Team Sinai Haiti

Reflections on 9-11

2011-09-11T13:56:00.002-04:00

September 11, 2011

Watching the various 9-11 memorial services on television today, I am moved to write down on paper, or more correctly, on my laptop, some of my own thoughts and memories of this earth shattering event that is still so fresh in the memories of anyone alive today who was over the age of 6 or so on September 11, 2001. Nine-eleven is, after all, the prototype of one of those momentous historical events that are seared on our collective memories, branded into our collective cerebral cortex. There are certain news events for which we can remember not only the event, but also our personal location when we first heard the news of the event. For me, the list starts with assassination of President Kennedy, and continues on to the explosion of the space shuttle Challenger, the opening salvos of Gulf War I, the reading of the O.J. Simpson verdict, the news of Princess Diana’s death, 9-11, and more recently, the Haiti Earthquake of 1/12/2010. It is curious what elevates an event to that level in one’s consciousness. After all, how can one compare the importance of the death of a princess with the 300,000 deaths from Haiti's 7.0 magnitude earthquake, or to the macabre deaths, unfolding before our very eyes on live television, of 2,977 innocent victims who woke that fateful September 11 morning, had their breakfast, coffee, and went to work, or to the airport to catch a flight. (The nineteen perpetrators of this outrage do not deserve to be included in the role of the dead. ) The truth is, of course, that there is no comparison, and while we may remember less important events with equal clarity, there is nonetheless a special place in the pantheon of these news events that we not only remember, but also remember where we were when we first heard the fateful news. I will leave it to the psychologists to explain why certain individuals may so vividly remember where they were upon hearing about 9-11 but not, for example, another, albeit smaller, terrorist event of the Oklahoma City bombing in 1995.

Nine-eleven changed us forever, and presented us with a fait accompli, a paradigm shift on how we relate to the world, how we pass through airport security, and how we will live for the next century. What about those Americans who have birthdays or anniversaries on 9-11. Can one celebrate on such a day? One can’t change the day of one’s birth, so we have no choice but to recognize our personal joys, albeit in a subdued fashion, while simultaneously paying homage to the tragedy that will eternally be associated with this event.

For those of us at the Rubin Institute for Advanced Orthopaedics, we spent the evening before 9-11 celebrating the grand opening of our newly minted Institute. We had actually begun clinical work at Sinai Hospital a few months earlier in mid July, but planned our official opening party to coincide with our 11^th annual (now in its 21^st year) Baltimore Limb Deformity Course. September 10, 2001 was a beautiful Sunday night, and the hospital team had done an incredible job at preparing a gala event, complete with a tent in the parking lot, great food, speeches, and presentations. Hundreds came, including many of our course attendees, relatives and friends from out of town. (Little did they know that exiting Baltimore by plane would be virtually impossible the following day). The next day, that clear autumn Monday morning of September 11, 2001, was the final day of our course. I remember the sequence of events as clearly today as if it happened yesterday. I was performing a live demonstration surgery, broadcasting by closed circuit TV to our attendees in the hospital auditorium. In the afternoon, we planned to bring everyone by bus downtown to the cadaver laboratory at the medical school, for a session to teach them various surgical approaches and procedures on cadavers. My morning surgical case was a supramalleolar osteotomy for malunion, using an external fixator. The closed circuit connection from the O.R. to the auditorium was not working properly, and at various times we had audio but not video, and vice versa. The course attendees were trying to help fix the audiovisual connection on their end, and wound up fiddling with the channels on the TV, soon landing on the live broadcast of the Twin Towers after the attack, so indelibly burned into our brains. At that point, one of the surgical technicians ran into the O.R. and shouted that New York was being attacked by terrorists. Rumors soon started to fly about Washington, and Annapolis. The attendees remained transfixed by the events unfolding on television, while we upstairs in the O.R. concentrated on expeditiously finishing the surgery. On completion of the surgery, I went down to the auditorium. Given the uncertainty and magnitude of the unfolding events, we announced that the cadaver laboratory exercise was cancelled, and scrambled to help our many out of town guests find accommodations. Indeed, there was no way to get down to the medical school, as the State Police closed Route 83 due to rumors of additional bombs in Maryland. Most of our course attendees were out of towners, many from outside the continental US. All those with flights scheduled that day and for the days to follow were now stranded.

At our home, my wife and I took in three attendees, one from Austria, one from Uganda, and one from New Zealand. The subsequent days and weeks morphed into a prolonged sleepover that only ended three weeks later when our last guest was able to fly home. Days were spent in incredulous awe, gathered around the television, with its 24 hours news coverage of 9-11 and its aftermath. Eventually, life returned to normal, though not quite the same for an entire generation.

Fast forward to ten years later….our institute has grown from the original four surgeons to now eight. We have become successful beyond our expectations. On a sad note, Jacques Rubin, our major benefactor and namesake, died at the relatively young age of 71 last week. He was a kind and generous man who achieved financial success from his prescient involvement in the biotech industry. His innate philanthropic personality led him to donate to charities even during the down times in his life. He is sorely missed by his friends and family. Now, on this tenth anniversary of the establishment of the Rubin Institute for Advanced Orthopedics, should we celebrate? Should we celebrate despite the death of Jacque Rubin, despite the forever recurrent pairing of the RIAO founding with the tragedy of 9-11? Common sense and human nature and the American spirit would dictate “yes” to these questions. Despite our losses, despite the sorrow, our lives go on. Our mission goes on, and our lives and the lives of our children and loved ones continue on. We can and should celebrate our 9-11 birthdays, our 9-11 wedding anniversaries, and our 9-11 important life events, including the opening of the Rubin Institute for Advanced Orthopedics. It is incumbent on us, however, to also simultaneously remember and pay tribute to the 2,977 souls who perished on that fateful day. For the foreseeable future, the current generation will look back to that day in respectful awe, much as my father’s generation looks back on Pearl Harbor Day. Eventually, these memories may be surpassed by future calamities, but for those of us who lived through those dark days following September 11, 2001, we will share a collective, life altering experience for the rest of our lives. It is incumbent on us to pass this memory on to our children, and they to the successive generations, to preserve 9-11 as a forever special and meaningful day in our nation’s history.

--John Herzenberg, MD

Haiti Trip Summary 5/29/11- 6/5/11 Team Sinai-Operation Rainbow

2011-06-10T08:18:00.002-04:00

Last Day in Haiti, tired but fulfilled!

After nearly eight days of hard work, the team finally made it back home, safe and sound, to the USA. All were exhausted, yet satisfied that we helped the patients and staff of Hopital Adventiste d'Haiti make it through another week of trials and tribulations that is the challenge of providing orthopaedic care in resource-poor, post-earthquake Haiti.
Strictly by the numbers, we operated on 32 patients. New for our team this year was a formal education component. Through the organizational help of Marc Julmisse, long term volunteer nurse education coordinator, our team delivered 11 lectures to the local Haitians. Topics ranged from Infection Control, EKG Interpretation, PACU Management, Ponseti Clubfoot Method, Diabetic Feet, Care of Spinal Anesthesia Patients, Care of Block Patients, among others. The audience included, at various times, local nurses, docs, and volunteer firefighters/first responders. The lectures were either delivered in English, with Creole translation, or by some of the team members (Job Timeny and Tara Montplier) in Creole directly. Our team included four native Creole speakers (Job Timeny, Tara Montplier, Ron Delanois, and Francel Alexis), giving us a distinct advantage both in clinic, on the wards, and during the educational sessions. In addition to the lectures, we provided staffing to the orthopaedic clinics, including huge general and pediatric orthopadic clinics on Monday and Friday, a ginormous clubfoot clinic on Wednesday, and modest drop-in clinics on Sunday Tuesday and Thursday. Our family practitioners, Ram Shetty and Julia Ramberg, worked daily general pediatric clinics as well, in addition to doing pre-op medical evaluations on each patient being considered for surgery (H&P's). Based on their assessments, many patients who were selected for surgery were cancelled due to unresolved medical issues, or recent colds. We strove to maintain this level of safety, similar to our practice at home, by doing site markings, and time-outs before each surgery. The post-operative recovery room, manned by both local Haitians and by our three ICU/PACU nurses was a welcome addition, further augmented by a generous donation of a sophisticated ProPak monitor thanks to Operation Rainbow. The local nurses have now been trained on use of the ProPak, and it will stay in HAH, hopefully elevating the level of post-anesthesia care for many years to come.
Our surgical volume was somewhat less than our trip last June 2010 (32 vs 50 operations), reflecting the downsized nature of the hospital volume as the earthquake related trauma diminishes. Last year, a full 1/3 of our cases were directly related to the earthquake. This year, only a few were earthquake sequealae. The majority of our patients were children with birth defects, and some adults with general orthopaedic and trauma problems.
The surgical procedures accomplished included (in order or prevalence), clubfoot related surgery (16), Ilizarov related external fixation (6), osteomyelitis-infection (4), knee arthroscopy (4), eight-plates (4), cerebral palsy (3), tibial hemimelia (2), hemiarthroplasty (1), and macrodactyly (1). Some of these were bilateral cases, so the total number of patients operated on was 32, though the total number of procedures performed was at least 41. Of special interest to our podiatric colleagues was the wide range of congenital foot problems, which will be the source of a future posting.
Of course, none of this could have been accomplished without the help and guidance of the long term volunteers: Terry and Jeannie Dietrich (Orthopaedic Surgeon and Nurse), Nathan and Amy Lindsey (Assistant Hospital Administrator and Volunteer Coordinator), Marc Julmisse (Nurse Educator), Lynn Byers (Nurse Clinician), and Brittany Blair (Lab Coordinator). We are very grateful for their help and guidance, and we are in awe of their commitment. For us, one week at HAH was exhausting. It is hard to even imagine what it would be like to volunteer for 6-12 months or more, as these brave souls are doing. Adventist Hospital has become one of the top orthopaedic hospitals in Haiti since the earthquake, though the future of this endeavor is still uncertain. Many long term questions remain: will it be fully Haitianized, or will it continue to be staffed partly by ex-pats? How will funding be developed for long term growth and daily maintenance? For the patients of Carrefour and surrounding areas, this hospital is a tremendous resource. It is obvious from the neglected clubfeet that we saw in young adults, that such care has not been available for many years past. Now that there is a weekly clubfoot clinic to cast infants with clubfoot, the number of feet requiring complex osteotomies and fixators will hopefully eventually decline. The problems are daunting, perhaps even insurmountable. One can gain some solice by remembering the old African proverb, "How do you eat an elephant?.....One bite at a time..."
One last comment, our hosts, Dr. Terry and Jeannie Dietrich left for a well deserved two week break, mid-way through our mission. The next team of overseas volunteers is not due for another two weeks, leaving HAH without Orthopedic coverage. Thankfully, two of our team members, Dr. Francel Alexis, a young Haitian orthopaedic surgeon finishing his fellowship training in pediatric orthopaedics in Santo Domingo, and Dr. Jeff Young, a newly minted attending orthopaedic surgeon and graduate of our fellowship in Baltimore, agreed to stay on for an extra week (Jeff) or two (Francel) to bridge the gap until Terry returns. These brave souls will not have the back up and support of our huge (n=20) team, and so we have dubbed them the Lone Ranger and Tonto (not sure which is which) for their bravery and dedication. We wish them the best of luck these next two weeks!
More posts to follow by various members on specific topics, but for now, we're all safe and sound back home! -----John Herzenberg, MD

Everyone has a hustle....

2011-06-05T00:08:00.003-04:00

Reading the Sinai Newsletter ("Bridge") at the main gate
leading into the hospital. No guns allowed except for the guard!

Day Seven........rounds in the morning, followed by a trek to an orphanage( a trek it was up a windy dirt road in the mud, the van fishtailed)......two stories no real running water but electricity. There were 20 or so kids there. We brought toys, soccer balls, coloring books, frisbees, pencils. We tried to give everyone something, we even had the hand made blankets we were giving out to our patients the previous week. A few members of our group went and bought snacks and pasta and fixings so the kids had some food to eat. Most gobbled up the snacks right away, some hid them to save for later. It was an eye opening experience for me as I heard of the owner trying to get us to contribute an extra ordinate amount of money to buy another property. Claiming no money to run the place.... Everyone has hustle, a way to try and get more. Although motives are questioned at least they have a roof over their heads and someone watching them.

After going back down the hill, we started our tour of Port Au Prince, squalor is the best word for the worst parts of the city with destruction, like the earthquake was yesterday. Masses of concrete houses placed on top of each other along the hillside, decimation at the valley. This slowly weaves along some paved and unpaved roads into a less cramped area with a hint of manicured lawn( our driver said it's a club where tennis is played) along the winding road beautiful vistas pop through concrete a glimpse of the port and ocean.....

We stopped for lunch at Epi D'or a cafeteria style bakery/fast food/Haitian restaurant in a relatively affluent part called Delmas. There were a few boutiques, the roads were paved although caddycorner from the restaurant was a decimated building. About 1/3 of our group partook in the pastries, 1/3 "American food" and rounding it out was a combo of Haitian food and crepes. Coca colas, Tampico and champagne cola as well as coffee was enjoyed at our tables. Geteau simple( Haitian cake) was introduced to us by Ron and Tara.....Thank you. A lighter crumbly pound cake of sorts with a hint of coconut was a a great treat!!

After our enjoyable lunch, we headed to the presidential palace. Across the street is one of the tent cities where I overheard a man say 2800 people live. The palace once shining and standing tall, now sits a little shorter, askew and across from a constant reminder that something must be done. We followed the palace down to the PAP cathedral, where the presidents used to be inaugurated. It was a shell of it's former self, some stained glass left in a skeleton church.
Residents of the local area came asking for money or food, when we gave they just asked for more. A difficult situation.....one inspiring man was a double amputee in his own motorized wheelchair. He sat in this wood box with a captains chair of sorts. He had a hand crank drive that motorized his cart. Ingenious!!

We returned to HAH tired, rejuvenated and excited at the same time. Our adventure had taken us not only out of the hospital but off the grounds of the hospital. We topped off the night with a yummy buffet at la auberge Quebec around the corner and up the hill from HAH.
We shared a meal with the volunteers at the hospital as well as our amazing translators. We shared in an operation rainbow tradition of an awards ceremony, yours truly received Miss Congeniality something I now share with Sandra Bullock, :) you'll have to check in with the rest of our amazing team as to who was the happy curmudgen, the girl scout, macgyver, the brave one, the designated hitter, the octopus, the juggler, the lone ranger, the eager beaver, the scrub-a- dub-dub etc........
My reflections on this trip will likely come out later...after sometime has past and thoughts have settled!

Yo Jen Peacing out from Haiti.....what a long strange trip it has been...I mean that in a good way!

Shabbos in Haiti

2011-06-04T01:10:00.001-04:00

Day 6 is in the bag!!!

Kiddush for Shabbat in Port au Prince

We have completed 32 cases this week, a variety of congenital deformities and a smattering of other pathologies. Today was the last push, we had all be working since we got here. This is where the coca cola came in, just enough sugar and caffeine to get to the end of the day. Our day was filled with OR and clinic, pain control and cast changes. Our teaching came to a close with defibrillator lessons, some EKG reading and clubfoot lectures as well as a practical lab for our great technicians!!! All in all, heat, rain and mosquitoes...it was an amazingly wonderful, heartbreaking, educational trip. It is amazing when there are a group of relative strangers with a common goal that can get together and get along! It's like the reverse of The Real World!! We have worked together and broken bread (MRE, Protein bars, Tuna, Mac and cheese). We have our routine, by the time I gather my bars and cup for coffee, John and Chris have heated up the water for their coffee and generously share with me! Cindy comes in to prepare our coffee and everyone elses starts filtering in. We set out for chapel or OR and get our day started, at the end we meet up casually checking email, eating dinner, chatting and getting to know each other. I am excited for tomorrow no real cases, no scrubs and a chance to really hang out although I feel like I know everyone....an amazing surprised was left in the break room tonight, courtesy of Brittany Blair, the long term lab tech volunteer serving here at Adventist. Brittany was a religion major at LLU, and she studied Biblical Hebrew and Judaism, among other topics. In order to make us feel at home, she prepared Shabbos candles, grape juice and challah bread, braided and doubled. Although I myself am not Jewish I felt a great sense of comraderey as Dr. H and his family lead the prayers. Shabat Shalom every one, Day 6 is done!
Yo Jen

Day 5 ain't it great to be alive

2011-06-02T23:22:00.004-04:00

Today was a day unlike any other, Day five had no clinic patients but a wealth of surgeries. It also said goodbye to a new friend( even though he's a red sox fan) Dre Dawg was missed today and we hope he had a safe trip back to Albany! Today would be the day for all the regional blocks! Day five welcomed a familiar face, Jeff the younger who joined us after a stay on the east side of the island to follow up on patients seen at the CURE hospital. Day five also saw a transition, a culmination of our work here, although we have a very busy clinic/ OR day tomorrow, we will be leaving this Sunday. Jeff will be heading up things as we leave and we are helping to train not only the nurses and EMTs and local docs but the fantastic OR staff as well, helping show our tricks quips and pearls to many of the trickier procedures...Day Five would not be complete without a few things.
1- JJ and Jeanty are two of the most caring, respectable and kind men I have ever met.
Jeanty left nursing school to help work at HAH 1 week after the earthquake, inspired by a
visit to this hospital to visit a friend who had been crushed. JJ is our glue in the OR, never hesitating to help us which is a big reason Nathan hasn't heard anything from our group except "hello and Bonjour"
2- Tara and John and Merrill. Our PACU team is amazing, working in a 2 bed room with a side table full of everything you need over flowing with all the generous supplies donated. On the cupboard top, blankets made for the children by some wonderful human beings who even sewed a pocket with a beautiful note- in creole. We have two loaner pro pac monitors for excellent post op care and AC which if we stopped running in and out would be more effective in cooling that tiny room! Charting is key here as the patients end up taking their post op instruction and operative slip with them when they are discharged. Merrill and John R keep us on task!! They are the unsung heroes, while the surgeries may be over for the surgeons at 7 their day continues until our patients are fully recovered, well enough to move to less monitored beds and sometimes it continues into the night to check on a girl that although an outpatient surgery lived to far away to realistically send her home.
3- Cindy, Jenel and Chris And Alex you guys are great. Alex and Chris wow what fast leathers you are- circulating running back and forth getting this suture and that wire or half pin.Cindy and Jenel have a solid experience base allows time to teach, Thank you for taking time to allow JJ and Jeanty to scrub and learn.
4- I saw a woman cry today, tears of disappointment, despair and longing. Tears we had caused. It was a day of long complicated cases, executive decisions had to be made as our most valuable resource, the team, if burnt out would be no good for any one. The shear amount of pathology we saw this week and likely adding to it tomorrow was a bit overwhelming, unfortunately the deformities we were mostly seeing were complicated corrections that take a bit of time to complete, leaving us at a loss for just how many we can help. These are the facts. I cried when I saw that mom. I felt for her and understood her despair. In certain towns, villages and cities around the world, foot deformities are of some of the more shameful conditions. This mother likely thought she would come, her child would be fixed and no more stigma, ostracizing or ridicule would be put on them....the hope in this story is that there are amazingly generous souls that do what team Sinai does and will be here to help her daughter soon, the tragedy of this story is....Now that the tragedy of the Earthquake is a years old....how many will still think about an island nation in the carribean with no front page news story? Operation Rainbow, team sinai and CURE will because they are dedicated to helping anyone and everyone to aid in contributing to a quality of life some of these children have never known. Now that the dust has settled, new tasks must be accomplished, new goals must be attained. We saw very few people affected by the earthquake this week. The majority the population were people, babies and children with congenital deformities that need our help. Need our supportus need us to not forget them when the hype dies down.
Love and Peace
Yo, Jen
P.S. Dr. Ron......thanks for the coca cola great end to a long day!!

Greetings from Ayiti!

2011-06-02T22:04:00.000-04:00

Greetings from Ayiti! Day three started with a beautiful Haitian morning, nice and warm way to wake up for the day. I slept like a rock (on my very comfortable cot) and managed to take a few moments to really take in the view of the hills behind the hospital and the chickens as they scavenged among the banana trees next to the hospital. While the day did not fully get rolling as early as many of us had hoped, but it was definitely a full day of work. It was so great to see the ortho/podiatry team doing their thing, pinning, releasing, and casting left and right. I thoroughly enjoyed swinging the C-Arm around and watching the xrays as Dr. Herzenberg, assisted by two Haitians (JJ and Dr. Alexis), placed each pin carefully into a TSF. The most memorable part of the day was seeing a young little girl, tears streaming down her face, gripping her arms around the smiling nurse Cindy. My feet are pretty sore right now. I will take that as a sign that I put in my days work. To quote one team member who was kneeling on the ground just outside the OR, “I feel good right now, I don’t think I can make it up the stairs.” The night ended with a rain storm, bringing coolness to a very hot day. Anyways, another day another dollar. Just kidding!! Its so great to be here, can’t wait to see what tomorrow brings.

Mango tasting party

2011-06-01T08:01:00.002-04:00

17 year old girl with never-treated
congenital clubfoot

What does the siani team do to unwind after a challenging day which included two tumor cases and bilateral cases on 8 month olds......A mango tasting party while perseverating on the days cases and our cravings for......shhh don't tell anyone at the hospital. MEAT. Although the food is really good here at HAH it is vegetarian and most of us are omnivores who enjoy red meat at times. I have a feeling that first taste of meat when we get back to the states will be the best any of us have had. Even with the mosquitoes biting( I had a target lesion, no worries not lymes diseas) and my DEET not working team Sinai came together over mangos and for most of the night...a very large brown speckeled orangish fleshed fruit that for the better part of the night, we had no clue what it was but some did partake, about an hour later Jaunty came in and told us it was an abricot!!! It was the largest apricot we had ever seen. Fun times were had by all Tuesday evening. This morning brings TSFs, arthroscopes, Triple arthrodesis, and a few Tals and maybe dinner at the auberge???

Same girl, after Penny modification of the
Lambrinudi triple arthrodesis

Yo, Jen
P.S.
Together We Move, a photo essay book about HAH is coming out next week. Check out Hatitogetherwemove.com to buy a copy next week. All proceeds go to help run the Hati Indigent Patient Fund which allows them to treat poor patients with debilitating conditions. Please support this wonderful community.

Thank you to our host Terry Dietrich, MD good luck to you and Jeannie on your travels back to the states!!!

dre dawg

2011-06-01T00:17:00.002-04:00

Dr. O and I blocking the popliteal nerve

From this side of the ether screen:
Day two of operating is in the books here at HAH. No clinic today for the orthopods, which meant that we could get through some serious cases in the OR with Drs. Herzenberg, Delanois, Dietrich and the fellows that are here. So we fired up early, with cases that are now blurring in my memory. Dr. Sauter popped in spinal after spinal and took care of many of the adults. Incisional biopsies, knee arthroscopies and the full range of adult orthopedic care. Dr. O'Loughlin is a master of the pediatric neuraxis. Caudals, caudal catheters confirmed by fluoro, and spinals that lasted the full duration of the complicated orthopedic reconstructions that Dr. Herzenberg undertook in OR 2 were placed and secured with smiles and good humor.

My trusty sonosite nanomaxx
that almost didn't make it past the TS

It was a fulfilling day for me as well -- I powered up the Sonosite Nanomaxx and put in a femoral nerve catheter on one patient who underwent a tumor resection from around the soft tissue of her knee and then a popliteal catheter on a teenager who had a unilateral club foot repair. Good, good times! I'm stunned at some of the medications that I have the priviledge of administering to my patients here. Clonidine, an adjuvant for regional anesthesia, is well known to increase the duration of a nerve block as well as enhance the quality of the block. And clonidine is available here at HAH! So all of the block patients received 2mcg/ml as part of their block and looked very comfortable when we tucked them in for the night.
Another day awaits tomorrow. The team is great. The HAH staff is welcoming, supportive and incredibly helpful. And the patients are the best of all. The trust they put into all of us is palpable.

Five Stars at the Adventiste

Arup De (aka Dr. Dre,aka Dre Dawg)

And there was darkness and light, the first day...

2011-05-30T23:46:00.005-04:00

Jossie teaches "Diabetic Foot Evaluation" to the Haitian
nurses, firefighters, and doctors.

Day one has come to a close, all is well after a hectic clinic/ OR day, big props to all of the amazing people here at HAH as well as our great team. On every trip, there is a learning curve, us learning the ways of our host hospital and the team learning each others ways. This can be a challenging process but one that brings respect, affection and admiration. We also started our teaching today. There were nurses, nursing students, OR nurses,EMTs and physicians from HAH as well as staff from other local PAP hospitals. This is a great way to

Job and a friend in clinic

" leave skills not scars" as Dr. H would say. These teaching opportunities not only help the staff at HAH but we hope it will affect long term patient care and broaden their knowledge bases which will allow growth at the institution. Looking forward to a busy day tomorrow. Much love goes out to our amazing PACU staff which took excellent care of our patients post operatively, Keeping us up to date on our paperwork and making sure everyone was taken care of. Cindy, way to take charge today. Jenel you did a great job! Thanks to Job and Dr. Delanois, it sure does make clinic easier when you have people on your team that speak the language. Thanks to Britt for running water to all of us and keeping the kids entertained!! Mesi, Mesi,
Ok time to go back to the mosquito nets and catch some ZZssss.

Jennifer

Welcome to Hati

2011-05-30T08:13:00.002-04:00

Bonju,
Yo Jen here.
Good Morning from hopital Adventiste d'haiti. Yesterday began our journey to port au prince with an early morning trip to BWI and great help from American Airlines that allowed us our second bag at no charge. From BWI to Miami allowed us to meet up with Dr. De and head on down to Hati where although only 1.5 hours from Miami we gained an hour of time (Hati does not participate in Daylight savings time.) We were welcomed by our hosts, The Lindseys who are helping to run the hospital. We had many helping hands take our bags into our living space, an area upstairs from administration. There were many people to help take the equipment down to the Operating room, as Jenel and Cindy helped Jeannie set up our OR, our awesome anesthesia team got the ORs ready for our big surgery days. While some members of our team were setting up spaces, Dr. H, myself, Jossie and Job helped Dr. Dietrich screen some of the more complicated cases. All were pediatric patients ranging from baby to 17 years old most with severe deformity included untreated clubfoot, posterior medial bow of tibia, residual foot deformity after treated clubfoot and arthrogryposis. Today brings a busy day of 30-40 patients and 5-6 surgeries. We will also be lecturing on all aspects of hospital care from Anesthesia to Post anesthesia care to CPR and Infection Control as well as wound care and Diabetic foot exam. This week promises to be a challenging life changing adventure!
Jennifer

the Hatians adore their children

Propac for Haiti

2011-05-26T23:51:00.008-04:00

Tara and I testing the ProPaq that we
are bringing for the new HAH PACU

We're continuing down, getting ready for our mid-June mission to Haiti. The hospital where we will be working, Hopital Adventiste d'Haiti, until recently did not have any Recovery Room facilities for patients undergoing surgery. They simply were woken up in the OR, and transported to the floor. Needless to say, this is not the safest scenario, but it is one that is repeated daily in small hospitals throughout the developing world. We read about another orthopedic group that was visiting HAH a few months ago, and had a disaster occur in a 10 year old girl a few hours after surgery. Apparently the child did fine initially, but was found without signs of life on the ward a few hours after surgery. There is no way of telling if a recovery room (PACU - post anesthesia care unit) would have saved her life, but in any case, the hospital administration decided that it was time to invest in a PACU. To help bolster this effort, we are bringing down four PACU/ICU nurses to help train the local Haitian nurses.

Alex Herzenberg packing gear for Haiti

We also are bringing a donation from Operation Rainbow, in the form of an advanced (well actually, used and refurbished) ProPaq monitor for their newly minted PACU. This allows monitoring of a patient's blood pressure, temperature, and heart rate, and pulse oximetry simultaneously during the first few critical hours after surgery. We tested it out on a young man who had come over the house to tutor Brittany in her schoolwork. Poor fellow found himself hooked up to leads and cuffs, and electrodes, and then John started interrogating him. It looked like a scene taken from "Meet the Parents"...
We approach our mission with both excitement and trepidation, hoping that the Lord will watch over us and over our patients. Our goal is to go, do good work, and get all our team members back home safely, and leave all the patients healthy and healing.

The Real Dr. D. Stands Up...

2011-05-25T00:31:00.001-04:00

Ronald E. Delanois, M.D., is a senior orthopedic surgeon at Sinai Hospital in Baltimore at the Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, where is he also the Fellowship Director. Prior to coming to Sinai, he served 18 years in the United States Air Force, the last eight as the division head of the Adult Reconstructive Service at the Naval Medical Center Portsmouth. He is a widely regarded expert in joint replacement.

Ron obtained his M.D. from the Uniformed Services University of the Health Sciences (USUHS). He did his orthopedic training in the Air Force at Wilford Hall Medical Center in San Antonio, Texas, followed by a Fellowship in Joint Replacement at Johns Hopkins. Dr. Delanois currently holds an academic appointment at USUHS, Bethesda, as a clinical assistant professor of surgery. He is an active member in the Society of Military Orthopedic Surgeons as well as the American Academy of Orthopaedic Surgeons.

Dr. Delanois lives in Lutherville, Maryland, with his wife and their three children. He enjoys competitive cycling and collects fine writing instruments. Ron speaks both French and Creyole.

Dr. O

2011-05-22T20:09:00.007-04:00

Dr. Ed O’Laughlin is a pediatric anesthesiologist practicing for many years in the Baltimore area and currently working at Sinai Hospital of Baltimore. He is looking forward to our upcoming June trip to Adventiste. "Dr. O" has already served on two previous orthopedic missions to Haiti, the previous two being with Dr. Scott Nelson, working out of Cap Hatien. Ed is a Francophone, and is working on his Creole.

Ed is a devoted father of five, grandfather of three, married 35 years. Ed is an avid croquet player and enjoys the travel and competition. He even has his own professional grade court, one of the best on the east coast. While he supports himself and his family through his work as an anesthesiologist, he dreams of the day that croquet will become an Olympic sport, opening up an opportunity for Ed to be the oldest U.S.A. Olympian.

Croquet now...

Croquet then.....(Edouard Manet)

Jeff the Younger

2011-05-22T14:08:00.015-04:00

Welcome to Dr. Jeff Young, who will be joining us on Team Sinai at Adventiste. Originally a native of Maryland, Jeff studied at the University of Pennsylvania Medical School, and then went off to Northwestern University (Chicago) for his orthopedic residency. He completed a pediatric orthopaedic fellowship at the Royal Children’s Hospital in Melbourne, Australia. Subsequent to that, he did a six month fellowship with here in Baltimore at the International Center for Limb Lengthening at Sinai Hospital. Jeff has already been bitten by the mission bug. His prior mission trip experiences include trips to Guatemala, Colombia and Nicaragua. On his return to the USA from Haiti, he will be joining Drs. Larry Rinsky, Jim Gamble, and Meghan Imrie on the orthopedic faculty at Stanford University in Palo Alto, California. The Bay area is the home of Operation Rainbow, co-sponsor of our upcoming mid-June mission to Haiti, so Jeff plans to continue as an active participant in overseas missions with Operation Rainbow.

Jeff and friends in Nicaragua

Hawaii Nurse, Waka Waka Lua!

2011-05-22T12:06:00.004-04:00

With a young friend in Esteli, Nicaragua

My name is Alex. I am a 27 year old ICU nurse, and recently moved back to Baltimore with John and Merrill (the ‘rents). I was born in North Carolina, but grew up here in “Bawlmer”, including graduating from Villa Julie College of Nursing (AKA Stevenson University). For the past 4 years working as a travel nurse. My work has taken me to NYC (Bellvue Hospital) , Hawaii, San Francisco, and most recently, San Diego. I went on my first of several missions with Operation Rainbow to Nicaragua, 11 years ago. I started as a young “helper”, then in subsequent years, as a nursing student, and finally as a full-fledged RN. My earliest memory of mission work was greeting my dad coming home after his first mission to Nicaragua in 1998. His team was caught in Hurricane MItch, and stranded for a week. By the time they arrived home, the news media was staked out at the airport covering the return. That was pretty exciting for me to see. My mom also went on several missions to places that made the Top Ten Travel Warning List of the State Department, including Pakistan after an earthquake, Sri Lanka after a Tsunami, and Haiti, two weeks after the earthquake. Some how, my parents decided that these missions were safe enough for my little sisters and me. Throughout the years, all of us have joined my parents on these mission trips, usually to Nicaragua, though my little sister Brittany was with our parents at Adventiste in Haiti last year. Our friends didn’t quite understand it when I showed them pictures from our trips.

Administering an IV in Nicaragua

They thought that when we went to the tropics, we must have been going to fancy resorts! In any case, these were the most special experiences in my life, and they helped to cement my decision to become a nurse. In fact, it was on a Rainbow mission in 2006 when I began my passage into professionalism, learning I had learned enough to pass two things: my first Foley catheter and the NCLEX (waiting desperately for my test score results to download in the painfully slow dial-up internet cafe in Esteli).

Waiting for a fake wave in Singapore.

During the past few years I’ve enjoyed practicing in a different kind of tropics: the Aloha state of Hawaii, as a traveling nurse. I feel extremely lucky and excited to join the team this year on the mission to Haiti.

Real waves, Kailua Beach, Oahu

Climbing in Hawaii

Francel, we're so glad you are here!

2011-05-21T19:13:00.002-04:00

It's a pleasure to introduce the most recent addition to Team Sinai, Dr. Francel Alexis. We are so grateful that he will be joining us, and also staying on after we depart to help look after the patients we treat when we go to Haiti later in June.....

I am a 31 years old (young) Haitian orthopedic surgeon. I was born and grew up in Les Cayes, in the South of Haiti. I attended high school in Port au Prince at the Institution of Saint Louis de Gonzague. I graduated from the Medical School of the Haitian State University in 2004, and then worked for one year of national service in Les Cayes. Soon after, I started my 4 year orthopedic residency at the Haitian State University Hospital.

I have had the opportunity to spend some time rotating through various hospitals in the USA and France. Since 2007, I have attended the yearly SIGN Conference for Treatment of Difficult Fractures in Richland, Washington. In North America, I have had the privilege to visit famous hospitals in Kansas, Texas, Indiana, North Carolina, and Ottawa. I also visited a hospital in Guadeloupe, France. Back home in Haiti, I recently enjoyed working at Hopital Adventiste with the long term volunteer docs: Terry Dietrich and Scott Nelson, so I am already familiar with the workings of Adventiste.

Immediately after the earthquake of January 12, 2010, I volunteered at the General Hospital (HICC) in Les Cayes along side Médecins sans Frontiérs (MSF).

I am doing now a Fellowship in Pediatric Orthopedic Surgery at the CURE International Hospital in Dominican Republic since November 2010 with Dr. Dan Ruggles. I am married to my lovely Wideline and we have three beautiful children. I look forward to working with the other members of Team Sinai!

Francel ALEXIS, MD

The Prodigal Daughter

2011-05-21T10:39:00.000-04:00

I am a Haitian American Nurse Practitioner who specializes in Cardiology. Helping Haiti has been a goal of mine for some time and the earthquake disaster only intensified my desire to go to my homeland and help out. I hope this trip will only be the first of many back to Haiti in a professional, volunteer capacity. It is important to me to go back to my country and help rebuild and support my people.

A little about myself, I studied undergraduate nursing in Chicago at University of Illinois. I worked as a Cardiac nurse at Miami Heart Institute and in the Cath Lab at Baptist Medical Center in Miami, Florida. I came to Baltimore 10 years ago for graduate studies at Johns Hopkins School of Nursing. For the last five years I have worked for the Johns Hopkins Division of Cardiology as a Nurse Practioner. I look forward to being a part of this Team Sinai and going back to my homeland! Oh, and one more thing, I speak Kreyole and French much better than my cousin Ron!

Hooray for Bollywood!!

2011-05-18T23:34:00.002-04:00

As we continue to introduce you to the new members of Team Sinai, please welcome the beautiful, vivacious, and brainy Dr. Jossie Abraham, AKA "Bollywood", AKA "Toesie". In her own words...

I'm not Kim Kardashian,
I just look like her...

I am extremely excited to be on this trip to Haiti and can’t wait to make a difference! First a little about myself, I was born and raised on the streets of Manhattan. :) Going to catholic school and wearing a school uniform everyday meant a very limited wardrobe for me. Hence, my sense of style only came into play at the age of thirteen when I moved into suburbia to start public school. A slower pace with squirrels running wild couldn’t keep me from heading back to living the city life. I went to Lehman College (Bronx, NY) for my bachelors and then to the New York College of Podiatric Medicine for graduate school (back to Manhattan!!!). Somehow I ended up in Scranton, PA where I completed a three year residency in foot and ankle surgery. Currently I’m at the Rubin Institute for Advanced Orthopaedics at Sinai Hospital of Baltimore, completing a fellowship in foot and ankle reconstruction. This has been an amazing opportunity and such a blessed experience.

Me and my man!

Jossie and Jen at work in clinic

Before I started my path in medicine, I experienced witnessing my grandfather passing away in a small rural hospital in India. It was then I made a decision to make a difference in this world and to do whatever I can with my hands to benefit those that are less fortunate. I can’t wait for my first mission trip and I hope this will not be the last.

Yo, Jen!

2011-05-16T01:23:00.002-04:00

Meet Dr. Jennifer D'Amico, one of three podiatric fellows who will be joining Team Sinai in Haiti next month.....

Dr. Jennifer D'Amico graduated from her podiatric residency in beautiful San Diego, CA where she gained valuable experience in foot and ankle reconstruction as well as orthopedic trauma. While living in San Diego, Jen also reconnected with her passion for the arts which included ceramics.She's now with us in Baltimore at Sinai as a limb reconsruction fellow doing a great job. Dr. D'Amico loves to volunteer (homeless outreach, Girls Think Tank). After graduating, Jen had a whirlwind mission trip to Nepal with Healing the Children where they did mostly reconstructive surgery on children and adults with neglected clubfoot. That experience in Kathmandu solidified her passion for helping the disadvantaged. Jen herself came from a modest background, surviving with her mother and brothers on food stamps and help from mom's family. Through hard work and dedication, Jen is realizing the American dream, graduating from college, podiatry school, residency, and finishing up her fellowship. She'll be returning to San Diego as an attending surgeon this summer. Jennifer is looking forward to continuing her mission work as a way of helping people around the world who are disadvantaged. She is very excited to be joining Team Sinai for our June 2011 Haiti mission. She is not concerned about potential security issues in Haiti. She knows that if anything were to happen to her, she has three Italian brothers who will come protect their little sister!

Jen and her big brothers in the "hood"

Papa Doc and Baby Doc

2011-05-14T23:26:00.054-04:00

Team Sinai is proud to welcome two “new” members who are actually both experienced volunteers at Hopital Adventiste d’Haiti. John (Papa Doc) Sauter has worked with CURE teams twice in HAH and son Chris (Baby Doc) helped his dad on the last mission.

John (Papa Doc), Chris (Baby Doc) at HAH
with interpreters Tony and Roosevelt.

Dr. John Sauter has been in anesthesia practice for the past 23 years. Following residency he served four years of active duty in the US Navy practicing anesthesia, including stints on Aircraft Carriers Saratoga and Forrestal, and aboard the Baltimore based hospital ship USNS Comfort. Since separation from the service, John has been practicing in the Philadelphia suburbs. His special interests are obstetrical and cardiothoracic anesthesia, but has a broad experience in orthopedic, general surgery, GYN, and urology anesthesia.

Chris Sauter is 23 years old and currently with 'rents in Philly. He graduated from Colgate University last spring where he concentrated in Molecular Biology and minored in Economics. He spent one semester working at the National Cancer Institute and another semester at the University of Cardiff, Wales. He currently works at a research laboratory at Thomas Jefferson University in the division of Medical Oncology, spending most of his time in the company of mice and rats. In his spare time, he enjoys outdoor activities, reading, and volunteering. He is a certified Wilderness First Responder. Chris’ previous experience as a volunteer in Haiti was a unique, eye opening experience, and cemented his desire to follow in Dad’s footsteps in a medical career.

Chris outside the wire at HAH

John’s wife Eve is proud of the two men in her life
As a family, they enjoy hiking and cycling.

Gentle Jenel

2011-05-14T22:31:00.001-04:00

I'm working here....

Jenel Slonaker is a Surgical Technician at the Rubin Institute for Advanced Orthopedics at Sinai Hospital. She was born just north of us in Lancaster, PA, and studied Surgical Technology in New Jersey. After graduation, she worked at the Hospital for Joint Diseases in New York, and at Shock Trauma Hospital in Baltimore. For the past several years, she has been with us at Sinai. Jenel is a Surgical Tech by day, and a student at CCBC (Community College of Baltimore County) by night, working on her Bachelor's Degree.

"Dr. D, did you forget to put
this back in...?"

Jenel is mission experienced, having traveled with Operation Walk Maryland to Ecuador in 2010. Our own Dr. Harpal Khanuja led that mission, and reports that Jenel worked hard, and was inspired by the opportunity to help people in need. Her long term goal now is to become a Physician Assistant.
Jenel is pictured above helping us to remove an external fixator, and we're not sure WHAT she's doing with that proximal femur on the right, though she looks like she is ready to blast off into outer space....
We anticipate running two operating rooms in Haiti next month, and this should keep Jenel on her toes!

Will the REAL Dr. Dre, please stand up!

2011-05-10T21:45:00.003-04:00

Doctor Dre

Team Sinai welcomes Dr. Arup De (pronounced "aw-roop dee"), anesthesiologist extraordinaire. He doesn't know it yet, but his official Team Sinai nom de guerre will be Dr. Dre (AKA Andre Romelle Young, the West Coast G-funk Rapper). Why not just plain "Dr. De"? Because that nick name is already taken by our very own Dr. Ron Delanois, universally known at Sinai Hospital as "Dr. D". Here in his own words, the real Dr. Dre stands up...

Doctor De and Friend

I as born in India, grew up outside of Boston, and completed my undergraduate and medical education at the University of Massachusetts. Next came residency in anesthesiology at the Brigham and Women’s Hospital in Boston. After completion of my training, I worked in several different private practice hospitals in Massachusetts and Texas. I decided to return to my academic roots, and so I currently work at the Albany Medical Center in Albany, New York. My major goal is to establish a program in international anesthesia outreach for our senior anesthesia residents. Adventiste may turn out to be an ideal location for my residents to rotate through on an ongoing basis.

My international experience to date includes three Operation Smile missions in India – one in Kolkata, and two in Guwahati. My Bengali fluency came in handy in all three missions. Not sure how much Bengali will help me in Haiti, but I have been reviewing some Kreyole phrases to get ready!

I'm also part of IMSuRT, the International Medical Surgical Response Team, which operates through NDMS (National Disaster Management System), under the executive branch of the United States Government. Through IMSuRT, I spent a frigid January week in Washington DC, during the Obama inauguration. Luckily, there were no disasters, other than a few frozen finger tips.

Professionally, I am keen on ultrasound-guided regional anesthesia. This has great promise as a practical tool in the developing world. Regional anesthesia is almost always safer than general inhalational anesthesia, though it can be trickier to perform regionals. Ultrasound guidance has the potential to make regional anesthesia the method of choice in the developing world, thus imparting a greater margin of safety for patients. I hope to share these skills with our Haitian anesthesiology colleagues next month at Adventiste Hospital.

Queen of the Tundra: Cindy Swanson

2011-05-09T21:32:00.002-04:00

Cindy Swanson writes…
Merrill asked me to write about myself for the Team Sinai Haiti blog. I guess I always have trouble talking about myself but here goes... My international travel started in 2000 when I joined the Peace Corps. I was in Belize as a part of a group that was training elementary school teachers how to use computers. It was a neat experience being there and lived there for six months.
My next adventure was teaching in a public school in Alaska. It was a village accessible only by bush flight on the Yukon National Wildlife refuge. The interesting thing was, it was more remote, otherworldly with less amenities than being in Peace Corps. I taught elementary and high school art in a village that was all Native Alaskan. I learned to live on the tundra with no running water. In the two years I was there, I learned an important thing that sociologists talk about, that there are two levels to another culture. There are the material things and the non-material things. It is relatively easy to get used to not having water, living in a house on stilts, the food, traveling by boat or plane, etc. The things that are more difficult to grasp are the intangible things like values, communication, and cultural norms. These things are usually learned more slowly. What I value might not be the same, what is normal for them may not be the same for me. As a teacher, I had to be very careful not to assume my way was better.

Tundra Cindy and the Shock Trauma Crew in Haiti

After coming back to the lower 48, I went to nursing school at Johns Hopkins and from there began working in the OR at Shock Trauma and have been there ever since. Last year after the Haitian earthquake, our hospital organized a team and set up camp in a half collapsed hospital in the city. Each week new teams would be rotated in to do basic triage and surgery. I went last April, and staffed three OR's doing mostly orthopedic, and general surgery. That week we were lucky to have an OB/GYN doctor with us, so we did OB as well. We had to learn to do surgery with limited supplies, intermittent electricity,and only a mini c-arm. I have wanted to go back since then, so I was really excited to learn that Team Sinai needed an OR nurse. See you all in June! ----Cindy Swanson, RN

Heading Back to Haiti

2011-05-08T21:28:00.003-04:00

Bonjou and welcome to the official Team Sinai Haiti blog for our upcoming mission to Port-au-Prince, Haiti. Our team is returning to volunteer at the same hospital where we served last year (June 2010), Adventiste Hopital d’Haiti. From the moment we left after our weeklong mission last June, we couldn’t wait to go back. We had an amazing, life altering experience, and were able to help over 50 indigent patients who needed orthopedic surgery. Many were originally injured in the earthquake of January 12, 2010, and some were more recent trauma victims, and many were children with birth defects. We had arranged to return to Adventiste Hopital over the Christmas break, 2010, but our plans were thwarted by political and civil instability surrounding the December elections. Things in Port-au-Prince got pretty hairy, prompting American Airlines to temporarily suspend flights. Moreover, the organization hosting us, Adventist Health International, decided to temporarily evacuate their expatriate staff at Adventiste to the Dominican Republic. By the time the smoke settled, we had lost our travel window. Over the next few months, we planned, calculated, and regrouped, and finally were able to reschedule our mission to this June 2011. Most of the original 18-team members from last year were not able to make the new date, but we have successfully recruited replacements. The returning team includes six veterans: Merrill, John, and Brittany Herzenberg, Job Timeny, Ram Shetty, and John Russell. (See me, Job Timeny, and John Russell rounding last year...)The brave newcomers are John and Chris Sauter, Ed O’Laughlin, Arup De, Julia Ramberg, Tara Leroy, Ron Delanois, Alex Herzenberg, Jossie Abraham, Jennifer D’Amico, Janel Slonaker, and Cindy Swanson. Over the next few weeks we will be introducing our new team members. We haven't yet told them about the first class accommodations for volunteers at Adventiste (see below), or the fact that it is 95 degrees in the daytime and 85 degrees at night. Air conditioning? Guess again...

Last year, we worked with Dr. Scott Nelson, who spent 6 months at Adventiste after the January earthquake. Scott's replacement is Dr. Terry Dietrich, who is serving for one year, together with his lovely wife Jeannie. We really look forward to helping Terry and Jeannie, as they are so tireless and committed to providing orthopedic care to the indigent population of Port au Prince. Stay tuned, more to follow in the coming weeks.

Team Sinai - Operation Rainbow Plans Haiti Return

2010-12-25T14:26:00.006-05:00

From the day we returned this past June from Port au Prince, we have been planning our return. Our experience at Adventiste Hospital was for all of our team members, uniformly, life changing. It didn’t matter if we were veterans of many international relief missions, or if we were first timers. None of us will ever forget the children and adults that we treated that week. Scott Nelson put it aptly, “Haiti messes with your head.” Well it is certainly a point in fact that Haiti messed with Scott’s head. He was back earlier this month for a two week volunteer stint at Adventiste. (Read more about Scott and Marni Nelson at http://www.caribbeanortho.com/caribbeanortho/Nelson.html). As you may recall, Scott had been in Haiti for a full 6 months after the January 12 earthquake, and did amazing work organizing what has become the top rated orthopedic facility in Haiti. He left shortly after our June mission, to start his new life and career at Loma Linda University in California. Scott returned in early December to help orient Terry, and provide his inimitable expertise and enthusiastic, boundless reserves of energy to serve the Haitian underserved population. In his place, Dr. Terry Dietrich, from Appleton, Wisconsin has now arrived, as of November, along with his wife Jeannie Dietrich, R.N. for a year-long commitment. (Read more about the Dietrichs at http://www.caribbeanortho.com/caribbeanortho/Dietrich.html).

Team Sinai / Operation Rainbow all packed and ready to go.

Our plans were to return for a week of service on December 26, at which time we would be the only expatriate medical team present, with the long term volunteers being scheduled out for the Christmas/New Year holidays. We were ready to welcome some new team members, including Drs. Ron Delanois, Dr. Rishi Thakral, Dr. Julia Ramberg, and Dr. Jossie Abraham. Unfortunately, fate intervened, and we have had to cancel our trip. Here’s the story…

Over the past 6 weeks, the political situation in Haiti began heating up considerably. Nationwide elections took place on November 28, plagued by controversy, with accusations of ballot rigging, and other irregularities. Haitian electoral law requires that the winning candidate capture at least 50% of the casted ballots. With over 20 candidates to choose from, no single candidate took a majority, which leads by Haitian law to a run-off election (scheduled for January 16^th, 2011) between the top two candidates. The third place candidate, who by the official count, trailed by a mere few thousand votes, cried foul, along with many other candidates. This lead to mobilization of various supporters in the form of street demonstrations that turned violent, and essentially shut down the city for the better part of a week. HAH was on lock-down, and all volunteers present were forbidden to leave the hospital compound. Things got so bad that American Airlines stopped flying to Port au Prince for about a week. New reports showed street barricades, gunshot victims, and burning tires. Tap-taps stopped running, and the general populace hunkered down, waiting for the political game to play itself out. Unfortunately, things are at an uneasy stalemate, with many of the stake holders still negotiating and posturing. Even today, no one knows if there will be a recount (unlikely), a re-election (more unlikely), or a continuation of the current government as a provisional government (who knows?). The US and Canadian embassy shut down, and forbade their staff to go to downtown PAP.

Street riots and barricades in downtown PAP

The enthusiasm of the rabble to create mayhem has died down over the past two weeks, given the paralysis of the government and the electoral board. This past Monday, the final election tallies were to have been announced, and everyone feared that this would provoke yet another round of unrest. Fortunately, the government decided to postpone any further election announcements until the entire mess can be worked out by a combination of the government, the Organization of American States, Bill Clinton, the candidates, and the UN. Don’t expect anything to be decided too soon. Once there is a decision, it is feared that the losing party/parties will be unhappy, to say the least. According to Haitian law, the run-off elections should take place on January 16^th and the new government installed on February 7^th. It is doubtful that this time line can be maintained, given the current impasse that has become, in effect, a political Gordian knot. Rumors of renewed civil strife, unrest, and even civil war are floated. Given the volatile nature of Haitian political history, with numerous past coups, military takeovers, and dictatorships, these possibilities are not far fetched. For an insiders view of Haitian politics, see the Haitian news site www.haitilibre.com which has an English version as well as a French version.

On top of the political strife, Haiti is enduring a nationwide epidemic of cholera, that has now infected, by official count, at least 120,000 people and killed 2,500. See an epidemiologic analysis at http://www.reliefweb.int/rw/fullmaps_am.nsf/luFullMap/2D9992968E894422852577F2007C2B3E/$File/map.pdf?OpenElement . It should be noted that these figures are widely believed to be underestimates. See this recent posting from Haitilibre…. http://www.haitilibre.com/en/news-1972-haiti-cholera-epidemic-the-mspp-hides-the-truth-to-the-people.html . In yet another twist, the Nepalese soldiers from the MINUSTAH (United Nations Mission for Stabilization in Haiti), have been accused of being the source of the outbreak of cholera, though in the boiling cauldron of Haitian culture, at least 45 voodoo practitoners have been lynched by street mobs who are convinced that the cholera epidemic is being promulgated by the voodoo priest casting spells on the unfortunate victims. For details of this bizarre aspect of the epidemic, see http://www.haitilibre.com/en/news-1975-haiti-social-lynchings-at-least-45-dead-cholera-or-religious-war.html

Given this volatile mix of civil, political, and electoral unrest, with a dollop of a deadly cholera epidemic thrown in, and intermittent cessation of airline flights, the Adventist Health International (AHI) has decided to suspend the short tern volunteer program at HAH. Two weeks ago, with only a few days notice, they officially evacuated the short term volunteers who happened to be at HAH at the time, plus the five long term volunteers, which included the Dietrich’s, the Russell’s (assistant administrators), and nurse Lynn Byers. Scott Nelson, and his Dominicana nurse Lucilla and anesthesiologist Dra Adrian were also there when the order came to evacuate. Predictably, he and his crew placed patient safety above the orders from the AHI home office, and chose to stay a few extra days beyond the AHI ordered evacuation deadline to make sure that the recent post-operative patients were stable. Scott even managed to squeeze in an emergency open reduction of an unstable pelvic fracture that had been told by MSF doctors to stay in bed for three months. For a description of the last few hectic days of the evacuation, read accounts from Terry Dietrich and Scott Nelson from December 16,17,18 on the www.haitibones.org website.

Rishi, Ella Joy, Amy and Merrill packing duffles.

The current situation over the holidays is that all expatriates are now gone from HAH, and the hospital continues functioning with a Haitian only staff. Obviously, the orthopedic capacity has been reduced dramatically. On a hopeful note, AHI is considering giving the permanent expats (Terry and Nathan) a tentative go-ahead to return in January. The fate of the short term volunteer program (that’s us) remains in limbo.

Up until two weeks ago, when we were notified of the evacuation order, we were busily preparing for a December 26 departure. Dr. Rishi Thakral, orthopedic fellow at Sinai Hospital, and Nurses Amy Monitillano and Ella Joy Napoles Brown came to our house to prepare more than a dozen duffle bags stuffed with hospital supplies that had been requested by HAH, including sterile OR drapes, gowns, and towels, bandages, as well as ex-fix components and various and other assorted sundries that have been donated for this mission. Amy and Ella Joy worked with Sinai surgical techs Hassan Hooper and Jenel Slonaker to collect discarded but otherwise unused drapes and gowns from surgical packs that would have been sent to trash. Instead, they reprocessed/resterilized them for our mission. Another packing party had been planned for the following week, but we cancelled once we had the official word from our sponsoring agency, AHI, that we were no longer allowed to volunteer at HAH until such time, indeterminate, that AHI declares the situation safe.

Palisades, NJ Rotarians donate to our mission after hearing my PowerPoint.

All of us were sorely disappointed, but we have regrouped, and are planning to use our American Airlines tickets (minus a change fee…) to reschedule our trip for later in 2011. We will be in close contact with AHI and the permanent volunteers at HAH to determine the safest and earliest date. When we went to Haiti last June, we were representing Sinai Hospital. This time, we are proud to be co-sponsored by Operation Rainbow.

John and I have been long associated with Operation Rainbow, going on yearly trips to Nicaragua or Ecuador. Thanks to the vision and generosity of Laura Escobosa, executive director of Operation Rainbow (www.operationrainbow.com), we have the additional logistic support that promises to make this mission (when it actually happens…) even bigger and better than our previous trip. We've been fundraising to help buy medicines and Medika Mamba (Plumpy Nut) for our patients. Special thanks to the Palisades, New Jersey Rotarians for enduring my Power Point of our June mission, and for their kind donation. Additional thanks to the Rubin Institute for Advanced Orthopedics (RIAO) at Sinai Hospital for their Save-a-Limb Fund which helps support our mission plans. Each year, Sinai has an annual Save-a-Limb Bike Ride http://savealimbride.org, and this year's October 2010 ride brought over 600 participants.

Save-a-Limb Ride and Team RIAO

One thing for certain, Haiti is still suffering from the destabilizing effects of the January 12 earthquake, the agonizingly slow rebuilding phase, and the confounding factors of political unrest and a cholera epidemic. Clearly, there is a continued need for volunteer groups such as Team Sinai / Operation Rainbow to provide orthopedic care for the masses of Haitian adults and children that cannot afford to pay for what might be considered even the basic necessities of life. The overall theme that AHI has planned for HAH is to increase the Haitian national medical presence, with a goal towards sustainability. For the foreseeable future, however, volunteers are still desperately needed.

--Merrill Chaus, RN

Team Sinai - Mission Report JUNE 2010

2010-08-28T21:32:00.001-04:00

Mission Report: Team Sinai at Hopital Adventiste d’Haiti (HAH)

Prepared by John Herzenberg, MD

Introduction

Team Sinai spent one week at HAH (June 10-17, 2010). We were an 18 person team, primarily from Sinai Hospital of Baltimore. This report is based on our experience there. During that week, our team included one orthopaedic surgeon, two orthopaedic fellows, one podiatry resident, one anesthesiologist, one family practitioner, one physical therapist, six nurses, one prosthetist, one central strerile tech, and three helpers. We worked closely with Dr. Scott Nelson, Orthopaedic Director of HAH. We also “drafted” several volunteers from other teams to work with us (Loma Linda residents, medical students, and nurses from an Oregon team that overlapped our stay). We performed 54 surgeries, and operated past midnight on four out of seven nights. Thirty-one cases had anesthesia by our team anesthesiologist, the remaining twenty-three had anesthesia administered by three Haitian anesthesiologists. We worked hard to accommodate both the elective cases that had been prepared for us, as well as the emergency and urgent cases that were brought in. Examples of cases we performed: hemiarthroplasties for hip fractures, pinning of hip fractures, osteotomies for femoral neck non-unions, SIGN nailing for tibial and femoral fractures, SIGN nailing for nonunions, posterolateral bone grafting for tibial nonunion, plating of femur fractures, ORIF ankle fracture, 8-plates for tibia vara, release of knee/ankle contractures, many clubfoot surgeries, CP tendon lengthening, Fassier Duval nailing for Osteogenesis Imperfecta saber shins, I&D of abscesses, VAC changes, amputations, bone transport for tibial defect (Ilizarov), open reduction of neglected shoulder and hip dislocations (from the January 12 earthquake) and iliac crest bone grafting for various nonunions. In addition, we staffed an orthopaedic clinic on three days, and a Ponseti clubfoot clinic on one day. Average orthopaedic in-patient census was 45. About 50% of patients we operated were below age 21. One third of our cases were earthquake related.

HAH was a 70-bed hospital where not much orthopedic surgery was done before the January 12, 2010 earthquake. It is one of the only hospitals in PAP that survived intact after the earthquake. There is only one thin crack in the structure, and it has been certified by the Army Corps of Engineers as safe and in no need of repair. We were told that the original architect/engineer who designed and built HAH was from California, and that he built it to withstand earthquakes. Immediately after the earthquake, nobody wanted to enter any building in PAP, fearing the aftershocks would cause more damage. Thus, for a short period of time after January 12, 2010, operations at HAH were being performed in tents in the parking lot. Dr. Scott Nelson came to HAH shortly after the earthquake, and stayed for 5 months until June 20, 2010. During those five months, he and others did a tremendous amount of organizational work, and developed one of the most active and advanced orthopedic services in PAP. During the week that we were there, many patients were transferred from other medical facilities (such as MSF and Medishare) to HAH with complex orthopedic injuries, including hip fractures and spinal fractures. Drs. Richard Schwende and Kaye Wilkins were commissioned by the Pediatric Orthopaedic Society of North America to survey potential sites in Haiti for POSNA members to staff, and wrote that based on their survey in late March 2010 that “HAH was the best-equipped and administratively managed hospital among those visited”. http://www.posna.org/news/Haiti_Apr8Update.pdf

Physical plant

HAH is in the Carrefour district of PAP, and is about ¼ mile from the Adventist University. It is about one hour’s drive from the PAP airport, in a mixed residential/commercial neighborhood. There are nearby markets and stores within a few blocks from the hospital. The entire hospital compound is protected by a wall, and has a guarded gate entrance. HAH is a two story concrete hospital, with attached chapel. There is no elevator to the second floor, but there is a covered circular ramp, so that patients could be wheeled on gurneys to the second floor. The first floor contains the ER, OR, pre and post-op wards, radiology department, pharmacy, cast room, clinic, and administrative offices. The second floor has numerous private rooms (one patient per room), numbering about 24, and more administrative offices, and a volunteer’s break room. Air conditioning is present in the three OR’s, break room, cast room, and clinic room. There is a separate, adjacent pediatric ward and OBGYN ward in front of the hospital, about 50 feet away. There are several donated large military style tents on the hospital grounds that are used as step-down units, and there are also numerous small tents on the hospital grounds where many ex-patients and Haitian staff (translators, for example) are staying.

HAH has its own water supply piped directly from a nearby spring. This reliable water supply was actually developed after the earthquake. There is also an onsite purification unit for drinking water. Two generators on site provide back up power if the city grid goes down (almost a daily occurrence). There is good cell phone reception and the hospital has free Wi-Fi available. Due to generator issues, we did have to operate several times in the evenings briefly by lantern/head lamps. In the basement, there is a hospital kitchen that provides one meal daily to patients and volunteers.

The majority of the ex-pat volunteers sleep in a breezy, covered veranda on army cots and under mosquito nets. A few intrepid volunteers pitched tents on the roof of the hospital. Some volunteers stay in the unused private rooms. There is a sufficient number of flush toilets and cold showers available for the volunteers to be comfortable. One meal per day (lunch) is provided by the hospital for patients and volunteers. In keeping with Adventist tradition, the kitchen is strictly vegetarian. Volunteers also bring their own food, which can be prepared in the adjacent air-conditioned volunteer break room, which is equipped with dining tables and a microwave oven. Hospital housekeeping provides dishwashing service. The volunteer sleeping area and break room are guarded 24 hours/day to discourage theft. We never encountered any problems in this area.

Staff

There is a full time Medial Director, Dr. Lesly Archer, who is a Haitian OBGYN. He trained in Montreal, and maintains residences in both Canada and Haiti, but has been continuously present in Haiti since the earthquake. He is charming, trilingual (English, French, and Creole) and was very helpful. They have about three obstetric deliveries per day at HAH, which take place in a separate, adjacent OR facility that I did not see. Dr. Archer does elective OBGYN cases in the main OR facility.

Until recently, Dr. Scott Nelson was the Orthopedic Director, but he left on June 20. Dr. Terry Dietrich of Appleton, Wisconsin tj.dietrich99@gmail.com, is his replacement, but is not due to arrive until November 2010. Dr. Dietrich has served as a volunteer with Dr. Nelson at HAH previously, so he is familiar with the system. For the four month interval until Dr. Dietrich arrives, HAH is relying on part time and short term orthopaedic volunteers, including Dr. Mark Perlmutter, an orthopedic hand surgeon from Pennsylvania, Dr. Barbara Minkowitz, a pediatric orthopedist from New York, and Dr. Karl Rathjens, pediatric orthopedist from Dallas, Texas. A team from New York Columbia Presbyterian is also scheduled to arrive in November. Dr. Lars Hansen, president of the Haitian Orthopaedic and Trauma Association, visited us but we did not see Haitian orthopaedic surgeons operating at HAH.

There are three Haitian anesthesiologists, but their schedules require coordination, and they are generally not available after hours.

The wards are staffed by Haitian nurses, but due to the large volume of patients, dressing changes, and complex problems, it is highly recommended to have a full cadre of volunteer nurses. There is an ex-pat nurse, Brooke Beck brooke.bbeck@gmail.com who has been working for the past four months. She coordinates many patient care aspects as well as coordinates the volunteers. She is scheduled to rotate out of HAH in September, and work with another NGO in Haiti. A new expatriate nurse, Jessica Scott has arrived, and will be staying for the foreseeable future. There is also a Haitian American floor nurse coming this fall, which should be a great help in keeping the hospital running efficiently.

The OR has Haitian orderlies, and central sterile personnel for decontamination and instrument sterilization. There are Haitian radiology technologists in the x-ray department.

Haitian doctors staff the ER and peds ward. Many volunteer groups have augmented the Haitians with US family practice or ER docs.

Numerous volunteer translators are ever present to help the teams. While French is spoken widely by the educated class, including nurses and doctors, most of the patients speak only Creole. It is customary for the international volunteers to provide a gratuity to the Haitian translators before departing. Such tips are greatly appreciated by the translators, and other local personnel, many of whom are working for free, and truly depend on the generosity of the international volunteers.

Early on after the earthquake, there was a full time ex-pat relief administrator, Dr. Andrew Haglund, who helped coordinate the reconstruction efforts at HAH. He left about two months ago, and is sorely missed. Recently (late June), a full time ex-pat assistant administrative director has arrived, Nathan Lindsey nlindsey@llu.edu mobile +509-3491-6539 along with his wife, Amy, a nurse. They will be staying for an extended tour of duty. This should be a great help to further develop the long term viability and growth of the HAH. The challenge for volunteers, both long term and short term, is to scrupiously respect the feelings and sensibilities of the Haitian indigenous personnel, encourage them to become invested in the workings of the hospital, and ultimately become sustainable rather than dependent on expatriates.

Affiliation with Loma Linda University (California)

HAH is affiliated with the worldwide network of Adventist Hospitals. HAH has a special relationship with Loma Linda University’s Global Health Initiative. They are also partnering with CURE.

Coordination of volunteers since the earthquake has been through LLU. The contact person at LLU is Alex Sokolov asokolov@llu.edu

At any given time, there are 25-35 volunteers working at HAH. Some groups also have ventured out to staff clinics in the refugee camps and tent cities.

The hospital is affiliated with the Seventh Day Adventist church, so the Sabbath is celebrated on Saturday not Sunday. The OR’s and clinic are closed on Saturday, except for emergencies. Sunday is a regular OR day. Scott Nelson started each day with a 6:30 inspirational meeting on the steps of the hospital. This time was used to read some inspirational passages from sources such as Mother Teresa, to relate stories about what it was like after the earthquake, and to discuss organizational issues. It was conducted in a culturally sensitive, non-denominational fashion, which was important for our team, which included many orthodox Jews.

OR facilities

The OR suite at HAH comprises two large OR’s and one small one. There is a changing room, toilet, large well-organized storage room for orthopaedic sets, a small storage room for sterilized sets, refrigerator (used for blood, drugs that require refrigeration, and drinks), and large central sterile room with two large sterilizer units that can handle any large tray. Between the two large OR’s, there is a small pharmacy storage area. There is not a specific room in the OR that would handle the volume of equipment that Rainbow brings, but there are one or two rooms just outside the OR suite doors that could potentially be used for this. The large OR’s can accommodate any big case, including use of the c-arm. The small room is appropriate for simple cases.

There is a modern c-arm (OEC 9600) with a double monitor and printer. This can be wheeled from room to room. There is a plethora of orthopaedic gear including the following: Synthes large and small fragment sets, cannulated screw sets, Synthes battery powered drills, external fixator sets (Orthofix, Synthes, Hoffman, and Taylor Spatial Frame), hemiarthroplasty set and implants, SIGN nail set and a pedicle screw set for posterior spinal fusion. There are also many surgical instrumentation trays available that are appropriate for orthopaedic cases. There are many wound VAC machines, and a modest supply of consumables for the VAC’s. Suction and Bovie electrocautery were available in each room. For tourniquets, we used Esmarch bandages, and also brought a supply of Hemaclear disposable tourniquets.

Anesthesia facilities

The anesthesia machines and monitoring machines in the OR were old, and only partly reliable. Oxygen was readily available in the OR from tanks, and these could be transferred to the floor if needed. This is similar to what we have encountered on previous missions to Nicaragua and Ecuador. The Haitian anesthesiologists favored spinals over general, and used Ketamine liberally. It is highly advisable to bring a Propack and i-stat. Laboratory facilities at HAH are rudimentary. It was possible to obtain a CBC quickly. We had an i-stat which allowed us to get nearly instant blood work. Microbiology and Blood Bank services are available only off-site. Obtaining blood for transfusion is an ordeal, with the patient’s family having to bring a sample and request to the central Red Cross facility in downtown PAP. Two days is a routine time frame for obtaining blood.

Hospital supplies

There are three fairly cavernous (think last scene of “Raiders of the Lost Ark”) storage rooms which have been well organized and labeled to store the enormous amounts of equipment that was donated after the earthquake. Still, maintaining the supply chain is a challenge, particularly for sterile drapes, gowns, and other OR consumables. We brought a moderate amount of sterile gowns, drapes, towels, lap sponges, and gloves, which came in handy. The hospital routinely washes bloody lap sponges, dries them, and then resterilizes them for re-use.

Orthopaedic Clinic

There is one clinic room and a cast room. Both are air-conditioned. Additional rooms could be made available if needed in the nearby ER suite. There is a digital radiography machine, which stores hundreds of images in its memory. Efforts are being made to obtain hardware that would allow transfer of these images to a PACS. There is also a film radiography machine in the x-ray department, but this was rarely used due to the need to pay for consumables (film and chemicals). Orthopaedic clinic was held three days per week, including one morning of Ponseti clubfoot casting (20 babies). Patients hand-carry their own prior medical records and hard copy radiographs, and are very reliable about bringing them. Most patients have cell phones, so reaching them is not a huge challenge.

Security and Safety

Prior to our mission, there was concern about security and safety issues, based on reports of violence in PAP and kidnapping of MSF workers. Happily, we encountered no problems whatsoever. We felt safe and secure within the HAH compound. We did not experience any episodes of theft or pilfering. The patients and staff at HAH were welcoming and appreciative. Some of our team members ventured on foot a few blocks outside the hospital to purchase soft drinks and fruit at the local market. They reported that the chief safety concern was from road traffic, not people. On two occasions, members of the group went on a supervised walking tour outside the HAH compound to the nearby (1/2 mile) Adventist University site, which has become a tent city. The locals were warm, friendly, and were happy to engage in conversation. Our team included three younger volunteers (age 16-19), and they all had a very positive experience.

No member of Team Sinai became ill during the trip. All were taking malarial prophylaxis. Two members had needle stick exposures, and started taking anti-retrovirals until the HIV test from the involved patients came back negative (24-48 hours later).

Summary

HAH is a very viable site for North American volunteers to consider. It is currently perhaps the most advanced orthopaedic facility in Haiti. The facility is comparable and in some ways superior to other sites in Nicaragua and Equador and Colombia that I have worked at over the past 12 years. There is a generous amount of existing orthopaedic surgery sets and instrumentation, but restocking is a challenge. Teams coming should communicate with the hospital well ahead of time to determine what supplies should be brought down.

Until Dr. Dietrich arrives in November, it will be challenging for teams to get as much accomplished in a short time as we did under the supervision of Dr. Scott Nelson. Nonetheless, the needs are great, and the potential impact that volunteer teams have is tremendous. The local needs are for both pediatric and adult types of cases. Orthopaedic surgeons, nurses and anesthesiologists who go to HAH should be comfortable treating both children and adults. There is much earthquake related trauma sequelae, as well as fresh trauma, and elective pediatric orthopaedics.

Volunteer groups need to partner with Loma Linda University for coordination purposes. LLU is well organized, and even provides malpractice insurance and health insurance to the volunteers. They keep track of various volunteer groups and individuals to insure that there will not be excessive overlap of manpower. Loma Linda does charge each volunteer $15/day to cover the cost of food (one meal/day) and airport transfers.

The Sinai Hospital team had a remarkable and positive experience, and to a man, expressed interest in someday returning. In fact, we are currently making tentative plans to return in December 2010.

Team Sinai in the Baltimore Jewish Times

2010-07-09T22:55:00.000-04:00

Sinai Team Back From Haiti

Sinai team returns from earthquake-ravaged Haiti.

July 9, 2010

Alyssa Jeffers
Editorial Intern

“We take for granted what we have here — food, clean drinking water, state-of-the-art medical equipment, even oxygen,” says Dr. Aaron Zuckerberg. “They don’t have any of that, and yet they don’t complain.”

Last January, a magnitude 7.0 earthquake rocked Haiti, a poor Caribbean country the size of Massachusetts. Approximately 230,000 people died, and there was widespread damage, particularly in the capital of Port-au-Prince.
Since then, relief has poured in to Haiti from all over the world, including a recent volunteer group from Sinai Hospital of Baltimore.
Dr. Zuckerberg and Dr. John E. Herzenberg, along with 16 other Sinai-affiliated doctors and health care workers and volunteers, as well as some of their family members, traveled to Port-au-Prince to help take care of injuries sustained in the quake. They were there from June 11 to 17.
Getting to Haiti was not easy because of airline restrictions, according to participants. Not allowed to transport crates, extra bags and narcotics, they said the team worked around the clock to pack three bags per person — for food, clothing, and necessary gear and supplies.
Upon arrival in Port-au-Prince, they said they immediately saw tents lining the streets and roads covered in sewage. Trash removal was provided only by wild pigs roaming the areas, they said.
Dr. Herzenberg, head of pediatric orthopedic surgery at Sinai and director of the International Center for Limb Lengthening, said Haiti was “orders of magnitude worse” than what he has seen on 13 other relief missions. He said Haiti was “three levels worse” economically than prior to the disaster.
The Sinai team was based at Adventist Hospital in the capital. During 6 1/4 days, they performed 54 surgeries, on little to no sleep. Dr. Zuckerberg, a pediatric anesthesiologist/intensivist who is director of the pediatric intensive care unit at Sinai, performed anesthesia on 31 of the patients, while Haitian medical personnel anesthetized the rest.
“Normally, [anesthesiologists] get the day off after a late night, but not here,” said Dr. Herzenberg. “Aaron would work all day, get a few hours of sleep, and be up again bright and early the next morning. He personally saved the lives of two patients. He went above and beyond what he was trained to do and performed two very important surgeries. With any other anesthesiologist, those two
patients would have died.”
The team grew particularly close to an 8-year-old girl named Mia.
“Every mission I go on, there is one patient that sticks out in your mind,” said Dr. Herzenberg. “[Mia] had been struck by a car and broke her femur. Her leg from the knee down was completely dead. She had a fractured femur that was completely infected. She was very anemic, with her hemoglobin down at 3.5 [the normal rate is 15].”
The Sinai team operated on Mia four times. “She needed blood, but it was taking too long,” said Dr. Herzenberg. “My wife [registered nurse Merrill Chaus] donated her own blood in order to receive blood for Mia. During the transfusion, Mia began bleeding profusely. She had citrate poisoning, meaning her blood wouldn’t clot. That night we decided to operate, even though we had wished to do it the following morning.
“I was convinced she was going to die on the table,” he said. “Thankfully she didn’t, and we successfully amputated her leg. We took her back two days later to redress her and see how things were doing. There were bits of dead tissue we missed the first time, so we went in to clean them out. Suddenly, the femoral artery burst and was spewing everywhere. With the team working together, we saved her. The next morning, we went to check on her before we left, and she was sitting up brushing her teeth.”
Despite language and cultural barriers, the team communicated with Haitians “through smiles and laughter,” as Dr. Herzenberg’s daughter, Brittany, put it to Dr. Zuckerberg.
Team members were particularly impressed by the Haitians support for each other. They said nearly every patient had at least one family member with them at all times, and if a patient did not have any relatives, a stranger would step in to help.
In addition, the team members said they were impressed by the Haitians’ commitment to their faith system and respect for other religions.
“The Haitian nurses and doctors pray before every operation and have a prayer service every morning,” said Dr. Zuckerberg, who was one of the shomer Shabbatteam members. “They tried incorporating Judaism into common practices, making it very workable. There was an understanding that life-saving operations fell under the umbrella of work allowed on the Sabbath.”
At the end of the trip, all of the team members were in tears. “We were all very touched by this,” said Dr. Zuckerberg. “We were all crying when we left. We all want to go back. The question isn’t if, it’s when.”
Check out the team’s blog at teamsinaihaiti.blogspot.com/.

Photo captions:
Sinai Hospital’s Dr. John E. Herzenberg chats with a Haitian patient.

Team Sinai’s Haitian-born Dr. Job Timeny gives a patient Mia, 8, a big squeeze.

The team’s John D. Logue examines an earthquake victim.

(photos provided)

2010-07-09T18:46:00.002-04:00

Getting to Haiti

Reading through the blogs of first responders to the January 12, 2010 earthquake, travel to Haiti at the time was difficult, as all commercial flights were cancelled in the initial emergency phase. Those intrepid volunteers who ventured to Haiti in the early weeks hopped aboard military transports, freight planes ferrying relief supplies, or flew commercial to the Dominican Republic, and took a long overland route on four wheel drive vehicles from Santo Domingo, DR to Port-au-Prince (PAP), Haiti. For my first trip to Haiti in late January, I went the latter route. At the time, the border between Haiti and the DR was free flowing so we went through without so much as a glance from border officials. However, the mass exodus of Haitians created a bottleneck at the border gate, as throngs of aid workers tried passing them on the narrow dirt roads.

Commercial flights from Miami to PAP resumed in March, so now the American Airlines flight is a mere 90-minutes from Miami to Port au Prince (PAP). For our recent Team Sinai mission, we flew American Airlines from Baltimore to San Juan, Puerto Rico, and then caught a small American Airlines commuter jet from San Juan to PAP. There is one inviolate rule that I have learned over the past 10+ years of mission work, namely, “something always goes wrong”. For us, it began early, at 5am in Baltimore. We had arranged for our entire (n=18) team to meet at BWI airport at 6am, a full two hours before our departure. As team leaders, John and I decided we ought to arrive 15 minutes early, to set a good example, and scout out the landscape before the rest of the team arrived. We had spent most of the night before doing our final packing, weighing and re-weighing each bag to make sure that we were exactly at 50 lb. maximum allowed per checked bag, using extra packages of “Plumpy Nut” as ballast to bring us up to exactly 50 lbs on those bags that were a tad under. Our family (John, Brittany, our nephew David, and myself) woke at 4:30am, washed, dressed and waited for our 5am pick up. I had arranged for a car service to take us to BWI, as that would be less expensive than parking our car for 8 days at BWI. I even managed to find a budget car service that would take our luggage and us to BWI for $100. (The first company wanted $150). A 5am pick up would give us plenty of time to make it to BWI before the required 6am meeting time. After waiting 20 minutes, we began to become suspicious that something was wrong. I called the car service, and they initially pretended to not know who I was, and then claimed that the pick up was scheduled for 5pm not 5am. We immediately went into crisis mode, putting together Plan B, despite the reassurances from the car service that they could send someone out right away, to arrive at our house by 6:15am. OK, we’d be late for the meeting time with our group, but still in time to make the 8:00am flight to San Juan. Not willing to bank on that, we woke up our daughter Danielle, just home from graduate school, and prepared two vehicles (we couldn’t possibly all fit into one vehicle with our luggage). We would have to leave one at the airport, but that was the least of our concerns. We piled the 8 large duffels, and 4 carry-on bags outside our house, and began to wait once again for the car service. We decided on a drop-dead deadline of 6:30. If the car service did not show, we would leave without them. Danielle wasn’t happy about being woken at 6am, but she put on her best game face and waited on the ready with us. At 6:20am, we called the car service again, and they confirmed that they were on the way, and only about 15 minutes away. On a whim, I asked them what kind of vehicle they were bringing, as we had originally agreed on a van. The answer came back, “Lincoln Town Car”. Knowing that there was no way we could fit four of us and all of our bags into a Town Car, I said, “Thanks, but no thanks” and vowed never to use that car service again…

Next came the frantic piling of suitcases and bodies into Danielle’s Ford Escape, and my Acura MDX, and we were off the runway (well, actually the driveway) by 6:30am. John called ahead to our anesthesiologist and chief medical officer, Aaron Zuckerberg, to let the rest of the group, by now fully assembled at BWI, minus their team leaders, to explain why we were running late. Aaron, always cool, calm, and collected, was in full relaxed mode. After all, he deals with disasters and emergencies every day as Director of the Sinai Pediatric Intensive Care Unit. He answered John’s frantic call not with the usual “Hello…” but rather in the calmest voice imaginable, “The patient is asleep, prepped and draped, ready for you..” John had to laugh, and went into the lengthy explanation as to what was happening on our end of Baltimore. What a great way to start a mission. We were sweaty and breathless and in crisis mode, yet we had barely left our driveway….

More excitement awaited us at BWI. One of the team members had forgotten her passport, and her husband was racing back home to pick it up (left on the photocopy machine while making the recommended copy of her passport to keep in a safe place in case the original was lost). We checked the rest of the team in, and only had to pay for a few overweight bags. (The trick of placing your toe under the edge of the bag while it was being weighed hadn’t been adequately disseminated to all the team members…) Some scrupulous pre-trip planning had averted a minor disaster. Aaron had packed his sensitive and delicate anesthesia monitors and glass vials of medicines into hard sided packing cases. Merrill spoke to AA a few days before we left about extra bag fees in case we wanted to bring more than the two bag, 100 lb limit per person. She was informed of a baggage “embargo” to the Caribbean so NO extra bags (even if you’re willing to pay) were allowed, and NO packing crates or cases either, only soft-sided luggage or duffels, thank you very much. That bit of information came in handy, as it allowed Aaron a few days respite to re-pack all of his anesthesia team gear into some quickly acquired duffle bags. As an aside, a colleague from Pennsylvania who traveled last week to volunteer for the Adventist Hospital, was not aware of the embargo. He was not allowed to board last week on AA out of Philly because his two checked bags were plastic hard sided packing cases. He had to rebook for the following day, and repack everything into duffels. We had a similar experience years ago on a mission to Nicaragua, though we managed to run to an airport luggage store and purchase (at exorbitant prices) from Wilson’s Luggage some soft sides suitcases, and transferred everything on the floor from our cases into the newly acquired bags, while being stared at by everyone else in line at check-in. Having experienced this, we were vaguely aware of the potential for a clerk at check-in to turn you down for the unmentionable sin of packing your gear into hard sided cases, even if they do fit the 62” linear size limit and the 50 lb weight limit. Go figure. It’s an “embargo”. (I thought an “embargo” was what we are doing to Iran for not allowing nuclear inspectors…)

John waited behind with our passport-less member (name deleted to protect the not so innocent), and the two of them caught up once hubby screeched to a halt in front of the AA terminal with the priceless passport. One last hurdle, no-passport team member also had a rough time going through security screening due to an excess amount (according to TSA) of little Jello cups in her carry-on bag. Apparently, liquids must be not only 3 oz or less, but also the total volume of liquids must fit into a one quart plastic baggie. I’m not sure how anyone would hijack a plane with a few cups of Jello, but it’s generally not a good idea to argue with a TSA inspector, so we said goodbye to six individual serving cups of Jello.

We all made it to the 8am flight to San Juan, and picked up two out of town team members who had flown from Dulles and Montreal. After a 45-minute layover, we trundled into a small commuter jet bound for PAP. One more roadblock….one of the ground crew members packing our luggage into the fuselage smelled something suspicious coming from one of our team bags. Apparently, a plastic bottle top from a large Purell dispenser broke, and the entire 16 ounces of Purell spilled into the duffel bag. After a standoff of 45 minutes, with detailed negotiations between the captain, ground crew, Aaron, and the tower chief, AA agreed to let us empty the contents of the offending duffle bag into a plastic garbage bag. The duffle, sadly, was not allowed to travel, and is now enjoying a new, and very sterile life in San Juan. At least we made it off, with all of our 36 duffels, headed towards PAP. The commuter jet was only half full, and the flight attendants carefully balanced the plane by asking some of us to move from one side to the other so we could presumably fly straight. I couldn’t help but notice that the passengers were either wearing blue Ekip Sinai Lespwa pou Haiti shirts (us) or they were Haitian nationals. I guess Haiti is not much of a tourist destination these days.

To summarize, we had more than our share of misadventures on the first day, and we hadn’t even arrived in PAP. More about our arrival in another posting…

Prosthetics in Haiti

2010-06-28T08:40:00.000-04:00

The following is a post from John Logue, CPO at D&J Medical in Baltimore. He accompanied Team Sinai to Adventist Hospital, and spent the first three days with us. The original plan was for him to uncrate a prosthetics lab that had been shipped by freighter from California to Adventist. However, the freighter was delayed at sea, and the scheduled arrival of the prosthetics lab is indeterminate. Therefore, on Sunday of our mission, John was drafted to join a prosthetic unit at Mission of Hope, one hour away by car, northwest of Port au Prince. Here is his report...

Its 86° at 10:30am in Baltimore on Sunday, June 27, 10 days after returning from Haiti. Its already a little hard to go back to Haiti, even mentally. Its going up to 98° later, but we’ll be in the AC enough not to be bothered by it. Debbie and I are back from the Baltimore farmer’s market. What a stupendous wealth of grown things. Debbie will start volunteering at her friend, Pam’s organic farm tomorrow in exchange for boxes and boxes of fresh grown food. I emptied my perforated trash can that was supposed to be making beautiful compost. It wasn’t too good. Its OK though, because I know I’ll adjust and it’ll get better, and then good, and then ‘very good.’ That’s the trajectory of good living.

Its hard to imagine upward trends like that for most Haitians anytime soon. Still, check out the latest photo update from my patient/friend Myrline:

I thought we had made a prosthetic liner. I didn’t know we were making for a Saturday Night Live conehead flashback. Haitian people are irrepressible.

My time in Haiti was much more of a vacation than it was for the rest of ‘Team Sinai’: no problem with heat (Alabama upbringing?), no mosquito bites (with or without a net or deet), plenty of sleep, not one but two Sabbaths (Saturday with the Adventists and Sunday with Mission of Hope), a pretty light load of patients, and no life threatening emergencies (the closest thing being when I thought I was messing up my prosthetic work). It doesn’t seem quite fair. Especially the part where about a dozen super attractive young women came into the shop and bared their legs, and took turns casting each other to make cosmetic covers for future Haitian prostheses. And cosmetic they will be. I am sure there is some sort of Halacha (Jewish law) saying I shouldn’t have been witnessing such a thing. If I chuckled when it was happening, the devil made me do it. Yeah, Haiti was tough.

The thing about the work I do is that its not done in a week, really. The real outcome depends on a longer dynamic process and responsive relationships. The real outcome doesn’t show itself for a while, maybe a few months, and several people need to put their bit in: There needs to be therapy, fitting adjustments to accommodate limb changes, and the user needs to develop various patterns of understanding and behavior. Maybe the best thing that remains from this trip is the set of connections that are still functioning which can support some of that longer term sort of thing.

After I write this I will review the report that Dhinesh made for me. He is a ‘personal assistant’ in Bangalore, India who works for the company GetFriday. (You should check it out and say I sent you when you use the service so I can get my service for free.) I share him with a patient/dear friend in New Jersey. He investigated how a free listserve can be done for the various prosthetists who volunteer at Mission of Hope. If it works, the participating prosthetists might pool resources and coordinate with Diana Cherry, the prosthetic coordinator and up and coming prosthetist at MOH, so that whoever is going down next can take with them the optimum amount of exactly what’s needed, and we (the prosthetists) can speak to each other to refine techniques and solve whatever problems show themselves. One practitioner has already offered to host a Haitian for a year to train him or her in prosthetics. That’s a line of input to be supported for sure. Its just one more puzzle piece that might support moving things from not good, to better, and eventually to very good for as many people as possible, and for Haiti itself as much as possible. Haiti is a blessing to me in the sense of having the chance to connect to people literally all over the world for a worthwhile common purpose that involves a dynamic, very human, set of relationships and developments. Its engagements like that, even more than any trajectory, that makes for real living, Enough preachy stuff. Sorry.

Team Sinai is superb in that each person is super competent, super to be around, super organized, and super effective as a team. My own orbit is not exactly the emergent hospital thing, but there is enough overlap for real connection. I am so grateful that it exists.

John Logue CPO

Deadly Mangos of Haiti

2010-06-20T19:48:00.002-04:00

Haiti is definitely hungry. Native grown mangoes and plantains are the staple, along with imported rice and beans. Fortunately, there is an abundance of Mango trees, and therein lies the problem. Mangoes can be deadly. Not eating them. They have a thick skin that must be peeled to reach the underlying, sweet, succulent meat. The rind shields the edible fruit from bacteria and other pathogens. It is not eating the mangoes that is deadly, but harvesting them. While we were at the Adventist Hospital last week, we admitted two young men with serious injuries sustained when they tried to quench their hunger by climbing mango trees to pick the fruit. It turns out this is an international problem, not limited to Haiti. In all parts of the developing world, the mango is known to be deadly to those who climb in search of its fruit.

Our first mango victim was a 17 year old boy, electrocuted by a wire passing through the branches of the tree he was climbing. In electrocution injuries, there is an entrance wound, and often multiple exit wounds. For Jeff, the entrance was in his left wrist, permanently frying his ulnar nerve, and the exits were multiple, in both Achilles tendons, both thighs, and both feet.

I haven’t seen many electrocution injuries, and so I used the marvel of the internet to e-mail a quick photo from my iPhone of the severe wrist burn to my friend Dr. Andrew Pollak, head of orthopedics at Baltimore’s Shock Trauma Hospital. His reply by phone was immediate. “No need to operate immediately. OK to admit, apply Silvedene burn cream dressings, and evaluate in a few days.” Perfect! There is a plastic surgeon from Washington state scheduled to arrive in a few days, right after we leave. This will be right up his alley. We admit Jeff, give him pain medicine, burn dressings, and ask him to wait. For the next two days until we leave, Jeff lays on his canvas army cot in the hallway, never complaining, waiting for the plastic surgeon. I don’t have the heart to tell them that he would lose half of his wrist, and that his ulnar nerve will never again function. By coincidence, Dr. Pollak, who has been heavily involved in rebuilding Haiti’s orthopedic infrastructure, will be in Port au Prince the next day, and I show him Jeff during a quick visit he made to Adventist Hospital.

The second mango victim was even more severely injured. John, originally from the Dominican Republic, desperate for food, fell from the mango tree he was climbing, and sustained a devastating and irreversible spinal cord injury when his 12^th Thoracic vertebra dislocated one inch away from his 1^st Lumbar vertebra. He stoically accepted his fate, though one point indicated he would prefer to be dead. There is not much that can be done, other than to repair the bone injury with rods and screws, allowing the patient to sit in a wheel chair. We heard that there is a spinal cord rehabilitation unit somewhere in Haiti, so there is hope for John after all. Haiti is tough enough with an intact spinal cord. As a paraplegic, you are really in big trouble in Haiti. Scott Nelson, our host, is an accomplished spinal surgeon, and he deftly reduced the fracture dislocation, and rodded the spine with modern state of the art pedicle screw instrumentation, allowing John to be sitting up the very next day. The surgery came none too soon, as when we turned John to position him face down for the surgery, he had already started to develop pressure sores on his back from laying on the narrow canvas army cot.

The surgery had been put off in favor of more urgent procedures, but finally, after waiting for two days, we put him on the schedule yet again, even though it meant starting the case at 9 pm and finishing at midnight (with one more to follow...) To my knowledge, Adventist Hospital is the only facility in PAP set up to operate on spinal fractures. Scott has really built up an incredibly versatile orthopedic unit here.

--John Herzenberg

Job, the Prodigal Son--I'm SO glad you came!

2010-06-19T22:40:00.003-04:00

Somehow, the mantra of our mission came to be, "I'm so glad you came!". We think that this originated with a comment that John kept on saying to Job, in tremendous appreciation for all of his hard work and efforts. Gradually this came to be the Mantra and greeting for the entire team, with a wink and a smile. One of the most beloved members of Team Sinai is Dr. Job Timeny, podiatry resident from Regional Medical Center in New Jersey, who spent a two month rotation with John at Sinai. Job brought to the table not only his work ethic, medical/surgical expertise, but also his linguistic skills. While HAH did supply us with skilled translators, Job had the unique ability to convey the medical issues with the most accuracy due to his understanding of both the medical intricacies as well as the Kreyol language. Job is a native of Cap Hatien, and moved to the USA when he was 16 years old. He graduate from the New York School of Podiatry, and is now a second year surgical podiatry resident. On Wednesday of our mission, he staffed the unusually busy and hectic Clubfoot clinic and applied more clubfoot casts in one morning than he cares to remember. We can't help but believe that the Haitian patients felt a unique connection to Job, the Prodigal Son, returning to his native land to provide expertise and succor to the sufferring people of Hiati. Job's perspective as a Haitian American is special, and he shared his feelings with the rest of the team on our return in this email.....

Bonjou!
I thank all of you for your willingness to forsake the American life just for a little while to wipe away a bit of our sorrow. Your dedication to help my country gives me hope that tomorrow can be better; but more than that emboldened me with courage to embrace my reality and be part of the solution. you went to help a nation you could have ignored and blamed for their destiny but instead I saw tears in your eyes and a burning desire to return; I saw your closing eyes that pray for a nap but a huge heart that thought about one more life to save and one more smile to brighten. It was 11:00 PM but the consistency of your steps made it feel like it was 3:00 PM. I am so glad you came! and I'm sure the Haitian people are saying the same thing but in silence.
I sometimes looked around hoping that someone else of my cultural background would come to counterbalance the foreign volunteers but my 8 days were spent as the only one helping my owns. I finally realize color and geographic barriers are just metaphors and we are all ONE through the living air that was breathed into us by the Almighty.
I have so many story to tell but one that stands out in my mind is the selfless act of Merrill who gave her own blood to save a Haitian life. I think the instantaneous nature of the decision was enough to make me realize that she was one us as all of you were.
May your blessings be countless and hope to see you soon!

mesi bokou

Job Timeny

Apology

2010-06-19T15:46:00.001-04:00

Our team is back home, safe and sound, after an amazing and exhilirating week of hard work, blood, sweat, and quite a few tears. I would like to apologize to our readers for the long delay since our last posting. I had intended to post daily, but both John and myself found ourselves to be utterly exhausted by the end of the long days, and came to the realization that we would have to post in a non-contemporaneous fashion when we got home. So there you have it. Now that we are back to our normal routines in the USA, we will endeavor to catch up and in a thematic format, rather than a diary format.
Luckily, our nephew David Herzenberg, a newly minted Graduate Nurse, had the youthful energy to write a daily blog, in a classic stream of consciousness style, that is at one person's view of what happened this past week. Here is David assisting Dr. Job Timeny, our Haitian American podiatry resident.

Reading it makes me think of the old parable of the blind men and the elephant, in this case, Haiti, as viewed by the viewpoint of a newly minted rookie nurse. I think you'll find David's writing style refreshing, and reminiscent of the classic novel about the First Year Intern's life in the House of God by Samuel Shem....

Here is David's vision of the elephant that is Haiti...

David’s Impressions of Haiti

Another day…

I must say, I severely dislike the cot I’m sleeping on. If feels like I’m laying on the stretched skin of a tambourine. Similarities end when I toss and turn on the cot. Rather than the charming jingle of a tambourine, my cot more mimics a creaking door in an Alfred Hitchcock movie. I attempt to erect my mosquito net and acquire my much-needed nighttime comforts. I am deeply saddened that I cannot construct my signature pillow nest. Thus I lay in discomfort and attempt to will myself to sleep. I am actually almost successful, just as my subconscious begins to cross the threshold of my mind my animal brain is thrust into action. The scream of a patient’s mother sends bolts of adrenaline throughout my body. I’m up and running to her room before I realize I’m not dreaming. Apparently the child just had a seizure, and now she is lying, post-ictal, the stares blankly up at the ceiling while her respiratory level continues to drop. “Who has the key to the O2 tank?”, yells our pediatrician. “Key!?” I think to myself. Now seriously, why would you need a key for an O2 tank? On a side note this is the second time I’ve been in a situation where no one had the key for the O2 tank. That’s like putting a combination lock on a toilet.   After much cursing, crying, and possible voo doo, the girl is stabilized and I wander through the darkness back to bed. Struggling to fight my way through my mosquito net into my bed I find myself relating to sea turtles that are unfortunate enough to find themselves trapped in fishing nets. I lie in bed still, and contemplate the unyielding heat. Even at 2:30am the heat is oppressive, the air sits heavy and thick around me. I feel like I could bite the air and spend a good deal of time chewing it. I fall in and out of sleep for the next few hours. Fact about Haiti, where there is no Daylight Savings Time, the sun rises at 4:30 am. Once again I wake up sweating and sticking to my cot from hell. I count at least three mosquito bites and contemplate the possibility of a lifetime living with malaria. … I stagger to the 6:30 am morning meeting, doing my best zombie impersonation… how appropriate for Haiti. I quietly give in to the heat and accept the fact that all the baby powder in the world won’t keep my butt dry. There is no way I can sum up everything I experienced today. Suffice to say, I learned more today than I did over the past year in nursing school. I must have seen 40 patients myself on the floors. I lost count of how many dressing changes I performed. I struggled with language difficulties. I witnessed children and adults cry. I saw injuries that made me sad. I discharged patients that wanted to stay in the hospital because, while primitive, it was far better than their own living conditions. I scrubbed into two surgeries in which I suctioned, helped suture, and stapled wounds. I learned a lot more about what people look like on the inside. I saw bone being harvested from a hip. I ate rice and beans. I made new friends. I surprised myself. I missed people back home. And finally, I felt really good about what we accomplished today. It’s getting late and there is just too much detail to get into.

Another day…

Drained… totally drained. Again, with the 2:30 am crying. I have a feeling this is a nightly occurrence ☹. Hopefully I won’t strike out with the whole sleep thing again tonight. I’m draining my batteries faster than I can recharge them.   Today was Sabbath, the day God rested… I’m not a god. I awoke to the sound of church music and prayer. Saturday was supposed to be our slow day. Our usual 6:30 am meeting was replaced by 6:30 am rounds so we could get some rest… explain to me how that works exactly? Anyhow, rounds gave way to our frenetic pace, (I assume this to be the standard). I have my hands in a little of everything here, med. surg., OR, ER, social worker. After sweating like crazy in pre and post op, a couple quick dressing changes and finding adequate staffing for the ER, I found myself back in the OR. I seem to be spending a lot of time in the OR, not specifically because I prefer it, but because I feel like I know the least about this area of nursing practice (Its also the only air conditioned patient care area). There are so many protocols and procedures that must be followed in specific sequences. Even the act of putting on your gown requires a significant amount of planning and thought.   I was the scrub nurse in one of the OR’s today. I was responsible for setting up the table, getting all the gear/tools/supplies, getting everyone’s gown and gloves, helping everyone get dressed, setting up the sterile field, knowing the names of all the instruments, killing insects (yes there are flies in our OR because of swinging doors that do not stay shut), and producing the correct instruments when requested by the surgeon. I was basically wearing a really ugly light blue sterile burka. What with the mask, hair net, eye shield, lead vest, gown, shoe booties and two pair of gloves I was following Sha’ria law to the T.   Our first case was a simple wound vac dressing change. Unfortunately we seemed to hit a snag with every step. What was supposed to have taken an hour ended up being more like two to three hours. Our patient’s IV was infiltrated and was of course a hard stick. And to add the icing to the cake, guess who our patient was. Yes, the unfortunate little girl who has been keeping us up every night. A little history on our girl… Compound fracture of the right femur during the January 12 earthquake. External-fixator put on to keep the leg healing straight (think pins and braces), and a skin graft flap in an attempt to cover the skin defect, (think really big open wound that is too wide to close on it’s own). Since January, every team who has come through our hospital has attempted to treat our young lady. In that time her wound has been infected and debrided, and flapped and VAC’d on many occasions. In that time she has developed quite a tolerance to opiate and narcotic drugs. I’m beginning to understand why she cries every night, she’s in pain, not so much because of the injuries themselves, but because she’s in withdrawal. Morphine is hard to get in Haiti. Our team brought drugs with us, but no narcotics, as it is difficult to go through all the DEA diversion paperwork to carry narcotics on the plane.  

Attempting to get an IV back into this girl proved to be a challenge. As you can imagine, the majority of her veins are all used up, I’m sure she has been stuck a thousand times by every team since the earthquake. We wanted to change her wound VAC with conscious sedation and needed to have a line in case we needed to load fluids. In an attempt to calm her down, (she was already hysterical), we gave her Ketamine, Fentanyl and Propophol. And during the entire procedure it was clear that she was still feeling it. She kept repeating in Kreyol, “I’m in pain, I’m in pain”, over and over through out most of the procedure. Even at her most sedate she was still moaning and trying to wriggle off the table. We had some trouble getting a good seal with the wound VAC. What’s a wound VAC (Vacuum Assited Closure). Imagine an open, infected wound the size to two bananas, side by side, on a 60 lb. girl’s thigh. Now, imagine a bunch of 1/4” diameter pins sticking out of the femur above and below the wound; each connected by an articulating rod the width of a toilet paper dowel. All this is on a hysterical frightened little girl who has been traumatized, continues to live in trauma and is going through opiate withdrawal. Ok, you with me? Take out the old dressing, and vigorously brush down that wound. Pack it full of new sponge, cut it to fit of course, and seal it with really sticky flimsy sheets of tape. Make sure to wrap each of the six pins to prevent any air from entering or escaping the wound. Now, cut a hole and reattach the vacuum pump. The suction should pull infected fluids out and promote tissue granulation and healing. Oh yeah, and keep the procedure sterile.

 Ok, so we do all that and we find out we don’t have an airtight seal. Jiminy Cricket! I’m so sick of wearing this mask and not being able to scratch my nose! I can feel my finger tips pruning up inside my gloves. We work on it for another 45 minutes. That’s it, we can’t get it to seal and she’s been sedated for a long time and we don’t want to keep her under any longer than we have to. I break my sterile field and race back to the hospital ward. As it so happens, a volunteer from another team here this week is a wound care specialist. It’s time to bring in the ringer. We get her in and within 30 min. we have the wound dressed and re-sealed. Guerilla medicine is awesome. It feels so free to conduct our procedures based on need rather than protocol. We are working in reality; the ivory tower of NCLEX seems so alien and distant. I’m going to have to will myself back into NCLEX logic when I return to S.F. But until then I will fully enjoy implementing need-based practice. There is so much more that went on today… I’m just too tired to relay it.   Final thought… I’m spoiled, really spoiled, so spoiled in fact that I have the audacity to complain about my sleeping situation in the face of all this disaster around me. I may not be totally comfortable… but just down the hall are all my patients, just as hot, with broken limbs, only getting one meager meal a day, staring down an incredibly difficult future of rebuilding their bodies, lives and country. They are sleeping on the same miserable canvas army cots as me, and their families are sleeping next to them on the floor. And I complain about heat and mosquitoes… Get yourself in check David!  --    

Another day…

Before I write anything of substance just know that my feet feel like hotdogs that were cooked in a microwave… all bloated and tight… about to pop and spill foot meats all over. I’ve been standing up all day.  As if the conditions in which we operate aren’t difficult enough, imagine trying to perform surgery without electricity and solely by headlamp. Yikes! Don’t ever get sick or injured in a third world country. But I’m getting ahead of myself… lets start with how today began… or rather how last night ended. I’m trying to write a blog a day which is proving to be difficult. Not because there is a lack of content but rather because I’m so tired by the end of the evening. The lack of quality sleep is catching up with me. Last night the same ol’ song was playing again. Same girl, same weeping. I’m a little ashamed to say just couldn’t face it again last night. I crept out of my cot and made my way into the dining lounge, which is much cooler.

Anyhow, had lots of surgery cases today. Here are some highlights.  1. We took off a guy’s external-fixator and opened up his leg. Wow, necrosis… Dead muscle is gross, but dead bone is just sad. The total operation took 6 hours between removing the ex fix, removal of dead bone, insertion of antibiotic cement beads (which I made myself), and application of an Ilizarov cage fixator. This case requires extensive set up. Tons of tools, drills, pins, needles, hundreds of little nuts and bolts of all sizes and variations… Orthopedic surgery is very similar to carpentry… or a really complex piece of IKEA furniture.   2. I did my very first sterile set up all by myself today, Yay, all by my self; I’m such a big boy! (Just a side note, a young man was brought into the ER basically lifeless, and was coded by our team, but without success. This is the second one today like that…) Ok yeah, so my very first sterile set up, we put an ex –fix on a ten year old girl with a fractured femur (very common injury). I had everything dialed in, and was totally sterile. I only forgot one thing…my lead… and yes we were using Fluoro (real time X rays). We must have taken at least 150 x-rays during this case. I found myself ducking and diving behind the other surgical team members who were leaded up. I will consider that my workout for the day. I’ve been doing push ups, sit ups and various other exercises every night… but I don’t think it’s gonna happen tonight. It’s already so late.   3. Last case of the evening, open reduction of a hip dislocation on a 44-year-old woman. Basically her hip was dislocated during the earthquake. We think she was trapped under rubble and her hip dislocated when she was dragged by her leg out from under rubble. The dislocation was severe, so severe the femoral head, (very top of the thigh bone which connects into the hip), tunneled through near by connective tissue and settled near the internal lady bits. The head surgeon asked me to insert my hand into the would and probe into the tunnel to feel calcified bone/scar tissue that had formed and prevented the hip from settling back into place. I almost got up to my wrist. I must say it was kind of exhilarating… I know how strange and perverted that sounds but don’t worry, I’m not a serial killer. We lost power several times during this case and worked by headlamp… that too was exhilarating.   4. I finally left the hospital today and ventured into the outside world. A local Haitian anesthesiologist was kind enough to work with us all day. She worked till 9 pm (well after dark) and expressed her concern regarding driving home alone tonight. Apparently, our hospital is located in the second worst neighborhood in PAP; only to be outdone by our neighboring area of Cite Soleil with is the worst and most violent. So I offered to ride with her to her neighborhood and be followed by one of our vehicles, at which point I would ride back with our transporter. It’s pretty apocalyptic out there. Trash fires, rubble, police, UN soldiers, burned out vehicles, and chaos everywhere. Life it tough… If you are reading this on the Internet, you will probably never struggle through life like these people are. (Obviously myself included).   Every day here is sobering. It’s really difficult to describe in words what I’m seeing and experiencing. How do you describe a hopeless moaning child, or driving through a population wild with desperation in the dark, or hearing that a mother just stopped by the hospital because her baby is dead and is asking for verification so she can have her child buried for free, or the look of gratitude when you see a patient smile even though you know he doesn’t understand you and is scared out of his mind. I’m not a poet; I’m trying my best to bring you guys here with me, its not all mosquitoes, heat and insomnia. This stuff is a real guys… it’s real and I don’t see any solution.

Sleep, glorious sleep! Finally, a full 5 hours. I feel moderately recharged. Today began without power or water, kind of crummy considering you wake up sweaty and gross. The one comfort I’ve been able to keep constant is my oral hygiene. It took a while but I was finally able to brush my teeth today. There is nothing worse than smelling your own bad breathe inside a facemask in the OR for hours in the heat. Today’s highlight: I drove with Aunt Merrill and a translator to the Red Cross to get blood for two patients whose labs made them ineligible candidates for surgery. The first, a little girl who needs a high above knee amputation who has a hemoglobin of 3.5 and the second is a young man struck by a car with a femur fracture with a hemoglobin of 5.0. Getting blood is a major chore, as there is only one donor/collection site in PAP, at the University Hospital (much grittier than the name sounds). Families are supposed to donate four units for everyone that they get, but certain blood types are in high demand, and our patients fall in that category. We were so desperate to get him blood that Merrill actually donated her own blood (she’s O-negative) for him yesterday. Even so, we had to come back the next day to get the two units we needed for our patients, as it was a Saturday and the technician who cross matches the blood doesn’t work after a certain hour. Of course this being an island third world post disaster country, nothing happens quickly. So they asked us to wait till today. Waiting for blood is never good. So we make the trip back to the Red Cross to get blood again today. And once more we are asked to wait an additional day. This, we cannot accept, our patients condition is growing more critical and an additional patient requires a transfusion as well. We attempt to explain our situation to the receptionist at the Red Cross without any success. Everyone else waiting in line at the Red Cross, (all Haitian) have similar stories if not worse.  Let me back up for a min. Obviously we had to leave Adventist Hospital for this particular adventure. We hired a Tap Tap, which is basically a covered pick up truck with an open tailgait that are used as communal taxis. Most are extremely colorful and painted boasting either religious references or music lyrics. The Red Cross itself was shockingly in disrepair. How may advertisements have you seen by the Red Cross asking for donations for Haiti? Seeing the actual Red Cross in Port Au Prince makes me wonder where all those donations actually go. This country went through its worst disaster in recorded history and the Red Cross which is multimillion dollar NGO only sponsors 1 blood donation site in all of Haiti, and its dilapidated, understaffed, and falling apart?!   We even offered to pay for the blood, but were informed by the Red Cross technician that the blood was free, albeit with a long long wait to get it. We finally got our two bags of cross matched blood, in a neat little cooler on a bed of ice. Ironically, as we are leaving, a California surfer dude in Banana Republic clothing driving a brand new shiny, tricked out SUV with a Red Cross logo pulls up, beeps and waves at us… is this where your Red Cross dollars are going? To pay salaries, hotel fees, and buy new SUV’s for expat relief workers? How about updating the blood collection center and hiring more technicians so that people don’t have to wait two-three days for their emergency blood transfusions. Whatever…

Don’t remember if I described what driving in Port Au Prince is like. I took some video and I’ll post it when I get a chance. Although it’s not as bad as Sri Lanka or Java, it’s pretty darn bad; the combination of short burst acceleration and roads that are totally messed makes for dangerous travel. I almost messed in my pants when we were speeding down a one-way road into oncoming traffic, on the wrong side of the median, during rush hour, for like 5 minutes straight!   So we get back, we are heroes, we transfuse the blood, we break and anticipate surgery. I sit down to check my Facebook and begin this blog. That was almost 5 hours ago. A team member runs up to find the rest of us. Our little girl is getting her blood, but suddenly starts to bleed heavily from her leg. Starting off with a Hgb of 3.5, and it seems like most of the precious blood we finally were able to transfuse into her is now pooling beneath her leg on the canvas cot. My uncle John applies femoral artery pressure and we rush her to the OR, scramble to prepare, and hope for the best. It was tense in the OR. Aaron our anesthesiologist stabilizes her and John and Scott wrap a rubber touniquet around her groin. We knew she was definitely going to lose her left leg, but we had hoped to do it in a more orderly fashion the next morning. Aaron figures it out. The sudden bleeding must be from citrate toxicity. The Red Cross adds Citrate in the blood bag to keep it from clotting, but if they have too much in the bag, it causes a clotting disorder when transfused into the patient. Aaron gives the antidote (calcium) and her clotting stabilizes. John and Scott proceed with the definitive amputation, now that she stable (if you can describe a Hgb of 3 or 4 as being stable) enough to survive the procedure. Mind you she is an 8-year-old girl with a bad infection from poor treatment that she received for an open femur fracture in another hospital far away. After languishing in the other hospital for a month, her father had the gumption to take her out, and bring her to Adventist. Unfortunately, the foot was dead and the thigh massively infected and swollen when we met her. We had operated on her the night we arrived, draining 2 quarts of smelly pus from the thigh, with the intent of stabilizing her for the definitive amputation. We knew we would have to amputate. Knowing you’re going to have to amputate a beautiful little girl’s leg conjures bizarre sensations. On one hand you feel terrible because you know you will take part in a life-altering event that will most likely affect someone’s life for the worse. (Forget being an amputee in the US, imagine it in Haiti) But on the other hand you are kind of excited to be part of this complex high-risk medical procedure. I still don’t know how I really feel about the whole thing. It was fascinating and gruesome at the same time, I found myself amazed and horrified at the same time. Not so much because of the gore, but because she would have to live, (fingers crossed), with the outcome of this savage procedure. There were many tense moments; no one was totally confidant we could pull this off. Despite all the blood, bone and flayed flesh, the most disgusting part for me was after the leg was actually free. The sound the leg made as the surgeon dropped it’s dead weight into a plastic bag really bothered me. The sickening thud accompanied by the sound of the femur piercing the plastic brought me back to the reality of what we had just done… We cut of this girls leg… Oh my god… we really just cut off this girls leg.

Confused, disgusted and upset, I found myself sitting alone on the front steps post op. I have seen a lot of crazy things on this trip in the past few days, but I haven’t cried. I even walked through a tent at University Hospital when we went to get blood, and saw at least 2 dead or nearly dead babies and managed to remain stoic. But I just let loose tonight; the seal broke and I sobbed, letting all my emotions drain. I dried my eyes and gathered up the strength to go see her in post-op and say a few encouraging words to her fully knowing there is no way she would understand. I did, and I felt a little better. I can only hope that this scared yet stoic little girl derived some measure of comfort from my touch. On my way out of post op 1, I crossed the hall to post op 2 to check on our other guy who received a transfusion as well.

Although we could not communicate well, we knew each other. I always greeted him and we had somewhat of a connection. Kind of difficult to explain. I smiled at him, he did not return. I looked closely, something was not right. He looked paler than usual and was shaking slightly.

Oh damn, transfusion reaction was the first thing that entered my mind. I got a quick set of vitals HR 129 (very fast) BP 130/90 (a little high, nothing serious) Respiratory Rate 25 (elevated), and Temp 104, (really high). I called for help, and our team arrives, the tremors become more violent, the temperature climbs to 107, his heat races, and his mentation changes. We slam some steroids, pain meds, Tylenol, and fluids.

We are trying to cool him down. Ice, where can we get ice? I don’t know who brought it, but now I have it in a basin. Carotid arteries, armpits, femoral arteries, neck, forehead, and abdomen. We pack his body in ice. We put a Foley catheter in him, we run the IV lines through ice baths; There is running, shouting, sweating, running, tripping and searching. All without any privacy whatsoever. Every other bed and family member in this small room is watching exactly what’s going on. And his shaking gets worse, and his speech more garbled. Gradually he responds to treatment, and we set up a rotating mini-ICU. Gratefully, there are some SICU nurses and a cardiologist in the other team this week, and they offer to stay up with our guy throughout the night. We are not made out of the same things the Haitians are made of; they are so much tougher and resilient in almost every way.

The Days feel like weeks and the weeks feel like days. I can’t believe this week is coming to an end so soon. Although I feel like I’ve been working my ass off, there is so much left to do.

It’s no stretch of the imagination that I didn’t get much sleep last night. Strangely, I’m getting used to running on fumes. I am, however, totally over drinking instant coffee… what I wouldn’t give for a large ice coffee with a Splenda. Soon enough… Anyhow, despite not having adequate caffeine I still managed to power my way though another marathon day. In fact, it’s not even close to being over. Turns out I’m going to have to scrub for a late night case. I probably won’t even begin to prep. the case until 11: 30 pm. Oh god, last one… well, until tomorrow. I think we are going to squeeze in a couple before we head to the airport. I really hope we don’t have any complications tomorrow and we can just make our flights. Not that I’m eager to leave or anything. Haiti has captured a part of my heart. I’m sure this is not the last time we will meet and our paths are destined to cross once more in the future.

There is just so much work to be done. There are so many obstacles to overcome. And there are so many desperate people here. Patients are getting word of our impending departure. I always feel awkward around this time. I’m almost embarrassed that I get to return to my American lifestyle. Like I said before, this is just an adventure for me, something that makes me feel good and gets attention and praise from others. But it’s weird, I’m not some angelic savior, sent from the heavens to save the people. I guess I’m here for a couple reasons.

First, someone needs to go. I have a really hard time watching people suffer. And second, it makes me feel good. A big part of why I do this is for myself. It makes me appreciate who I am and what I have. Although I really appreciate the fact that you have been reading my blogs; commenting and giving me such positive feed back, just know that I’m no hero. I’m not doing anything that is beyond any of your capabilities. Just like Michael Jackson said, “If you want to make the world a better place, just take a look at yourself and make a change”. Yeah, I know, uber cheesy, but very true. 

Ok, enough preaching. Lets talk about today. Nothing shocks me anymore, well almost nothing. Today was swelteringly hot, the kind of hot that makes you actually feel like your being slowly cooked. I had that gross wet pant leg stuck to your calves and thighs feeling all day. So again I bounced back and fourth between the OR and Post-op again today. If I wasn’t wet enough from my own perspiration, I walk into Post-op 1 and into an inch deep puddle of toilet water. Apparently a pipe burst in a nearby bathroom and flooded. Ugh, great. Now my scrub bottoms are soaking up poo water and the water line is having a race to the back of my calves. Sigh… But like all toilet tragedies it isn’t the end of the world and eventually gets taken care of. The morning dressing changes continue. I become intensely focused on changing a complex dressing on an Ilizarov fixator. I kneel down on the tile floor silently, super silently. So quietly in fact that I touch down without any sound at all. That’s odd, I look down at the far end of my thigh and am horrified that I just knelt on a turd, a wet, loose, lonely, brown turd. Good thing my knee decided to keep it company….

A bunch of us are in the breakroom when my uncle comes up to let me know that I need to take over for his usual scrub nurse who has been working all day, and at 11pm has hit the wall of exhaustion. There is still one more case to go, and I need to scrub in to fill her place, Our surgeons started a spinal fusion at 9pm on a 23-year-old kid who was recently paralyzed from falling out of a tree while picking mangoes. One more case to go (dressing change on our little 8 year old amputee from the other night). Ok, I’ll write more if I have the energy when I get back from both of theses cases. We’ll see though.

Can’t write any more, need to be awake in 4 hr. Very dramatic case, thought she might bleed to death… never been part of anything like that. She made it

OK, well I wanted to post that last night but the Internet was down by the time I returned from the OR. I ended up catching the very end of the Spinal case. Although I didn’t end up scrubbing the spine, I saw them suture and close. The final case was to debride and do a dressing change for Mia, the little girl who had the amputation and captured our hearts. We didn’t even bring her to the OR until midnight, always a bad omen. I went to retrieve her from post-op one and found the room dark and everyone to be asleep. Rather than wake everyone up, I decided to carry little Mia into the OR. She is so brave, she hardly protested at all.

She knew what we were going to do and what kind of pain she would wake up with. She buried her head in my chest and held on to my neck with her tiny arms. That’s it; she crushed my heart right then and there. It’s a bizarre feeling; causing physical pain to children with the knowledge that it’s for the best. Although I knew I was taking part in an operation that was certainly going to save her life, I had to battle with the reality for how much trauma we were going to cause her, both physically and emotionally. It tore me apart to wake her from her fitful sleep to take her to the OR.

I take care to step over sleeping family members asleep on the floor at the foot and sides of our patient’s beds. It’s truly amazing how devoted Haitians are to each other. They do so quietly, and with out any protest; thankful for the fact their loved one is receiving any medical attention at all. Seriously, think about that. They sleep on the dirty tile floor, most without a blanket, some with the luxury of an unfolded cardboard box to lie on. Each patient has at least one family member who stays overnight with him or her. In the short week that I’ve been here I have never seen a patient alone. The difference between American and Haitian hospital culture is astounding. I walk down the hallway in the dark, guided only by minimal light and a sense of familiarity I have developed over this past week.

We got her on the table and Aaron gave her the anesthesia drugs. She cried a little and went to sleep before she made it to the point of being completely hysterical. We estimated the entire procedure would take around 30 minutes from start to finish. Just a dressing change, maybe a little debridement of any residual necrotic muscle. She goes down, we open her stump back up and are immediately blasted by the stench of infection and necrotic tissue. That smell is unforgettable, and indescribable. There is no known substance or combination that accurately mimics the scent of infected necrotic flesh. Although the wound didn’t look terrible, it certainly smelled that way. So we go in, scalpel, forceps, retractor, Bovie (an electric cautery tool that sears blood vessels shut)…. Sponge…. Hold here…. Irrigation… suction, irrigation… suction, scalpel, forceps, bovie…. Scalpel… And oops… looks like we nicked an artery… bleed, bleed… ok pressure right here with those sponges…. Bleed, bleed. Wow this one is really going, do you think it’s the femoral artery? Squirt, Squirt, Spray, Ahhhh, holy crap, Sponge! More sponges, get more sponges. At this point the sponges are soaking through just as fast was we can press them down. Bright red oxygen rich book flows out from around the sponges and floods the opened stump and runs onto the blue table dressing and down the sides of the table. These shoes are definitely not coming back to the United States with me. The possibility of Mia bleeding to death right here in front of me is becoming a terrifying reality. My uncle John and I are furiously fighting to stop the bleeding long enough to have a clear view of the hemorrhaging artery so we can clamp and suture it closed.

 She’s down about 300 ml of blood. We cannot keep losing blood like this. John asks Scott to scrub in and help him search. Although I have learned A LOT this trip, I know when the limit of my skills has been reached. Looking at anatomy books and identifying color coded 3-D models is one thing, trying to pick through a mutilated, necrotic stump for an elusive artery as it is constantly being submerged in rising levels of blood is another. My role changes from stopping the bleeding to retracting the wound as wide open as possible so that John and Scott can search for the femoral artery. We need to find where the bleeding is coming from! It’s really squirting now, high enough where it sprays my goggles and gown. More sponges! We continue on like this for a few more minutes that seem to stretch on forever. Adrenaline pulses through my body and I am hyper aware of every passing second and ml of precious blood that is lost. Damn, we can’t lose her tonight, the night before our departure, not after everything she and her family have been through.

Ok, ok, one clamp on, finally the bleeding subsides. We quickly suture the artery and finally take a moment to breathe. We cautiously continue on with the debridement, and remove bits of dead bone, muscle and tissue. I cannot accurately describe what this wound looks like, nor would I want you to be able to clearly picture it in your head. Just know it does not belong on this beautiful little girl. Life is cruel and indiscriminant. Being here in Haiti, I am reminded of how fragile humans really are; just membranes full of meat and bit of bone. We finish removing the odious tissue and pack the wound full of clean gauze. A couple of loose sutures pulls the skin flaps around the gauze and recreates the stump. We tightly wrap the stump with an ACE bandage. It is so high that we have to wrap around her little waist to get the dressing to stay on. I hope the compression prevents any additional bleeding. As it stands, little Mia is going to have to face a wound debridement and dressing change in the OR every day or two for a while, hopefully minus the severe blood loss. But for now she is stable and sleeping, and we bring her back to bed….Sigh…

It’s 2:30 am; finally time to get some rest before my 5:30 am wake up call from the sun and the heat. One more day. Not even a full one. The days have melted together to the point that I can’d distinguish one from another. I don’t want to leave….

2010-06-15T23:31:00.000-04:00

This is day 5 of Team Sinai's adventure in Haiti. We can't believe that we are this far into it. Even those of us who have been on mission trips before have never quite had an experience like this. We are living on the second floor of the hospital which is open to the outside and open to a patient ward. We hear everything especially at 3 in the morning when a patient with PTSD wakes up and starts screaming. When we try to get back to sleep the roosters start crowing. We start our day at 6:30 with a meeting out on the front steps (Aaron can't find the lid to the percolator so we can't even have real coffee!) Last night we finished at 1130 tonight was earlier for some of us but others are still in the OR....
The need is so great here. We have many patients scheduled for the OR each day. The ortho team round on between 40 and 50 patients a day. As well as taking care of the patients there we have a pediatric ward which has between 5-7 patients a day. The urgent care center is closed when we are busy but people still come. People are waiting outside by the time we go out to our morning meeting. W e have been seeing at least 15 pediatric patients a day (another pediatrician also is seeing kids at the same time). The ER is hopping with interesting cases. We have seen the beginnings of life as well as the end. Many happy moments and many sad.
The people are wonderful and so appreciative of everything we do.We are working with other volunteers from the US who are also great and very helpful.
The nurses who work in the hospital are paid very little and have many patients to care for. Most others who work in the hospital are volunteers. All of the translators (our best friends) volunteer. They are great! Sometimes you are not quite sure that they have told the patient what you want them to say of if they are saying what they think they should be told. Sometimes they say much more than you have told them to. :)
It has been an extremely tiring week but one none of us would ever take back.
Goodnight.

Welcome to Haiti... this is what you wanted!

2010-06-11T17:02:00.001-04:00

Posted by David Herzenberg, GN, our beloved nephew...

Let me preface this blog with a couple truths.

1. I only slept 3.5 hours last night

2. I woke up at 4:30am

3. Been traveling all day

4. I refuse to check or edit this blog for content save for spelling errors

The Herzenbergs plan a disaster relief mission to Haiti in wake of the most recent earthquake… hilarity ensues. Keeping in tradition with past travels, our late night of packing is not to be out done by our early morning emergency. Our transportation to BWI airport seemed to have overlooked a minor detail of our reservation. It’s in situations like these that I see the true value in using military time. We somehow rise to the occasion and hit the road by our own volition at 5:30 am, or 0530hr to clear up any confusion. Miraculously we arrive at the airport with time to spare, greet the rest of the team, and manage to board the plane with thoughts of anticipation, excitement and nervousness.

And we’re up and off… and for the most part the first flight was uneventful, which happens to be a quality I quite enjoy while flying. Sleep, sweet, sweet much needed sleep. We land in San Juan around 1200hr local time. The reality of our mission is becoming more of… well… a reality. Although we are still in the terminal I can feel the sweet sensation of tropical heat though moistened breaths. I am slightly disheartened to see a Cinnabon in the terminal… Don’t get me started!! Anyhow, we board the tiny double propeller plane on the tarmac and I instantly feel like I’m sitting in a giant croc pot, stewing in my teammates juices. We have an issue with one of our bags that delays our departure. Apparently a few moderately large containers of hand sanitizer have managed to spill contents and the smell has alerted the crew. Unsure as to the source of the smell, the crew spends an additional 45 min “solving” the issue before we depart.

Finally we are up and off again… Just a quick oceanic voyage from San Juan to Port Au Prince. It is instantly clear we are traveling in the midst of the rainy season. I play a long game of charades with the low hanging cumulonimbus clouds. It was not difficult to appreciate the Dominican landscape… rolling green pastures enclosed by even greener mountain ranges. My eyes pick out several unexpected yet familiar shapes. The landscape is dotted with a myriad of baseball diamonds, so many in fact; Sammy Sosa himself would be impressed. However, this wondrous backdrop does not continue forever. Like a slide in a power point presentation, our lush greenery is abruptly replaced by a landscape that is stripped and brown. My mind is jarred by the contrast and is searching for answers as to how such a dichotomy can exist. Static from the overhead speakers is followed by the captain’s voice, “Attention passengers, we have just crosses into Haiti’s airspace.” Closing in on the capital, tell tale signs of disaster make themselves known. Those bright blue dots, some spread out, some so close together, what are they, they seem so familiar. No, those drops of bright blue are not swimming pools, they are the lengths of blue tarp that are covering damaged homes and providing extra shelter from monsoon rains. Welcome to Haiti.

We land, we deplane, we make our way across the tarmac into the terminal. Unapologetically Haiti greets us in the only way she can. We are blasted by heat, assaulted by humidity, overcome by noise, and intimidated by a culture that remains a mystery to most of us. We rally, we steady our nerves, we collect our baggage. We feel good with the knowledge that all of our bags and our entire team has made it, at least, to the airport. Only one problem remains… does anyone know how we are going to get to the hospital? I’ll spare the details, but if you have ever traveled in a third world country, much less after a disaster, you understand how difficult it can be to get to your destination from the airport. Our arranged transport arrived, somewhat delayed by unpredictable PAP traffic, and underequiped to transport of team of 18 laden down with 2,000 lbs of geat. After another hour in the sun, we wade our way through the airport loiterers and solicitors and fill three vans with our crew and bags. We are moving again.

I’ve had the honor of volunteering in the wake of several disasters; the atmosphere here in Haiti is no different. Filthy streets, undulating crowds of people, outstretched hands reaching into your vehicle looking for a donation, animals rooting out a meal, piles of trash clogging the streets, rivers of plastic damming up the gutters, the sweet stench of rotting organic matter, that dry feeling you get in your nose from swirling dust and diesel fumes, crippled buildings, roads, and infrastructure, numerous tent cities, and traffic, my god the traffic! Ladies and Gentlemen of Team Sinai, you have arrived; this is what you asked for.

There is more… but I’m just too tired to write. Part of the team got drafted to the OR within an hours of our arrival. The rest of us unpack, set up our mosquito nets on the open air veranda. We have a 6:30 am preconference tomorrow before we hit the floor. Just know that I’m safe, (perhaps not from the Mosquito’s) I’m at the hospital we are staying at, and it’s hot! Hotter then… well… Haiti…

Again, sorry for the bad grammar and poor usage of imagery. More to follow...

Stay tuned.Publish Post

Carlene "Central Sterile" Williams

2010-06-09T22:24:00.001-04:00

Team Sinai is getting ready to depart for our long planned mission, and final preparations are at a fever pitch. Pictured here is Carlene Williams, Central Sterile Technician at Sinai Hospital. She will be responsible for organizing, cleaning, and sterilizing all of our surgical equipment. Pictured here with Amy Montillano, O.R. nurse, Carlene has contributed significantly to our preparations and organization. Carlene was in the U.S. Army for more than 10 years, so she is no stranger to working under difficult field conditions.

Dumpster Diving

2010-06-08T02:33:00.000-04:00

We'll be in Haiti next week, so we're down to the wire on our preparations. Aaron and his crew are busy readying the anesthesia and pediatric gear, John is preparing surgical sets, and the rest of us are getting our gear together for wound care, nursing care, nutrition, and any number of miscellaneous items. Just when we thought we had all bases covered, we heard that the hospital is "very very low on IV fluids...." so now wer're scrambling to locate IV bags of Lactated Ringers Solution. Luckily, our hospital has a corner of the Recieving Dock set aside for discards from the hospital. We are allowed to "dumpster dive" for all kinds of goodies that would otherwise be periodically picked up by a distribution group called Project Hope. (Sorry Hopers.....we diverted some of the discards that were coming your way...)

It's been weekend of packing. We were about 90% done when American Airlines threw us a curveball: there is an embargo on any extra bags to Haiti. We were hoping to have several of the team members take three checked bags so that we could bring in more gear. AA says ixnay on that. Now we're scrambling to jettison that which is not "mission critical" and make our selves leaner and meaner. AA also decided that they will only accept duffle bags (no crates). Great news for Aaron who just finished packing his delicate anesthesia monitors and other breakables into 6 shipping crates and now has to move everything into duffles. It could have been worse, we could have found this out at the airport during "check in"....

Packing is an event, and in this picture, you can see Amy Montillano (the O.R. nurse on Team Sinai) and Ella Joy Napoles. Ella is a Sinai O.R. nurse who has been on missions past with us, but unfortunately can't make it to Haiti. However, she is planning to go with us to Ecuador in October. Ella is a great sport, and spent Sunday afternoon at Chez Herzenberg helping us with the packing.

Who shot JR?

2010-06-05T15:05:00.005-04:00

John Russell ("JR") has been a PACU nurse at Sinai for ten years. His hobbies include fixing broken things, gardening, cars, and cooking. (John: should be plenty of broken things to fix, not much gardening, no fancy cars, and not much cooking at HAH...bring your own food!) John tells us that "I am looking forward to Haiti for the opportunity to work with a group of people who are there only to do what is right, not for money, fame or prestige."

John is an avid camper and hiker, and has already staked out his corner of the hospital roof to pitch his four-man tent, to be left behind as a gift for a homeless Haitian family.

The Three Musketeers (Les Zuckerbergs)

2010-06-04T23:17:00.004-04:00

"You are not required to complete the task;

nevertheless, you are not exempt from beginning the work".

"If I am only for myself, who am I?"

"The more charity you do, the more peace you will create"

--Ethics of the Fathers

Gabe, Jeremy and Aaron Zuckerberg are honored to join Team Sinai's mission to Haiti.

Gabe, a Beth Tfiloh High School junior and Jeremy a University of Maryland sophmore have spent long hours working with children both in and out of the hospital setting, and are anxious to bring smiles and friendship to the patients in Port au Prince.

Papa Aaron is double boarded in Peds and Anesthesia. His day job is Pediatric Intensivist, but he dreams of being a professional cyclist. This photo of Aaron in Sponge Bob Land (his unit is a shrine to the Bikini Bottom group..) is taken from the article in 2009 Baltimore Magazine's "Best of...". Aaron was voted the Best Pediatric Anesthesiologist in Baltimore.

Plumpy'nut and Medika Mamba

2010-06-03T23:32:00.001-04:00

In the simple yet eloquent words of Haitibones blogger traumaqueen, “Haiti is hungry. Very hungry”. http://traumaqueen1.blogspot.com/2010/05/everyone-here-has-chest-pain.html

Most people in Haiti eat only one meal per day. Even the patients hospitalized in Hopital Adventiste d’Haiti (HAH) are given only one meal per day. Even if that meal is 500 calories, it is still inadequate nutrition to heal wounds, clear infections, and knit bones. Many returning volunteer docs and nurses we have contacted after their return from HAH confirm that malnutrition is a huge problem.

A little research on the Internet, and we found “Plumpy Nut”, a Ready to Use Therapeutic Food (RUTF). That's NGO-speak for a food product especially designed and manufactured to treat hungry children in Africa suffering from moderate to severe malnutrition. Where to find Plumpy Nut? There's a great story by Anderson Cooper that explains the origins of Plumpy Nut and how its use in Niger and other African nations has made a huge dent in the need to hospitalize children with malnutrition. http://www.cbsnews.com/stories/2007/10/19/60minutes/main3386661.shtml

Plumpy Nut is manufactured in Niger, Ethiopia, Malawi, Mozambique, and the DR of Congo. How are we supposed to get PN to bring with us to Haiti? A little more research and deeper drilling on the internet reveals that a new factory (Edesia.... http://www.edesiallc.org/index.html) recently opened in Providence, Rhode Island (and Plymouth Plantations) for manufacturing Plumpy Nut. Our daughter Danielle happens to be a grad student in Providence at the Rhode Island School of Design (RISD), and just finished her first year in the Interior Architecture Department. What an opportunity to kill three birds with one stone, so I flew up to Providence this week, had a back stage tour of Edesia (see photos of our Edesia tour), purchased 500 lbs of Plumpy Nut, threw the 15 cartons (34 lbs each) in the back of Danielle's Ford Escape, and drove back to Baltimore with Danielle, Matisse the cat, and 15 cartons of Plumpy Nut (each containing 150 sachets, 500 calories per sachet, 75,000 calories per carton). Now all we have to do is figure out how to distribute the 15 cartons into the checked bags of Team Sinai along with all the other gear and supplies we're bringing! More about Plumpy Nut and the Haitian factory in Cap Haitien producing Medika Mamba later...

The Huddle before the Storm

2010-06-02T22:31:00.000-04:00

Team Sinai will be departing soon for our mission week in Haiti. In preparation, we put together some words of advice and hopefully wisdom and maybe even inspiration for all team members to consider....

Bonjou Team Sinai,

As we approach this mission, our collective thoughts and consciousness subtly but inexorably will shift away from our natural day to day activities stateside, and towards the mission ahead of us. Today we want to talk about the issue of cultural sensitivity. This is going to be a daily challenge during our entire stay in Haiti. Here's some thoughts to consider:

1. We are guests in a Haitian hospital, and so we must always behave as the gracious guest. There may be times when you are feeling exasperated by some of our host doctors/nurses/staff/patients. Take a moment to compose yourself, and act graciously. Always defer to the sensitivities of our hosts. Scott Nelson, our orthopedic host, has pointed that it is more important to build relationships than to simply provide medical expertise.

2. While we are "Team Sinai", we are not competing with any other team, other than ourselves.

3. Make a serious effort to use Kreyole or French phrases whenever possible. Say "Bonjou" (good morning), or "Bonswa" (good afternoon) to every Haitian staff or patient you come across. By using their language, you are sending them a message that you value and respect their culture, their language, and them. It is also a great ice breaker when you mangle a phrase. While we are in Haiti, make an effort to learn MORE phrases. Arm yourself with a phrase card you can study from. Here's one: http://steelsculpture.us/haiti_cheatsheet.htm Your homework (BEFORE WE ARRIVE) is to learn how to say in Kreyole "How are you?".....there will be a quiz when we meet in the airport....Hint: there are two correct answers to this question...Extra credit for anyone who gets both...

4. Make an effort to work with the local Haitians, not around them. Ask them what they think is the best way to treat something or deal with a problem. The entire nation of Haiti is in the lowest, most desperate point in their history. The last thing they need is to feel their pride or integrity or intelligence challenged. We are going to be in Haiti for a mere seven days. They live there forever.

5. Be kind and sensitive to the patients. Explain (with the help of a translator) what you are doing, if it will hurt, and why you are doing it. You may want to take a photograph of a patient. Ask permission first. Back home you would never think of whipping out your camera and photographing a patient without first asking permission. The same standards must be observed in Haiti. If you photograph someone without their permission, particularly if they are in a compromised situation, in pain, or incompletely dressed, then you are relating to them as if they were less than human. Kindness and consideration should always be at the forefront of your actions.

6. If you witness another team member acting inappropriately, take them aside and gently point out to them that their actions may be interpreted as insulting or dismissive.

7. Don't do anything in the hospital that you would not be allowed to do back home. This is particularly important for the young people in our group. The Haitian nurses and doctors and patients will be constantly observing our every action. The Haitians are sensitive to the concept of having to suffer with a lower quality of medical care than most of the rest of the world. Nonetheless, as a matter of pride, they will reject any medication that is beyond its expiration date. Please do NOT bring any expired items! Many of you may be willing to take a Tylenol in your own homes that is slightly beyond expiration date, but this is not acceptable during our mission.

8. Dress modestly. In the USA, it is common for men and women wear shorts. Many young women in the USA bare their midriffs. In Haiti, this is not acceptable. Remember, we are guests. Be friendly and engaging. Make an effort to talk and interact with the Haitians. Do not spend all your time with the other Team Sinai members. Make local friends.

9. We are working in an Adventist Hospital, affiliated with the Seventh Day Adventist faith. The Adventists pray frequently, openly, and often use biblical references. Team Sinai is comprised of a multicultural and multiethnic mix. We must always be respectful of our SDA hosts. When our hosts pause to pray, your appropriate response is to also pause, lower your head, and be respectful.

10. We are going as volunteers, and must be willing to do whatever the local authorities deem important for us to do. Be gracious, be flexible, and always cheerful. We are not heroes. We simply have the privilege to serve.

Orvwa,

Merrill and John

John Logue, Prosthetics and Orthotics Guru (P.O.G.)

2010-06-01T23:55:00.003-04:00

The earthquake of January 12, 2010 left over 200,000 dead. Of the survivors, many thousands are now newly created amputees. Haiti has limited resources to serve this disabled population. As a specialist in artificial limbs, John Logue has the potential to help rebuild many shattered lives. In his own words.....

"I am a prosthetist/orthotist from Alabama, New Orleans, New York, New Haven, and now Baltimore. This is my first real mission, though each of those other stops seemed like a 'mission' in its own right; though maybe not as altruistic as serving in Haiti. The thing I'd like to think I took from those places, is knowing that I need to be useful for a worthwhile purpose. Albert Schwietzer got the idea right in the quote on the Haitibones.org site...

'I don't know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who will have sought and found how to serve.'

The happiness he speaks of there certainly seems to show in the faces of the mission experienced Team Sinai folks. I am very grateful for the chance to be a part of this effort."

Ram the Man

2010-05-31T09:57:00.007-04:00

Dr. Ram Shetty is our out-of-state "ringer" from West Virginia. It's a convoluted story how Ram from West Virginia joined Team Sinai. Here it is, in 25 words or less.....Ram's sister-in-law Seska volunteered with me in Sri Lanka after the Tsunami of 2005. When Seska heard I was going to Haiti, she told me about her sister-in-law and brother-in-law, Julia and Ram, both of whom are Family Medicine specialists. Both volunteered to join our team, but they had to flip a coin to decide which one would go to Haiti, and which would stay home with the kids. Ram won the toss (Sorry, Julia!). A Family Medicine specialist, Ram will likely be commandeered by the ER at HAH to help treat the ~100 patients that come to the Triage/ER on a daily basis.

Dr. Ram Shetty was born in Calcutta, India but came to live in Atlanta, GA when he was only three years old. He graduated from Georgia Tech with a BA in electrical engineering and then got his MD from the Medical College of Georgia. He went on to a residency in Family Medicine at West Virginia University and has been in practice with Julia his wife, in rural West Virginia since 2003.

Amy Montillano, RN

2010-05-30T16:03:00.005-04:00

Operating room nurses are a special breed. They have to be mind readers, scavengers, diplomats, and angels of mercy. They deal with contentious surgeons, demanding anesthesiologists, and patients in distress, often at the same time. Amy Montillano does all this and more, and always with a smile and the highest degree of professionalism. She is equally adept at scrubbing and circulating. Amy came to Sinai Hospital 8 years ago from her native Philippines, where she participated in many outreach clinics and surgery camps to under served areas on her island (Cebu). She accompanied us on an Operation Rainbow mission to Quito, Ecuador two years ago, where this photo was made. (Amy is on the right). She is tireless, and as the only OR nurse on Team Sinai, will undoubtedly be very busy...

Louise Reid Boyce Nichols, RN, MD

2010-05-29T22:57:00.005-04:00

We're leaving in a few weeks, and all of our team members are kicking it into high gear, gathering supplies, packing and preparing for our mission. Tonight, we introduce Dr. Louise Reid Boyce Nichols, AKA "Reid". Reid has four names and two titles. She began life as a nurse at Johns Hopkins, and switched teams to the doctor side, and is now a fully trained orthopedic surgeon. This year, she is completing a fellowship in advanced limb lengthening and reconstruction techniques at Sinai. As part of the fellowship program, all fellows are encouraged to accompany one of the attending surgeons on an international mission. This year, the three fellows (Dan Prince, Marie Gdalevitch, and Reid Boyce) have been on missions with either my husband John or his partner Shawn Standard to Nicaragua, Dominican Republic, and now Haiti. Lucky Marie gets to go twice...DR and Haiti.

Reid was originally scheduled to go on a two week surgical mission to Eritrea, until political unrest put the kabosh on that trip. The good news is that she is able to join us in Haiti instead. In her own words....."I have wanted to travel to Haiti to help since the earthquake. I watched as a friend started an Orphan Relief Fund while I worked at home. I am a doer, not a watcher. I feel very blessed to join a team of exceptional people who I hope will do exceptional things."

Our favorite Canadienne, Marie G.

2010-05-28T20:44:00.004-04:00

Dr. Marie Gdalevitch is a Canadian orthopedic surgeon in Baltimore for fellowship training in Limb Reconstruction surgery at Sinai Hospital. A few months ago, she accompanied John's partner Dr. Shawn Standard on an orthopedic mission to the other half of Hispaniola - the Dominican Republic. That trip had been planned well before the January 12 earthquake, and so unexpectedly, Marie and Shawn found themselves in the midst of a disaster relief mission. In addition to being a highly skilled surgeon, Marie is also a pretty decent hockey player, and a die-hard Montreal Canadienes fan. She is finishing her fellowship in Baltimore next month, and headed to Australia for yet more training in her chosen sub-specialty of pediatric orthopedics. In her own words....

"I am Canadian, born and raised in bilingual Montreal where there is a large and vibrant Haitian community. After hearing news of the earthquake, I felt helpless at the tragedy that was unfolding on televisions worldwide. Only to realize that I was heading to Dominican Republic on a pre-earthquake organized medical mission trip. Two weeks after the earthquake, I found myself in San Juan, DR working at one of the bordering hospitals, treating Haitian refugees. My experience was short and the help our small team provided was a drop of water in an ocean of need. I felt I had left prematurely and with much unfinished work. I often wonder what happened to my patients? Did they survive? Did they walk? Did they return to Haiti and if so what were their living conditions? The prospect of being able to return, with a bigger team, and the hope of doing more, is extremely invigorating. I approach this upcoming trip with much anticipation, but also with heightened awareness. No matter how much we contribute, I will likely remain humbled and wondering upon my return."

The rest of our PICU team...

2010-05-27T22:58:00.001-04:00

Yesterday, we introduced Theresa Fagan, pediatric nurse practitioner. Today we are introducing the other half of the dynamic duo, Janie Ginsburg (Pediatric Intensive Care Unit Nurse).

"Most of my nursing career has been in the Pediatric ICU. I spent one year working with children in an army hospital in Germany. Since the beginning of my career I have wanted to go on a humanitarian trip to an area where the need was great. This was the perfect place for me to start (many years late). When not taking care of my kids at work, my husband and I take care of our 3 kids and our exchange student at home."

- Janie Ginsburg

Theresa Fagan, Pediatric Nurse Practitioner

2010-05-26T22:47:00.003-04:00

I have been at Sinai as a Pediatric Critical Care Nurse Practitioner for 3.5 years. Prior to that I was PNP in primary care for 2 years, and a PICU nurse for 5.5 years. I have been on 3 medical missions to Ecuador with Ecuadent Foundation where I have worked in hospitals in Pasaje and Esmeraldas providing pre-op and post-op care to pediatric patients receiving surgeries such as cleft lip and palate repairs, scar revisions, and hernia repairs. Ever since hearing about the earthquake and devastation in Haiti, I have wanted to go and offer whatever help and care I could provide, so I am thrilled to be able to travel with Team Sinai. This photo was taken in Ecuador. (I'm the one on the right)

"Physical Terrorist, I mean Therapist..."

2010-05-25T20:18:00.004-04:00

One truism in orthopedic surgery is that it doesn't matter how good a surgeon you are, if you don't have an excellent physical therapist backing you up. For the past six years, Moshe Roth has been making sure that the good work of the fine docs at the Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening, has been followed up with diligent, high quality physical therapy to insure the best possible outcomes for the patients. Moshe is a pediatric physical therapist. PT's sometimes get a bad rap from patients, who often refer to PT's as "Physical Terrorists" and "Pain and Torture" specialists. In fact, it is difficult work, made even more challenging when dealing with children who can't always understand the concept of "no pain, no gain.." Moshe manages to pull it off with aplomb, and the kids adore him, despite all he puts them through. Moshe has a huge fan club amongst the kids he treats. In Moshe’s own words, “The opportunity to join the Sinai mission to Haiti really serves a life goal for me. When I chose to enter the Physical Therapy profession, part of my decision was motivated by the opportunity to work with the under served and to make a difference in the lives of those less fortunate. Haiti is the first of what I hope will be other future medical missions.”

The Littlest Nurse

2010-05-23T21:07:00.002-04:00

My nephew David Herzenberg is the youngest and least experienced nurse on our team, sort of. While David just graduated from the Samuel Merritt College Nursing Program last month, he is no stranger to international disaster relief. David has accompanied me twice on international relief missions: Sri Lanka in 2004 after the Tsunami, and Jammu Kashmir, Pakistan, in 2005 after the massive earthquake. After his experiences in the field, he was inspired to choose nursing as a profession, with the intent to work overseas. I am proud that in some small way, I have influenced David to join our noble profession (though his Dad was hoping for a legal eagle instead of a nurse). Here are two pictures of David, on the left with his cousin, my daughter, Brittany a few years back, and on the right, in Islamabad stopping for a burger at the only McDonalds in Pakistan (David is the one in the middle). Apparently Ronald McDonald is a controversial figure in Pakistan, hence the armed guard. David is currently waiting for a slot to take his NCLEX (Nursing Licensure Exams), and depending on getting a slot (and passing the test) before our trip or after, will determine if he goes as an RN (registered nurse) or a GN (graduate nurse).

David will, predictably be offended by my posting him as the "Littlest Nurse" on our team of six nurses, as he is in reality a pretty big guy (that's one reason I took him to Pakistan and Sri Lanka....as muscle for protection). David is a personal trainer with the chiseled abs and massive guns of his namesake, David (by Michaelangelo). David's Dad was a Peace Corps volunteer in Malaysia, where he met David's mom, a Chinese Malay, and hence the handsome and exotic multicultural David, my nephew, and the Littlest Nurse on Team Sinai.

The Trials of Job

2010-05-23T20:41:00.002-04:00

Today we had an organizational team meeting for our upcoming trip to HAH. In the next series of posts we will introduce our team members. In his own words below is our Podiatrist, Dr. Timeny....

My name is Job Timeny. I was born and raised in Cap-Haitien, Haiti. I am a resident in Foot and Ankle Surgery at South Jersey Regional Medical Center, Vineland New Jersey. I am so glad to be part of Team Sinai. Ever since the earthquake, the desire to go to Haiti and serve my fellow Haitians was heavy on my heart. I was ecstatic when Dr. Herzenberg invited me to come along while I was in a 2-months rotation at Sinai hospital.

Being able to help will be a way to connect with myself and give back to my country. To be honest, it could have easily been me in the current disastrous situation as many of my friends and classmates who moved to Port-Au-Prince to continue their education or simply for a better life. I was fortunate to instead move to the US to continue my education and now I am happy to return to my native land to serve those in need.

Gratitude, thank yous, and praises are not my motives. I’m fulfilling my duty as a Haitian-American and a physician.

“ Haiti renaîtra de ses cendres.”

Job Timeny

Getting Ready for Haiti

2010-05-22T21:19:00.006-04:00

Hi!

My name is Merrill Chaus, and I would like to welcome you to our blog. We're blogging so that friends and family can follow our progress. Moreover, I've found that the blogs of previous HAH volunteers have been very informative and allow us to prepare better for our upcoming mission.

www.teamsinaihaiti.blogspot.com

In just a few weeks, our 18 member team will be leaving Baltimore for Port au Prince, Haiti. We represent Sinai Hospital of Baltimore. Our mission is to provide support to the Hopital Adventiste d'Haiti (Haiti Adventist Hospital - "HAH") in Carrefour, Port au Prince. This is a 70 bed hospital, though we've been told that the hospital census has swollen to ~300 following the earthquake of January 12, 2010. The focus of our team is to provide reconstructive orthopedic surgery to the earthquake victims, and general support to HAH. Our team members include three orthopedic surgeons, one podiatrist, one anesthesiologist, one family practicioner, five nurses, one physical therapist, one surgical instrument technician, and three volunteers.

This is my second mission to Haiti, the first having been in January 2010, shortly after the earthquake. During that mission, I worked with a group called IMANA (Islamic Medical Association of North America) in an impromtu field hospital set up in an abandoned amusement park.

This time, I am organizing a group together with my husband John Herzenberg, an orthopaedic surgeon at Sinai Hospital of Baltimore. We have assembled a great team of volunteers who are highly motivated and eager to help at Adventist Hospital. HAH survived the earthquake relatively intact, and has been functioning under the leadership of an incredibly dedicated young orthopedic surgeon from Loma Linda, California, Dr. Scott Nelson (more about Scott in a later post) since January. Tomorrow we are having an organizational meeting at our home. More to follow...