Blog

Tim Gerke Trip Report

Haiti trip report: January 2012

Haiti Adventist Hospital front gates

I spent the final week of January at my home away from home; Port-au-Prince, Haiti. If you would have asked me a year ago where I most enjoy spending my free time, the last place I would suggest would have been post-earthquake Haiti. Yet after each subsequent trip to Haiti I find it more difficult to leave and often feel a sense of loss for my Haitian friends I leave behind. Haiti and its beautiful people have a way of changing ones outlook on life. While it’s true that Haiti has needs beyond needs, the people of Haiti are blessed with a kind, loving and caring spirit unlike any group of people I have come across. I often say I get more out my trips to Haiti than I provide to those whom I serve, and this trip was no exception. I left for Haiti with a heavy heart, traveling for the first time without my amazing wife and without Terry and Jeannie Dietrich, as Terry recovers from a back injury. But together with eight new friends, I had another incredible to trip to Haiti as I helped serve those in need.

Our trip consisted of nine members; I was joined by Bill and Sue Shawler (an ER physician and a recovery room nurse from Portland), Randy and Carrie Goethke (an anesthesiologist and a family practice physician from Appleton), Chris Jobe (an orthopedist from Loma Linda), Kenny Jahng (a third year orthopedic resident from Loma Linda) and Maria and Lucia (an anesthesiologist and a nurse from the Dominican Republic). In many ways our time there was like two trips in one with our time split between working in the hospital and visiting several orphanages around the city.

After a jolting awakening each morning around 6am by a cold shower, our team had a quick worship service and then it was on to the clinic. Dr.’s Jobe, Shawler and Jahng ran the orthopedic clinic with Dr. Francel Alexis. Dr. Alexis graduated in 2004 from the Medical School of Haiti State University and divides his time between very busy clinics and the OR. He now serves in the position of Director of Orthopedics, which Terry had served as last year. We had general orthopedic clinics Monday and Friday and a clubfoot clinic Wednesday.

We had a variety of cases in the OR during our week. One of our first cases was a teenage boy who had an elbow dislocation around Christmas. Unfortunately we missed in the translation that it was Christmas of last year, 2010, which made the case much more difficult. We planned for a three hour case and spent closer to seven on it. Due to the long duration during which the elbow remained dislocated and not used, the ligaments and nerves were injured, and a large amount of scar tissue and calcification had formed around the joint. Hours were spent trying every trick in the book until we finally had to put a pin in to fuse the elbow. The next morning the patient was doing well with limited pain and bleeding, so he was discharged home and will come back for a checkup.

Another surgeon (Dr. Bull Durham) transferred a patient from another hospital to ours to use the equipment we have to fix her hip fracture. Randy and I provided the anesthesia; I did my third spinal block, three for three so far this trip. The case went well. The head of the bone was completely broken off and floating free. To fix this we applied traction to her leg to realign the fracture, then three pins were placed to hold everything in place. Then three canulated screws (screws with hollow centers) were fed over the pins and screwed into place. Then the pins are removed and the screws hold everything together. After a few months the bone will heal and the girl will be good as new.

We did several other cases during the week ranging from children as young as four years old to a hip replacement on a 70 year old woman. Thanks to many generous donors, every person who comes to Haiti Adventist Hospital, young or old, wealthy or poor, obtains the same high quality care. We also performed a few knee arthroscopies and various other surgeries. Sue and I really enjoyed recovering patients in the PACU and working side by side with the Haitian nurses. Bill and Carrie also stayed busy down in the pediatric clinic. Carrie’s French came in very handy when translators where not available. It was a great week and while the OR was not as busy as some prior trips, I feel we made an impactful difference in the lives of many people.

After our work was done in the hospital, many members of our team ventured out into the city to visit the local orphanages. With each trip to Haiti I find myself spending more time with these amazing children. Thanks to many of my friends and family, I was able to bring enough donated clothes to give over 140 children new outfits. Many children were wearing the same shirts from my other visits in March and July. Carrie and Sue also brought clothes, shoes, toys and toothbrushes for the children. We visited four orphanages over the week and saw so many amazing children. We also made time to go to local markets and buy each orphanage enough bulk food to last 4-6 weeks.

Our first trip included visits to two orphanages: Mr. Wilson’s and Mary Lou’s. Mr. Wilson has 25 children and they were out of food, so along the way we picked up enough bulk food for both orphanages and all the kids to last them for a month. Rice, pasta, cooking oil, spices and beans were on the menu. We toured their place and were surprised to see where they slept. They all had a bunk to sleep on but no mattresses. Instead they each had 1 or 2 layers of cardboard between them and the metal frame of the bed. That’s it. And yet they were the happiest kids I have ever met. I arranged to buy them each a mattress so hopefully by Monday they will each enjoy the “luxury” of sleeping on a mattress. We then spent a few hours playing with the kids and handing out the clothes, toys, shoes, toothbrushes, and the “Gerke Nutrition packs” we brought down for them. I gave out over 100 nutrition packs this week, I can only imagine how many of those were the only meal of the day for some of those kids.

Next we went to Mary Lou’s. She has 15 kids but her house is only 7 feet by 20 feet in size. All 15 kids, ranging from 4 years old to 11, had to squeeze and share only three twin mattresses. And they had no beds so they just put the mattresses right on the floor; dirt, bugs, rats and all. Dr. Bill Shawler and his wife Sue are arranging to buy them a few bunk beds to sleep on, and hopefully we can get them some clean, new mattresses as well.

Some of the bulk food we purchased earlier was brought over for them. Only in Haiti have I seen a child cry over receiving rice as a gift. What life must be like that food is so sparse that a 50 pound bag of rice brings an 11 year-old to tears.

The other orphanages all had more happy children. One of the orphanages had done some construction to build one additional building, however about half of their spaces are covered with tarp roofs, many of which have large holes in them. I am going to try and arrange to have metal roof built over some of them to keep them dry. The final orphanage had ten children, all of which were all very sweet but very shy. They had a nice home with a small flat area to run and play. This was the first of all four orphanages to have somewhere for the children to get exercise and be near their home. There are four boys and six girls. The boys shared three beds and the six girls shared two beds. The boys did not have mattresses, only a single layer of carpet for padding. The girls only had cardboard to sleep on. I also found out that every child under 12 gets a free education in Haiti, however they must have their own uniform. The orphanage only had five uniforms so only half the kids went to school. The uniforms ended up only costing $10 each so we bought each child a new one and now all 10 children can get an education. $10 will allow a child to get years of otherwise free education in Haiti, not a bad return on that investment.

At each orphanage I asked how much it costs to provide for each child. On average it only costs about $1 per child, per day. For $100 a month you could clothe, feed, provide shelter and an education for 3 needy children and have some money left over.

We had a wonderful trip to Haiti and I was blessed in so many ways. You too can bless the needy by donating to the Haiti Indigent Patient Fund. By donating $50 you will receive a free copy of our book, “Haiti: Together We Move” and the money you donate will go on to provide life changing medical care to a needy Haitian.

Together we can move Haiti forward.

God bless the Haitians.

On the ground report from Dr. Dietrich

Haiti Never Ceases to Amaze

Nov 2
I felt like running when I woke up at 5 o’clock. I started out on the uphill a bit faster(not quite as agonizingly slow?) as usual. The gas was pretty well gone before even getting to the more level section at the top. Pushing on was not fun but there was still some hope that today might be the day. The more flat section decreased the negative sensations a lot and the timed spots seemed to come a bit sooner than usual. The more flowing feeling on the descent turned the whole experience into something actually positive. 27’ 10” My best time yet. To think that my goal after doing this run several times when I first started was to break 30 minutes. Now I’m nearly 10% under that. If I can keep up the improved times I will logically reach 0 minutes and 0 seconds. Then time will begin to go backwards and every time I run I will get a little younger. It took for me to spend a year in Haiti to discover the secret of eternal youth. What an awesome year this has been.

I concentrated on the clinic while both Ian and Mario got our cases going. Several more patients with frames came in and they almost always take a while to make sure everything is going well. One patient with bilateral PonseTaylor frames for severe clubfoot is doing quite well. I checked all of her strut settings and a couple of them were way off. The mom said the strut was hard to turn so she just stopped. They live quite close by. I don’t know why she didn’t come to get help before her appointment. We got it straightened out and changed a couple of struts that needed it. A patient of mine that I put a TSF on for a tibial malunion came in. He looked a bit overcorrected and the xray confirmed he is in a bit of varus as well as more distraction than I had programmed. I discovered that he has been adjusting his struts to try to get one of the rings way from his skin. All of the struts but one were totally off.

I programmed a residual for him that will take a few days. I’ll check it next week before we leave. The orthopedist at Medishare called to ask if we could take a couple of hip fractures. Apparently they have limited Carm capabilities. His name is “Bull” Durham and he is from Tuscon Arizona. He came over along with the neurosurgeon and I showed him around. This is his 4th time working at Medishare. He is getting to the point where he feels they are regressing in their capabilities. He also feels frustrated that they are not allowed to get out in the community at all because of security concerns. He wants to come here next time.

A neurosurgeon at Medishare called and asked to bring a patient with a C6 spinal injury for surgical stabilization. He had jumped facets and complete quadriplegia. I told him it was fine to bring the patient and I would help him with the case. We started it about 5:30 and finished before 8 pm. I passed sublaminar wires and we bent a rod and wired C4 to L1 and fused him. He was reduced and nicely stabilized when we finished. Derek gave the anesthesia and was a pretty tired guy by the time I got him to the hotel.

Nov 3
Our surgery schedule was lighter than the usual Thursday. That was ok because Ian had heard about the Hotel Olafson and the really good food there. He wanted to take the whole team there because today was Mario’s last day. We had several smaller cases, another diabetic foot that needed a transmetatarsal amputation and a 10 y/o with severe neglected clubfeet. I assisted Mario with the clubfeet. The first side was easier and he got a good correction. The second side was limited by both medial skin contracture and the neurovascular bundle. It will require a second stage procedure. Dr Durham from Medishare called back to see if he could bring a case over to do tomorrow. Their C-arm apparently quit working yesterday. We have two cases for the C-arm tomorrow but it should be available in the afternoon.

With our cases wrapped up before 5 o’clock, we headed off to the Olafson in the pickup. The traffic was absolutely terrible. The jams appeared to be related to the road work that is being done on the main road through the city. Roosevelt helped us find the hotel. It is a decades old Victorian building and very photogenic. The long veranda wraps around the end of the three story building. Overhead fans keep the air moving. There was a classic looking hotel bar just inside the front door. Many of the tables on the veranda had people sitting at them smoking cigarettes. It was much like a scene out of the movie “Casablanca.” We had a really good time telling stories. I toasted the whole team and especially Mario for all of their help and hard work. Most of us had sandwiches for which the hotel is well known. Derek really enjoyed the rum punch which is also a house specialty. After several of them, he decided to take a swim in the pool which he said was delightful. We explored the rest of the old building before leaving. The traffic was all gone by the time we returned home.

Nov 4
I expected the clinic might be larger than usual because of the holiday on Wednesday. It was. Quite a few new patients came in including one young man with a history of chronic infection in a distal femur fracture. He was last operated on at the navy ship for a debridement. He continues to have significant purulent drainage from just above the knee. He has just a jog of motion in his knee. I explained the options and recommended amputation. He would need at least 3 more operations and likely more to clear up the infection. If the process were successful, he would still be left with a short leg with virtually no knee motion. He had already been thinking about this possibility and fairly quickly agreed. We’ll try to work him in in a timely fashion this coming week. The power went off for quite a while during clinic.

The patient with the hip fracture from Medishare is 98 years old. She was quite active and not demented before her fall a couple of weeks ago. I had Ramon Rivera evaluate her when she got here yesterday and he cleared her for surgery. We tried to get things going in the OR as quickly as possible hoping to finish in time to go back to Petionville to look for some paintings and carvings. Ian wants to try to have a fund raiser in his church in Ohio with the Haitian art work. Unfortunately, things went very slowly. The hip fracture, using the hillbilly fracture table went nicely. Lilly helped me and drilled several holes and put in screws and did some suturing. She has been great to have here. A patient with a tibial nonunion for a SIGN nail was supposed to be next but we had several smaller cases that each needed Derek. That slowed the whole process down and we didn’t get the tibial case started until nearly 2 pm. I helped Dr Durham from Medishare do that case and by the time we finished it was after 4 o’clock. The power went out during the procedure and would only come on for a few seconds every half hour or so. It was very maddening. After finishing the tibia the clinic was still going but almost done. I couldn’t leave Dr Durham alone to do his distal radius fracture and Jeannie was the only one left to help circulate. We eventually finished with everything by around 7 pm. Petionville would have to wait. Ian and Sue and Derek leave tomorrow morning so we’ll have to go to plan “B” with that one. Jeannie and I will try to get what they want before we leave on Wednesday and take it with us. We can ship a box to them when we get back to Appleton. Ian is really excited to try this fund raising for Haiti. If it works, he wants to come back and get more art and do it on a regular basis. Jeannie and I took Lilly to the Auberge and we spent a couple of hours with them reprising some of our interesting times during the last two weeks. Scott and team arrive tomorrow.

On the ground report from Dr. Dietrich

Haiti is Beautiful!

Oct 29
The Alexander/Adames team all wanted to do something this weekend. Some wanted to go to the mountains and others to the beach. Some wanted to do both. We decided on the mountains today and the beach tomorrow. The group was ten strong and we filled both the cab and the back of the pickup. We stopped on the road to Petionville and looked for souvenirs. We also found some great citrus that was very sweet and juicy. We also got a large watermelon for lunch. The paintings, metalwork small decorative boxes, and wood and stone carvings were even better in Fermathe, the little town where Ft Jacques is located. We all thoroughly enjoyed the fort. It is very picturesque and has such a great view of Port au Prince and the bay far below. We got lots of pictures sitting on the cannons and climbing around. A woman in the parking lot was selling some just picked raspberries. We bought a bag full of them and Jeannie plans to have them with waffles. It was a very relaxing day for everyone to get away from the intensity at the hospital. Ian and Sue found some nice metal work and a couple of paintings that they liked.

Oct 30
Jeannie and I made rounds early. We changed all of the dressings that needed it. All of the patients seem to be doing well. They lady with the bilateral femur fractures that rode here on a motorcycle for several hours is all smiles whenever we come in. Her right side was definitely the most painful and now that it has been fixed with a SIGN nail, she is able to get out of bed with no pain. The left side is now nealy healed even though it is malunited. She is several centimeters short on that side. Her hemoglobin remains too low to do any further surgery right now. She would have to be transfused first as well as have more blood ready for an open reduction and fixation. She has no resources and all of the volunteers that are able have already donated.

We had only one translater with us today so the back of the pickup wasn’t quite so crowded on the way to the beach. Kaliko Beach resort is quite nice. The beach itself is smooth pebbles and rocks but there is a wide sandy area between the beach and the buildings. Some small sea grape trees provide shade for much of the area. There was a small rowboat hanging out just off the beach. It said “taxi # 13” on the side. I asked Ian and Mario and Derek if they were interested in going out for a ride. Only Ian wanted to go so we negociated with the guy, Fritzner, and out we went along with Roosevelt. The guy is a fisherman who fishes three days a week. On good days he can make more than $50 US. He keeps all four of his kids in school even though he says the fees are high. I tried rowing on the way back but was pretty much a failure. I don’t think I made any headway into the breeze. The oars as well as the boat were handmade. They were quite heavy and I struggled. Fritzner took over again and we made it back in short order.

Lunch was next on the agenda. It costs $30 US per person to access the resort for the day but that includes a great buffet lunch as well as 5 tickets for drinks. The salads were very fresh and there was a lot of rice, beans, chicken, meat, potatoes and other vegetables. We were all thoroughly stuffed. The rest of the afternoon was a total enjoyment in the pool and looking for shells on the beach. I had a great time talking with both Ian and Lilly. We started out for home later than we should have and it got dark about halfway back. I am very reluctant to drive at night because bicyclists and many motorcycles have no lights or reflective devices. It is also way harder to identify the potholes. Thankfully it was an uneventful return. We will have another big clinic tomorrow I am sure.

When we got back to the hospital, we found our good friend, Ramon Rivera. He is an internist who lives and practices in Puerto Rico. He and I worked together at Hospital Bella Vista more than 30 years ago. He has a real heart for Haiti and has been here on two different occasions. The first was before the earthquake. He came and worked in Cite Soliel for 2 weeks. After the earthquake, he responded and rented a pickup in Santo Domingo and drove here, caravanning with another vehicle. He would like for the Adventist hospital in Puerto Rico to be involved as a sister institution with HAH. He will be able to help us a lot the next week and a half. We have a lot of patients with comorbidities, especially the diabetics.

Oct 31
The Monday clinic was a typical large one. I got taken away for part of it by a fairly long phone call from an orthopedic surgeon at Medishare. His name is John Durham and has been called “Bull” since he was a child. He has been to Medishare 3 times previously. He practices in Flagstaff, Arizona. He doesn’t have a fracture table and doesn’t want to try to do intertrochanteric hip fractures without one. He also has a patient with a femoral neck fracture and has no hemiarthroplasty implants. He also wants to borrow some plates and screws to fix a distal radius fracture. With all three of us seeing patients steadily we finished by about 2 pm. We had 4 smaller cases to do and finished with everything by about 6 pm. Our last case of the day was the lady that I had treated for a malunited tibia with a TSF and osteotomy. She had been lost to followup for a while and developed an equinus contracture of her ankle. We treated it surgically with a gastroc slide and then immobilized it by extending her frame to her foot and putting in metatarsal wires. She had healed well and her foot was plantigrade when we removed the lower part of the frame and the metatarsal wires two weeks ago. Upon going home, she apparently made no effort to prevent another equinus contracture. She came in to the clinic today with the same fixed equinus she had before. I was sure we could do a manipulation and get her foot plantigrade. Ian suggested making a foot plate orthosis to attach to her TSF so Jamison did that while we were waiting for her stomach to empty.(she ate spaghetti at 9 am) Sure enough, the manipulation was successful. She is now in a little bit of dosiflexion, held by her custom foot plate tied up to her TSF. During a break in the afternoon, we celebrated Mario’s 41st birthday. Jeannie made brownies and we had ice cream and the fresh raspberries that we bought up at Ft Jacques on Sunday.

We had a tremendous thunder and lightning storm that hit suddenly. The wind blew very hard and I heard a loud crash outside. I carefully opened the door to our balcony and found my cool banana plant laying on the floor as though someone had shot and killed it. It was still raining hard. I’ll try to resuscitate it tomorrow.

Nov 1
We had a big day scheduled – 4 cases for the c-arm. Two of them were cases that Dr Bernard Nau had sent. One was a lady with a SIGN nail and femoral nonunion. The other was the patient he sent a few days ago with a painful swollen ankle. The joint crunched a lot when it moved. The xray showed the talus(ankle bone) was riddled with cysts. There was hardly any bone left. Dr Nau had arranged to come for both of the cases. Ian did the case with Ben assisting. The huge cysts in the talus were impressive. Meanwhile, Derek was already next door getting a 3 year old ready for a bilateral posteromedial clubfoot release. I assisted Mario on them and they went well. Ian finished the tibio-talar-calcaneal fusion with a large distal femoral locking plate. Ben then came in and watched while we finished the second clubfoot. Ben and I then did the lady he had sent me with the femoral nonunion. We took out the distal locking screws and a third “blocking”? screw. The knee was very arthrofibrotic and required a big incision to mobilize the

patella to get the retrograde SIGN nail out. We reamed her to 11 mm and then put in a larger 9mm SIGN nail that was 20 mm longer and locked it both proximally and distally after impacting it. Ben got bone graft from the iliac crest and I exposed the nonunion and cleaned it up and made a good bed for the graft. The case went very well. It was a pleasure working with Ben. We were able to give the patient an additional 30 degrees of knee flexion as well. The last case was really interesting. The patient had a history of a fracture dislocation of the ankle that got infected after surgery. Eventually the infection got cleared up but the patient was left with a very painful ankle. Ian decided to fuse her tibia, talus and calcaneus with a SIGN nail. He did the case with both Mario and Bernard assisting. He did a beautiful job. He is really a master surgeon. He had never seen a SIGN nail before coming here.

On the ground report from Dr. Dietrich

Alexander Team Arrives

Oct 24
The Ian Alexander team arrived yesterday. He is a foot and ankle subspecialist from Ohio. He is sponsored by the Foot and Ankle Society. His trip here is to help the leadership of the Society decide if their involvement here will be an ongoing program. They want it to be a teaching program as well as a help for the local orthopedic surgeons. He has his wife, Sue, with him. She is a pediatrician. He also has a peds foot and ankle specialist from Brazil. Mario Adames practices in the Southern Brazilian city of Florianopolis. It is largely on an island and has 42 beaches. It is well known for its surfing. He says they do a lot of windsurfing and kiting also. Sue is an OR tech with them. She is extremely good at orthopedics. She sets up the room as if she has been working at HAH for years. Derek is a great anesthesiologist. He is from Ohio but will be moving to Virginia in a few months. He grew up in Lake Tahoe, Nevada and studied in Arizona. We are lucky to have him. He loves to do blocks.

The clinic was made all the more challenging by three diabetics with foot infections. One had an entirely infected and dead foot. Another had a dead fourth toe. Everyone in the hall was wearing a mask to deal with the odor. We were able to take the patient with just the toe involved and debride her foot. The other patient had a very low hematocrit and needed transfusion first. I hope we can get blood so we can do her surgery tomorrow.

I was able to schedule several cases. The little boy with the TSF being treated for short tibia came in again with infection around several of his pins. He has had several trips to the OR already for similar problems. He still needs his frame since the new bone still isn’t strong enough. I’ll take him back again tomorrow for revision of his frame.

The final path result finally came back today on Katiana Paul. It is a fibrosarcoma. I emailed Dr Bibiloni and Dr Mehne with the results to see if they might have any connections that can get her adequate treatment. Dr Larson answered that the only possibility in Haiti would be a hip disarticulation. That wouldn’t address the pelvis that appears to be locally invaded.

Both teams enjoyed a pizza dinner at the Auberge hosted by Frank and Kaye. I got to know Ian better during the meal. He has been a business man also, developing and selling software. The “peekleez” was a hit with most everyone, especially Steve.

Oct 25
We had a big list of cases on the board and didn’t finish until after 9 pm. Ian and I did a takedown of a malunited tibia and placement of SIGN nail. Ian enjoyed learning the nuances of the SIGN system. The case went well. A 20 y/o came into the ER after being hit by a car. He had a puncture compound very comminuted distal femur fracture as well as an unstable fracture of L2 without neurologic deficit and a deep abrasion on the back of his hand. Frank put in a SIGN nail and then cleaned up the wrist abrasion. We’ll have to plan the spine surgery. He will need to have blood available. Mario did some of the peds cases. I showed Ian the book while we had a bit of time in between cases. He was very impressed with the quality and the content. I explained the opportunity that we have to establish this program with satisfactory funding. He immediately mentioned that he has a very wealthy patient that he is sure would give a large donation and that he is going to give her that opportunity. I’ll sign a book for her that Ian can give her.

The Whitney/Mulder team leaves tomorrow. Jeannie made a great spaghetti and salad meal for their team and we had a late dinner.

Oct 26
Jeannie and I bid the team goodbye. Frank said that he and Kaye were seriously considering taking over for me. After working with him for the last week and a half, I am sure that he would do a great job. After they left, I went for my run. I had my best run yet 27’ 40” even though I was still a bit stuffed up with a cold. We made rounds and after finishing, Ian was very excited to tell me some ideas. He said that he had been brainstorming about getting exposure for the book. He wants to arrange for a booth at the American Academy of Orthopedic Surgeons annual meeting in San Francisco in February. For more than two months I have been trying to figure out how I could make the right contacts to see about having a display there. Ian has done it many times and has all of the equipment. He wants to arrange a schedule of times for Scott and me to alternate being at the display for book signings. I sure hope we can work out the details and that it isn’t too late.

The clinic didn’t look all that big so I tried to get some important administrative work done. Scott had developed a proposal for keeping Francel here at HAH. He is being courted by MSF where he worked for a while before starting his peds ortho fellowship. I gave him my input on that important issue. Arrangements have been made for the orthopedic surgeon from Curacao to come the day before we are scheduled to leave. It is not nearly enough time for him to become familiar with the multitude of different areas that he will need to learn on his own. Dr Nau emailed me about a case that I had scheduled for surgery next week. He wants to come and help. He apparently knows the patient.

I helped out with the last half of the clinic and meanwhile, Mario went to the OR and started a case. I really enjoy working with Ian. Unfortunately, many of the foot and ankle cases we had saved up were operated on by Dr Perez when he was here just 2 weeks ago. Ian did the BK amputation on the diabetic today.

Oct 27
The surgery schedule was full. Dr Bernard Nau, a well known Haitian orthopedic surgeon arranged to have a patient of his evaluated this morning. Dr Alexander did the evaluation and felt that he was a very good candidate for a fusion of his ankle and subtalar joints. The patient has very large cysts throughout his talus(ankle bone.) He injured his ankle playing basketball 2 years ago and has had progressively worsening ankle pain since. He walks with a noticeable limp now. This type of problem is an area of expertise for Dr Alexander. We scheduled him for surgery next Tuesday. Dr Nau is planning to assist.

I did an arthroscopy with Lily assisting. She is very good with her hands and handled the instruments very well. She has a very good knowledge of anatomy as well. Mario did more children’s feet and leg cases and he and Ian took out a SIGN nail and put in antibiotic beads and placed an external fixator on a tibia. ZJ and I revised an amputation stump on a young girl that he has been following closely and has gotten to know very well. We tried giving her tetracycline and using a black light to try to identify dead bone. I can’t say that it worked convincingly. We put antibiotic beads in the stump. I hope it finally clears up her infection. We have another diabetic with a severe infection in her foot that we will try to take care of tomorrow. This is our fourth case in 3 days.

The reply from the Academy was that it is NOT too late for a display. In addition, it is complementary for nonprofits. Ian and I are excited. He is planning a ¼ page ad in the ORTHO NOW newspaper to raise awareness before the Academy. It will be fun to hopefully interact with many of the attendees and share with them what is happening here at HAH and what a wonderful opportunity it is.

I received word via email from Frank and Kaye that they have decided to not take over here for us. Of course, I am disappointed. I know he would do a great job. Perhaps they can be convinced to help this transition for a shorter period of time. I know this is God’s project and have complete confidence that He will keep this project accomplishing what He wants it to do.

Oct 28
The clinics continue to be large and challenging. Ian, Mario and I worked steadily through the morning. We got in another diabetic patient with two dead toes and infection in the forefoot. Ian took him to the OR and removed the dead tissue and packed the wound open. Another patient with an Ilizaroff frame needed the foot wires and plate removed under anesthesia. The big case was Felix and his ankle. Felix had and open fracture of his ankle more than a year and a half ago. He also had a femur fracture. He first came to us several months ago with a nonunion of his femur and an infected failed ORIF of his ankle. Drs Weinfeld and Den Hartog removed the hardware from his ankle and debrided it thoroughly and placed an Ilizaroff frame. The infected wound was left open. It finally completely healed about a week ago. In the meantime, the ununited femur was treated with first an external fixator to get the bone out to length and then a SIGN nail was placed by Dr Yoon about 3 weeks ago. Mario tackled his ankle today to do a formal ankle fusion with iliac crest bone graft that Ian helped Lily harvest. We are all hopeful that this will be the last procedure that Felix will need.

I saw several patients in the clinic today in followup. One was Stephanie Bryce, the nine year old with severe bilateral Blounts that was treated with TSFs and tib-fib osteotomies. She and her family are so happy with her result. She is back running and playing again and is very happy. Her osteotomies are completely healed. Her mom brought us another great meal for lunch. I saw the ACL reconstruction that Anthony Feniston did four months ago. He is likewise doing very well. He is anxious to return to playing soccer. I am going to let him start some light jogging and then gradually increase his activities. Perhaps in 2 more months he will be able to play again. The patient with the TSF that I did last week came in. He has no problems. I had Franz teach the family how to adjust the struts properly. He will return next week to check on his progress.

On the ground report from Dr. Dietrich

All in the Family- A visit from Cameron Dietrich

Oct 14
The clinic was the usual size today. I had a meeting with Nathan and we discussed a number of items. There is a possibility for another orthopedic surgeon that might be able to replace me. He is from the Philipines and is currently working at the Adventist hospital in Curacao, apparently doing just administrative work. The funding apparently wouldn’t be an issue. Even if he doesn’t do much surgery, perhaps he could keep the program organized so that the specialty teams have good cases set up and there is satisfactory followup. He and Francel could run the clinics and take care of the

everyday cases. It will be interesting to see where that possibility goes. Of course, Dr Frank Whitney and his wife Kaye are coming on Sunday. We have hopes that he will be willing to take over for me for at least six months or more. The surgical cases were mostly foot today, but Dr Bibiloni did the tumor case. I was busy in the clinic when he did it but he said the tumor was immediately on the vessels in the groin but not invading. He again did an excellent job on a very difficult case. We have been hoping to get the report back on our teen age girl with the lesion in her hip that Dr Yoon biopsied especially with Dr Bibiloni here to help with the management. Dr Perez and Dr Guzman have done a really great job on all of the foot and pediatric cases we have had. We arranged to have dinner together this evening at the Auberge where the team is staying. We had a really great time talking and telling jokes and getting better acquainted. Juan told Jeannie and me about his 500 acre farm in central Puerto Rico. He farms about 100 acres. He has Valencia oranges on most of it. He also has limes and some plantains. He has a foreman and 9 employees. He has 3 children and loves his wife very much. He has a big concern about the drugs, crime and violence that seem to be more and more prevalent every year in Puerto Rico.

Oct 15
Another Sabbath has come to give me the break that is so helpful in keeping balance in my life. Having a special day each week that is set aside as God’s day is one of the best gifts ever given to mankind. I took an early morning long walk up the hill. We all wanted to go to the prosthetics program that the Puerto Rican team has developed so we took the pickup to Delmas with Emanuel leading us. It took a while to find the site. We even arrived before the Puerto Rican team who had to call us for directions. We got a bunch of pictures especially of Cam and the younger amputees. We had lunch at a nearby café and talked with Cam and Chris about funding the project. Chris has many connections with the media especially in England. On our way home, we took pictures of Haiti’s ruined nationalcathedral. There were a number of beggars at the site. It is hard for me to walk away from people who have so little but I have resolved to not encourage begging. We also stopped at the ruined National Palace for more pictures. The internet went off today. It won’t be worked on until Tuesday since Monday is a holiday.

Oct 16
I was able to do my early morning run in 28’ 05” . It was my best time yet. Whitney/Mulder team arrived fairly early in the day. I had an enthusiastic meeting with them sharing how I perceived the unprecedented opportunity here. Of course, my hope that Frank will takeover for me had no influence on that at all. Steve Mulder’s return is his first since the “Rocket Man” episode. He calculates that he has spent 50 days here in Haiti since the earthquake. Mimi Batin is a trauma subspecialty trained orthopedist who shares the ER work with Frank in his work in San Luis Obispo, California. She has been here before not long after the earthquake. She is very enthusiastic.

The students and Cam wanted to go to Petionville to check out the souvenirs and paintings. Jeannie and I found one that we liked a lot. As we were leaving we had an interaction with a group of youth who were asking for money for “protecting” our vehicle while we were looking at paintings. It was a somewhat threatening situation and required a hasty departure.

Oct 17
The clinic was much smaller than usual due to the National holiday in remembrance of the assassination of Haiti’s first president/emperor, Dessalines. We were finished before 2 pm. That gave us an opportunity to all go to Franz’ orphanage. The kids put on a great program singing and dancing. We took a lot of gifts and clothes and candy. Cameron really enjoyed having fun with the kids. Josh and Andy did also. The students and Cam and Chris all wanted to go to Leogane, the epicenter of the earthquake so we spent the rest of the day driving there and looking around and then coming back. Still no internet

On the ground report from Dr. Dietrich

Haiti Stands Up

Oct 10

Freddy left very early for the airport. ZJ also left for the week to get some medical issues checked and treated in Miami. I went for my morning run and felt really good when I started. I was pretty sure I would have a good time for the run and I was able to do it more than a minute faster than my last run. (28’ 50”) I’m getting close to my best time ever. Ed and I started the big Monday clinic. The Puerto Rican team arrived mid morning. They immediately dove in and started working. Juan Bibiloni and Humberto Guzman are the two orthopedists leading the team. Dr Ramos is their anesthesiologist. They have 2 OR nurses/techs also, Ulisses and Julia. Juan is a subspecialist in both reconstruction and orthopedic oncology and teaches at the University of Puerto Rico orthopedic teaching program. He did his oncology training in Boston with Dr Mankin and also at the Instituto Ritzoli in Bologna, Italy. His joint reconstruction fellowship was also in Boston. Humberto did a fellowship in children’s orthopedics in San Diego, the same program where Scott did his fellowship. Humberto finished fairly recently and has never met Scott. They have both been very involved here in Haiti. They have been instrumental in starting a foundation called “Haiti Se Pone de Pie.”(Haiti stands up) or (Haiti gets back on its Feet). The emphasis is on providing prostheses for the many amputee victims of the earthquake. Humberto and others from Puerto Rico did many amputations starting three days after theearthquake. They brought an entire truck over from Puerto Rico on the Ferry from Mayaguez to the Dominican Republic. They made it as far as Jimani at the border and found a facility with many patients needing care (amputations, external fixators and fasciotomies for compartment syndrome.) Their experience was wrenching but also gratifying. They had an incredible experience in the aftermath of their week of nearlynonstop, heroic efforts to help injured Haitians. Several pictures were posted on Facebook by team members that were totally misinterpreted by some members of the press in not only Puerto Rico but also in the national media in the US. Such a negative light was shown on them all that they were even brought under threat of medical license revocation in Puerto Rico. They paid several thousand dollars to take out a full page ad in the Puerto Rican news media explaining the misinterpretation of the pictures. It clearly shows how the popular media can take information and without proper analysis, use it in an inflammatory manner that can discredit highly trained and qualified specialists who are donating their valuable skills to save peoples lives in a disaster situation. Of course, the motivation is to attract more viewers and readers to “sell” their product and improve the “bottom line.”

Two more orthopedists will be arriving on Wednesday. Juan and
Humberto started evaluating patients as if they were at home. I am
really impressed with them. Ed did a case of tibial 8 plates and I
did a couple of small cases. Dr Bibiloni then started the case of the
large popliteal cyst with the peroneal nerve palsy. He spent between
2 and 3 hours very carefully dissecting out the lesion and identifying
the peroneal nerve and the neurovascular bundle. The peroneal nerve
was located between two large lobes of the cyst and was flattened so
that it looked almost like a ribbon. Clearly it had been under
pressure for quite some time. The neurovascular bundle was displaced
significantly toward the medial side of the knee by the cyst. Juan is
certainly a skilled surgeon. He made what for many orthopedists would
be a sphincter puckering experience look fairly straightforward.
The cases as well as the clinic were all finished by about 5 pm. It
was a rainy day all day long so I chauffered the team to the Auberge
in the “new” tap tap to be. I also took JJ and Roosevelt home so they
wouldn’t have to find a taptap in the rain. The traffic was awful out
on the main street in Carrefour and what should have been a ten minute
event took more than half an hour. The evening was still young so
Jeannie and I took Ed and the two medical students to the Auberge for
pizza. The Puerto Rico team was just sitting down so we joined them
and had a great time talking and getting to know each other.

Oct 11
We had a good list of cases for today. Unfortunately, we had to
cancel a child because of a cold and two other patients didn’t come
including the patient with severe Blounts for a TSF. We were able to
call one of the patients scheduled for tomorrow and he agreed to come
in. It turned out to be a good day after all. Tomorrow the
foot/ankle specialist, Dr Perez, arrives as well as the sports
medicine specialist, Dr Mayol. Today was Ed’s last day. Jeannie made
dinner and we invited him to join us. We had a good time talking for
nearly 3 hours. Ed and I went to college together and he was one of
the more colorful students. He was involved in several pranks that
eventually led to him being asked to leave. The experience didn’t
embitter him and he finished premed at another school and ultimately
did orthopedics at Loma Linda. During residency we did socialize a
bit and have stayed in contact since, mostly through the Neufeld
Society of which he was a founder and our common interest in
supporting the orthopedic program at Loma Linda. Jeannie and I really
appreciate his support of the work here. Many of the orthopedists
that I know well and had hoped would be willing to donate a week of
their time during this year have not been able to come. Ed has come
TWICE and that puts him in a special category for us. He has been
extremely generous also with helping with resupply of implants. He
brought the 7.0 cannulated screws that he tested and then ordered and
payed for from the company in India. We now have a full set as well
as replacements that should last for quite a long time. The Zimmer
7.0 screws are much better than the Synthes 6.5 screws because the
guide wire used with them is much beefier and doesn’t deflect like the
thin one for the 6.5 Synthes one. The screws can be placed more
accurately especially in the hip.

Oct 12
Jeannie and I got up early and bid farewell to Ed. The clinic was big
as usual. Having two more orthopedists to help when they weren’t in
the OR helped us finish before 4 pm. An unexpected case came in for
Dr Perez, the foot specialist who arrived around 10 am along with Dr
Mayol, the shoulder specialist. Another tumor case came in to the
clinic. The lady has had a lesion growing in her groin for several
weeks. It is large and has eroded through the skin. Dr Bibiloni felt
it was something that he could remove. I would have never attempted
something like that. It was so intimately related to the
neurovascular bundle. We arranged for her to get blood ready and to
come back on Friday for surgery. We eventually did seven cases and
finished before 8 pm. Dr Bibiloni runs 2 or 3 times a week as well,
so we arranged to run together early tomorrow morning. Our son,
Cameron, has been having intermittent symptoms of pain in his ankle
that sound somewhat like a loose body. He would like to be evaluated
by Dr Perez to see if an arthroscopy might help him. He is going to
try to make arrangements to come here with a professional
photographer. He lives in Cabarete in the Dominican Republic and
could drive. I encouraged him to fly. The challenge of finding his
way across Port au Prince if he drives would be daunting, especially
never having been in the country before. The digital machine for the
ortho clinic has finally been repaired enough to be usable again. It
definitely makes the clinic go more smoothly.

Oct 13
Cam’s early email said he had decided to fly and would be in this
afternoon. Juan and I ran my route and had a good time. We stopped a
couple of times to enjoy the view from high above the hospital. There
were 12 cases on the surgery schedule today. There were three
arthroscopy cases including the Bankhart repair of the shoulder.
There was no clinic so we could use all three rooms for at least part
of the day. The fifth orthopedic member of the team, Artemio Torres,
arrived this morning from New York. He is also sportsmedicine and
does mostly knees. Five of the cases needed C-arm so we still didn’t
get done until after 7 pm. I did a talectomy case with Humberto and
that was a first for him. Dr Mayol is an extremely skilled surgeon.
He set up the shoulder arthroscopy as if he were operating in his home
hospital. Dr Torres assisted him. He made what for me would be a
challenging case look very simple. He put in three very accurately
placed anchors to repair the Bankhart lesion and the shoulder was very
stable. He has a great sense of humor as well. All of these guys,
except the serious one, Dr Bibiloni, are constantly “putting each
other down.” They make snide little comments about how slow one is
compared to the other. It is all in fun and they have a great time.
They obviously respect each other very much. Cameron arrived with
Chris Black, the professional photographer this afternoon. He had the
sportsmed guys and Dr Perez, the foot and ankle specialist, examine
him and the ultimate conclusion was that surgery wouldn’t be likely to
help him. Of course, the ankle isn’t bothering him right now. Chris
is an extreme water sports photographer. He mainly shoots surfing and
kiteboarding. He is from England. He has a lot of connections in the
movie industry. He and Cameron have planned to come here to get a lot
of photos of the project and then combine them with photos of a kiting
trip on the north of Haiti. They are sure that they can make a
several page spread in the kiting magazines that will help get media
exposure for HAITI: TOGETHER WE MOVE and the project here. I talked
with Chris about the possibility of getting national media exposure in
England for the book. He thinks there is a good possibility. With
the popularity of ‘reality shows’, he is going to work on getting one
done here to help publicize the opportunity and needs.

On the ground report from Dr. Dietrich

Outing to Furcy

Oct 7
I saw several more patients in the clinic today in followup of their frames. I also saw a new patient with severe Blounts for a TSF. We had several smaller surgical cases that Ed did while I concentrated on seeing clinic patients. We finished with surgery and clinic by 5 pm. Wilfredo Perez arrived this morning from Puerto Rico. He brought manuals and tools and kits to go over our anesthesia machines. He started to work right away on the machine in room 3 and after several hours we concluded that it would be better to test the machine in storage downstairs for leaks. We brought the other machine up from downstairs and he began working on it. It didn’t take him more than an hour or so of testing it and checking all the hoses and connections to conclude that it is in better shape than the room 3 unit. It doesn’t have any significant leaks and we decided to concentrate on getting it in good shape rather than waste energy and time and resources on the older machine that may be more problematic. Dr Adrian tested both machines and she agreed. He has really gotten a lot accomplished since he got here this morning. About then, the Sabbath had begun so Freddy put his tools down. It is once again a delight to have a day apart from the business of the week. Jeannie made a great meal of savory beans and rice that everyone really enjoyed.

Oct 8
Our patients are doing fine. I planned to take Ed, Andy and Josh away from the campus so they could see some of the Haitian countryside. Freddy wanted to come as well. They all wanted to go up to the cooler high country. I had missed seeing Ft Jacques the last time we were up there. It is a fairly well preserved fort built just after independence in 1804. Our four main translaters wanted to go as well. Jeannie decided she needed the rest and stayed at the hospital. Emmanuel did a nice job of directing me to Petionville and then on up the narrow, winding road to Fermathe where the Baptist mission and hospital is located. The group all looked through the mission and then we headed out on a very bumpy, never paved road to the fort. There was some very nice scenery on the way so we stopped a couple of times to take pictures. One spot was a rock wall along the road with several different types and colors of hibiscus hanging over. I love flower photography so took a few minutes to compose about a dozen images.

The fort’s small parking lot had several people selling fresh fruit as well as cooked food. There were French fries, whole vegetables thatlooked like a potato, and some other veggies as well as ‘peekleez.’ I got a plate full of a variety and it was very tasty. Most everyone except the translators were a bit reluctant at first but once they tasted it, it was “Katy bar the door.” Two more platefuls were bought and devoured. Everyone really liked the peekleez. We paid admission to the fort and a young guide started the tour. His heavily accented English was fun to listen to. The earthquake had caused a lot of damage and the cannons had been taken off the walls and placed on the ground in front of the fort. We all enjoyed poking into various rooms and areas and taking pictures. I set up a groupphoto and the guide did a nice job of working everybody’s camera. The small central “plaza” has a cistern nearly filled with water and lily pads. The flowers were beautiful. We got more pictures at the end of the tour on the cannons as well as of the Haitian flag on the flagpole in front of the fort. I paid the guide very well for the group but he continued to hang around and started asking the others for money also. I don’t have patience for that sort of thing and he quickly got the message. Back in the parking lot, four more plates of food with peekleez were purchased. It all disappeared quickly.

We continued on our outing through the town of Kenscoff. It continued to get cooler. The Lonely Planet guide book describes the little town of Furcy as “picturesque” so that was our destination. We continued on the road that became more and more “rustic.” It seemed as though we travelled quite a bit farther than the guide book had indicated before we finally got there. I got a couple of relatively uninspiring photos and we put the pickup in 4 wheel drive for the trip back to Kenscoff. It runs very well in 4×4 and felt very solid. The whole trip back to Delmas took about 2 hours.

Stephanie Bryce’s family had invited us to their house on Saturday again. I had told Emanuel that we were going to Kenscoff and beyond and weren’t sure how long it would take and when we would return. Freddy also planned to spend the evening working on the anesthesia machines. I told Emanuel that we wouldn’t have much time and for them to not make us a meal. We got to the Bryce’s around 6 pm and they had a whole meal ready. We all had a great time with the family. Stephanie is doing really well. I had JJ take some pictures of me dancing with Stephanie. Everybody got a kick out of it. We didn’t stay late. Freddy worked late into the evening on the machines. He is unbelievably knowledgeable. He plans to get up early in the morning to get as much done as possible.

Oct 9
Pt with femur fixation last week by previous team had some persistent serous drainage so I took him back to the OR. I only found a hematoma/seroma. I washed him out thoroughly and closed him so he hopefully can seal and not drain any more. I spent a lot of time on the computer also catching up with my journal and sending emails. Freddy worked all day long with only a short lunch break. He finally wrapped it up after 11 pm. All of the machines are now functioning and have been serviced. He services each of his machines every 6 months. I hope we can arrange with Bella Vista Hospital for him to come every 6 months. Even better would be for us to have Freddy train a Haitian to be our Biomedical technician and have our own department. Roosevelt spent almost the whole time with Freddy. I will have to get some feedback now from Freddy to see if he thinks Roosevelt has the aptitude to do the job.

On the ground report from Dr. Dietrich

Wisconsin September, Haitian October
Oct 2
Arrived back in Haiti. Ed Miller is back for his second stint helping me. He will be here for
10 days. There are two students from DO school in Colorado here for three weeks. Dr Pat Yoon’s
team covered the last two weeks while we were gone. They left earlier today. Francel is also gone.
He will be spending most of the month of October with Dr Karl Rathjen in Dallas. I accepted a
young teenager with fractures of both of his tibias. Apparently a stack of bags of cement fell
over on him this morning. We won’t have any anesthesia until Maria gets here from the DR Tuesday
afternoon. The fractures are closed so we will just have to wait until Tuesday or perhaps Wednesday.
We checked out the anesthesia machines and then called Freddy again. He wants me to take
pictures of them and email him with more information.

Oct 3
The Monday clinic only had about 40 patients but it took a long time.
I think I saw at least a half dozen patients with TSF and Ilizaroff
frames. Each one took quite a bit of time to study and sort out
potential issues. I also saw a 57 y/o man with a huge fluid filled
cyst that fills his entire popliteal fosso(area behind the knee) and
extends out around the lateral side of the knee and welll up the thigh
behind the back of the knee. He has had the cyst for several months
but in the past few days noted that now he can no longer dorsiflex his
foot and ankle. The cyst was very tense and filled with what felt
like fluid. We put in a needle and drained a lot of dark colored
fluid. I suspect Pigmented Villonodular synovitis. At most we were
able to only get about 20% of the fluid out by aspirating with a
needle. I emailed the clinical data and pictures of his knee to Dr
Bibiloni in Puerto Rico. He is an orthopedic oncologist who teaches
at the University of Puerto Rico in the orthopedic department. He is
helping organize the team from Puerto Rico that will be here next
week. I would prefer to wait for Dr Bibiloni to do the definitive
surgical treatment since that is his specialty. Perhaps keeping the
cyst partially decompressed will relieve enough of the pressure on the
peroneal nerve that it might have a chance to recover. We still don’t
have an x-ray machine working in the clinic and there may be an issue
with the Ministry of Health questioning our use of the C-arm for
clinic patients. We are encouraging patients to go to the xray
department for permanent films. Many of the patients seem to be able
to pay the fee involved. Ed did a couple of cases in the OR with
local anesthesia and also helped in clinic. Clinic lasted until
nearly 6 pm. Jeannie made a really nice meal for us and we invited Ed
and both of the students to join us. We had a good time talking for a
couple of hours. I called Freddy again tonight and he has gotten
permission to come. I’m really excited! I hope this will be the
beginning of a good working relationship with Bella Vista Hospital.

Oct 4
There were 7 cases scheduled for today in anticipation of Dr Adrian
and Lucia arriving early this afternoon from the DR. They didn’t get
in as early as we had hoped and we didn’t get started until after 4
pm. A patient with a calcaneal fracture came into the ER last night.
His fracture is displaced and should have a surgical reduction and
fixation. We should have time to do his surgery on Friday. That will
give the swelling time to go down a bit. We postponed one case until
tomorrow. Ed and the students did the hip hemiarthroplasty with JJ
assisting. ZJ and I did the rest of the cases in the other room
including an arthroscopy on a patient with an AK amputation. We
finished all of the cases and got everythingcleaned up just before
midnight. Dr Adrian did her usual terrific job. It was even more
impressive given the fact that she had hardly had any sleep the night
before because of a neurosurgical emergency that she gave anesthesia
for until 5 am. ZJ did very well with the arthroscopy. He has very
good hands.

Oct 5
Apparently the patient with the calcaneal fracture knows Dr Hans
Larson, the president of the Haitian Orthopedic Society. He wants Dr
Larson to do his surgery. He has been admitted as a private patient.
The clinic including the clubfeet patients was large as usual.
Several more patients with frames came in and took quite a bit of
time. We had three cases including the boy with the bilateral tibia
fractures. Ed did his usual very careful, well thought out, precise
surgical management of a difficult case. The entire medial tibal
plateau, half of the entire growth plate of the proximal tibia was
extruded medially. The ACL was shredded as well. The students, Josh
and Andy, are getting totally inundated with amazing orthopedic
pathology. Jean Sondy, the boy who was an inpatient for so long last
year with the infection in his tibia, finally got his Ilizaroff frame
removed today. He has no infection and the tibia is healed although
it is a bit short yet. He is really happy and expressed his
appreciation for all we have done. His father did likewise. I
continue to be impressed with the Haitian people. Another case was a
4 y/o orphan boy who is being treated for neglected clubfeet. Dr
Nelson put Taylor Spatial frames on both feet and legs in August.
Using the TSFs for these deformed feet is considerably more difficult
than a straightforward frame for a long bone deformity. If I could
have a few more weeks doing these kinds of cases with Dr Nelson,
perhaps I could even do them myself. The reality is that they can
easily wait for a few weeks until an expert can do them and then I can
follow them. This boy’s followup has been a little more complicated
than usual and I had to spend some time on the phone with Scott last
night and again today to get everything right. These cases need two
separate treatment programs. The first is to correct the forefoot and
midfoot so that the navicular bone is reduced on the talus. Then the
wire that is stabilizing the talus is changed from its attachment to
the proximal ring and attached to the distal ring. The new program
then corrects the remaining equinus deformity(foot pointing down
toward the floor). Of course, it requires a completely new
prescription. The data is again entered into the computer including
the amount of deformity(equinus). The patient and the caregivers then
adjust the 6 struts over a period of several weeks to get the foot
straight. It is fairly common for patients to have infections around
pins or wires during the several months that they have the frames.
The simpler infections respond almost always to oral antibiotics. I
have had a couple of patients with infections that were significant
enough to take to the OR for debridement and IV antibiotic treatment.
So far, I haven’t had to take any frames off before finishing with the
full treatment because of infection.
The clinic and surgical cases were all done by 7:30. I admit that the
12 hour days are preferable to the16 hour days.

Oct 6
Seven cases were on the board for today including a 17 y/o girl with
severe Blounts for TSF and osteotomies of the tibia and fibula. About
10:00 I was told that Dr Hans Larson was coming at noon to do the
surgery on the patient with the calcaneal fracture and was going to
start at noon. That left us in a bit of limbo since we were planning
to use the C-arm for two cases that could each take up to 3 hours. We
certainly want the Haitian orthopedists to want to come here and do
surgery without having to wait for a room or equipment. We waited
until nearly 2 pm and didn’t have any word from him so we went ahead
with our shorter case. Then we followed with the TSF. Ed helped me
with it and it went very well. He had never seen one done before. We
had a really good time doing it together. Of course, we had to clean
up all of the instruments and trays and restock all of the trays with
the bone screws, rings, struts, connectors and bolts. We finished
everything by about 8:30. Dr Larson did the calcaneal fracture in the
other room while we were busy in Room 2. I guess he didn’t need the
C-arm.

On the ground report from Dr. Dietrich

Go, PACK, GO!

Sept 12
We had another quite large clinic today. In addition, we had a couple of cases including a hip hemiarthroplasty that I did with ZJ. It turned out to be another fairly long day. Nathan and Amy came back today. He still has the symptoms of dizziness when he stands. I asked about the xray machine getting fixed. The Fuji rep apparently needs to come here to deal with the problem. He is going to try to get that arranged in a timely fashion.

Sept 13
7 cases were scheduled today. We canceled one and did 5. One patient didn’t show

There were some smaller cases. One was the bilateral clubfoot patient that Bill and I did last week. The feet look really good. We recasted them in neutral. The next cast change should let us get to 10 degrees of dorsiflexion or more. The biggest case was the obese lady with the pathological fracture of the femur and many metastatic lesions throughout her femur and pathological humerus fracture. We fixed her femur with a SIGN nail and methylmethacrylate. She bled significantly and since we only had one unit of blood decided to not fix the humerus. The case took quite a long time. I also did another arthroscopy with Francel. The patient is morbidly obese and Francel had difficulty getting visualization. I took over and the case was not easy for me either. It may not have been the best learning experience for Francel. Our last case was an elderly gentleman with an intertrochanteric hip fracture. We set up the fracture table and the case went well. We finished at nearly 2 am. Irma was a real trooper all day long and until we finished. I offered to watch the patient in recovery but she insisted that it was her responsibility.

I talked with Francel earlier in the day and he told me he will be here til end of year and would like to stay on afterward. That is great news for us and the program here. I am sure there will be some financial issues and probably a need for us to be involved in subsidizing his practice in some way. I’ll talk with Scott and others about that.

I had an interesting encounter with an expatriate today also. Anthony Kilbride is a friend of Brooke Beck. He is from England and works here on water project. He has had an ongoing problem with a knee for about a year. He suspected it was a meniscal injury. He had a prior meniscal lesion in the other knee several years previously and had an arthroscopy. I assessed him and his findings are consistent with a torn meniscus. He was very surprised that we do arthroscopy here at HAH. He thought he would have to go home to England to have it taken care of. I talked about HAH, the work being done here and the need for fund raising for this program to have long term stability and success. He must be a fairly important person in his program because he told me he meets with Bill Clinton on October 8. He said he would like to talk to Clinton about our work here. I plan to scope his knee before that. I gave him a book to give to Clinton.

Ernie Schwab from the LLU School of Allied Health was here for a few days. I talked to him about the possibility of getting some type of certificate for JJ as an Orthopedic Technician. He believes it shouldn’t be very hard to do.

Sept 14
Clinic went well. I left for the airport at 2 pm for Santo Domingo. Jeannie and Cameron picked me up and we drove to Cabarete. It is so nice to be back here again. It’s great to be with Jeannie after nearly a week.

Sept 15 -17
Just two days in one of my favorite places is hardly enough. A couple of good windsurfing sessions and a nice round of golf made the short trip worth it. Tim and Summer were there also. Tim got out on the windsurfer and did really well. He is making steady progress.

Sept 18 – 29
Pat Yoon from Minnesota is bringing a team to cover for me in Haiti while I am gone. He has been very involved in the project and his commitment to the work there is remarkable. This is his third or fourth trip there. I cannot thank him enough for what he and his teams have done to keep the work going. He is fellowship trained in foot and ankle and does a lot of trauma in the Twin Cities.

This was our last return trip to Appleton to work during our Year in Haiti. I was again on call for 9 of the 11 days. I once again enjoyed being “home” with Jeannie even though we are staying in our neighbor’s downstairs apartment. This trip back was fairly similar to the others with office hours and several elective cases including total joints and one Oxford. I got several cases in while on call also. We ate out several times and made it to the tennis center several times. I had several meetings in New London to work on getting things ready for my work beginning there in November. Jeannie and I also attended a Foundation banquet in New London and had a good time meeting and talking to several of the people that I will be working with. We took some time to look at houses with a real estate agent and found one that was a really good price that we like a lot. It has been on the market for two years so perhaps we will have time to sell our house and buy it. It has a main floor and basement – NO upstairs which I like. The kitchen is perfectly functional but some changes will need to be made. There is no fireplace in the master bedroom either. There is a three car attached garage and a two car detached one. That will be perfect for a tractor to deal with the acre lot. The landscaping in the front is bad and will need to be redone. It is less than 5 minutes from the hospital and office. I would favor moving to New London mainly because of the winter road conditions.

Something very special occurred also. We were able to meet with Joan Malchowski, the director of publicity for the Packers. Jeannie and I had about an hour with her. I explained the work being done and the amazing opportunity it presented. I gave her a signed copy of the book as well as two others to give to whoever in the Packers organization she wanted. She is very interested and supportive and will try to spread the word to Packers fans.

Sept 29
I got an email from Haiti that we have only one functioning anesthesia machine. The large team coming from Puerto Rico is wondering if they should even come. I am sure we can solve this issue with a good biomedical technician. I have offered several times to bring the head of the biomedical technology department at our sister Adventist hospital in Puerto Rico to help us develop this area at HAH. Now will be a good time to bring him over to solve this “crisis.” It might be the start to developing our own program with their assistance. The young man, Wilfredo Perez, who heads their department is a good friend of ours. When we first moved to Puerto Rico more than 40 years ago, his family lived two houses down from us. His mother did medical transcription for me. He was about 3 years old. A few years later, I taught him to windsurf. He still practices it avidly today. When he decided to study biomedical technology, he came to Walla Walla, Washington where we were living to study. He spent many weekends at our home during the years he was studying there.

Sept 30
Last day of work in Appleton. We leave tomorrow morning to return to Port au Prince. I called Freddy Perez today and told him about our needs. He is very interested in knowing more about the types of anesthesia machines that we have at HAH. He will have to check with administration to see if they will give him the time off to come and check things out.

On the ground report from Dr. Dietrich

“Bonjour, Haitien!”

Aug 28
It has been two weeks since I made the hole in the roof over the small
balcony outside our room for the AC and it still hasn’t been hooked
up. At least a third of the nights are hot enough that it makes
sleeping somewhat difficult. Sometimes I will read for an hour or two
in the middle of the night until sleep finally becomes inevitable.
Most nights do eventually cool off a bit by 3 or 4 in the morning.
The green duplexes have finally been emptied of the occupants who have
no relationship with the hospital. They aren’t very large but are a
bit bigger than our current unfinished hospital room. They have a
very small bedroom and tiny kitchen area and bathroom. There is a
fair sized living room and another small room that could accommodate a
bunk bed and serve as a second small bedroom. They are in awful
condition. Besides some obvious earthquake damage, they are dingy and
dark. The doors and windows need to be replaced. The electrical and
plumbing is nonfunctional and there are no working sinks or commode.
AC will be needed and then a complete paint job done. Jeannie thinks
it could be made “charming.” Obviously a fair investment will be
needed. The four units could probably accommodate all of the long
term volunteers for a few months. That would then allow the
unfinished wing where we are all currently staying to be emptied and
finished. The lost revenue from the hospital not being able to use
them for patient care has been significant.

Our little balcony really needed some greenery. A banana plant from
down behind the peds clinic building was about the right size. It
needed to be dug up with roots and all but now is nicely decorating
one end of the balcony. There are at least two or three dozen more in
the area it came from. The balcony gets a lot of direct sun in the
morning. This will provide some nice natural shade. Randy gets to
harvest any bananas that grow over onto his side of the balcony.
Emmanuel had told me that Stephanie’s father had found a reasonably
priced lot about “twenty” minutes away. It took nearly an hour to get
there and then the traffic on the way back made the return a half hour
longer. It is in a nice place on a hill overlooking a small pretty
valley as well as a view of the sea iin the distance. A very nice
breeze was blowing. An American organization is building a fair sized
school about a block away. It is definitely much too far away from
the hospital for us to be interested.

There was a concert at Emmanuel’s church this evening that he had
invited us to attend. It was an interesting eclectic mixture of
music, poetry and choreographed movement.

There was another very heavy rain tonight. We were prepared and able
to fend off the water that wanted to come in from the balcony.
I dug up another banana plant and brought it up on our little balcony
to add some more greenery. It is about nine feet tall and I had to
lean it over so it wouldn’t rub against the ceiling. I’d really like
to get a couple of other plants including a hibiscus to add some
color.

Orthopedist, Mark Slovenkai, unable to make it today d/t Hurricane
Irene. He will arrive on Tuesday. Edith Newberry our anesthesia
provider for the week made it fine from Nashville.

Aug 29
My early morning run took 28’ 20” . That is 15 sec slower than my
fastest time so far.
Reasons/excuses
1. my calf is still bothering a bit.:)
2. It has rained heavily the last two days and the roads/trails are
slippery and there are big puddles to negotiate.
3. A big dump truck slid partway off the trail near the top and I had
to go in the mud to get around it.
4. I got a “Bonjou Haitien” from a man that I greeted with “bonjou”.
It caused me to lose focus. (it is the first time I have been called
a Haitian)
5. I still detest running uphill and refuse to do it(my SLOW jog is
hardly running).
6. I ate too many Hot Tamales last night while Jeannie and I were
watching an episode of “The Guardian.”
7. I ran by myself so had no one to spur me on.

Big Clinic(>50) for just ZJ and me. I also had 4 cases to do. They
all went fine but kept pulling me away from the clinic. I was on the
home stretch in the clinic at about 6:30 pm when I suddenly got
sweaty, dizzy and nauseated. I had to stop in the middle of a patient
evaluation and go upstairs and lay down. The symptoms lasted for
about 4 hours. 7 Up seemed to help settle my stomach. I hope it
isn’t a relapse of whatever organism invaded my system a few months
back. We’ll see what tomorrow holds.

Aug 30
Jeannie and I had to go to the US Embassy to get more pages for our
passports. We have been warned a couple of times now as we pass
through immigration that we have very little space left to stamp. We
got up and left the hospital shortly after 6 am. We dropped a person
off at the airport and then went to the Embassy for our 7:30
appointment. After two levels of security, we finally made it in
nearly 15 minutes late. It took them almost 2 hours to do the job.
Maybe that was really speedy. It just seems like it would only take a
few minutes to look over the applications that we had filled out and
then add the pages in. There must be many important details that have
to be looked at and thoroughly checked out. After waiting about a
half hour, I was called to a window and asked if the Social Security
number I had given on the form was my actual number. I checked the
number written on the form and I assured the person with the skeptical
look on her face that, yes, indeed, it was my correct number. Then
she read it out loud over the intercom so the 6 or 8 people including
the Haitian guard could hear it clearly and asked again if it was my
correct number. I found it odd that such a thing should happen and
wonder if perhaps someone there has some type of scam going to steal
identity. The traffic was very congested coming back but finally made
it around 10:30 to start our first surgical case of the day.

The cases all went well including the 83 y/o with the hip fracture.
We set up the fracture table again and it worked like a charm. Dr
Slovenkai and his 17 y/o daughter arrived part way through the case.

Our last case was the man with the lateral tibial plateau fracture. Mark helped me. I was very glad for his help. It was a difficult one. The lateral tibial articular surface had a coronal split. The anterior 2/3 had partially buttonholed through the anterolateral capsule and was just under the skin. The part of this fairly large fragment still in the joint had already started to heal to the underlying intact tibia. There was a second free fragment with the remainder of the lateral articular surface. The lateral meniscus had a complete radial tear out to the rim and the entire tibial spine was in many fragments with the ACL nothing but mush. The articular fragments went back together and held well with two threaded K-wires. A lateral buttress plate and screws held well sandwiching it to the intact medial side. Everything was solid and I could flex it to past 90 degrees. I put him in the CPM for immediate range of motion. I’m glad he was only 3 weeks post injury. It seems that so many of these types of injuries are delayed in coming here for a month or more. It makes it so much more challenging when the fragments have already healed and started to remodel.

A few days ago, I had asked Randy to see if he could find a newer pickup to replace the “taptap.” I have come to the conclusion that putting more money into the old one is just going to be throwing good money after bad. He found a Chinese pickup that has the same size box. It is a 2010 model and is 4WD and diesel. The make is JMC(GMC?) and there is a dealer here in Port au Prince. We had a mechanic check it thoroughly. It seems to be in excellent condition. The price the owner was asking seemed reasonable. We would really like the hospital to have a vehicle that can serve several purposes. Picking up groups at the airport, transportation for groups on outings, hauling items
for the hospital, and a vehicle for the orthopedic director to use at his discretion are all important uses. The front and back seats can carry 4 or 5 passengers and another 6 or 8 could ride in the back. Most importantly, the taptap cover that I made will fit. We finalized with the man selling it yesterday. It should be a fairly good vehicle for trips to the Dominican Republic from time to time.

There were no more of the odd symptoms today that laid me out yesterday for a bit.

Aug 31
The run this morning went well. There were still some obstacles including the dump truck which had been pulled back up onto the road but was clearly not working since it was just at an angle sitting there. It made progress slow to get around it without falling off the hillside. The road is just dirt at that spot and fairly muddy still. The bothersome calf has healed and wasn’t an impediment. Overall, it was my best time ever by 20 seconds. The uphill part definitely presents a major psychological effort but the flatter section at the top is ok and the downhill part is even kind of fun. Surely there are health benefits that make the negative parts of the run worth it.

The clinic wasn’t as big as the one on Monday and of course, Mark was here to do the cases in the OR. There were a couple of smaller cases and then the below knee amputation on the man with the large malignant melanoma. It was an option to do a much wider excision with margins. That would have involved removing about the lateral ¼ of his midfoot with some of the forefoot and the heel. Getting coverage of such a large defect would have been a big challenge. The patient and his family decided to have the amputation which I think was a good decision. Mark did a very nice job with both JJ and Jeanty assisting him. Edith said that he spent time teaching both of them and letting them suture as well. The clinic finished before 5 pm thanks to ZJ’s strong help. The C-arm still needs to be used for x-rays. It isn’t ideal but the clinic unit is still not functioning. Nathan continues to try to get the Fuji techs to try for an online fix. Patients do have the option of paying for their xrays in the radiology department. At least 20% have the money. Perhaps those patients should also be paying something for their surgical care.

Jeannie and I wanted to have more time with Mark and his daughter so we walked with Edith and
Irma to the Auberge where they are staying. We ate dinner together and Mark generously offered to pay for the meal. They wanted to know all about how the program started and of course, about Scott. It was a very good evening together. He seems very interested in continuing to periodically come and help with the work at HAH. Edith has been a great anesthesia provider. She comes from Nashville and knows several of the people who came and worked with Dr Lovejoy earlier this year. Mark was anxious to do plenty of cases and we put 7 on the schedule for him. Some are small but one is a bit of a challenge. She is a patient I put a TSF on about 2 months ago for a malunited tibia fracture that occurred in the earthquake. She hasn’t followed up well and has developed a significant plantar flexion contracture. Her correction is quite good and she only has a few days left on her strut
adjustments to finish the prescription. The plan is for Mark to do the final strut adjustments under anesthesia and then do a TAL and then put an Ilizaroff frame to hold the foot/ankle in neutral while
the tendon heals. I built the frame for him and it is being sterilized tonight. I wish I could be there for the case but tomorrow, Jeannie and I leave early to go to Ben and Sarah’s wedding in Southern California. They are a great couple and we think it is important for us to be there. Ben is an outstanding resident. He really made an impression on everyone during his time here in March.
Sarah is doing an OBGYN residency. She is a member of the LLU School of Medicine Class of 20010 that adopted Haiti Adventist Hospital. I think they would be a great team to work here at HAH. We fly back Sunday pm/Monday am on an overnight flight. I should be back for a good share of the clinic on Monday. The DeMuth team arrives on Sunday. ZJ and Lynne can get them started with rounds and then seeing patients in the clinic. I haven’t scheduled any patients for surgery for Monday. A patient or two may show up for cast changes or something may come in tomorrow to clinic or over the weekend that might need to be done on Monday. We have a fairly full schedule of surgical cases for the week and I am sure that more will come in during the week.