Thursday, September 29, 2011

Expecting the Unexpected

seeking shelter from the rain
Today was slated to be a very busy day in the OR. We originally had 8 cases scheduled - several of which were very long cases. When we finished our morning meeting and rounds, only two of our seven scheduled patients had arrived for surgery and we had one in-house that we donated our blood for yesterday and needed to pick up his typed & cross-matched blood today prior to doing surgery. Two of the cases went simultaneously. By the time those two were done, one other scheduled patient had shown up for surgery. This was a woman with an ankle fracture that didn't heal properly and had ended up with a very painful ankle due to arthritis and a non-union. She was fixed today with an ankle fusion. By this time, it was just before 4:00 pm so we stopped for a dinner break before doing the in-house 8-month-old femur fracture case whose blood had been picked up that morning by one of the long term volunteers while he was running errands. After eating our very late lunch, we went to look for our patient's blood and could not find it! Turns out, the volunteer who went to pick up the blood did not check that the blood he was given was the blood that was typed & crossed for our patient. MSF (Doctors without Borders) was also picking up a unit of blood this morning and our volunteer was handed the blood for their patient. By the time this mistake was realized, the Red Cross was already closed and there was no way we could get the correct blood for our patient tonight. So our in theory long day turned out to be quite short as 4 of our patients did not show up for surgery and one did not get the correct blood. Unfortunately, one of our cases that was added on for tomorrow (a traumatic femoral neck and distal radius fracture from one month ago) could not go today because he also needs blood for his surgery (his family should most likely have it by tomorrow).

Instead of staying up late doing cases, we stayed in and relaxed. There was a huge thunderstorm happening (still going on actually) so we didn't leave and Paige, Ruth, and myself watched the move Thank You for Smoking and ate kettle corn popcorn. It was a nice end to the evening and good to relax especially since we already had two big cases on for tomorrow and had to push the one from today onto tomorrow. 

Wednesday, September 28, 2011

For 1 Unit of Blood, 2 must be Donated...

foot deformity from post-polio syndrome
Today, like all Wednesdays, is clubfoot clinic day which is always a busy clinic day. In addition to clinic, we had three cases scheduled for the OR - one was a case that had been moved from last week, one was a repeat I&D for the kid with the abscess we did on Monday, and the other was a case that was on the schedule for yesterday but was pushed to today due to the family not being able to get here 2/2 living far away and having car trouble. So we planned to do the kid first but discovered on rounds that he had drank some juice that morning so we had to wait for his surgery. Our second choice was a hardware removal that had been rescheduled from last week. For whatever reason, this patient was not as ready as the patient that we had intended to do last, so we started with our originally intended third case first. It was scheduled as a triple arthrodesis for an unknown diagnosis in an 18 year-old male. We originally guessed is was most likely an untreated clubfoot, but we were wrong. It was actually a kid with post-polio syndrome that had affected the entire left side of his body. He was unable to walk due to his foot deformity and had to hobble around on one crutch. Because of his arm/wrist/hand deformity, he was unable to use two crutches. 

donating blood at the General Hospital
The whole case was fairly complicated and was still going on 4 hours after we started when I had to scrub out and leave. We have a patient in-house that had a femur fracture 8 months ago that was improperly treated and never healed. So since his fracture was so long ago, it will make the case that much more difficult to do and he will likely lose a lot of blood. Blood in Haiti is in short supply and patients have to bring their own for surgeries that require it. Typically the family members of patients will go to the Red Cross to get blood - two units have to be donated to receive one unit. Our patient, like many other patients, doesn't have any family here. So in order for him to get his surgery, he needs people to donate blood for them. In order to get to the Red Cross in time, I scrubbed out of the case and went with Pat and Ruth to the Red Cross to donate blood for our patient. I have never donated blood before, so I don't have anything to compare it to but I would imagine it is different here than in the US. For one, I was definitely hemoconcentrated due to dehydration and even with that, my hemoglobin was 12.1. Adequate for donation in Haiti. They didn't care that I had received a vaccine within the past 4 weeks. Once I finished the paperwork and had my vitals taken, I was escorted into a small room with a TV playing dubbed over soap-operas and sat into a very 1960s-esque reclining chair. The lab tech pulled out a sterile contraption with a bag and some tubing. She tightened a tourniquet and picked out her favorite vein. She uncapped the needle and I don't know that I have ever seen a needle that size be placed in any person's vein - it looked appropriately sized for an elephant's vein. Thankfully, she got my vein in one stick and so I sat waiting for my blood to fill the bag. Afterwards I sat for a while before getting up and leaving. We waited outside the Red Cross which is part of the General Hospital complex for about an hour until our ride came to pick us up. 

The final case was just being finished in the OR by the time we returned and I came to the only air conditioned room outside of the OR to sit, re-hydrate, and update you all on my new life experiences today. 

Tuesday, September 27, 2011

Today is Tuesday and I am all caught up :)

Wow, finally caught up on the blogging. Well, as I am typing this I am attempting to post my previous blogs that I spent some time on this morning getting caught up with. So today was an interesting day. We had our usual morning meeting at 730 then made our rounds. One of our patients that has been here for about two weeks already is a young 20 year-old woman with osteomyelitis that caused a pathologic fracture of her hip as well as formed a huge soft tissue tumor that encompasses her proximal thigh and the pelvis. For those of you who don’t know much about osteosarcoma, it’s bad news. As I have mentioned before, if chemo and radiation therapy exist in Haiti, it is extremely expensive and difficult for most everyone to get. In addition, due to the size of her tumor and it’s involvement of the soft tissues, she would basically need an amputation of her leg with a hemi-pelvectomy to have any chance of survival. Until yesterday, she didn’t know that this was what she had. We had been slowly broaching the subject over the past week, letting her know that it’s possibly a tumor and would likely involve major surgery. Yesterday, she was finally told details of her disease. 

So other than following her in rounds for the past 1.5 weeks, I became more directly involved in her care today. She was diagnosed with “a vaginal infection” upon arrival at the hospital and had started treatment by one of the local medicine doctors which included augmentin, azithromycin, and nystatin cream. Not surprisingly, her “vaginal infection” had not improved after over a week of treatment with this regimen. I was asked my the long-term volunteer nurse, Lynn if I would be willing to do a speculum vaginal exam on her to try and determine what she has and what would be best to treat it with since she had not had any symptom improvement. My treatment of the woman with breast cancer and bone mets and vaginitis had apparently proven my “expertise” as a gynecologist. Well, at least amongst our group here, I am probably the one with the most up-to-date knowledge and experience of gynecological issues (thank you HCMC Ob/Gyn rotation!). So, on my ortho humanitarian aid trip, I found myself performing a speculum exam on this 20 year-old female in a large ward with minimal privacy. I asked her more specific questions about the types of symptoms she was having (which I won’t detail here) and found out that she had been raped as a child and had never had a speculum exam before. To make matters even more difficult, she could not lay down due to her hip fracture. I was not the most successful in the exam, but I was able to see enough and hear enough history to determine that her current regimen was definitely not appropriate and started her on a more appropriate empiric treatment for her symptoms.

Another of the day’s highlights was my first experience of real Haitian coffee. Now I’m hoping this doesn’t end up giving me uncomfortable GI symptoms, but even if it does, it may have been worth it. Haitian coffee is not just straight black’s mixed with other things and almost takes like the best mocha you have ever had except for less sweet and more of a kick. If you have ever had New Orleans coffee, it is a similar experience in that it is not what you would necessarily expect when ordering coffee but turns out to be a delightful surprise. I already knew Haitian coffee was good as I have bought beans on several previous trips and also discovered the immense pleasure of drinking Rebo coffee at the airport prior to departure on our last trip here. Their version of the frappaccino should be enough to send all coffee-lovers on a pilgrimage to Haiti. 

After being a gynecologist and drinking some delicious coffee, I joined the team in the OR for some cases. Since we have two surgeons and two anesthetists, we were able to run cases simultaneously (ones that needed a ventilator in one room and ones that could go with just a spinal in the other) and finished 4 cases by 4 pm. We should have had one more, but the patient had car trouble and was not able to make it in for his surgery. All in all, it was a great second day of our second week and it looks like we may be headed to the Auberge again tonight. This time for some fried plantains and of course, more Prestige.

ps...I tried to upload photos but it takes way too long on this internet connection so I will add photos later (either when the connection is better or when I get back to the US)

My Second Monday

So with two CRNAs and two surgeons, we thought that this week we would be able to get way more accomplished - we could run clinic and the OR at the same time. On OR days, we could run two rooms. However, with only one working anesthesia machine and the local surgeons having priority of the OR on M/W/F, it did not look like we would be as efficient and productive as we had all hoped. Appropriately, our morning meeting reflection was about just that. The idea of efficiency and productivity is very much valued in Western medicine. In Haiti, you will end up only feeling like a failure if that is all you focus on. Instead, it’s important to try to focus on the relationships you develop with your patients and the local staff and the other ways you help other than cranking out a large number of surgical cases.

The local surgeons did not have any surgical cases scheduled until the afternoon, so we had the morning to try and do our two scheduled cases of the day. Pat Yoon was in clinic and Pat Ebling did the cases. The first was (yet another) antibiotic bead removal. I was not in the room before the spinal anesthesia was administered to ensure that we took some c-arm xrays to determine if the patient actually had antibiotic beads in place. So the spinal was in and our patient was numb from the waist down when we discovered that SURPRISE! no antibiotic beads. So we didn’t actually do anything surgical and instead brought the patient to recovery until her spinal wore off. 

The second case of the morning was a pin/wire change on an external fixator that had become infected. This went smoothly. After we finished our two cases, Pat Ebling and I went to clinic to help Pat Yoon finish up. I helped remove some pins from an external fixator in a teenager with Blount’s disease. We also scheduled an evening case in a kid with fever and a posterior distal thigh abscess. After the local surgeons completed their cases, I did an I&D of the abscess and got out a large amount of pus. It was a great way to end the night. We went out to the Auberge for some pizza (which they had this time, but didn’t get our order correct on the type of pizza we ordered) and Prestige and mentally prepared for a big day in the OR on Tuesday.

Sunday: The Land of the Ex-Pats

overlooking Port-au-Prince from the hotel
Paige and Kris, 2 CRNAs from HCMC and members of our week 2 team, arrived safely Saturday night and the group of us enjoyed one night together before Amy and Tom headed back to the US. Sunday morning we did our rounds and all of us went to bring Amy and Tom to the airport. It was sad to see our friends go after sharing another incredible week in Haiti together. After dropping them off at the airport, Pat, me, Paige, and Kris again headed up the mountains to La Ibolalia to meet with Pat’s friends who had been living in Haiti since soon after the quake. His friend Al is a prosthetist from Minneapolis. La Ibolalia is a hotel with a pool that anyone can come to and use as long as you order food and drinks. They make up for not charging for pool use by making their menu very expensive (US$16 hamburgers). We immediately discovered that this is where the ex-pats in Haiti hang out. We could understand why--the setting was beautiful. We had a great view overlooking Port-au-Prince, the coast, and the mountains. We enjoyed spending the afternoon sitting and talking by the pool, drinking Rhum punches, and eating delicious food (I had one of the most amazing omelets I think I have ever tasted). Before leaving that afternoon, we also enjoyed a few orders of mozzarella sticks.

I need to take a moment to mention the driving situation in Haiti. The roads are in terrible condition and the rules of driving are not completely clear to me. While driving up the mountain, I was afraid at one point that we were going to go off the road to our death as we passed another car at way too high a speed that was on our side of the road to avoid potholes. I have a new appreciation for construction. Everyone honks as the way to communicate that they are driving through and if you don’t move, you will be hit. It’s a constant game of chicken. In addition, most of the motorcyclists don’t wear helmets and those that do, don’t use chin straps. There are people lining the sides of the roads and the medians and weaving in between the cars. I spent the majority of our ride gripping the seat back in front of me (as if that would help) and just hoping that we would make it to our destination unscathed. Thankfully we did and we returned to the hospital to meet with the rest of our 2nd week team who had arrived - Pat Ebling (orthopaedic surgeon from Minnesota) and Ruth Bowen (ortho sales rep from Minnesota). We all went to bed early in order to be ready to start another week. Pat and I felt revived after our weekend oases and were ready to start a new busy week at the Adventist Hospital. 

Finally the Weekend!

At the Orphanage
We got up Saturday morning and did our rounds before leaving the hospital for a day’s excursion. All our patients were doing well so we left in a tap-tap for the orphanage. We have been going to the same orphanage on every trip I have been on to Haiti and it’s been really fun to see the changes happening within the orphanage and to see the kids growing up. They definitely remember us! Each time we have gone, the orphanage has become more of a structure with walls and less of a tarped-off area. There are still a ton of kids there, but like always they greet us with smiles and singing. We brought them more clothes, shoes, and care packages that were sent from the team that followed us back in November 2010. We stayed and played for a while and I had the complete joy of holding this little girl who walked up to me the minute we got to the orphanage and held out her arms to be picked up. These kids are always so cute and seem to be happy and enjoying life. It’s sad to think about their situation, but hard to not feel joy after spending time with them.
Pat, Tom, Amy, me at La Reserve

La Reserve
After leaving the orphanage, we took the tap-tap up the mountains and stopped for lunch at La Reserve. Walking into the restaurant,  you would have no idea that you were in the middle of Haiti. The scenery was gorgeous and the decor was completely impressive. We all treated ourselves to Rhum punches and ordered a slew of appetizers. Interestingly, although they were “out” of chili fries, they did have fries and they did have chili (which was on the nachos we ordered). I am thinking there may be a trend with ordering in restaurants in Haiti...

Me, Pat, Tom, Amy at Fort Jacques
After a delicious meal, we headed further up the mountain to Fort Jacques. This is the ruins of a fort dating back to the Haitian revolution. The Fort overlooks the entire city of Port-au-Prince and the coast of Haiti. The view was breathtaking. After spending some time walking around the Fort and getting a questionably accurate account of the fort’s history, we wandered through the nearby  forest and got a great view of the mountainous farmlands of Haiti. 

On our way back to the hospital to meet up with some of our 2nd week team members that were flying in that night, we saw a man walking across the busy streets of Port-au-Prince on his knees. He clearly had some untreated congenital disorder that left him without lower extremities that he could walk normally on. And after our brief oasis, we all were brought right back to the reality of where we were.
at the Orphanage
random truck from St. Paul in Haiti

Friday: The Last Working Day of Week 1

Friday we woke up refreshed after having been able to leave the hospital and have a more relaxed evening the night before. We had a clinic that morning and a couple of cases lined up for that afternoon. Looked like it would be a pretty reasonable day and we would likely have the chance to leave the hospital again that night. The most interesting clinic patient that morning was a girl we had seen earlier in the week with DDH. She came in with the xrays that she had to pay for since our free machine has not been working. The xrays showed definite DDH and the girl and her family were told to come back in two weeks when Dr. Dietrich returned as he has much more experience with fixing chronic DDH. 

Our first operative case was a woman who needed removal of antibiotic beads. Since we had a case earlier in the week with difficult to find beads and another case in which no beads were actually present to remove, we took some c-arm xray shots before giving her anesthesia to make sure that (1) the beads were present and (2) where they were located prior to starting our case. Surprise, surprise, this woman did not have any beads anywhere in her femur. She did, however, have sutures that had been left in for two months and were encased in a combination of scab, scar tissue, and some foreign body granulomas. So I spent the next 20+ minutes trying my best to remove all her suture while Pat talked with her family to try to figure out why this patient was scheduled for a bead removal when she clearly did not have any beads in her body. After that frustration, we got to the femoral intertrochanteric fracture fixation. Pat and Dr. Alexi did a DHS for fixation while I again served as our xray tech. It’s interesting because in the US, I am not allowed to push the button to take an xray. The case went smoothly and we finished around dinnertime and headed to the Auberge for another round of pizza and Prestige.

The interesting and endearing(?) thing about the Auberge is that you never really know what you are going to get when you order from there. Apparently that night they were out of pizza so we were forced to look elsewhere on the menu for dinner. The strange thing was that after we were told they were out of pizza, we saw two different groups of people leave carrying pizza boxes. What we ordered were Prestige for everyone, two chef salads, three orders of fries, and 2 orders of rice&beans. What we got was Prestige for everyone, one chef salad. Two orders for fries (one small and burnt, the other large and plump), a basket of bread, and 2 orders of rice&beans. We also ordered a couple of papaya juices which from a distance looks like delicious milkshakes. When you take a sip from this milkshake-looking drink, you immediately discover that it’s warm. And if you can imagine the smell of an operating room crowded with sweaty people mixed with used 4x4 gauze, you know what this warm drink tastes like. Pat somehow managed to drink most of his. Amy and I gave up very quickly and stuck to the Prestige. All in all it was a fun night and we looked forward to our outing the following day as the wind down of our first week in Haiti.

good fries vs bad fries with papaya juice in the foreground

L DDH in 3 yo F

Week 1 Thursday

Like Tuesdays, Thursdays are our other primary surgery day. We had an ambitious schedule of 7 cases which I knew we were not going to get to all of them. Instead of making patient numbers 6 and 7 wait around all day without eating only to not have surgery, I went with the long term nurse volunteer, Lynn, and rescheduled those patients and sent them home. The evening before an elderly woman with a few day old femoral intertrochanteric fracture was transferred to our hospital for definitive treatment and so she was also added onto our schedule providing that her uncontrolled hypertension (180s-200/100-110s) was lowered. To try and accomplish as much as possible of our ambitious schedule, we had planned to skip the morning meeting and start surgery right at 730. But like all things in Haiti, starting on time never goes as planned. The local general surgeon had a tumor removal that morning and a woman came in for a C-section so we no longer had an OR to work in and instead of starting at 730, we started our cases between 930 and 10. Oh well. By the time we took a break for lunch, all we had accomplished were two cast changes - one for a child with clubfoot and the other for a child who had been badly burned a few years ago and developed a severe flexion contracture making him unable to walk. When he was brought to the hospital for his initial surgical correction, his parents abandoned him at the hospital, leaving him as a functional orphan. Since that time, he had been staying in the long term rehabilitation housing and was being taken care of by the other adult patients also staying in that housing. 

After lunch, our next case was a middle-aged woman with untreated metastatic breast cancer who had developed bone metastases in her left femur and right proximal humerus leading to pathologic fractures. Her femur had been fixed the week before and in order to discharge the patient and free up a hospital bed, she needed to have her humerus fixed. There is rumored to be chemo and/or radiation available in Haiti, but we are not sure that even if the patient could pay for it that it actually exists. Her proximal humerus was completely eaten away by tumor and since we had no humerus rods available, a Kuntchner nail was used. Kuntchner nails were developed by the Germans during WWII in order to fix femur fxs so that pilots and drivers would be able to use their legs to drive. On a side note, this patient also had developed a vaginal infection while in the hospital and since I happened to be the closest to my Ob/Gyn rotation, I was the “expert” of our group with respect to treating vaginitis. So in addition to fixing her humerus fracture, we also cured her vaginitis. 

At the end of this, we had planned to take the femur intertrochanteric fracture for fixation since no PT was available over the weekends. Unfortunately and fortunately an acute abdomen presented to the hospital and the local general surgeons needed our room for an exploratory laparotomy. Only one anesthesia machine is working in the hospital so any patient that needs GET anesthesia has to be in the ortho room. So instead of operating past midnight for a second night in a row, we finished at a reasonable time and left the hospital for the first time all week and went to our favorite local place, the Auberge de Quebec, for pizza and Prestige!
walk to the Auberge

pathologic fx from bone mets

fixation with K-nail

LLC on boy with flexion contracture

Monday, September 26, 2011

Week 1 Wednesday

We started out Wednesday in clinic after our usual 730 AM morning meeting and making rounds on the hospital patients. Wednesday is clubfoot clinic day so there are always a lot of kids that come in with clubfeet that are starting or in the process of getting corrected through casting or a combination of surgery and casting. I saw the most severe clubfoot I have ever seen in a pre-teenage girl. She was in the process of correcting one side with the other side still showing the deformity. She was unable to walk on her own and had to be carried around by her father. 
Even though we are nearing 2 years out from the January 12th earthquake, we still see patients in clinic on a near daily basis with untreated orthopaedic injuries from the quake. One of our clinic patients had a non-union distal humerus fracture and had been unable to effectively use her arm since the earthquake. Because she was so far out from her injury, surgery to correct her fracture would be incredibly difficult and complicated. We tentatively have her scheduled for surgery this upcoming week, but if traumas come in or other cases don’t get done on their scheduled day, she may very well be bumped from the surgery schedule this upcoming week.
At the end of clinic, we had a trauma come into the emergency room. It was a 9 yo girl who had been the pedestrian in a motorcycle vs. pedestrian accident the day before and had broken her distal femur. So instead of doing the case we postponed the day before right after clinic, we added on an ORIF of the femur. I really  enjoy doing femur cases and this was no exception. The age range of this girl made the case challenging especially since we do not have flexible IM nails at this hospital. So we did an open reduction with a plate fixation and I got to drill through her femur! We ended that case and finally got to our guy who then ended up waiting all day NPO to have surgery again. The case ended somewhere between 12-1 am. By that time, we brought him to the ward and there were no nurses to be found to check in on him post-op. It took a while to wind down from the night and we finally ended up going to bed just before 2 am. 

bilateral club foot: R side in process of correction

humerus fracture from the quake

humerus fracture from the quake

me holding traction and the femur reduction

Sunday, September 25, 2011

Playing Catch-Up: Tuesday

Tuesday was a first full surgery day. There were 6 patients scheduled for surgery and we knew it was likely that we would not get to all of them that day. It’s always difficult to prioritize the order of surgery knowing that the people scheduled for last would likely not have surgery and those near the end might be NPO all day and still potentially not have surgery. The morning started with a couple of cast changes under anesthesia on children with clubfoot. We then did a knee manipulation on a child who had a severe leg length discrepancy that was in the process of being lengthened. Lengthening involves surgically breaking the femur and placing an external frame that is cranked a little each day so that over time, the two ends of the bone are pulled farther apart and new bone forms in between thereby lengthening the bone and correcting the limb length discrepancy. During this process, the child’s leg had become quite stiff in the past week so we took him to the OR to try and loosen him up. This was followed by a break for lunch (rice and beans - big surprise...) and back to the OR. In the afternoon, we fixed a  2-week old distal radius fracture in a kid with an open reduction and percutaneous pinning. It was the first time I had pinned a radius. Definitely a challenge, but I was finally able to get the pin in place to hold the reduction. Our final case of the night was a hemiarthroplasty for a hip fracture. The local orthopaedic surgeon, Dr. Alexi, scrubbed with Pat on the case, so I observed and helped out around the OR as circulator/anesthesia assistant/xray tech. This case presented a huge challenge because the woman had a narrow femur, narrower than our smallest stem of our hardware available. Unfortunately, trying to place a the hardware in a too narrow canal led to cracking of the femur in two places. At this point, the head of the femur was already removed and we had to make something work. Thankfully, we found a smaller prosthesis in a secret stash kept by one of the other orthopaedic surgeons who has spent some significant time at this hospital. In order to prevent this woman’s femur from cracking further, wire was placed further down the bone. She was closed up and discharged from the hospital a few days later doing very well. 
This took us to the end of the night (around 10 pm) and I had to tell one of the patients who had been waiting all day for surgery that we were not going to get to him that night and he was finally able to eat after not eating all night. We told him he would likely have surgery the next day and could eat breakfast but nothing after that and we would hopefully do his surgery after clinic in the early afternoon.

Hemiarthroplasty (Dr. Alexi, Pat, Tom)

Saturday, September 24, 2011

End of Week 1

It's the end of my first of two weeks in Haiti, and I have to say that I failed at keeping up with blogging. At the beginning of the week, I thought that this would be a really long two weeks. Now, I can hardly believe that one week is at it's end and Pat and I are halfway done with this trip! Tom and Amy leave tomorrow. Two of our second week's group members (Paige and Chris) arrived tonight. Tomorrow the rest of our second week crew arrives. I have been taking notes about this past week and will need to do a massive blog update with all the going-ons of this week. But, that will not happen tonight. This is the first night in a while I have to the chance to get a good night's sleep and since somehow I managed to get a cold in Haiti, I think sleep is probably the best option for me. It's been a great week and I have lots of stories and pictures to share!

At the orphanage

our friends from the orphanage

Fort Jacques

children in a rural farming community outside Petionville

mountain pathways through the farmland 

Farming up in the mountains near Fort Jacques

Wednesday, September 21, 2011

Doing work

Well, it's 1AM and we just finished putting our last patient to bed after a full day of clinic and operating all evening. Needless to say, it's been a long couple of days. I have been taking some notes, so I hope to find some time tomorrow to catch up on my blogging. It's not looking too promising though as we have a full OR schedule and are starting bright and early tomorrow morning! Time for me to get whatever sleep I can...

Monday, September 19, 2011

No easing into a first day back...

Well friends, it has been a busy first day back at the Adventist Hospital. We started out the day with the morning meeting at 730 then proceeded to round on our hospital patients. The biggest change I have noticed from my first trip to this one is how much more organized the hospital has become. Patients are no longer being roomed in the hallways. They have started charging patients for private rooms and so unless our patients can pay, they are crammed into one of three small rooms on the main floor of the hospital. The operating room is run a little differently as well. Ortho has priority in the OR on Tuesdays and Thursdays. If we need/want to add on cases on Mondays, Wednesdays, or Fridays, they have to be in the afternoon and we do not have a recovery room available to us for our patients post-operatively. 

Some things, however, never seem to change much. Cases always take longer than anticipated and we always seem to be eating dinner at 10 pm or later at night. We end the day tired and it becomes difficult to reflect on the things we have seen and done throughout the day. I will do my best here, but I can't say that it will be too insightful since what I am really looking forward to is going to bed!

As usual, our Monday was spent in clinic and it was a fairly busy clinic (also as expected). We see some bread-and-butter ortho but also have the (unfortunate) opportunity to see disease pathology further along in its natural course than we see in the US. For example, our first patient of the day was a middle aged man who was born with bilateral clubfoot. He has been able to adapt to his deformity but not without significant cost to his mobility. He walks on the sides of his feet and has built up extremely large calluses. His legs are not in normal alignment which causes him pain elsewhere in his body. A few patients later we saw a 3 year old girl with developmental dysplasia of the hip. Her DDH was caught at a young age but due to the earthquake in Jan. 2010, she was unable to return to get it corrected until now. The years between the diagnosis and now means that she will have a much bigger operation which also corresponds with bigger surgical risk. 

We ended clinic around 3 pm and then had a couple of cases to do in the OR. The first case was an I&D of a wound. Not a terribly complicated case, but the patient happened to have the smallest veins and so a significant portion of time (and pain on the part of the patient) was spent trying to get an IV started. We finally got one started in her foot and proceeded with the case. After that, we had another I&D with a change of antibiotic beads in a hip. What complicated this case was that the woman's surgery for antibiotic bead change had been rescheduled a few times so instead of having them changed within a few weeks, it had been a few months. This meant that the beads were encased in scar tissue and buried and extremely difficult to find and remove. These factors about doubled the time our case took. So now it is 10:36, I am still working on finishing my dinner, and tomorrow we start all over again. There are 6 cases already on the surgery schedule, 4 of which are large cases. We will not get through them all and will probably be putting in 14+ hours of operating. So please send your good vibes our way! We could use a little luck :) Thanks for reading!

Sunday, September 18, 2011

Destination 1: Hopital Adventiste d'Haiti - Carrefour, Haiti

It's my first blog, so I am sure they will get better as I get more practice over the course of this next year. I left Minneapolis this morning for my third trip to Haiti to kick off my year (well, 9 months) abroad. We are an orthopaedic surgery humanitarian aid mission led by Pat Yoon (the surgeon). Pat and I will be in Haiti for 2 weeks (double the time of our previous trips). Coming with us for the first week is Tom (surgical tech) and Amy (CRNA) who have both been on previous trips to Haiti. On Pat and my second week, we will be joined by Paige (CRNA and return volunteer), Chris (CRNA and first time volunteer), and Dr. Pat Ebling (orthopaedic surgeon, first trip with the team). We have also gained a new member of our team, Charlene, a emergency medicine fellow from Loma Linda University who is here to help train local ED and hospital staff. There is also another medical team from the Twin Cities here doing a week of hernia repair surgeries. We were all on the same flight and hope to run into each other during our time here!

So we arrived in Haiti after a very eventful morning of traveling. Pat was almost not allowed on the plane due to water damage on his passport. We were able to get on the plane to Miami, had to retrieve our luggage, and recheck in hoping that the American Airline desk workers in Miami would allow Pat to get on the plane to Haiti. Thankfully, we made it after a stressful morning and we didn't lose any bags on the way down! The power is currently working at the hospital, we have fans in our sleeping area...overall, life is good. I feel like I have come back to visit a long time friend.

These were some of my first impressions of Haiti after 4 months of being away: The security seems to be increased. The UN workers here are from Sri Lanka. There are a lot more police cars patrolling the airport and the roads. There are more stoplights on the streets (which are still ridden with deep potholes and lined with garbage and rubble). The garbage situation is slightly improved. On our drive to the hospital, I noticed at least 3 pick-up soccer games. It was fun to see kids out playing. Although it is 90F here, there is a breeze and so the heat is tolerable for now. It also gets dark around 6 pm. Had both a luna bar and a peanut butter sandwich for dinner (I can't say that my dining experience is anything too exciting in Haiti). I have not taken any pictures yet, but as I do, I will post them to the blog and update as I can, power and time permitting. 

Thanks to all of you who are following along! Should be a pretty wild adventure this year.