But not simply blessed just because I live a life of relative luxury compared to the millions of poor Haitians who live in constant poverty. Not just because I live in a home with four walls and a roof, nor that I eat three nutritious meals each day of my choosing, nor because I actually have to make a decision as to which pair of shoes to wear on a given day or even that I have straight legs upon which to walk. More importantly I am reminded how blessed I am to know and be friends with the Haitian people. To hear the genuine laughs and see the bright smiles of the selfless translators who work at the hospital. Men like Roosevelt, JJ, Emanuel, and Joseph who greet you with a smile and embrace you like family. To spend a week interacting with dozens if not hundreds of orphaned children who have never known anything but poverty yet are somehow filled with joy and happiness. To hear them sing praise songs after church and hear them giggle uncontrollably as you tickle them. To work with caring people like Mary Lou and Dorvil who willingly choose to live in poverty with these orphaned children in an effort to give them a better life. And to have a poor Haitian pray for you and your family that I may be blessed and cared for by God. Yet another trip to Haiti where I can’t help but feel that I benefited more than those I went to help.
I set off to Haiti with an amazing group of people. From Portland I was joined by my ICU RN co-worker and friend Leah Herr along with her husband Andrew. This was their first mission experience and first time to Haiti, they were both invaluable members to our team. Dr. Scott Nelson, who was one of the first doctors to arrive in Haiti after the earthquake and who is largely responsible for the work now being done at Haiti Adventist Hospital, joined from Loma Linda University along with third year ortho resident Dr. Alan Sull. Dr. Ian Alexander of the Foot and Ankle Society came from Ohio State while Jeff Nepple, a fifth year ortho resident, made the trip from St Louis. And no Dr. Nelson lead trip would be complete without Maria and Lucia, an anesthesiologist and OR nurse from the Dominican Republic. Their energy carried us through the week and their fine cooking filled our empty bellies.

         With each trip I take to Haiti I find myself spending more and more time working with the local orphan children outside the hospital. Earlier this year, my wife and I decided to create an outreach program in an attempt to provide orphans in Haiti with a better life. In January we started the Margaret Friar Haiti Children’s Fund to provide life’s basic needs to Haiti’s orphans. With the inclusion of Andrew on this trip who is not in the medical field, we were able to coordinate a few projects outside the hospital to rebuild and improve a few local orphanages. This latest trip really was two full and separate trips all in one. We had a full medical trip at the hospital performing over 25 surgeries and seeing hundreds in the clinic while at the same time other team members were at various orphanages tending to and overseeing a number of building projects. I was able to split my time between both projects and had a full and enriching experience.

The hospital was full each morning with patients young and old waiting for their turn to be seen in the clinic. Taylor Spatial Frames and external fixation devices were on full display, some still attached to crooked legs as their deformities were still being corrected while others were attached to now straight legs of similar length to their partner. Most patients who have leg deformity correction at the hospital go home after a few short days and manage their new hardware at home. Many external frames, such as the complex Taylor Spatial Frame, are used to slowly lengthen short bones or straighten warped ones. These frames have moveable struts which the patients are taught to adjust over a period of months to correct their individual deformities. The patients come back to the clinic for regular check-ups but otherwise are independent in the management of the devices used to correct their deformities. On Wednesdays the hospital also holds a large clubfoot clinic. Those patients whose club foot correction can be managed without surgery come in regularly for progressive cast changes to aid with the correction of their feet. Others come for check-ups to monitor the progress and recovery from surgery. Several Haitians such as Roosevelt have been trained to aid in the cast changes.
On large clinic days it takes the entire day to see all the patients, often Dr. Nelson and the team are still seeing patients until dinner. The clinic also provides the opportunity to see several special sides to the Haitian people. Patients and families are always very kind and thankful for the services provided to them. They begin to arrive at the clinic by 6am and wait patiently for their turn, sometimes for the entire day. Often times they are wearing their Sunday best with girls arriving in cute dresses with their hair in braids with pretty bows. The Haitian people, while living in a dusty and unclean environment, are themselves were clean and hygienic. 

       During our week long stay we performed close to 30 surgeries, most on indigent patients. The hospital continues to provide high quality medical care to those in need. Dr. Francel Alexis is still ever present caring for the day to day needs of the orthopedic patients and continually scheduling patients for visiting teams. The Haitian women who make up the nursing staff continue to grow as nurses and provide ever improving patient care. On prior trips Summer and I spent the majority of our time teaching these women the basics of recovery nursing and their knowledge and understanding has improved greatly. Most surgery days a Haitian nurse is staffed in the recovery room and they are now nearly independent in recovery and caring for these post surgical patients. We often kept the nursing staff busy shuffling the patient bed allocation process as we had the entire in-patient unit full of post-operative patients.

          It is awe inspiring to see the miraculous changes created by Dr. Nelson in children with drastic orthopedic deformities. Children with clubfeet, bowlegs, knock-knees, windswept deformities all benefited from the gifted hands of Dr. Nelson and the team of orthopedists during this trip. This trip was a good combination of patients who suffered from both acute and chronic conditions. We even treated an elderly 87 year old man who was in a late night car accident. He had numerous lacerations requiring sutures and a left tibia fracture. We put a SIGN Nail to fix his fractured tibia and admitted him overnight. While we did some fascinating surgeries and cases two really stood out for me.
The first was a 14 year old girl named Kati who had fracture dislocation of her spine. In addition to being paraplegic she was hardly able to sit up due to the severe angulation and pain in her spine. Kati’s father died several years ago and then her mother was killed in the 2010 earthquake. She was living with some relatives in a house that had been condemned due to earthquake damage when a wall fell on her last August. Her friend was also in the house and suffered an amputation of her leg. When her uncle found out that Kati was permanently paralyzed, he abandoned her at a local hospital. An operation had been performed by a visiting doctor but this had only made the situation worse. Fortunately some workers at a spinal cord rehab unit adopted her. A recommendation had been made for her to go to the United States to have a surgery to straighten her spine, but they were grateful to hear that the same quality operation could be performed right here at Haiti Adventist Hospital.
Due to the severity of her deformity, the previous operation and the time since injury, the spine straightening operation was somewhat of a formidable task. Her preexisting paraplegia dramatically reduced the stress of the operation, and Lucia’s prayers were appreciated by all as Dr. Nelson carefully mobilized the vena cava and aorta around the front of the spine in order to completely straighten her back. 12 screws were placed along with two parallel rods to correct the deformity. While she will always be paraplegic we hope this correction will provide the rest of her life with some comfort and relief to sit up straight and lay flat at night. It was an incredible transformation.
The second operation was on a young boy named Wilner. He lives several hours away and his trip to the hospital was coordinated from the states by Karen Fields. He arrived with a drastic deformity of both legs, although the left leg has vastly more disfigured. He suffered from a windswept deformity of his legs, his leg bones are warped in a “C” pattern on both sides and he looks like his legs are blowing in the wind. Dr. Nelson performed the operation and applied some external fixation to keep his now straight legs in alignment. He will soon be running and playing with straight legs like all his friends back home.

           Sabbath evening Scott led our entire group for a walk up the hills behind the hospital. While Haiti is indeed very dirty, overcrowded, and still in disrepair from the earthquake, there are still pockets of beauty. This hike was up in the green hills with very pretty sunset vistas and fresh air blowing up the hillside. The view was spectacular. From the top you were removed from the noise, the smell, the taste of poverty and witness to the unveiled beauty of this country. Corn was growing on the hillside, the city was far below, the ocean and port beyond, all mixed with the colors of the sunset. As we continued, the hum of thousands of Creole voices could be heard so distinctly from the tents and shacks lining the hills that, although we were on the other side of a valley, it was as though we could speak back and be heard. Like a swarm of bees all around us, the gentle hum of their voices guided us onward down the valley. We knew that in each of those shacks was a family, or, more likely, families, living daily life in 100 square feet of cinder blocks, cardboard, and tarp. They were likely preparing for another evening of maybe food, maybe bed, maybe neither, and no lights. Viewing it from above was surreal. Suddenly, as if to remind us, "this is Haiti," a young girl, not older than 12, walked up the same steep hill it took us nearly 30 long, gasping minutes to scale, carrying a bed frame on her head...The girl, the bed frame, the backdrop, the sunset, "this is Haiti."

         Aside from a full and satisfying week in the hospital and operating room our trip was also enriched by helping dozens, if not hundreds of orphaned children. While Leah and I spent several full days helping with these efforts along with several trips between surgeries, I must thank and credit Andrew Herr and Jonathan Euler for their tireless efforts coordinating these projects. We visited six local orphanages during our trip visiting the children, bringing them homemade nutrition packs of dried fruit and nuts, and assessing their needs. We also chose two orphanages, Mary Lou and Dorvil, to invest some extra time to improve their living conditions.

            We spent most of the Sabbath visiting these orphanages. Our first visit was to Frantz's orphanage. He has 54 children living in a space about 1,500 sq feet. There are four wooden bunkhouses with bunk beds. The place was a little unkempt, dirty and smelly, which was sad to see. Summer and I have visited this orphanage a half a dozen times and during past visits this orphanage had always been clean. But this visit the conditions looked worse than before. I got the feeling the children were almost kept in this condition to incite pity for them and thus generate more monetary donations. We had a long talk with them that we have been helping them financially to give these children a better life, not the unacceptable conditions we saw. We informed that our aid would temporally cease until we make a few surprise visits to inspect their progress. Our aid bears the responsibility that it will be used to help propel their orphanage into progress and that the orphanages are expected to use it to improve the lives and living conditions for the kids.

          The kids themselves were happy to see us, taking pictures with the cameras and showing each other. We gave them all nutrition packs and they spent about 30 minutes enjoying them. Most kids only each rice, beans and cornmeal in Haiti so these nutrition packs (filled with walnuts, almonds, peanuts, sunflower seeds, dried fruit and a few jelly beans) are sometimes their only source of the vitamins and minerals they need for healthy bone growth and development. We also gave out some clothes and shoes to the kids that were donated from our friends Becky and Markus from Germany.
Our next visit was to Mr. Wilson's orphanage. There about 25 kids here ranging from age 3 to 16. They took us to their rooftop play area and we had a great time playing with all the children. Mr. Wilson runs a good orphanage; the kids are all well cared for and clean. They were just getting back from church and they all attend school. Mr. Wilson was low on food and his kids have only been fed twice a day while waiting for more food arrived. We fixed that problem this week. More toothbrushes, clothes, and shoes were handed out. Thanks to Bill and Sue Shawler (who went to Haiti with me in January) the kids now all have mattresses. The 12 mattresses we bought are all being used!

         Our final stop was Dorvil's orphanage. I'd had not been here so it was great to meet him and the kids there. Dorvil has 17 kids from age 4 to 16. They were all at church when we arrived so were toured the area while waiting. They have one wooden building for girls and a tent for boys. The girls all have beds with mattresses. They sleep 2 or 3 girls per bed. It is a nice space and adequate for them. The boys share a large tent which was close to 120 degrees inside. Outside it is likely pushing 90 degrees but the heat of the tent took my breath away upon entering. There was little ventilation and only an uneven dirt floor. There were enough bunk beds so that each bed only has to hold 2 boys. The only problem is that six of the bunks didn’t have mattresses. Imagine a grid of metal rebar spaced about 6 inches apart and just one (yes that's only 1) layer of cardboard or blankets for padding. That is what these boys slept on. Mattresses are $30 each so we bought 6 of them for the boys. Jonathan spent several minutes trying to talk Dorvil into planting some veggies around the buildings. They have enough room to grow some corn, tomatoes and peppers, maybe enough room to have excess to sell at the market.

          Many Haitians are so used to getting support and handouts that they often don't utilize the full potential of their space to help themselves. We are trying to assist them but also push them to find ways to provide for themselves. Dorvil also has two broken sewing machines we are trying to get fixed so he can make some money mending clothes, again we'll have to keep trying because they were not too keen on doing the work. But the more they can do for themselves, the more independent they can become, the better they will be able to provide for the kids.

            Our main project this week was to work with Mary Lou to improve her orphanage and try to give her kids a better life. Her orphanage cares for 16 kids, a few more girls than boys. From our very first visit they were happy, energetic, and full of spunk. When we first arrived to assess their needs and develop a plan for the building project we were overcome by flying kids. The little ones jumped off chairs and tables at us to and held on for dear life. We had 4 or 5 kids hanging from us at times. We returned the favor by tickling them into submission.

            Mary Lou’s orphanage often gets overlooked and has received the least outside assistance of any of the six places we visited. She lives up in the hills in a small cinderblock home. The building is 12 feet wide by 30 feet long and is almost carved into the hillside. It is a several hundred foot climb up steep slopes to reach their home. The area in front is steep with loose rocks and there is only a 2 foot gap between the back side of the house and a vertical wall of the hill. The only place to play is on the roof however there are no walls for safety and rebar is sticking out everywhere. Our main project for the week was to build a wall around the roof to give the kids a safe area to play. Mary Lou’s kitchen was tucked into the small two foot gap between the building and the hillside, it was adjacent to the toilet. We decided to incorporate an outdoor kitchen into the roof project giving her a clear, sanitary, and open place to cook for the children. We also built several small items like new stairs to access the roof and 2 new bunks beds with mattresses for the kids.

            Jonathan and Andrew oversaw the building projects along with their Haitian crew chief Gregory. Together they made numerous trips into town to purchase all the raw material: 230 cinderblocks, 1500 pounds of bagged dry cement, a truckload sand, lumber, tin, bunks and mattresses. Jonathan’s truck broke down twice during the supply runs, both times fully loaded with heavy supplies. Eventually we had to hire taptaps to get the materials to the job site. A few hard working Haitian men were hired to haul all the material up the hill to the orphanage. They carried 100 pound cement bags up two at a time and hauled cinderblocks three high on their heads up the slope. Jonathan hired a local masonry crew to construct the wall, it took three men two days to complete the project. On the second day, after the job site was cleaned, a spontaneous soccer game broke out on the roof with a ball Andrew brought for the kids. What an incredible experience; these children never had a flat area to play and now they have a safe, sunny and relatively spacious area to run and just be kids.
Jonathan and Andrew designed and supervised the building of the kitchen so it has a view of the ocean, ventilation for the charcoal stove smoke, fresh air, and a nice sloped overhanging tin roof to keep it dry and protected. The new kitchen is about 12 feet square with a 3 foot overhang to keep the area dry. This area will also provide some shade during the hot summer days to eat and work on homework. We also built in some cement stairs into the very steep hillside to make it easier to get around. We hung some chalkboards for the kids to play with and practice their school work. We also hung a new tarp to give them some shade and bought them bunk beds and mattresses. Our next project will be to build some terraced garden beds in front so they can grow their own food and have something to sell at the markets.

Mary Lou herself was amazing to work with. Almost every night our team would note how we all felt thankful to have “chosen” to spend the week working with Mary Lou and her kids. She'd make us lunch every day, which we politely ate, feeling guilty the whole time. She'd later specifically say how much she appreciated us sitting down to eat with them. The image that will stay with us longer, however, is her carrying supplies up that steep hill because she realized every bit of help she could give towards the construction project would result in more food and help for the kids. That demonstration of love and sacrifice really solidified to us that this orphanage was the right place to be focusing our time that week. By week’s end it was clear that our personal thoughts of rightly choosing to work with Mary Lou had been superseded by overwhelming gratitude that God had guided us there to enrich not only the lives of Mary Lou and her children but more importantly our own.

On our last day, Leah, Andrew and Jonathan spent the day purchasing and delivering food to four orphanages. An orphan can be fed and cared for in Haiti for less than a dollar a day. We spent about $1,000 the final day buying over 2,600 pounds of food for the orphans. This should last each place over a month until Terry and Jeannie can buy more food in August. When we first arrived, all the orphanages were lacking sufficient amounts of food to feed their kids. One was even relying on old Canadian army rations to eat. One of our favorite memories was delivering food to Dorvil’s orphanage. The children had been instructed to sit on a bench while we delivered the food. They inched closer and closer to the bench’s edge as they excitedly watched us arrive. When the mother of the orphanage went around the corner all the kids leapt from the bench and ran happily up the hill toward us. They helped carry the food down and placed it into neat stacks outside their kitchen. The stacked bags of rice were taller than some of the small children. It creates both sadness and joy to see how exuberant a child can be to realize there will be food to eat this month. I’ll never forget the kids dancing around the piles of food, hoisting cans of tomatoes above their head like super bowl trophies.
It was another great trip, I am very thankful to have traveled with such a great group of people. We are already planning our next visit; hopefully it will not be too far into the near future.

Thursday, June 7, 2012

Day 6 - Finishing Touches

Today, Wednesday, was another busy day, we split our time again with Leah and I working at the hospital and Andrew and Jonathan at the orphanage. We did 7 cases today, we ran 2 rooms again and I was able to run the anesthesia for a few cases. We did a surgery on Wilner today, he had a windswept deformity of his legs, with the left being more distorted. We were able to straighten his legs and he should be able to walk normal again soon. The pictures of the correction are pretty impressive, check out my facebook for them. We also did several cases where we installed external fixators for various reasons. The hospital provided a recovery room nurses so Leah was able to float around help in both rooms and check in on the recovering patients. She is getting pretty good with the C-arm. I was able to put in a few more spinal blocks and even intubated one patient (Wilner from above).

The guys finished at the orphanage today. The wall is complete and the tin roof has been installed over the outdoor kitchen. We also built in some stairs to their very steep hillside to make it easier to get around. They hung some chalkboards for the kids to play with and practice their school work. We also hung a new tarp to give them some shade and bought them bunk beds and mattresses. We bought them enough food to last a solid month or longer. We did all this for under $1,000. Our next project is going to be to terrace their front hillside. There is a space about 20 feet wide and 30 feet long that is on their property. The problem is that it is so steep you can’t even walk on it. And it’s covered in loose gravel over solid rock. For $300 we will be able to terrace the area into three levels and haul up dirt to plan veggies. We think/hope this would not only provide enough room to grow all the food they need to eat (and healthy, nutritious food instead of rice and cornmeal) plus have enough food left over to sell at the market and help provide their other needs. So far a few hundred dollars we can help make then entire orphanage self sufficient and thus provide them with a better, stable future. Mary Erickson (the wife of Terry’s partner Eric) is going to Haiti in August, I hope to talk with her a find a way to send her the money to complete the project then. If you want to help make this idea a reality let me know.

One more day tomorrow, should be a long surgery day. The other guys plan to make one final orphanage run to buy food for all the kids (over 100 mouths that need to be feed for the next month). We are off to dinner tonight, one of the docs here, Ian Alexander, is taking the whole team to the Auberge restaurant.

Another busy day in the club foot clinic
 Patients will wait all day to be seen if they have to, and very rarely complain.

This little guy was born with this contracture, he will never walk normally but we straightened his legs so he can have some mobility.
 Club foot

 Leah and I with our favorite translators, JJ and Roosevelt

Scott, Jeff and Alan working on a hip fracture

My office for the week, I put in a few spinals today and even intubated a patient

What a cutie!

 We all headed to dinner together for our last night together, thanks to Dr. Ian Alexander for everything


Wilner gets his surgery!

This is Karen writing. Tim's Day 6 update will be posted later today, but I want to tell you a story about one of the patients Scott and Tim operated on on Wednesday, June 5th.  It is a story of how God works in all circumstances and weaves together lives to make a difference for others.

I'll start with a brief history.  In January 2009, in Santo Domingo, the Dominican Republic, I met Scott Nelson for the first time through Terry and Jeannie Dietrich.  I would do some volunteer work with him and the Dietrichs in the DR a few times that year.  January 12, 2010, and the massive earthquake hits near Port Au Prince, Haiti.  Scott, just a few hours away in the DR, responds with a team and begins to work, just two days after the quake.  Four days after the earthquake, Jeannie calls me to say that she and Terry will be going to Haiti at some point, and would I want to go. There was no other answer for me than, "Yes!"  In April of 2010, we join Scott at HAH for our first two week trip.  At the end of those two weeks, among other volunteers, I meet a nurse midwife volunteer named Rita. Our trips overlapped by just a couple of days.  Back in the US, we eventually connected again through Facebook. 

Fast forward to March of 2012.  Rita returns to Haiti with a medical team, and goes to the region of Fond Parisien in Haiti to provide medical care to those in need through the ministry of Love A Child.  I closely watch for her updates and photos when she returns, eager to see what is going on in Haiti.  As I page through her photo albums on Facebook, I see a video she posted of a boy walking, a boy with a significant leg deformity, causing him much difficulty in ambulation. Her caption stated that she wanted to get this boy to the US for surgery. These were the screen shots I captured from her video:

I messaged Rita through Facebook and told here that this boy could get surgery right in Haiti, at the Adventist hospital in Carrefour, for free.   I emailed these photos to Scott who agreed that he'd see him and operate on him the first week of June during his next trip.  All we had to do now was to find him and arrange for him to get there when Scott Nelson was there next in June.  Rita immediately got me his name and location, and we started the process of finding him.  Eventually, we got a hold of a man who served as a translator at the clinic Rita was a part of in Fond Parisien, who agreed to take him and his mother to HAH to meet Scott at the Orthopedic clinic.

Monday, June 4th, Scott and Tim met Wilner in the orthopedic clinic, and scheduled him for surgery on Tuesday. Due to a equipment issue, it was postponed till Wednesday, the 6th, but at 8am local time in Haiti, Wilner had surgery.  When he went to sleep, his left leg was bowed inward at a horrific angle, making walking difficult.  When he woke up, it was straight!  To see the photos, visit the album on Facebook. Click here: Wilner Gets Surgery

Praise God who used Terry & Jeannie moving to my small Midwest town so I could meet them; Scott Nelson being moved by Terry's work in the Caribbean to go there himself as a missionary surgeon instead of to Nepal, where he had planned to work; God moving in me to go with Terry and Jeannie on their trips to the DR where I would meet Scott; an earthquake moving Haiti to move us all to go there; God leading Rita to deliver babies for a career and then to care for women and children in Haiti so that our trips would over lap by a few days so that we could meet;  Mark Zuckerberg for inventing Facebook so that we would reconnect and keep in touch;  God taking Rita back to Haiti to Fond Parisien; of the hundreds of patients seen at the Love A Child Clinic, Wilner got matched with Rita for a clinician;  Rita posting her photos and video on Facebook, and me being on Facebook that day to see them. Praise God for all the ways he weaves our lives and circumstances together for His glory and to care for His Children.

Day 5-- Surgeries!

Another great day, another busy day. Today the crew took the divide and conquer approach again but for a different reason. Today Leah and I stayed behind to work at the hospital while Andrew and Jonathan were at the orphanage to manage the building project. We all had unbelievable days. Here is a little recap.

Leah and I worked with Scott and his team in the OR today. We did 9 cases today, three were very complicated Taylor Spatial Frames. We ran two operating rooms but only had one anesthesiologist which meant Tim was a CRNA for the day. Maria helped with the first few cases but we ran two independent OR rooms towards the end of the day. By the last patient I did everything from put in the spinal anesthesia block (with Maria watching) to waking the patient up and everything in between. It was a great day, fun to be able to help the team be more productive and thus help more needy kids get their surgeries.

Our first big cases were TSF patients. Maria and I did the first together, he had rickets and developed knock knees. One leg had previously been operated on so we just put a TSF on the other leg. He had a good result. We also put a TSF on a patient with a club foot deformity. All the doctors have been a dream to work with, Scott is a one man wrecking crew and whatever he missed Maria cleans up. The residents have been very kind to take a few minutes to teach me various things about each operation. I even scrubbed in to suture last night.

Leah got in some time helping various cases and working the C-arm for x-rays. She had never seen one before but now she is running it like a champ. She’s be great to have around to help recover, without her I wouldn’t be able to help with anesthesia and we wouldn’t get as many cases done.

After some time early in the day working in the OR she got sucked in and consumed with coordinating tasks with the Haitian staff. This can be extremely difficult and frustrating due to the language barrier and lack of organization around the hospital. Nearly all the long term volunteers are gone so it’s up to each team to get patients ready for OR, get them to and from recovery and manage all the other non-OR nursing tasks. She has handed it better than I would have, Amy was also great to ask one of the translators to stay on overtime until 10pm (they usually leave by 5). When they are not here late at night we have zero people who speak creole to communicate with both the nursing staff and the patients. Having a translator available today was great.

We did lots of other cases, an amputated stump revision, a 9 month old hip dislocation correction, an toe amputation and others. We put in a 16 hour day today. The guys were just as busy at the build site.

Jonathan was at the orphanage before the sun came up (which is very early in Haiti) while Jonathan went right to buying supplies. I didn’t make it out there today but they had a great day. The wall is now finished, it looks really good. Jonathan hired some local Haitians to install it and they did a professional job (by Haiti’s standards). They also got started building the outdoor kitchen’s roof structure. By tomorrow Mary Lou can cook in a nice kitchen space instead of a 2 foot wide, 5 foot deep alley that was next to the toilet (which does not connect to a sewer). A mega-upgrade. We (Jonathan and Andrew mostly) designed and supervised the building so the kitchen has a view of the ocean, ventilation for the charcoal stove smoke and fresh air and a nice sloped and overhanging tin roof to keep it dry and protected. They also did some clean-up around the area, put a new tarp over the neighbor’s patio (which the orphanage uses to walk up to their roof) and fix some dangerous wires. Tomorrow they finish the roof, pour some new cement stairs, hand some chalk boards inside and maybe even paint. Should be another busy day for them tomorrow.

We started the day with this 3rd toe amputation, I got back into the OR and ran the anesthesia for the case.
The next case was this 22 year old with blounts disease, we will put a TSF in correct his left leg

All hands on deck for this one (Scott is right surgeon)

TSF being placed

Finished product, he should be walking again soon

    Jeff and Ian working on an ankle fracture

This little guy has a left clubfoot needing correction, we put a TSF on him too

 My man Jean Joel Boyer scrubbing in as our scrub tech

Little 9 month old waiting to get her hip dislocation fixed.

Putting a SIGN nail in a tibia fracture (Scott is center of the three surgeons)

 Leah focused and working the C-arm for real-time floro (-x-rays)

 We dropped our last patient off in the peds/neonatal unit and found this cute baby
 Meanwhile Jonathan and Andrew Herr were at the job site, here is the sunrise from the roof construction project

 The workers cutting long pieces of wood for the outdoor kitchen roof supports. They use natural lumber that is not cut flat on the sides, it's like a big branch but dried and very hard. Closer to metal than a 2x4 in strength

More supports being cut to size

The first roof struts going up

This was the crew chief, he and his workers are doing a great job, with some encouragement.

Lots of progress

 Keeping their shoes clean, the Haitians are very clean. They always take showers and have clean clothes on

Jonathan wanted to plant some flowers and veggies around the orphanage. This little guy (who is 4) wanted to help, he brought up several buckets of dirt to the roof

 Then his 6 year old orphan sister helped poke holes in the bottom

I think she likes the new wall.

Tuesday, June 5, 2012

Day Four: Walls are going UP!

Going to make this quick, it's past midnight and I only got 3 hours of sleep last night and have to get up in 5 hours. So....

Today was just a clinic day so we took advantage and went to get some more work done on the Mary Lou orphanage project. First though we stopped by and planted some Hibiscus at a work site Jonathan is finishing at the Adventist University. He and his team did a great job and the flowers were a nice touch.

Then it was off to buy 10 mattress for some needy kids, we brought 4 to Mary Lou's for the new bunk beds. They only cost $35 each and they are certainly and upgrade from sleeping on the floor or a sheet of cardboard.

The we met up at the work site and the workers already had a good portion of the wall up. It looks really good and will be much safer for the kids. Tomorrow we finish the wall and start the new kitchen space. Jonathan has been a blessing and has made everything possible. Together with his Haitian crew boss and translator they are getting things done in a hurry (at least in Haitian time).

We only got slowed down by a voodoo doctor. He just showed up on the job site and started giving us problems, distracting the workers and making everything uncomfortable. In the end Jonathan informed him that our God is bigger than his and that he needed to leave. 45 minutes and lots of translating later he finally did. He said the devil sent him there and that he would put a curse on us. Interesting.

We played with the kids for hours today. The best/worst/funniest part of the day was lunch. We all happened to be at the hospital during lunch time so we all ate a big meal, Jonathan a really big meal to the point where he didn't feel good. Within minutes of arriving the Mary Lou's she served us lunch. It is insulting not to eat from your host so we had no choice. It was pretty funny watching each other shove more food where there was no room and try to look happy and thankful At least her food is delicious.

We finished at the orphanage 10 hours after we started the day and headed back to the hospital. I went to the OR and scrubbed into a leg amputation surgery. They needed an extra hand as the Haitian crew had gone home. I got to help suture the wound at the end of the case which was a real treat.

Ok, more to come later, tomorrow is a huge day (at least 10 or 12 or more cases tomorrow), going to be a marathon.

We started the day at the Adventist University. Jonathan and his crew remodeled a building for a rehab program. We planted some hibiscus outside the front door
Mattresses for the new beds at Mary Lou's orphanage

The children trying out the new beds
Some of the girls watching the action
This guy brought up two 5 gallon buckets of water at a time up a steep 500 foot hill. He did this about 10 trips in a row without stopping or complaining. It was 100 degrees outside. Impressive
Here are those before pics again of the rooftop.  There was no wall and the kids could get hurt on the rebar or fall down over 15 feet and die
So we are building them this wall to keep them safe and let them have room to run and play. This is the only space they have to be outside and now they can do it in a safe environment.
We built this wall only 3 bricks high so even the shortest kid would be able to see the ocean and feel the ocean winds blowing on him, we thought it was important. I think he likes it.
The little kids watched all day in fascination

Another Haitian kitchen. Outside 365 days a year
Same kitchen from a distance

Busy day at the clinic, took 4 docs all day to see all the patients
This the Wilner, Karen Fields arranged to get him to the hospital to have his legs straightened. He has a windswept deformity in his legs. Scott plans to put a TSF on each leg on Tuesday the 5th
My main man JJ working with some TSF struts in the clinc

I came back from the orphanage and scrubbed into these surgery, a non-union of a femur fracture. He has had numerous operations to fix it and this time we plan to amputate the lower leg