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Sunday, February 28, 2010

2/27/10 Team 6 is on the ground!

Team 6 arrived late in the evening on a 737, had a quick debrief with Team 5 and off to Mission of Hope!

Brad Parker, MD, orthopedic surgeon, Medical Park Orthopaedic Clinic
Dave Bryant, MD, anesthesiologist from Dallas
Jeff Benoit, OPA, Medical Park Orthopaedic Clinic
Kristen Damery, PT, Integrity Rehab
Heidi Walker, RN, Stonegate Surgery Center
Kim Walior, RN, Stonegate Surgery Center
Eric McNeil, RN from Denver, CO

We are also lucky to be joined by two teams this week, the Chapel group from Ft. Wayne, Indiana and Canadian nurses and paramedics!

2/26/10 - Team 5, Day 6

From Alicia Michalz, CST
I write this with a very heavy heart, as our time has come to an end. Today is the last day to see our helpers for the week and the clinic is now closed. I can't even begin to tell you how most of our lives have changed. Dr. Bryan gave us our last debrief. It was warm and gracious and so spiritual. Tears were shed as we all realized we had come into a routine and are not ready to leave. Dr. Guy, who is Haitian and from the Bridge Team also expressed his thanks for helping his native country.

We have seen patients come and go but yet all of them have touched us one way or another. Again, I cannot say how precious and kind these people are. I believe that somehow they will never forget us either. Each time I give something, hug someone or smile I hear the same warm words, "God Bless you," I will pray for you. I would have never thought that I would have so many people praying for me. How lucky am I?

I believe there was a reason for me to be here. God lead me here and I have this strong feeling he will lead me here again. I have this urgency to continue this cause and make sure my precious boys that have spent the whole week with me are doing well and thriving.

I sign off for now so I can enjoy the company of my team and the stories they are sharing from today.

1. 14 day old in the clinic
2. Dr Bryan giving us our last debrief. We are going to miss him.
3. Expired supplies but great helpers!
4. The supply helpers, sitting still for once listening to a wind up radio that plays the story of Jesus.

Friday, February 26, 2010

2/25/10 - Team 5, Day 4

Update from Alicia Michalz, CST:

It's the end of another long day. The Compound is somewhat quiet right now, many either getting ready for bed, or the night shift and the ward and Dr. Bryan, Pastor Dave, John PT and Chuck Paramedic just walked down the hill to transport a patient from recovery to the ward. They are transporting by foot which is often how it done here.

We have had some cute little babies come through the ER, not so much patients but their mamas. They were tiny little things and our nurses just loved on them. One of the mama's had the baby at 2 in the morning and had some complications. Paramedic Chuck and Heather transported them to MOH. Heather held the little one was just under 6 pounds.

My little buddy Job wanted me to pick him up, so I did and sang to him. He just laid his head on my chest and rubbed my arm. I just wanted to cry. He is so precious. All of my boys are. They are always helping and getting creative with all the little things that we find in the boxes we have been unloading. Sometimes they get a little crazy and I quickly get into mommy mode, they know that Madam Alicia's word is the law. They are always asking if they can have something and Elena always defer's them to Madam Alicia.

Wound Care has been hopping. Today they saw the first skin graft patients done this week and the wounds look great! There is a young guy named Gaby whose wounds on his legs have been active and festering for over eight years. He suffers from sickle cell anemia and is a frequent flyer to MOH. He is a special patient here and holds a little space in everyone's heart. Today he had skin grafts done to close his wounds and tolerated well! Very exciting news! Please include him in your prayers and hope that the grafts survive.

Let me tell you a little about the ward. They have goats and dogs that frequent the halls almost make their own rounds like our docs. The nurses have found being able to get close to the patient and their families is something special. The families are so much help and care so much about their family member. There are not too many patients in the states whose family empty their bed pans or bathe them. Not only that but they are so greatful for the nurses and constantly dote on them. Again, another example of the gifts we receive.

Dr. Bryan is wonderful and truly has been taking care of us. He makes notes daily and advocates us to the MOH on how our jobs can be more efficient. Towards the end of the working day it looked like it was going to rain. He radioed up to the compound to have someone close our tents so our stuff wounded ruin. How awesome is that?

Again, a great team, a great leader and another great day of work.

Picture 1: Clinic didn't want table paper but made for a great arts and crafts day.
Picture 2: A woman was dropped off at the clinic today lethargic and basically unresponsive. We learned that she had just delivered a baby a couple hours before and had been having seizures since the time of delivery. She was eclamptic. We were able to stabilize the woman and she finally woke up although very confused. In the midst of treating her, someone brought a tiny baby into the clinic, handed it to me and told me the baby was hers. I took him to the "ER" room and checked out the baby who was very healthy but weighed only 4 lbs. We ended up transferring mom and baby to General but we loved on the baby a little in the meantime. Here is a picture of Bryan, paramedic, and the brand new baby boy.

Thursday, February 25, 2010

2/24/10 - Team 5, Day 3

Update from Alicia Michalz, CST:

Today was HOT! Today was a busy for everyone. Seven cases today in the OR and plenty of woundcare too. There were 14 patients in the ward including a sweet 4 year old named Job. He has an allergy to the sun and has been very ill. He just came from the US Comfort. He lost one of his eyes to the condition. I was in the ward speaking to Amy and he walked by and swatted my backside and then ran off laughing! The supplies just keep coming and Elena and I thought we were going to lose it. But we regrouped and left with a smile. The orphans are great they are constantly finding supplies and playing with them. Today they made capes from U drapes and one had a special necklace he made. It was a foley catheter! They are so creative and easily pleased. A couple of docs and paramedics made it into town. Some bargins were made and patients secured for tomorrow at least 8 cases posted. So as you see we are still succeeding. Each day is a gift and we all haves been blessed in way or another .

Pictures provided by Rachel Feeler
Picture 1: This is Amy, RN with Rachele who has been here for a while. Amy and I taught her how to do pin care today and she was very excited to do it herself and make the pin sites clean. She did an excellent job and was transferred today to CAM down the road.

Wednesday, February 24, 2010

Sugar Cane Clinic

Post provided by Barbara Bergin, MD

I spent the summer between my first and second years of medical school in Mexico City, working with an ophthalmologist who did some volunteer work for the sugar plantations. We saw some incredible stuff. The tolerance for suffering in people of Third World countries is extraordinary. Loss of an eye is common in the sugar plantation work. I guess they get stuck in the eye with part of the plant and it punctures the eyeball. So then they would schedule an appointment to see the doctor much like you or I would schedule an appointment for a routine eye exam. There was no emergency visit to some big eye center in Mexico City. They had a 9:30AM appointment just after the guy who was there to get a pair of second hand glasses. Then they would get scheduled for an enucleation (eye ball removal), which would also get done whenever the doctor had an available time on his surgery schedule! Their eyeball would look like a little raisin sitting in the socket. And the patient wasn’t there, screaming like I would be, “WOULD-YOU-LOOK-AT-THIS-EYEBALL-AND-FIX-IT-NOW!” These plantation workers would walk around with the little raisin eyeballs as if it were an errant hair on their brow.
Their family members could also come to the clinic and many of them had amputations. Once you have an amputation in Mexico as in Haiti, you become a ward of the state (whatever that means in Third World countries). There were no prosthetics, unless you knew someone who could make you something out of wood or you could afford to buy a used or stolen one at some market. Most people had ancient crutches, like the ones you see in old Civil War photos. They look like wooden t-posts. They had huge callous formations on the web space between their thumb and index fingers and I could tell by looking at their hands, many had lost the function of their ulnar nerves from leaning on the crutches for years. Their pinkies were numb and contracted.

We rarely see this kind of thing in the United States. If you lose your leg, whether you have insurance or not, a whole system of doctors, nurses, social workers, prosthetists and physical therapists go into action to get you a prosthetic leg that fits AND functions. And if it doesn’t fit and function, then you have an opportunity to go on disability! It’s amazing and because of this system you see people who can run and compete in sports with a prosthetic limb! The people in Haiti won’t have access to this kind of process. They don’t even know it exists. A young man or woman or a child with wooden t-post crutches could easily become the “poster child” for Haiti rather than a healthy, hard-working Haitian with a functioning prosthetic limb. I’m not sure I know the answer for this. Knowledge and understanding the problem comes first. No, getting the Haitians past their rainy season comes first. Then a whole ship load of crutches…

Barbara Bergin, MD
Texas Orthopedics

2/23/10 - Team 5, Day 2

Update from Dr Lee:

11 surgical cases today: wrist fx, manipulated ex fixs, and mulitple skin grafts
6 cases planned for tomorrow
4 cases on Thursday and 1 on Friday as of now
Waiting on cases to mature from Mennonite clinic
ER and FP docs are working hard
14 ward pts. Difficult to staff at night with busy days
Supply organization staff sent with this team (Alicia and Elena) are a huge help
Univ of Miami and General Hospital in downtown PAP have both sent cases to them. Unsure of how busy they are.

Update from Alicia Michalz, CST:

The day as usual started early with a yummy breakfast of pancakes and papaya and yet another conversation of an earthquake at 1:30 a.m. The OR was full of cases today both Ortho and Plastic. I found out yesterday there were 300 patients seen in the clinic I am curious for the total seen today.

The wishes for supplies are starting to come in. Spinal Kits and a propofol pump for anesthesia. OR wishes for sterile OR towels, mini c-arm drapes and guide wires for IM rodding/Post op would like extension cords and surge protectors. PreLancets for sugar checks and D50 amps, linens and pillows for the ward. Funny how more simple, yet useful the requests.Dr. Dirk hooked us up with a couple of guide wires and are scheduled to be delivered to Texas Orthopedics. The Supply people (me) would love shelves, stackable bins and at least 2 people just assigned to supply next team. It is impossible to have anyone help, they are truly stretched.

Again, the people are so sweet and gracious. I actually had someone help me all day, totally under the assumption he was an employee. He also helped the ward nurses create pillows for patients out of tubigrip. Only to find out he is the husband of a patient in the ward who is status post BKA. He is a professor of mathmatics and speaks four languages. He asked me if I believe in Jesus and I replied "of course he is the one who sent me here." Shele is his name, and he prays everyday and gives thanks because he believes Jesus is capable of the impossible and is our Saviour. I have to agree. He was a pleasure to work with today. One of my 'little" helpers Roberto, was a little pistol. He would sneak pictures with my camera and put on tons of bandaids and hang on me like a monkey.

Elena and I walked down to the orphanage and gave out balloons. The kids came out of the woodwork. It was a joy!

Now that Elena and I have seen many supplies it is getting easier to meet immediate needs for the compound. It's either here or it's not but at least we know either way. I hope I continue to find little treats like saline flushes to put a smile on our great team. Everyone is finding their nitch. Dr. Lee is awesome! He is realistic, meticulous and helpful. He wears all shoes and this morning he helped Ms. Mona with the dishes. He debriefs us every night.

The end of the work day ended with Elena and I locking up our supplies, then sitting on the stairs of the ward watching the sun set and listened to service from a far. The praising was beautiful and there are no words to explain the song, just joyful.

Dinner was again a hit, red beans and rice and kabosh (sausage, cabbage and carrots with spices). The conversation quiet, as we discussed the day and all the special moments we had each encountereed, whether it be the orphans or patients or staff.

Picture 1: Two ward nurses (Melody/center, Laura/ right) and Shele.
Picture 2: Paramedics transferring a patient to the OR

Tuesday, February 23, 2010

2/22/10 - Team 5, Day 1

Update from Alicia Michalz, CST:

The team's travel was long, picking up members along the way. Finally all 18 of us boarded the last plane headed for PAP. We took a quick stop into The Bahamas to refuel and came across tanned rested people, clearly not on their way back from Haiti.

The arrival was a bit hairy, actually dark is more accurate. Somehow the power was out at the private terminal we arrived and we were left with our luggage and some security guards. One phone call to Bob King and we were on our way to MOH. Mark found us and Ruben was our host for the night.

The streets were streaked with street vendors, colored homes and plenty of crowds visiting amongst each other. We watched colored trucks and vans weave in and out of traffic with people seated in the back, some were standing and hanging on for dear life. The very art decored vehicles are called "tap tap" (cuz you tap the top of the roof when you want to get off) which is a taxi to us.

Upon arrival to MOH, Vanessa Johnson greeted us and showed us to our quarters. She is "Mrs. President" of MOH. Soon after we settled to a much needed meal. Spaghetti and salad and french bread. It was great! Dr. Cheryl showed up shortly after and started debriefing the teams.

She gave us history on MOH, the day of the quake until present. I still am speechless at how everything happened and the devistation of this poor country. I helped Dr. Cheryl in the debrief getting questions answered for the team and then she kissed me on the cheek because I am here to solve her supply maddness. We walked down to the clinic and ward for a tour. I think we were all anxious to see were we will be working for the week. It was just short of midnight when we made the long treck uphill back to our quarters.

Elena and I opted to sleep in a tent outside, it was much cooler outside. We were awaken by a rumble in the ground. It was morning that we realized the a 4.7 hit us. We also had another little shift in the afternoon. Most of us were up at 600am and the consensus was we didn't get much rest.

We started at the clinic taking a look at supplies. Patients and their families were starting to arrive to wait in line for treatment. Dr. Jennifer came out and greeted everyone with a prayer and hymn. It was just beautiful, again another speechless moment. A gentleman who was weak and staggering showed up. I couldn't help but leave supplies to help him down and get him on a stretcher. Sometimes I am so torn with cleaning and wanting to be with the patients. They all have such a gentle demenour and greet each one of us as they walk by. The perfect patient.

Supply madness is an understatement, there are rooms upon rooms of stuff, for lack of a better term. Somehow after 10 hours of work we managed to clean, sort and organize one room. The surgical supplies, for me a important one. Dave a pastor from Indiana helped put some shelves together with Cevere, my assistant. He went up to the quarters for lunch and "brought" Elena and I some lunch. Really it was for our sweet little helpers, Samual, Schneider and Richardson, Blez and Linder. They worked very hard taking "pupel" (spelled wrong but is trash in creole) out for us. We took a quick break and enjoyed our time with them. Cevere is determined to make us Texans fluent in creole, we have him laughing at us all the time.

Aside from our day we heard constant walkie talkie conversations with STAT calls and request for Docs to the Ward or Clinic and it is with great saddness that I say we lost someone today in the ward. Vanessa said it well at dinner when she explained to her daughter that the lady in the ward went to be with Jesus. I am confident she is there.

Our night shift nurses told us when the 4.7 hit the ward up and evacuated themselves in a moments notice, for fear of the same devestation that now is 6 weeks out. Even Ruben showed up in a wrist brace because he fell running out of his home. No one feels safe hear, except of us Americans who have no idea what these people have been through.

Five cases in and almost 200 clinic patients the day has started to come to an end. There are 5 cases posted for tomorrow and 3 preops are in our ward now, ready for tomorrow. Some Orthos and many STSG for Plastics.

Dinner was served around 6pm with seasoned potatoes, corn, jello and chicken. Everyone is exchanging stories and discussing plans for tomorrow.

I think the most exciting for me was our C-arm finally arriving and working. A successful tibial retrograde nail ( glad Dr. Dirk agreed to do) and my one measly room done with a gift of new friends I did not expect to make.

5 cases today:
2 split thickness skin grafts
Closed Reduction under spinal with wound closure
Debridment with wound vac
Retro Tibal Nail

Went to Mennonite Clinc and picked up 8 pts, General sent 3 prep-op pts (wrist fracture, plastics face, "foot something"), Miami scouting for pts for MOH

Picture 1: Helpers in organzing supplies

Monday, February 22, 2010

The Need for Prosthetics in Haiti

Post provided by Marc DeHart, MD

Seems like the acute care mission of the big injuries is slowing down, and it'll be good to hear Dr. Smoot's thoughts as he returns from his week of caring for the Haitians. A big part of the surgical care so far has been amputating limbs that couldn't heal or had infections that were threatening life. Like in war time, earthquakes take a major toll on vulnerable exposed parts like hands, arms, feet and legs. While the UN estimates over 250,000 Haitians have been injured, the best estimates of Handicap International include over 2000 amputations. Of course since the medical facilities have been wiped out, there is no infrastructure for prosthetics. Even with modern prosthetic legs in developed countries, the energy needed to walk increases. In a country where poor nutrition is common, any increase in energy needs compounds an already severe problem. As you might expect, the higher the amputation - the more energy that is required: near the heel ~ 15% more, below the knee (BKA or trans-tibial) ~ 25% more, and at the thigh level (above the knee, AKA, or trans-femoral) ~ 50% more energy required. It is interesting that walking with crutches takes more energy than a below the knee prosthesis.

Prosthetic legs can sometimes last less than two or three years, often require adjustments for fit and function, and require even more changes for children. A prosthetic leg in the US can cost over $2000-3,000, and expense that just won't work with the economics for the Haiti population. Low cost techniques that are relatively easy to implement will be required to give as many limbs to allow a return to survival. Several designs for "3rd world" prosthetics have been developed with costs below $100 (see The residual limbs ("stumps") usually require 4 - 6 months to heal up and form a strong enough scar to allow final fitting of a new prosthetic limb. Using resources available in Haiti and teaching survivors of the earthquake how to build, fit, and modify prosthetic limbs will be a major need in the next 6 - 12 months.

With the significant changes that are going to have to happen after the earthquake, it may very well be that a hard working Haitian - with a prosthetic leg - will serve as a potent symbol of their rebuilding island nation.

Marc DeHart, MD
Texas Orthopedics

Team 5 on the ground

Team 5:

Dirk Steven Gesink, MD- orthopedic surgery, Phoenix, AZ
Bob Shively, MD- orthopedic surgery, retired
Ed Styslinger, MD- anesthesia, Star Anesthesia, San Antonio
Jeff Henderson, MD- emergency medicine, Dell Childrens
Jessica McGraw, RN- Seton Northwest Hospital
Alicia Michalz, CST- Texas Orthopedics
Elena Perales, orthotech- Texas Orthopedics
John Wesley Thomas, PT- Seton Northwest Hospital
Kristin Joy Allen, PT- Dell Childrens
Doug Mather, RN- Stonegate Surgery Center
Amy Arredondo, RN- Scott & White
Casey Rosenbaum, RN- Brackenridge ICU
Jane Haycraft, RN- Stonegate
Heather Hyslop West, EMT- I10 FD
Chuck Garrison, EMT- Leander FD
Laura Milburn, RN- Brackenridge Trauma
Melody Volz, RN- Brackenridge Trauma
Rachel Feeler, RN- Brackenridge Trauma
Bryan Lai, EMT/CNA- Brackenridge Trauma

2/19/10 - Team 4, Day 6

Update from Diana McKeon:

I wasn't there to witness, but right before dinner last night we had a trauma- mom and baby were hit from behind by a vehicle while walking down the road. Baby was thrown and only suffered a leg fracture (diagnosed without xray and casted by feel) . Mom suffered severe degloving and fracture to left foot, ankle elbow and left scalp/ ear. Dr. Sandy, Dr. Brannon, Dr Cheryl and Dr. Lee worked on the patients in the clinic, then Dr. Lee helped transport the mom via ambulance to University of Miami Hospital in Port au Prince. What a last night!

Update from Josh Livingston, MD on Days 4-6:

Wednesday some of the team traveled to Port au Prince to visit General Hospital, among other places, in search of equipment and patients. By the time we arrived only one ortho patient was in the triage area - an 82 year old lady who had injured her foot in the earthquake and likely fractured bones. At the time, they dressed the wound and told her to come back later. Despite the family’s denial, she was demented and had ripped off the bandages at home. Her wound, which was grossly infected, had been swarmed with flies who had laid eggs. By the time we saw her at General, there were giant maggots eating the dead tissue of her wound and the smell was almost unbearable. She was in a triage tent and that stench filled it. There had been other ortho patients there that day, but they had been sent away to come back later.

We agreed to take the 82 year-old whenever transport could be arranged and told them that there would be an Orthopedic surgeon at Mission of Hope through the following week. Dr. Cheryl did her best to secure an anesthesia machine, but no dice. As we were leaving an English speaking Haitian asked me if I was a doctor and could look at a lady waiting outside the tent. She had a large scarf wrapped around her lower face. When she took it off, it was hard not to show my astonishment. She had a bowling ball sized mass growing off her jaw, predominantly to the left. She had been eating around this thing, which had been growing for at least five years. Another chronic medical issue that predated the earthquake. I got her information, took a picture (which I promised to share with only medical personnel), and took a picture of her x-ray, but nothing we could do about it.

We next made contact with Major Schillaci of the Army about transporting patients. He told us he would do what he could to help in that respect. No promises, but he would do what he could.

We were hoping to make our way to University of Miami that day, but a late start and other errands on the trip made that impossible. We agreed that we didn’t care to be out in Port Au Prince after dark, despite having armed security.

We stopped by Pain Plus for dinner on the outskirts of PAP. Despite the funny name (pain is Creole for bread), they offered some Americana and everyone opted for pizza. Pizza was pretty good at this point.

Sadly, Thursday was a dud surgically. Our 82 year old did not arrive until the evening. The ambulance crew had to end up fetching her, which led to a very thorough cleaning of the ambulance. I went to work organizing the anesthesia area of the OR and then the second floor of the ward/school, which was to be the medical supply storage area. That ended up being a much harder job than being in the air conditioned OR. Apparently my little bit of type A personality came out, because along with some Haitian muscle, we got a lot done. Jared assisted, Kathleen helped in clinic and organized the OR, Dr. Brannon saw ortho patients in clinic, Diana had a very busy day of wound care, and Dr. Sandy & Dr. Lee busted booty in clinic (like they did every day).

Friday the OR got some work done, first doing a below knee amputation on the 82 year-old. Dr. Brannon and Jared had the foresight to clean her leg wounds thoroughly and blast out the maggots before bringing her to the OR. Despite our efforts the smell still endured. I had a difficult time getting a spinal thanks to her auto-fused spine and lack of cooperation with positioning. Was finally able to get an epidural and ran with it. The case proceeded well.

Next up we had two surgeries on one patient. Fritz had a both bone forearm fracture that was now a month old, and a pilon fracture (just above the ankle). My job looked was easier than that of the surgical team. Dr. Brannon had to basically put the bone ends together at a 90 degree angle and use brute orthopod strength to lever his arm straight. He did an excellent job, got everything as anatomical as humanly possible. Next was the ankle fracture, which is right up his alley. Made that look easy.

The ER docs had their hands full with typhoid out the wazoo, sick patients everywhere. Diana had a particularly busy day. Three of her patients that stood out in my mind. First was the kid in his late teens with nasty, chronic wounds on the medial aspects of both calves. He had sickle cell disease, and later found out he was super profoundly anemic. These sores were a result of these problems and would not heal. This is a very tough problem in the US, much less here. Second was a young, beautiful Haitian woman that had a below knee amputation. She had apparently been Haiti’s preeminent ballerina. Not sure what she’ll do now. Third was a girl from the Mennonite mission that had been our first operation on Sunday, Jean. She was doing great, but had been the patient we all bonded with the most. It was good to see her and see the Mennonite women loving on her. That is a very important part of the recovery for them.

Friday night we were treated to hot dogs and mac & cheese. It was good. Better than I would have thought a week ago. Saturday morning Sandy and Diana went down to the orphanage. Dr. Brannon and team went for the final rounds on our patients. Everyone was doing well. We started to get nostalgic, there was a lot of bonding in this short week. I was a total outsider to this group initially, and I am going to miss everyone. Hope to get a chance to get back together at some point.

Flights home were pretty uneventful. After a week in Haiti the little annoyances are nothing and the good things you used to take for granted are really good. I like to think that while I was doing some good for Haiti it did a lot of good for me. Lord knows a week away from my family was rough, the longest I’ve ever been away from them. But an awesome experience. God bless the people of Haiti and the missionaries who make it their life’s work to help them.

Pictures provided by Josh Livingston, MD

Picture 1: Both bone forearm fracture x-ray
Picture 2: Diana with a patient in the ward
Picture 3: Dr. Smoot at General Hospital
Picture 4: Jean (patient) with Mennonite woman

Friday, February 19, 2010

2/18/10 - Team 4, Day 5

Update from Diana McKeon:

Saw little twin babies today- malnourished, poor little things are HIV positive. Don't know what their future will be. Saw another baby 8 months old with scabies and sores all over her feet ...and legs. So much more that I've seen. Not enough time/energy to even write it all down...

Picture 1: 5 story building
Picture 2: Dr. Smoot seeing a little boy with a crushed foot
Picture 3: This is a bottle I fashioned out of a water bottle and pacifier. I found a big bag of pacifiers. We had to cut it and tape it to fix.

Thursday, February 18, 2010

2/17/10 - Team 4, Day 4

Update from Diana McKeon:

Dr. Sandy's morning started with a bang. Right as clinic was starting, she was called to the ER room for a very sick 32 year old man. He presented with three weeks of fever, vomiting, diarrhea, altered mentation and ashen in color. He was in shock and probably sick with an extreme case of typhoid. Luckily, we had found oxygen tanks yesterday as his oxygen saturation was half of normal, 48%! His heartrate was twice the normal level at 152. With a team effort, they started two IVs that were open wide, started an antibiotic for presumed typhus, and placed him on the maximum oxygen level available. His heart rate did improve some and his oxygen level increased to 86%. With the assistance of Dr. Jennifer and Grant, MoH staff, they urgently transported the patient to general hospital. His tests later confirmed Typhoid Fever. We await word from General Hospital on his condition. Apparently, this is a common tropical illness in Haiti. It is unfortunate that the locals here don't realize that the Mission of Hope is giving free medical care after this earthquake disaster. The Haitians don't seek care sooner because they are afraid of the cost. This is such a great example of how supporting the Mission of Hope can provide aid to so many Haitians in so many ways. Food, tents, sleeping bags, medical care, dressings and supplies for people to take care of smaller wounds, infant formula. Not to mention what is provided through the orphanage and the school.The ministry through the church has tripled since the disaster. Before the earthquake, if service was scheduled for 9:30, the locals would show up around ten or ten thirty. Now, about fifteen hundred people start showing up around 6:30 am to go to service. The church is standing room only for every service. It is so wonderful that MoH can provide this. The Haitians are desperate to know that they are safe in the arms of God.

Picture 1 :Our entrance to the clinic. The guard on the left and Wilfred, one of the many interpreters, on the right. The bed in the background is where I see most of my patients.

Wednesday, February 17, 2010

2/16/10 - Team 4, Day 3

Update from Diana McKeon:

Late last night we found out that today was going to be another national holiday- carnival aka mardi gras. That meant clinic was closed, Haitian workers off duty, surgeries were still on for our ward patients and warehouses could be sorted. Dr. Brannon, Dr. Greg and Dr. Lee had gone down to talk with a young man about the need for a below knee amputation. His leg had been badly crushed in September and he had been getting around on crutches with with an open leg wound. He had had a procedure to try to heal his wound by a local orthopedist before, but it didn't work. He didn't want the amputation- he kept saying "I want to walk". After being told by the orthopedic surgeon that he would not have a functioning leg and he had no bone left to attach the foot, he realized that the only way he could walk again would be with amputation and a prosthetic later. After surgery he woke up crying in anguish with the realization that this was the way it was to be. Later, on at the ward, with his mother at his side, he was calmed. Dr. Brannon told the family he had high hopes that the mission if hope would be able to arrange for a prosthetic limb. They were left with many questions, but we are hopeful that the mission will be able to support him and countless other like him.

Since clinic was closed today, we had the opportunity to search through the warehouse and the upstairs of the school where Mission Of Hope had stored supply shipments. The mission is part of a group called Haiti One. This is a group of missions that collaborate to provide haitains with emergency relief now and in the future. One of our big tasks was to sort through a large shipment of supplies and separate items into 3 different palates. Two missions came in the afternoon to pick up truckfuls of boxes. After that we headed to the second floor of the ward. The ward is actually the mission's school. The first floor is our ward- our inpatients that need closer monitoring. The second floor had four rooms filled with shipments of supplies. We were tasked with organizing everything into rooms labelled surgery, er clinic, wound care, medicines, IVs, and "out"- things to be sent to other missions. Everyone worked relentlessly, getting filthy, dusty and hungry. We managed to get a good basic organization and found some needed supplies. I searched for more KCI VAC units in vain. We have four, but one is not working. I plan to bring it back to Texas for repair and hope to get it back to Haiti. Dinner looked ominous- a ginormous pot of spinach mixed with meat, beans, carrots and I think I saw a red pepper. But looks were deceiving, it was fabulous! A little rice mixed in and some animal crackers for dessert and we were happy campers! After dinner, we pow-wowed on the porch for about tomorrows game plan: off to the Menonite Mission for VAC and other dressing changes, then some of the TX team will be going to Haiti General Hospital and University of Miami (set up in tents at the airport) to see about more ortho surgery cases. I'm off to the showers. Thanks to Dr. Lee, we have much better shower flow.

Pictures: (courtesy of Diana McKeon)

Picture 1: This is in the second floor of the school. All these barrels are filled with supplies. Dr. Sandy has amazing organizing skills! We were some busy workers.
Picture 2: Lunch
Picture 3: Making rounds
Picture 4: School House now the ward

Tuesday, February 16, 2010

2/15/10- Team 4, Day 2

Update from Josh Livingston, M.D., Star Anesthesia

Today we woke up ready to hit things full force. OR team has proven itself resourceful. Anesthesia delays. Got four OR ortho cases done, plus a impromptu pediatric urology case by Dr. Schmidt (cardiothoracic) from Indiana. The OR team is trying to get as much done as we can, so that we may get time to organize, inventory, and assess needs. So much of what the OR team is doing now is old fractures, wound infections, issues that predate the earthquake or are unrelated (if possible) to the earthquake. ER/clinic crew definitely the hardest workers. Doing amazing things with the resources they have. Lots of common sense medicine. Laboratory is minimal in the strictest sense of the word.

The staff at Mission of Hope are Americans and Canadians. They were here before the quake. They will be here long afterward. The resources they have they share with other missions and hospitals. They reciprocate. Mennonites, University of Miami, General Hospital, Haitian Community Hospital, etc... They give more that they get in these relationships. Cheryl is queen of this and this is the topic of discussion tonight. What do we have, what do we need, what can we share. We have supplies that we haven't gotten a chance to go through. Tomorrow is Mardi Gras (Carnival here), so another national holiday. If things are slow, we are going to better assess what we have. What we don't need is given away.

This place that was a school, mission, clinic, orphanage, and more is now like a third world hospital. And soon school will resume. The school is our ward. The two certainly can't coexist. Life has to go on. These things are yet to be fully worked out.

Picture: Dolbrice- open wound to bone on shin. Using silver foam.

Monday, February 15, 2010

2/14/10 - Team 4, Day 1

Update from Diana McKeon, PT wound care on Team 4:

So the devastation in Haiti is great, but the people have such spirit. Today was the last of three days of a national holiday for prayer. No one worked since Thursday. As we Drove through PaP just after noon, churches were letting out and the streets were filled with people in their finest clothes. Nice dressy clothes and I couldn't believe in all of this dirt and destruction how white the shirts, pants, skirts were. They tell me that's part of the color of mourning in Haiti. The tents are everywhere along every street. Just outside of town on the way to the mission, we passed a lathe field of dirt at the foot of the mountains. The missionary president, Brad, tells us this is the mass burial site of 170,000 after the earthquake.The mission is nice- not much more rustic than some of the girl scout cabins I have camped in. The food is basic, but man did it hit the spot today! I had chicken salad in a wheat tortilla for lunch and some kind of chicken meatball with beans and rice tonight.I saw two patients this afternoon from a local menonite mission with vacs. Dr. Brannon took a patient to OR for a wound cleanout on her foot. She is about 20 and her foot was crushed under a car tire during the earthquake. Didn't look like such a bad wound, but all the long bones in her foot are broken. The girl couldn't bear to have the forefoot amputated, so we will try to heal her wound and let the bones heal as best they can. Sad. We went back down to the clinic to get organized after dinner only to have an emergency show up at our gate- a guy crashed on his motorbike and was all banged up and lost some teeth. I got to help the soca clean up the wounds and we sent him down to our ward to stay overnight. I'm clean in bed now after a cold drizzle of a shower, but it felt fabulous. It's 11:13 pm and I have a 6:30 am alarm set.

Update from Dr. Smoot:

Day 1 started with lost bags that were later found. As we traveled through PAP to MOH, we passed rubble, trash, and lines of people celebrating national day of prayer. It's warm and dusty. Patients in the ward are calm despite circumstances. Many patients with neglected fractures and infected wounds. The team is working well together.

Picture: Pt on the freedom vac. She is at the menonite mission close by. She has a stage 3-4 on buttocks. Granulating well. Her name is Lovely. She was trapped under the rubble of the buildings for five days. Her mother was the first person who she saw on her rescue. Dr. Bob wrote about it on the TxOrtho blog. Her name is very fitting. She never complains and smiles when you change her VAC. One tough cookie, and just one example of the resiliency of the people of Haiti.

2/13/10 - Team 3, Day 8

Our last day in Haiti upon us, I was up before sunrise. Several other volunteers were up, Bible reading, preparing for the day. I walked out of the guesthouse compound past the parked ambulance and clothes washing basins and drying lines, to a small clearing. I had stood here before. Looking southeast, the pre-dawn sky opened up wide over the lights and glimmering harbor of Port au Prince. The city itself wraps itself further east then around the bay, and north up towards the foothills. The sun broke over the horizon spilling orange onto this vista and our camp, illuminating the beauty of this place. I sat and prayed to God, in thanks for this moment, for this week, for our team and the others, and for Haiti. Lord, hear our prayers.
We savored breakfast, for each of us French toast with peanut butter and cut mango. Coffee. Our bus ride to PAP airport was to leave at 1:00, and we all had projects to complete this day, in preparation for Team 4’s arrival Sunday. We also had ward rounds and final chart documentation, list making, to assist the incoming team. The second day of continuous prayer and worship for those lost in the earthquake continued, and we all wandered over to the worship center as we could. If the Haitian parishioners were fatigued from the 8 hours of worship the day before, they didn’t show it. But I sensed more desperation in the kids and people I met today, several children, young teens, coming up to me as I entered the outer reaches of the packed pavilion asking for money, to be sponsored. One twenty-something polite young man with broken but effective English walked up with his toddler son and wife, and handed me his name written on notebook paper, asked if I would be his friend for life. I took the paper, hugged him and walked with him towards the church. A 10 year old boy in a bright green shirt, dusty Sunday best, came up, took my Sharpie marker out of my surgical scrub top chest pocket, asked me to extend my hand, and wrote his name “CLEO” on my palm. He asked me to please call him, he needed $100 for tuition for school. As he walked away, I prayed that he does get to school, that he reaches his dreams and that he becomes one in a new generation of Haitians that will re-build their country.

As I stood clapping and swaying to the Haitian hymns there for the last time, I noticed a ward patient laying on a mattress in a side aisle, her IV bag draped over a pew back, not dripping. As I inched up to check on her, a same-aged young girl led me up to show me her IV was backed up. Walking back to the ward to get some saline flush, the nurses told me she insisted on going to worship, as did many of the other patients on the ward this day. Back in the aisle, her line flushed clear easily, and her normal saline drip resumed. I stood, turned and walked out of the pavilion starting the half mile trek back to the clinic, knowing that I have been moved by my week here, moved closer to God, closer to my roots as a physician, closer to understanding my place in this life with my own family and friends.

Our flight did leave PAP airport, we did land safely in the Bahamas for refueling, and we did land safely in Fort Lauderdale, the brightly lit coastline a very welcome site to all 9 of us sitting in our small, Metro 3 prop plane, not least of all Dr. Adrian, who sat in the co-pilot seat and had his eye on the fuel gauge registering below empty the last fifty miles of the flight. As the next weeks and months slip by, I will try to get my brain around all I’ve seen and learned, there are still many stories to tell about the week we spent here.

God bless.
Robert Wills, M.D.
Austin Pain Associates

Sunday, February 14, 2010

2/12/10 - Team 3, Day 7

Friday, Day 7, Team 3
Dr. Oscar and I slept late until about 8 AM this morning, tents hot from the sun by that time. The rest of the team opened up clinic and pre-op. Tyler also slept in, Dr. Bill attending his IV, one of three of our team members who have gotten ill. We are not exempt from statistics. It has not been unusual to see a couple of IV bags hanging on the iron posts holding up the corrugated tin roof of the guesthouse patio from time to time, pumping fluids and anti-emetics to various volunteers here.

The patients scheduled for procedures today included a woman from CAM needing wound debridement, a distal radius fracture needing open reduction and plating, a central line for IV access in a patient with an infected BKA wound and no peripheral access, and ultrasound exam of a possible scrotal abscess. Our medical patients on the ward include a gentleman with probable rabies encephalitis, several admitted with dehydration and fever, a 16 year old girl with altered mental status, weak and dehydrated.

Our debridement patient did very well, the sisters and staff from the Mennonite Mission picking her up afterwards, placing her on a mattress in the back of their open bed truck, with still about 30 minutes of pain relief on board from her spinal to help with the bumpy ride back to CAM. Dr. Oscar placed a right internal jugular line with an 18 gauge angiocath on our BKA patient, and the US revealed orchitis rather than an abscess in our young male patient, he should do well with IV and then PO antibiotics and pain medicine. We postponed our radius fracture patient for Dr. Smoot’s team, arriving on Sunday, for lack of enough 14 mm fully threaded cortical screws. We have them now; Dr. Laura personally obtained them from the ortho supply tent at General Hospital later in the day.

Dr. Laura’s trip to General and Miami hospital in PAP was quite successful. She went down with Tim, Bob and David from HCBC. They arrived at MOH the day before, bringing with them a surge of energy and planning, both short and long term. Bob was here the first two weeks right after the earthquake, with Team 1, and knows how to get things done in Haiti. Dr. Laura got orthopedic surgical supplies from the ortho tent at Miami, ultimately getting a young US Army soldier to pop open the lock, when no one could find the keys. She also borrowed equipment form General hospital, for our cases. These hospitals in PAP are eager to share and send patients to MOH for surgeries, our surgical infection rate remains at 0%, due to the unique nature of our set up: small completely enclosed room with single air conditioner, strict aseptic technique with use of autoclave. The larger hospital facilities in PAP have had major post op infection problems, they are using chemical sterilization for lack of an autoclave and have open air surgical pods, leading to contamination of surgical wounds. Bob brought back four additional patients from these places, to MOH, who need surgical procedures best performed in our sterile setting.

New equipment and patients to care for were not the only blessings from Dr. Laura’s trip. The team stopped to visit our paralyzed GSW patient, recovering at General Hospital. Vanessa from MOH had befriended this young man, and right there along with the pastoral team from HCBC, he accepted Christ as his savior, squeezed in tight on the ward row among the suffering, the recovering, the chaos that is now the medical care delivery system in Haiti. God is great.

Back at MOH, we are celebrating the first of three days of prayer recognizing the month passed since the initial quake. Services across the country are to go from 6 AM to noon, then 5 PM until 8. The worship pavilion at the MOH was at full tilt. As I walked down the gravel path from the ward towards the loud, rhythmic, musical din I noticed the pavilion packed well beyond its open metal grated roof support column capacity. Families, kids, teens were strewn across the yard on blankets, cardboard flats, some standing arms outstretched to heaven, many moving, dancing, singing. I wiggled in to my usual section in the back, and squatted on the warm concrete with them, immediately surrounded by these people we have all grown to love, respect. It was already close to 9 AM, having finished helping with ward rounds, and these people had been worshiping the Lord for 3 hours now. They came and went down all the aisles, sharing space and water containers. To my left a young teen looking after a group of youngsters opened a plastic wrapping of Twizzler pieces. Each long strand had been cut into about 1 inch pieces, and as she passed them out to the kids with her, each turned and passed some on, reaching across blankets and pews, spaces and groupings, as a quick bright red wave of color spread around me like paint splatter. Then the red was gone, another ounce of strength for each, another demonstration of the love and communal strength of these people, their tactics for survival in the face of so little.

The evening was more relaxed tonight, Dr. Cheryl and Lawrence sat with us and talked about their long term hope to establish a full time, full service hospital complex at the mission. The school year is approaching, and we need to move the patients from the schoolhouse ward, into a different space. All of this provides challenge and opportunity. We took pictures and said goodbyes to the many medical volunteers we worked shoulder to shoulder with this week, we leave for the PAP airport around noon tomorrow, to begin our travel home.
God bless.

Robert Wills, M.D.
Austin Pain Associates

(At the time of this posting, Dr. Wills and Team 3 have returned to Texas)

Team 4 is on their way!

Team 4:

Brannan Smoot, MD - orthopedic surgery, Texas Orthopedics
Kathleen Datorre, RN-Texas Orthopedics
Josh Livingston, MD - anesthesia, Star Anesthesia, San Antonio
Jared Bush, PA-Texas Orthopedics
Sandy Garcia, MD-pedi ER, Dell Childrens
Diana McKeon, PT-Seton Northwest
Lee Chilton, MD-ER, Heart Hospital
(and pilot)
(Photo courtesy of Diana McKeon)

Saturday, February 13, 2010

Haiti Medicine

Post provided by Scott Smith, M.D.

It goes without saying that things are different in Haiti. Things were different in Haiti before 1/12/10. Things are definitely different now. This includes health care. It is quite ironic that in the USA we are debating health care reform (>$1.0 trillion expenditure debate) when in Haiti they'd take any healthcare. That's a future post. The performance of medicine in Haiti has many different hurdles to clear.

In my five days in Haiti I saw the problems as:

Access: Access to patients, or in other words, the ability of patients to get to providers. In America dial 911 and in less than 10 minutes trained professionals will come and take you to other trained professionals to be evaluated and treated. In Haiti, we had people present to our clinic two weeks after the quake with bones still sticking out of their legs. TWO WEEKS!!! Yes that compromised their outcomes.

Disposition: Where people go home to. In the US, we'd go home to our comfortable, clean, air conditioned house. In Haiti, the reason most people have fractures is that their house fell on them. Therefore they have no homes. They go "home" to a tarp tied to a tree. They lay on thin mats or blankets on the ground. If they have an open wound (which they all do) dirt, bugs, and other "bad" things have access to it. Less than ideal for healing.

Supplies/ Tools: In the US we have essentially an unlimited amount of tools, bandages, medicine and implants with which to treat injuries. In Haiti, what you have is what you carried there. We did not have xrays. This sometimes forces the healthcare providers to think outside the box for treatment options. This is improving as more trips are made to Haiti.

Quantity of injuries: The number of injuries is just immense. I never got a complete grip of the scale of injuries. I don't think anyone has yet or ever will. I'm not sure other than wartime if there has ever been anything like this. The injured people just keep coming. The type of injuries are not uncommon. I see similar crush injuries and fractures here in Austin. It's the volume of them that is unprecedented.

Poor nutrition/ secondary medical problems: Malaria, typhoid, HIV, cholera and others are all very prevalent in Haiti. So is malnutrition. If a patient's body is fighting these battles, it is less likely to heal injuries sustained in the quake.

Progress is being made but to say it is an uphill climb is an incredible understatement. Texas Orthopedics and the people of the USA will continue to support the efforts in Haiti. Every volunteer minute, every dime and every prayer makes a difference.

Scott Smith, M.D.
Texas Orthopedics

How do I help?

Texas Orthopedics is working in association with Hill Country Bible Church and other local medical providers to provide medical teams to the Mission of Hope over the next 5-6 months. Our first plea to the medical community for assistance yielded over 2 tons of supplies and equipment that are now being used day and night to serve the patients treated at the Mission of Hope. We have had many calls in days since wondering what individuals can do to help, here’s how:

1. Make a tax deductible donation online at By giving through HCBC today, you will be helping finance medical teams and supply flights from Austin to Port au Prince as well as other needs of the medical mission in Haiti. Click on “Haiti Earthquake Relief”.

2. If you are in the medical field and would like to be part of a medical team to go to Mission of Hope, email A volunteer coordinator will be in touch with you once we receive your interest.

Thank you for your interest and support. Texas Orthopedics is honored to be a part of this mission along with many other providers from the Austin medical community. Please take some time to read our blog and learn more about the efforts of the medical teams, stories of hope and healing, and the incredible strength of the Haitian people.

Pictured: Sharon Depmore, LVN, Team 2 nurse from Texas Orthopedics with a Mission of Hope patient

Friday, February 12, 2010

2/11/10 - Team 3, Day 6

If you want to be seen at the Mission of Hope clinic as a patient, you first have to get to the front gate. Before sunrise every morning patients and families mass up at the gate, and a pre –determined number are allowed in to come up to the clinic. Dr. Cheryl determines this volume daily based on the number of doctors available to work. Today, the gates opened a bit later and I had a chance to walk down to the orphanage. Ms. Rachel runs the orphanage, and is full of love and toughness. She let me sit with her while she gathered the kids in a group to make an announcement and give work assignments.

Dotting the rock and chicken scratched open yard between the school and the kids’ dorms now sits about 30 high quality dome shaped tents. These are the boys’ quarters since about two weeks after the earthquake. At that point one dorm was found sound, and the girls were moved in. Today is a big day, because, as Ms. Rachel explains in demonstrative Creole, the other dorm has been declared safe and we are taking down all the tents, and the boys are moving back inside. God is great.

As I made my way back toward the clinic, cutting around hanging wind dried clothes and groups of playing and working kids, Ms Rachel asked me to walk a sweet 8 year old girl up to the clinic to look at a hot soup spill burn on her back. Christine was in clinic and helped me clean and dress the burn, 2nd degree with blistering but not serious, and I walked her to the open door of the clinic, all the nurses and I gave her fist bumps and off she went. Bright white smile turning towards the orphanage.

Dr. Cheryl arranged for us to go into Port au Prince today. We are transporting our GSW paralysis patient, and assessing General Hospital, and trying to gain perspective on the extent of the human tragedy occurring in Haiti. Traffic was very heavy, bumper to bumper and side to side, trucks, cars, bikes, motorcycles, UN vehicles, US Army convoys, US soldiers in combat gear all crisscrossing in controlled chaos. I’m still processing all that we saw, but it might be indescribable, in terms of the utter devastation of the buildings and homes, the smells and stench and packed shanty town blocks tumbled up on each other, construction debris and garbage mounds two stories high closing in stagnant water concrete drainage canals. Everywhere people. We passed through an area outside of PAP controlled by gangs, and saw gun barrels sticking out concrete openings guarding territory. Street vendors head carrying corner-prepared food and produce circled everywhere.

We turned a corner, went through a large swinging gate guarded by three US Army soldiers, and we were “inside” General Hospital. The hospital is outside. It is a series of tents crossing three streets, some set up as medical, some orthopedics, OB-GYN, lab, trauma, on and on. We saw the nursing student building with the collapsed second floor, where 200 students sat taking a nursing exam, 100% mortality, all were killed. Tired doctors and nurses, medical staff, others, very large scope, they are doing hard work.

On the way back up to MOH, we saw a whole other part of Haiti. In better years known as the jewel of the Caribbean, we stopped at a place for a team meal that proved it. Wahoo Bay (see is a beautiful little resort, Dr. Cheryl knows the place and staff and set it up for us to stop and eat. Blooming bougainvilleas, brisk ocean breezes and good Creole cooking were an almost eerie contrast to the rest of our week. The resort was empty - no guests - and the many empty rooms seemed ironic in the face of the reality two hours drive down the main highway. We had invited the Canadian team to come with us, and we prayed and dined together.

Just before we left for Port au Prince earlier in the day, we admitted a 9 year old girl with fever and buttock swelling. When we got back from dinner, we stopped to do ward rounds, and she was very sick. Tachypneic, tachycardic, she was really struggling to breath. Her buttock swelling was tense, symmetric, and now had spread up to her midback and chest, and down to her thighs, front and back. All of this pointed towards a diagnosis of necrotizing fasciitis. Knowing that in our OR we could not control her airway, had no oxygen, and no advanced pressure monitoring, and no way to handle her post op wounds, we determined to try to get her transported to another facility. We alerted Dr. Cheryl, and made arrangements, and at about 1:45 AM finally pulled up to the University of Miami hospital. We were back in Port au Prince. This place was phenomenal. Set up in a large military style tent, it was overall about the size of a high school gym, fully air conditioned, divided about in half by hanging burlap sheets dividing the hospital ward from the “sterile” OR and ICU side. We rolled our scared, exhausted, patient back to the ICU and turned her over to a team of pediatric surgeons, trauma surgeons, EM docs and advanced staff of all kinds. They had a fluoroscopy unit, multiple ultrasound units, 5 anesthesia machines, advanced monitoring devices. A field-trached Haitian patient lay just inside the burlap divider, on 5 drips and monitors, dying. Before we left, the medical team had determined to try to get our patient air-flighted by the US Navy out to the USS Comfort. We hope to follow up, to see if she survived.

We finally arrived back at MOH around 3:15 AM, and my tent and sleeping bag welcomed me like a 5 star resort.

God Bless,
Robert Wills, MD
Austin Pain Associates

Thursday, February 11, 2010

2/10/10 - Team 3, Day 5

Viviane and Tyler both have connections to Haiti. Viviane is Haitian, born in Miami. Several of us had the treat today of meeting her 78 year old grandmother in clinic, she had arranged for her and others in her family to come up to MOH. Doubling as our medical translator, she knows both the language and the culture, and this has been a huge plus for our team.

Tyler was in Haiti on a medical mission in the year prior to the earthquake. Tyler contacted his friend when we arrived here, and this friend made the all day trip from Port au Prince on a Tat Tat taxi to the MOH front gate. Several hours later, the guards were able to get through to Tyler and his friend was allowed in. Security at this place is a serious matter. Armed guards patrol nightly, and must be trained to not speak to the guests, because a friendly “bon jour” to one in ear’s reach usually results in a blank stare and a quick about face, army issue rifle slung across the shoulder. I’m not complaining.

Tyler’s friend is an orphan, who now has his own son, and as the oldest brother was the primary caretaker for several siblings. As Tyler relayed this story to me today, it struck me that living in a makeshift “tent city” is not living at the bottom of the rung. Desperately trying to get a tent, to then try to get a spot in a tent city, is the tough living. He and his son live now in a lean-to against an abandoned car, its roof a cardboard flat. He sleeps with a machete for protection. This young man is bright and has life plans and dreams in place, but this is his reality now after the earthquake. We pray he finds his brother and sister alive and well.

Mitch was an operating room specialist in the army, and served in Iraq in 2005. That year, his unit was the busiest trauma center in the world. He now manages a 15 room surgical suite in an Austin, has 12 staff under his direction. Having him on this mission has been like having Clint Eastwood with you at a tough guy convention - very wise choice.

Our first surgical patient today was a serious and thoughtful 5 year old girl, admitted last night by Dr. Adrian with a neck abscess and dehydration. Since we had just opened the doors to the clinic, the pre-op area was not full yet, so we were able to play with her, get her giggling, one of the fantastic med/surg nurses from Oklahoma had a bottle of bubbles that we blew, she blew, and I slipped in the Versed during this moment of glee so her last memory before surgery would be a happy one. Her pre-op bay sat up against an open metal-grated window centering a green concrete wall, and just behind her in the grass were a couple of goats that had nosed up close, and they seemed to enjoy us as well.

Our surgical team performed two distal radius fracture cases today, open reduction internal fixations with plates and screws. Both patients had been injured during the earthquake, and neither had been treated to date. Repairing a 4-wk old fracture is technically and physically difficult, as the body has started trying to heal the break by then, and a functioning arm requires good alignment, so great care and effort is made to achieve this. Tyler first assisted these operations today, and Dr. Laura got them both repaired, with excellent prognoses for full functional recovery.

Our last patient tonight was also a victim of the earthquake but not through trauma. He is a young man, paralyzed from the mid-chest down following a gunshot wound to his spine over a year ago. He was in Port au Prince General Hospital on the day of the earthquake, and in the chaos that followed, his family got him out safely. Unfortunately in the weeks since, he developed decubitus ulcers on his back and hips, and presented late today with severe infections and sepsis. In the best of hospitals in the states, this is a problem with a high mortality. We took him to the OR for debridement and wound packing, going through 4 liters of saline with our pulsed lavage irrigator, and removed a significant amount of each wounds’ purulence and necrotic tissue. Dr. Laura, through Viv, then spoke to the family about the gravity of their loved ones situation. One of the pastor volunteers who stayed late into the night with us tonight helped me wheel our critically ill patient into recovery, and offered to pray for him and for us. We gathered together with his family around the stretcher, their dusty colorful frocks alternating with our blue and green surgical scrubs and caps, and prayed for his recovery.

Our ward is packed to overflowing tonight, both medical and surgical patients filling every space. Adrian has the call walkie talkie tonight, and will be available if needed, but with the nursing staff in place here, they will need very little if any help. Tomorrow we are being transported to the Mennonite Mission to do wound care and change out the wound vac sponges. This will take a few hours. We hope to train the staff there how to manage the vacs on their own, and we need to time out dressing changes and orders to fit in with our replacement team, which arrives on Saturday. After this, we are going to Port au Prince. There, we hope to meet some of the doctors and others with whom we have been sharing patients and resources, and learn a bit more about the capabilities of the various facilities. Then, Friday is our last surgical and clinic day, and we will prepare everything for Team 4.

Our travel plans for Saturday are still fluid, Laurence tells us that commercial flights from PAP are not being allowed to land in the US. Our Texas Ortho and HCBC home base will get us home, and until then we will do as much as we can here.

God bless and goodnight.

Robert Wills, M.D.
Austin Pain Associates

Wednesday, February 10, 2010

2/9/10 - Team 3, Day 4

As the days and weeks go on since the earthquake, networking lines of medical triage among and between the various hospitals and clinics that dot the country have developed. Key leaders, like our Dr. Cheryl here at the MOH, communicate regularly and try to match patients’ needs with the capabilities of each locale. Prior to the earthquake, MOH was a large clinic with a full time Haitian physician and staff, a lab for basic blood tests, and a pharmacy. This important work continues, if magnified. In terms of MOH’s surgical and emergent care capabilities, now 4 weeks out from the earthquake, we have become the destination for complex wound management and orthopedic injury continuity of care and follow up.

One small concrete-walled building about the size of a 2 car garage houses our operating room, triage station for the most seriously ill or wounded, wound debridement bay, pre op and stage 2 recovery step down unit, and the “doctor’s office” which is a converted closet with two desks and several chairs.

Today, we saw patient after patient with casts, splints, surgically implanted external fixation devices, healing and infected wounds, and many amputations. Many patients we treat in the pre op area, the most serious we take into the OR. Today we did a wound debridement and placed our second wound vac device. She had exposed EHL tendon and tibia at the base of her wound in her lower leg, and she was a great candidate for a vac. Our first case in the OR today was a patient with a retropharyngeal abscess, performed by Dr. Adrian one of our ER docs. Our first scheduled patient tomorrow is also an abscess, this one a right anterior neck abscess on a 5 year old girl.

Today we secured a facility for Dr. Jeffery to perform a VP shunt on a 1 year old. He will travel there tomorrow on our ambulance, and will be brought back when he is through. He is a blessing indeed for this baby and her family, as she has had a “big head” with fluid on the brain since just after birth, and this surgery will allow her head and brain to develop normally.

One example of God’s hand being with these people, was with one of our amputation revision patients. She is one of the patients directed to us from the Mennonite Mission, a joyful young woman who ran outside her house during the earthquake with her family, safely, only to be struck on the leg by her neighbor’s roof, losing it. Two days ago, her staff there diagnosed her with anemia, and arranged for her to receive a blood transfusion, which is a rare commodity in Haiti. Today in surgery, she needed every drop of that blood, as we had major blood loss due to a malfunctioning bovie and tourniquet. She is recovering now in our post op ward, being taken care of by an ICU nurse volunteer from Los Angeles. One on one critical care nursing, in Haiti, God is great.

A short time after dark, as we pulled our ambulance around the dusty corner leading up to the ward, with our last surgical patient of the day, we saw the open air worship pavilion, once again filled with people. Tuesday night worship service. As we rounded on the patients, helping the nurses with foley catheters, meds, monitors, I could see the service and hear the beautiful Haitian music coming through the open windows of the ward. As the service ended, many of the folks wandered over to the ward to check on loved ones, and they squeezed in among us, helping, translating, humming, loving on each other, and on us.

Dr. Laura, Dr. Bill, Tyler and I were the last docs to leave the ward, Bill and Tyler choosing to walk the mile long path up the hill to the MOH guesthouse, Dr. Laura and I hopped a ride in an ATV with an MOH staff member. A delicious, if simple, dinner of rice with pork, on tortillas with lettuce and salsa was held for us, then a quick rinse shower, and off to my tent to rest up for tomorrow. As I type this in my tent, a small group of people are gathered on the wooden door tables just beyond my tent, praying together and sharing devotionals. I pray for strength of faith, for my family who I now miss greatly, for these Haitian people we have come to serve, and for the safety and strength of our medical team as we prepare for another day.

Robert Wills, MD
Austin Pain Associates

Monday, February 8, 2010

2/8/10 - Team 3, Day 3

Oatmeal with brown sugar, orange wedges, tortillas with peanut butter, and a half cup of coffee started the day. Our team had a fresh head of steam, and as some of us walked down to the clinic, others drove the ambulance down the hill to pick up patients from the ward, to bring for surgery. EMT volunteers arrived later in the day, and took over the driving and transport responsibilities.

The clinic was scheduled to open at 7:30, so we arrived down there around 7:00 to get ready. The Haitians knew we had a full staff, and by then had already formed an impromptu line outside the clinic doors. They self-triaged the sickest among them, presenting them to us as we unlocked the large steel doors of our clinic, and we immediately admitted several patients with serious problems. As the Haitians lined up, eventually by the hundreds, they sang hymns together spontaneously, sitting in the hot sun, side by side on concrete walls and metal chairs, from the youngest children to the grey haired elders. Their spirit and toughness continue to amaze me.

One elderly lady turned out to be the mother of one of the MOH staff. She passed away this afternoon despite great efforts, and volunteers from the Oklahoma medical team helped the family transport her body to the family's home. In Haiti, families are required to remove deceased members and arrange for their burial. Despite the untold numbers of deaths here, every death we witness is accompanied with great mourning, large numbers of family and friends gathering, every lost life is great.

Today, one of our ward patients recovering from a very high above the knee amputation, who is also 6 months pregnant, was finally told by her family that her 3 year old daughter was killed in the earthquake. Mother and daughter were together inside a building when the earthquake hit, and were then separated, and when she was rescued she could not find her daughter. Her family chose to not tell her, and the medical staff here honored those wishes. The horrific sorrow she felt in this moment was difficult to bear.

Our first surgical case today was a trimalleolar fracture, and Dr. Laura performed an ORIF with plating and screws. The neurosurgeon from Oklahoma, Dr. Jeffery, scrubbed in and assisted expertly and this young patient will walk again, in time. By mid-morning, our "pre-op" area was filled with mattresses and stretchers, patients and families lining the walls between our procedure trays and block stations. Christina, our wound care therapist, worked tirelessly, all day long, on difficult wound debridements. I did ankle blocks as anesthesia, field blocks. One such patient was a young woman with multiple burns and wounds on her feet and back, rescued from the earthquake rubble. She did very well, and she has a very good chance of a full recovery. We did conscious sedation for others requiring difficult dressing and cast changes, and wound care. One patient required debridement of her infected below the knee amputation, and we cared for her in the OR under a spinal block. Dr. Laura was everywhere, triaging ortho trauma patients in the clinic and running back to the OR area to do the cases when we were ready for her. She has 2 year old twins and a 3 and a half year old. I asked her what drove her to come this week. She said simply that God had given her this gift of healing, and she intended to use it where it was needed the most. Wow, what an inspiration she is to all of us on this trip.

One other patient was brought in this afternoon in the back of a pick up, with what turned out to be bilateral acetabular fractures that she sustained during the earthquake who had not yet seen a doctor. We admitted her to the ward for pain control and fluids, and Dr. Laura thinks we will try to arrange for her to be transferred to a larger hospital in Port au Prince as soon as we can find one to accept her. We are not equipped here for that type of major surgery, but will care for her until she is transported.

We placed the first of our wound vacs today! We have been receiving requests from all over the countryside for wound vacs, as the word has gotten out the MOH has some. The rumor mill had us with "a dozen or more", in reality we have 4 with minimal sponges and back up supplies. This first one went to the young lady with the large wound on her low back, having been pinned for 5 days under her church rubble. The nuns and physician from the Mennonite mission who have been taking care of her, came with her to MOH, and all were so thankful and full of hope that we could help her. She needs more sponges, we hope to get some in with our replacement team on Saturday. With God's help, the wound vac, and close follow up, she can heal this wound.

We lost power in the OR and clinic twice today. The first time was in the middle of our first case, it was just a flicker of loss, but enough to shut down our autoclave and our fan. We were soaked head to toe with sweat by the end of the case, as was our young patient. Mitch and I fixed both the autoclave and the fan in time for our next operation. The power went off again just before sunset. It turns out the facilities here have two generators, one running the main guesthouse and staff quarters, and one running the clinic, orphanage and school, which is now our hospital ward. Last week the second generator went out, leaving just the one main one, now tasked with running the entire facility. When it went down, we were just starting the BKA revision. We used headlights and flashlights to finish the case. She did very well and is on our ward tonight recovering. She has a very high below the knee amputation, and Dr. Laura is trying to save as much tibia as possible, because if we have to revise her above the knee, recovery is much more difficult and the prospect of functional rehabilitation with a prosthesis is lower.

Talking with Dr. Cheryl today, we learned that the unemployment rate here is 85%, that 90% of the population is under 18, and that 30% of the country's GDP comes from the Haitian "Diaspora" - relatives of Haitians now living in America and elsewhere, sending money and support to their Haitian families. There were many problems facing this country, politically and economically, as well as medically, before the earthquake, and of course now those problems are multiplied. The staff and volunteers at this place are amazing, it is an honor to work with them. Texas Ortho and HCBC arrived right after the earthquake and literally raised a fully functioning hospital out of the dust. God's hand is everywhere I look, and I pray now for strength and endurance to do as much as we can, with this opportunity to serve.

Robert Wills, MD
Austin Pain Associates

Sunday, February 7, 2010

2/7/10 - Team 3, Day 2

Today was Sunday, which for Haitians means a day of worship. Our clinic was "closed" and we spent the first part of the day organizing supplies and touring the grounds with Dr. Cheryl, who is the full time physician in charge here. We then attended the most amazing worship service, lasting almost 3 hours, packed to standing room only with singing Haitian parishioners, and many local missionaries and their families. The music was loud, joyful and beautiful, and the people were standing and singing, there were kids everywhere, and goats, turkeys and roosters outside the pavilion - very colorful setting. The people are beautiful, and upbeat, not downtrodden or mopey, but full of joy and hope, amazing in their faith. Church here is "dressy" and many of the locals were dressed in their best, dresses and skirts for the women and girls, and pants and collared shirts on the men and boys. One very cute 5 year old boy didn't comply, and his orange t-shirt saying "if its broke, I didn't do it" made me laugh out loud. Dr. Cheryl tells us that the church service has tripled in size since the earthquake, with many Haitians coming to Christ as all else but Him falls to the ground around them.

After Church, our "closed" clinic soon had many patients walking up, some carrying sick family members looking for care, others trucked in from local villages seeking the same. We treated several with antibiotics, ibuprofen. One young man hobbled in on badly infected feet, which we debrided in our treatment room under a digital block, and plan to debride him under a spinal block in AM. A young woman rolled in with infected external fixator pins, another with a full leg cast put on the day after the earthquake then lost to follow up.

Later in the day we were taken to a neighboring Minonite Mission that is housing about 25 sick and post surgical patients. They have 5 or 6 with complex, non-healing wounds, after trauma or post surgical. We signed up 5 to be brought over to our operating room tomorrow morning to take a closer look at their wounds, debride and clean them, and place wound vacs.

Our "ward" has 11 patients, some post op, one awaiting ankle surgery in the morning - our first patient for the day tomorrow. We expect between 200 and 250 patients to come to be seen in the clinic tomorrow. We are prepared for them, with our medical team, supported by a team of RN's from Oklahoma that just arrived, we have a plan in place to work until the last patient is seen.

A neurosurgeon arrived with the Oklahoma team as well, and there is a plan for him to travel to a local hospital housing children with untreated hydrocephalus, and he will evaluate them for VP shunts.

The general trend here is definitely away from acute trauma and orthopedic injuries, and toward follow up care, and general medical care - the need for this is great.

One of the patients we evaluated today had a crush injury to her low back, with a large wound. She was pinned under the rubble of her church - she had just arrived for a class as part of a worship team - for five days. She was unable to move, but heard the voices of her rescuers, and eventually that of her own mother, who was the first to reach her. She also lost her left arm above the elbow, that surgical wound is healing well.

The stories of tragedies and miracles, horrific trauma and amazing recovery, fill this place.

We are resting outside our guesthouse again tonight, and are ready for another day tomorrow.

God Bless!

Robert P. Wills, M.D.
Austin Pain Associates