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
Thursday, February 11, 2010
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
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
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
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
2/6/10 Team 3 - Day 1
Our school bus stopped outside the gate, and we jumped out, once again forming a cargo line moving our supplies and bags from the bus to just inside. The drive from Port au Prince airport was bumpy, dusty, with fires burning along the road rubble of the city and dotting the hillsides on our way up into the Mission of Hope village. Even at this late hour, people lined the roads in many areas, and impromtu tent cities appeared and disappeared as we drove by. The devastation was apparent at every turn, its hard to imagine what it was like in the first days and weeks after the initial earthquake
The bus was a far cry and dose of reality from the private 9-seater executive jet that took us from Ft. Lauderdate to the PAP airport. We arrived at the MOH around 11:00, greeted by the mission caretaker Randy, who updated us that we had 16 patients in the "post op" ward of the hospital/clinic, one not expected to make it through the night. Dr. Goldberg informed us, when he met us earlier at the PAP airport, that he had placed 3 patients on NPO status for surgery tomorrow, we will meet them in the morning and make plans for their care.
We are prepared to be flexible, to make a new assessment of the patients here, and the capabilities of our team and the facilities, bright and early in the AM. We are told there is a huge worship celebration in our pavilion at 9:30, we hope to worship together and with the MOH staff as we start the day.
Randy tells us there are still patients in local villages waiting to recieve medical care, and many more who received medical care in the first weeks after the earthquake, who now need follow up care, dressing changes, cast changes, wound care, revision surgeries, medical care. There are 60 children in the orphanage here on the grounds as well. Some of us have brought artwork and pictures from our kids' elementary schools, we will share those things with those children tomorrow, God willing.
Our team, lead orthopedic surgeon Laura Torres, ER docs Adrian and Oscar Martinez, FP doc Bill Stavinoha and his 2nd year medical student son Tyler, husband and wife surgical tech team Mitch and Viviannne Pearson, PT wound care specialist Christina Schneider, and myself, anesthesiologist and pain mgmt, are spread out across a small "courtyard" just inside the gate in small tents, and inside the guesthouse. The accomodations are rustic, but clean and secure, with running water in two bathrooms, and electricity supplied by generators. There is a team of 4 RN's from Canada here, taking the overnight shift in the post op/clinic ward, and a team of additional RN's and a neurosurgeon is expected tomorrow from Miami.
As I type this, I hear trucks in the background, transporting the hundreds of crates of food, from which the MOH will provide 200,000 meals tomorrow. The medical mission here is only a small part of what this place does, providing hundreds of thousands of fresh meals daily to the people of Haiti, day after day after day, is a primary focus.
We praise God for this day and this moment, and for the chance to serve these people, in His name.
Robert Wills, MD
The bus was a far cry and dose of reality from the private 9-seater executive jet that took us from Ft. Lauderdate to the PAP airport. We arrived at the MOH around 11:00, greeted by the mission caretaker Randy, who updated us that we had 16 patients in the "post op" ward of the hospital/clinic, one not expected to make it through the night. Dr. Goldberg informed us, when he met us earlier at the PAP airport, that he had placed 3 patients on NPO status for surgery tomorrow, we will meet them in the morning and make plans for their care.
We are prepared to be flexible, to make a new assessment of the patients here, and the capabilities of our team and the facilities, bright and early in the AM. We are told there is a huge worship celebration in our pavilion at 9:30, we hope to worship together and with the MOH staff as we start the day.
Randy tells us there are still patients in local villages waiting to recieve medical care, and many more who received medical care in the first weeks after the earthquake, who now need follow up care, dressing changes, cast changes, wound care, revision surgeries, medical care. There are 60 children in the orphanage here on the grounds as well. Some of us have brought artwork and pictures from our kids' elementary schools, we will share those things with those children tomorrow, God willing.
Our team, lead orthopedic surgeon Laura Torres, ER docs Adrian and Oscar Martinez, FP doc Bill Stavinoha and his 2nd year medical student son Tyler, husband and wife surgical tech team Mitch and Viviannne Pearson, PT wound care specialist Christina Schneider, and myself, anesthesiologist and pain mgmt, are spread out across a small "courtyard" just inside the gate in small tents, and inside the guesthouse. The accomodations are rustic, but clean and secure, with running water in two bathrooms, and electricity supplied by generators. There is a team of 4 RN's from Canada here, taking the overnight shift in the post op/clinic ward, and a team of additional RN's and a neurosurgeon is expected tomorrow from Miami.
As I type this, I hear trucks in the background, transporting the hundreds of crates of food, from which the MOH will provide 200,000 meals tomorrow. The medical mission here is only a small part of what this place does, providing hundreds of thousands of fresh meals daily to the people of Haiti, day after day after day, is a primary focus.
We praise God for this day and this moment, and for the chance to serve these people, in His name.
Robert Wills, MD
Team #3 in Haiti!
Team 3 arrived in Haiti Saturday evening led by Robert Wills, MD - Austin Pain Associates! They are joined by a group of nurses and a neurosurgeon from Florida.
Members of Team 3:
1. Laura Torres, MD - trauma orthopedic surgeon, Herman Hospital Houston
2. Oscar Martinez, MD - Emergency physician, Dallas
3. Adrian Martinez, MD - Emergency physician, Austin
4. Robert Wills, MD - Anesthesia & pain management, Austin Pain Associates
5. William Stavinoha, MD- Family Practice, Austin
6. Tyler Stavinoha- med student
7. Christina Schneider, PT
8. Mitch Pearson, CST- NAMC
9. Vivianne Pearson, CST
Members of Team 3:
1. Laura Torres, MD - trauma orthopedic surgeon, Herman Hospital Houston
2. Oscar Martinez, MD - Emergency physician, Dallas
3. Adrian Martinez, MD - Emergency physician, Austin
4. Robert Wills, MD - Anesthesia & pain management, Austin Pain Associates
5. William Stavinoha, MD- Family Practice, Austin
6. Tyler Stavinoha- med student
7. Christina Schneider, PT
8. Mitch Pearson, CST- NAMC
9. Vivianne Pearson, CST
2/6/10 Team 2, Day 8 (Travel Day)
Update:
3 procedures today before return to Austin:
-dressing change under anesthesia on a boy whose foot was amputated (not tolerating dressing changes awake)
-ORIF ankle fracture on a lady (above) who had been walking on her dislocated ankle since the earthquake
-and a reduction of a wrist fracture, dislocation.
An anesthesiologist and CRNA from Tennessee assisted in these cases as they had not been able to find work in town.
Team #3 is on their way to Mission of Hope!
Pictures (courtesy of Dr. Goldberg):
Picture #1: Team 2 says goodbye to the OR. This was previously a lab in the Mission of Hope clinic that was broken apart after the earthquake. Team 1 spent 5 hours cleaning it up and creating a sterile OR - one of the only sterile facilities near Port-au-Prince.
Picture #1: Team 2 says goodbye to the OR. This was previously a lab in the Mission of Hope clinic that was broken apart after the earthquake. Team 1 spent 5 hours cleaning it up and creating a sterile OR - one of the only sterile facilities near Port-au-Prince.
Picture #2: Ankle ORIF
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