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.

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