Saturday, April 17, 2010

Random pics and comments

Commuting by Tap-tap to work, and an empty Tap-tap....they pack 30 people into these!

Stephen came to our ER with a broken arm and was quite skeptical of my care.
...but I managed to make Stephen and his mom happy with his new cast.

This little girl had an external fixator to stretch out burn contractures in her elbow....and had multiple other releases to her right arm and a graft to her back.  She is always cheerful and worked her way into all our hearts.

This is the entrance to the Adventist a giant tent camp for all the surrounding people who lost their homes.  It was the neatest and cleanest of the tent camps we visited.

The children here are friendly and polite and well dressed.  They love hugs and having their picture taken.

A roadside "pharmacy"...all those things on the outside of his container are pills.

The sleeping quarter of the volunteers at the hospital.

Thursday, April 15, 2010

Been very busy!

I've been either too busy to post or the internet has been down, so have not posted.  Many great stories and pics coming however.  For excellent description of our work here by Dr. Nelson:

My favorite Hait pic so far:

My favorite Hait pic so far:

Sunday, April 11, 2010

First Day - Sabbath

Sabbath started with more orientation, a lovely church service in the hospital chapel.  It’s round, concrete so the echoes made the acapella singing particularly stirring. 

We made rounds to get to know the patients.  There were multiple dressing changes, and getting acquainted with the planned surgeries for the day.  The majority of the patients here now are very complicated cases with infections from open fractures from the quake.  Many had been operated on elsewhere under widely varying conditions and have been referred here for revisions of their failed surgery or infections. Most are now in external fixators for their fractures. 
While no orthopedic clinic was actually scheduled today, several patients showed up, so we took care of whoever arrived.  There is no appointment system and the patient keeps their chart and xrays, taking them home and hopefully bringing them with them  each visit.

They schedule the infected cases last thing in the day, so other emergencies, and anesthesia shortages, and I don’t know what all delays pushed several cases from the week over into Sabbath.  After a C-section and an acute abdomen we finally got to do our five ortho cases.  With everyone cooperating they went quickly and with good results in spite of two of us having no idea where anything is, who is supposed to do what, and how the system works here.

There was time left to leave the hospital and walk through the grounds of the adjacent Adventist College, which is now a giant tent camp and unable to function as a school, though they hope to get portions of the school running next week.  I was greeted warmly by many people who thanked me for being there.  I was still in surgery scrubs and obviously foreign and couldn’t keep my camera in my pocket, so they new I was a visiting doctor.  One gentleman was a former professor  there and gave me a nice tour of the grounds and answered my many questions about life here.

I then learned why many are staying at the hospital.  The promised tap-tap back to my hotel didn't show and there was an hour of confusion and delays getting transportation back.  But the dip in the pool made it worth it all.

Hospital Adventiste de Haiti

We arrived at the hospital Friday night in time for introductions all around by the multiple volunteers here and an orientation tour by Dr. Nelson.  The hospital is well built and sustained no significant structural damage during the earthquake.  It is staffed with a combination of local nurses, anesthetists, and a few local doctors.  There are many translators of varying abilities, hired off the street for their ability to speak some English and their willingness to volunteer initially, right after the quake.  

The U.S. volunteers include therapists, nurses, several senior medical students from Loma Linda, midwives from all over, an OB doctor, the two general surgeons from PA, and many more I haven’t gotten to know yet.  The pic is a Sabbath morning C section.

We have four orthopedists right now; myself, Dr. Gordon Aamoth, (pictured) who has been here a week or so and has been sharing “how to get things done here” with me, Dr. Jack Frankeny, who arrived when I did, and Dr. Scott Nelson, who has been running the orthopedic program here since a few days after the earthquake.  We have three operating rooms, but only one U.S. anesthesiologist, Todd Schaeffer, but have local anesthetist come when they can.  None have this hospital as their only responsibility, so it is sometimes afternoon before they can get all rooms running.


My new friends with the Cure organization had made arrangement to stay in a hotel near the hospital; the LeAuberge du Quebec.  They invited me to join them.  There were no available additional rooms, but they generously offered to shift around bunk mates and made room for me. 

The grounds are beautiful and a stark contrast to the tents and  shacks just outside the gate. I’m living in luxury compared to the volunteers who are staying on cots under mosquito nets in the hospital.  My room has it’s own (cold only) shower and toilet. The rain drip through the uninsulated corrugated roof isn’t over the bed, and the holes in the screens that let in the little malaria vectors were easily patched with medical tape.  The ceiling fan is only a little noisy.  The reading light would likely work if it had a bulb. The power has only gone off twice while I write this.

The roosters out back awaken everyone about 5am, then the neighbors begin loud discourse in Creole. But I have fresh sheets every day, a nice restaurant if I had time to go there and a lovely swimming pool that I found blessedly refreshing  at the end of this long hot day.  …yes, in spite of packing extremely light, I always bring a bathing suit.

We get back and forth to the hospital via tap-tap.  This is John, a general surgeon from Pa, Emily, a nurse who's been working here for months, Mark, an Ausie EMT, and Beverly Frankeny, an excellent orthopedic nurse.

The Journey & First Impressions

A pleasant flight to San Juan, Puerto Rico with three hours of good reading time at the layover, then walk across the tarmac, put your carry on bag in the cargo hold, because the overhead racks are tiny, and take the twin turboprop to Port-au-Prince.   Circling the airport once to land gave a good view of the many thousands of destroyed buildings and huge areas of tent cities. 

All bags arrived with us (often not the case I’m told), made it easily through customs and immigration, then wait for the hospital van to pick us up.  While waiting the three hours it took to round up a second vehicle and get through the terrible traffic to the airport I got to know seven other people coming to the hospital from Pennsylvania.  Two general surgeons, another orthopedist  and his nurse wife, a nurse/orthopedic equipment rep, and a couple videographers, all traveling under the auspices of Cure International.  I also learned AT&T has good cell phone coverage, as we called the hospital to see if they had forgotten us.

Cramming the eight of us, two drivers, and 22 pieces of luggage in a couple Isuzu Rodeo size vehicles while being attacked by a loud insistent swarm of would be baggage handlers, each of whom feel they deserve a dollar for each bag they touch, was comical.  In the 20 mile hour and a half ride through heavy downtown traffic over rutted, damaged roads, my butt received a permanent imprint of the hand brake, as only half of one of my butt cheeks could find a seat.  But at least my view wasn’t obscured by a pile of luggage in the lap like of the people in the back seat. 

And what a view!!  The entire road is nearly gridlocked with cars and trucks and buses and cattle and goats and pigs and people and more people.  We rode along with the multitude of Tap-taps, the repurposed minpickups with welded bench seats in the bed and an improvised raised roof and welded on steps in the back.  They each have elaborate decorations, many extra lights, bright paintings, and most include multiple painted bible verses and a name on the windshield, such as “Merci Jesus”.  They cram over twenty people into these, and sometimes more hanging on the back.  They don’t beef up the rear springs enough, so when loaded most of them ride nose high with the back steps showering sparks when  they bottom out on potholes.  …and are there ever  potholes!!…everywhere…many would literally swallow a large truck, and there aren’t even traffic cones or warning tape around most of them.

The appalling scenes you see on the news.  It’s really like that EVERYWHERE.  If there’s a divided boulevard  the median is filled with scrap lumber,  corrugated tin, and tarpaulin shacks.  They are on every right of way, every lawn, every available corner where you might put a shack a tent or a lean too.  Every field or park is now a tent city, some are hodge podge, some are seas of uniform donated tents, often with an organization’s logo on each tent…Unicef, or ADRA, etc.  Many destroyed concrete homes have their family camping in the tiny front yard.  Shipping containers have windows and doors cut in them  and contain the contents of the destroyed store they sit in front of, or are dwellings for multiple families.

The people are everywhere.  They are not inside.  They are milling about.  They are lining the streets with merchandise, one woman selling oranges, the next family yams, another mangos.  Every corner has merchants on foot between the cars trying to sell trinkets, snacks, cold drinks, etc.  They appear overall very happy, quite clean and as well dressed as their poverty will allow.  Old people are scarce and obesity even scarcer.