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

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