Final Haiti Trip Report - Team Sinai Operation Rainbow June 2013

FINAL TRIP REPORT  Team Sinai Operation Rainbow 2013

We had a very successful mission this past March 2-9, 2013, our fourth visit to Adventiste Hospital in Port au Prince. Our local host, Dr. Francel Alexis was there working beside us every day, clearly settling in to his role as Director of Orthopedic Surgery at HAH.  Francel demonstrated a real dedication to the hospital’s mission of serving the poor, and providing a high level of orthopedic care to the community.  Throughout the past year, we have been in contact with Dr. Francel Alexis, who is providing expert follow-up care for the children and adults that we operated on last year. Many of the hospital programs and services are becoming increasingly Haitianized, in an effort to strive for sustainability.

Mac Christophe

For example, the international volunteer services are now coordinated by a bright, energetic, and amiable young man, Mackenzie “Mac” Christophe.  Mac took care of us from our arrival at the PAP airport until our departure, worrying for our needs, and doing everything possible to make our mission efficient and comfortable. We found him to be the ultimate major domo, concierge, ombudsman, and troubleshooter.  He never stopped advocating on behalf of the patients, the staff, and the volunteers. All that, wrapped up in a trilingual ever smiling handsome young man.  Coordination of the OR equipment has been taken over by Jean Joel “JJ” Boyer, a long term employee of HAH well known to all the groups who have rotated through HAH since the January 2010 earthquake. JJ worked hard all week to make sure that we had all the surgical equipment ready and in good working order. During surgery, he functioned as an outstanding surgical technician. Kind and gentle, JJ endeared himself to our entire team.

Our 18 team members included 1 Guamanian, 1 Haitian, 1 Russian, 1 New Zealander, 1 Lebanese, 2 Dominicana, and 11 born in the USA. The surgeons were John Herzenberg, MD (Team Leader), Ahmed Bazzi, MD, Job Timeny, DPM and Lee Hlad, DPM.  The Anesthesia team included Maria Adrian, MD, Tom Fernandez, MD, Brad Cohn, MD, and Gina Muscara, CRNA.

Our PACU nurses included co-Team Leader Merrill Chaus Herzenberg, MD, Kim Hammond, RN, and Tina Jorgenson, RN.  The OR nursing staff was led by repeat volunteer and designated surrogate mother, Lucilla Hernandez RN. Lucilla was assisted in the OR by Peggy Mertz, RN and Alex Kasselman, RN.   Surgical technologist Christina Jones rounded out the OR team.

Two assistants provided invaluable help: Joanne Marasigan, Medical Student From SUNY Upstate in Syracuse, and Brittany Herzenberg, doing her senior internship from Beth Tefiloh High School.  Kris Connor, professional photographer also joined the team, documenting the week’s events.

We arrived in PAP on Saturday afternoon, greeting by Mac, who arranged two stuffed to the gills pick-up trucks to carry our 34 duffle bags (1,700 lbs) filled with surgical equipment, medical supplies, medications, bandages, and all the fixin’s needed to run a week-long surgical mission. We settled into our new digs at HAH in the volunteer bunkhouse, with overflow diverted to some unoccupied patient rooms on the second floor, thanks to Mac’s willingness to accommodate our larger than average team.  Merrill and I bunked in the physical therapy gym, sleeping on the PT treatment tables, and enjoying the air conditioning and hot water. On Sunday morning, the team unpacked the duffles and set up shop in the OR, the PACU,  and the clinic, making sure all was arranged for a busy Monday clinic and OR. While the rest of the team set up shop, the four surgeons, along with our host Dr. Alexis, ran a three hour long continuing education seminar for 21 young orthopedic residents from the orthopedic residency program at HUEH.

At the start of the mission, the team members visited a local orphanage, delivering, in true St. Nicholas fashion, goodies, and good cheer. We made it through the week without any significant complications, save for our own team members who fell ill to water borne contagions. 

The total number of cases that we operated was 38 (28 children and 10 adults)

8/38 cases were bilateral, one child accounted for 4 of the procedures (multiple wound debridements/VAC changes)

The case breakdown by category included the following:

Peds Foot/Leg            21

Peds Ilizarov                6

Arthroscopy/Knee       3

Adult Trauma              8

Detailed Case Listing:

4/30/12

1.     ORIF Left Hip Subtrochanteric Hip Fracture

2.     Remove TSF

3.     Bilateral Core Decompression for AVN hips

4.     Remove external fixator from right Hip and Femur

5.     Bilateral Clubfoot release for Arthrogryposis

6.     Femur and Tibia osteotomy for Rickets, Application of TSF, Orthofix to Femur, Tibia, Foot.

7.     I&D Infected Distal Femur/Knee; Wound VAC

5/1/12

1.     Iliac Crest Bone Graft for Nonunion Distal Femur Left (EARTHQUAKE)

2.     Bilateral Tibia-Fibula Osteotomies for Osteogenesis Imperfecta, Genu Valgum

3.     Peroneal Nerve decompression, Achilles Lengthening, Application of TSF to Foot and Ankle (EARTHQUAKE)

4.     Labrinudi Triple Arthrodesis for Neglected Clubfoot

5.     Tendo Achilles, Flexor Tendon Lengthening, Completion of Epiphyseodesis Distal Tibia and Fibula, Right (EARTHQUAKE)

5/2/12

1.     I&D Infected Distal Femur/Knee; Wound VAC

2.     Remove 8 plates

3.     Epiphyseodesis Left Femur and Tibia

4.     Lambrinudi Triple Arthrodesis for Neglected Clubfoot

5.     Adjust TSF, add toe wires

6.     Adjust TSF, Remove infected wire

7.     Arthroscopy Right Knee

8.      Osteotomy Right Femur, Apply Ilizarov Right Femur and Tibia (EARTHQUAKE)

9.     Bilateral knee disarticulations for Tibial Hemimelia

10. Medial/Lateral Hamstrings, TAL, Triple.

5/3/12

1.     Edward Mayrs 9M: Left Lambrinudi Triple for Neglected Clubfoot

2.     Samy Orphe 2M: Bilateral tibial/femoral 8-plates for Blounts

3.     Stephanie Correpond 4F: Left Clubfoot Release with Anterior Tibialis Transfer

4.     Miramir Durosier 27F: Achilles Lengthening and Claw Toe reconstructions (EARTHQUAKE)

5.     Romulus Burtho 20M: Wound debridement, VAC, Left Tibia Injury

6.     Katiana Flenrimond 16F: Right Femur Lengthening with External Fixator (Orthofix) for Congenital Femoral Deficiency

7.     Carline Coral 38F: Bilateral Hip Core Decompressions

5/4/12

1.     Left ACL reconstruction

2.     I&D Infected Distal Femur/Knee; Wound VAC

3.     Left naviculectomy and calcaneocuboid fusion (recurrent clubfoot)

4.     Right Lambinudi Triple Arthrodesis (Recurrent Clubfoot)

5.     Right Gastrocnemius Lengthening and Hamstring Lengthening for CP

6.     Remove Bilateral TSF from Feet/Tibia, apply Casts

7.     Ilizarov Right Femur Osteotomy (EARTHQUAKE)

8.     Claw Toe repair after compartment syndrome (EARHTQUAKE)

9.     Bilateral Knee Flexion (Artrhogryposis) Capsulotomies, extension/shortening Femoral Osteotomies

10. Blounts- Bilateral Tibial Osteotomies and Bilateral Distal Femoral 8 plates

5/6/12

1.     I&D Infected Distal Femur/Knee; Wound VAC, Application of Spanning External Fixator Right Femur/Tibia