Team 7 members from Texas include:
Stan Rice, DO - Team Leader - ER (Brackenridge & Dell Children's ER)
Kurt Knauth MD - anesthesia (Capital Anesthesia-Brackenridge)
Maggie El-estwani, RN - OR (Austin)
James Grant, PT (Encompass Home Health)
Julia Chang, RN (Seton)
David Krussow, RN (Austin, Star Flight)
Kathy Bremer, RN (Austin Area OB/GYN)
Pam Rizo, paramedic (San Antonio, W-I10 Fire Dept)
Joining the team from other areas of the WORLD!
Glen Spiegler MD - orthopedic surgeon (Virginia)
Mike Mara, MD - orthopedic surgeon (Oregon)
Matt Shambaugh, MD - plastic surgeon (Indiana)
James Dudley, MD -FP/ER (Virginia)
Greg Schmitt, MD (Indiana)
Peg Kiester, RN-OR (Indiana)
Hannah Warren, RN-Mercy Ships (England)
Sally Greenway, RN (Canada)
Sandi Brock, RN (Georgia)
Agnes Hyma, RN (Canada)
Amie Mock, FNP (Virginia)
Suzanne Tolson CC-EMT (Virginia)
Lyn Westman-Mental Health, Mercy Ships
Sunday, March 7, 2010
Saturday, March 6, 2010
3/5/10 - Team 6, Day 6
Update from Heidi Walker, RN:
It rained today! This is wonderful considering it has been sticky and hot all week. There is actually a nice chill in the air tonight.
The day started with two women going into labor at the clinic. Unfortunately, MOH is not allowed to deliver babies and therefore we loaded them up in the ambulance and took them into Port Au Prince. The two labor and delivery nurses were excited and ready to deliver the babies, but they did not get to show us their skills.
The surgeries went much better today. Each surgery we do should be a lot easier than they have been, but with the lack of vital equiptment and these adverse conditions, we have had to work a lot harder . With passing time, these older injuries are getting more difficult to treat. Thankfully we were able to fix a bad tibial plateau fracture, an acute gunshot wound to the hand, a fractured and dislocated elbow, and of course a debridement of an infected wound (we have seen a lot of infected wounds). We were going to wrap up the OR team tonight, but we decided to leave Haiti with a bang with one last above the knee amputation tomorrow. Dr. Brad will be losing his scrub partner, Dr. Greg, tomorrow to a flight back to Indiana, so he has asked Kristen to be his assistant in surgery.
The ER was hopping today as usual. There were all sorts of people in there, which is much like it is in the states. We saw a 17 month old baby only weighing about 10 pounds who was severely malnourished. Of course this baby pulled at all of our heart strings and we did everything we could to get some fluid down. We eventually shipped her out to a hospital in Port Au Prince. We can only pray that someone else will care as much as we do and will nurse her back to health. We also had a patient come in yesterday who fell out of a building or tree depending on who you ask (no one is sure of the exact story because things get lost in translation). Dr. Jon was able to diagnose a C4-C5 cervical fracture and we immobilized him and sent him to stay the night in our ward. We were supposed to have a helicopter come into the mission today to transport him to a hospital that takes 10 hours by car, but they cancelled because of the weather. A helicopter around these parts sounds pretty unbelievable to me, so I will have to see it to believe it. Hopefully tomorrow’s weather will be better and the helicopter will come for him. Rick, the Canadian paramedic, made him a short back board to travel on so that his flight will be as comfortable as possible.
All of the people on this team have been amazing. It’s such an eclectic group, but everyone has had something amazing to offer. It’s great to see people working until exhausted for the same common goal of helping these people. We forget how lucky we are sometimes and thank God for allowing us these experiences to remind us. Our team will be disbanding slowly over the next 3 days and I think we are all feeling it. We wish we could keep the team together forever, but we are also looking forward to getting back to our family and friends. There really is no place like home!
It rained today! This is wonderful considering it has been sticky and hot all week. There is actually a nice chill in the air tonight.
The day started with two women going into labor at the clinic. Unfortunately, MOH is not allowed to deliver babies and therefore we loaded them up in the ambulance and took them into Port Au Prince. The two labor and delivery nurses were excited and ready to deliver the babies, but they did not get to show us their skills.
The surgeries went much better today. Each surgery we do should be a lot easier than they have been, but with the lack of vital equiptment and these adverse conditions, we have had to work a lot harder . With passing time, these older injuries are getting more difficult to treat. Thankfully we were able to fix a bad tibial plateau fracture, an acute gunshot wound to the hand, a fractured and dislocated elbow, and of course a debridement of an infected wound (we have seen a lot of infected wounds). We were going to wrap up the OR team tonight, but we decided to leave Haiti with a bang with one last above the knee amputation tomorrow. Dr. Brad will be losing his scrub partner, Dr. Greg, tomorrow to a flight back to Indiana, so he has asked Kristen to be his assistant in surgery.
The ER was hopping today as usual. There were all sorts of people in there, which is much like it is in the states. We saw a 17 month old baby only weighing about 10 pounds who was severely malnourished. Of course this baby pulled at all of our heart strings and we did everything we could to get some fluid down. We eventually shipped her out to a hospital in Port Au Prince. We can only pray that someone else will care as much as we do and will nurse her back to health. We also had a patient come in yesterday who fell out of a building or tree depending on who you ask (no one is sure of the exact story because things get lost in translation). Dr. Jon was able to diagnose a C4-C5 cervical fracture and we immobilized him and sent him to stay the night in our ward. We were supposed to have a helicopter come into the mission today to transport him to a hospital that takes 10 hours by car, but they cancelled because of the weather. A helicopter around these parts sounds pretty unbelievable to me, so I will have to see it to believe it. Hopefully tomorrow’s weather will be better and the helicopter will come for him. Rick, the Canadian paramedic, made him a short back board to travel on so that his flight will be as comfortable as possible.
All of the people on this team have been amazing. It’s such an eclectic group, but everyone has had something amazing to offer. It’s great to see people working until exhausted for the same common goal of helping these people. We forget how lucky we are sometimes and thank God for allowing us these experiences to remind us. Our team will be disbanding slowly over the next 3 days and I think we are all feeling it. We wish we could keep the team together forever, but we are also looking forward to getting back to our family and friends. There really is no place like home!
Thursday, March 4, 2010
3/3/10 - Team 6, Day 4
Update from Team 6:
The most exciting thing about today is the fact that Dr. Brad did the first ever, as we know of, hip hemiarthroplasty in Haiti. Actually, he did two! Way to go surgery team! And rumor also has it that there is a 19 y/o from the Dominican Rebublic who is wanting to come to the mission for his hip to be fixed as well, but there is no word on that yet. We are hoping to go international here at the mission by the end of the week!
It was a long day today as we were in surgery until almost 7 pm. As a matter of fact, I haven’t seen the recovery nurse yet so my guess is she isn’t back yet from the clinic. I think tomorrow might be another long day as well because we already have 2 femur fractures and 1 tibia fracture to fix as well as several wound debridement’s on our schedule and there is always a possibility of add-ons. We are going to sleep good tonight!
There was also some excitement on the ward with a pt that was dropped off yesterday for fever, nausea, and vomiting. His condition worsened today and it was determined that he probably had a ruptured appendix. Dr. Greg said he would have preferred not to take out his appendix in our OR, but he was standing there ready with scalpel in hand. Luckily we were able to transfer him to a place that the paramedics said looked pretty clean. I believe that he was taken to the OR for an appendectomy, but I’m not for sure on this.
Kim says nothing much happening in triage right now except that there are a lot of people coming through. Coincidentally, everyone in triage has the same complaints of fever, cough, n/v, and abdominal pain which they say have been present since the earthquake. Maybe it’s nerves. These people really have been through a lot.
Dr. Jon, the ER physician from Chapel, had a patient come in on Monday with a heart attack in progress. We treated him as much as we could and then sent him on to the University of Miami hospital. We have since then learned from his son that he passed away today. May God bless him and his family at this time.
From Dr. Greg: “I have had the distinguished honor of assisting one of the most brilliant orthopedic surgeons in the world doing the toughest arthroplasty that I have ever seen under extremely adverse conditions. In fact, one could say he was operating under the jaws of death.”
Text updates from Dr Parker via Chris Merrell:
Pts seen today:
2 hip replacements
hip spica on a 10 month old
2 endo prosthesis
debreided stump wounds
"lots of action"
Haitian orthos are up and running again
Still many malaigned fractures from earth quake
2 femurs and tibia tomorrow.
Lots of wound care surgery.
2 surgeries lined up for next week.
Still need RN's. Dr Parker feels ward will be full the next week.
Update from Haiti and our prosthetics team:"Chase just texted me that the meeting he had with the government, WHO/ICRC and Helping Hands went incredible!! The Government has not only give us a big green light, but they have asked Chase and MOH to help make the Prosthetics Standards for the NATION!!! WOW." So exciting!! Our prothestics clinic is scheduled to open April 3rd.
The most exciting thing about today is the fact that Dr. Brad did the first ever, as we know of, hip hemiarthroplasty in Haiti. Actually, he did two! Way to go surgery team! And rumor also has it that there is a 19 y/o from the Dominican Rebublic who is wanting to come to the mission for his hip to be fixed as well, but there is no word on that yet. We are hoping to go international here at the mission by the end of the week!
It was a long day today as we were in surgery until almost 7 pm. As a matter of fact, I haven’t seen the recovery nurse yet so my guess is she isn’t back yet from the clinic. I think tomorrow might be another long day as well because we already have 2 femur fractures and 1 tibia fracture to fix as well as several wound debridement’s on our schedule and there is always a possibility of add-ons. We are going to sleep good tonight!
There was also some excitement on the ward with a pt that was dropped off yesterday for fever, nausea, and vomiting. His condition worsened today and it was determined that he probably had a ruptured appendix. Dr. Greg said he would have preferred not to take out his appendix in our OR, but he was standing there ready with scalpel in hand. Luckily we were able to transfer him to a place that the paramedics said looked pretty clean. I believe that he was taken to the OR for an appendectomy, but I’m not for sure on this.
Kim says nothing much happening in triage right now except that there are a lot of people coming through. Coincidentally, everyone in triage has the same complaints of fever, cough, n/v, and abdominal pain which they say have been present since the earthquake. Maybe it’s nerves. These people really have been through a lot.
Dr. Jon, the ER physician from Chapel, had a patient come in on Monday with a heart attack in progress. We treated him as much as we could and then sent him on to the University of Miami hospital. We have since then learned from his son that he passed away today. May God bless him and his family at this time.
From Dr. Greg: “I have had the distinguished honor of assisting one of the most brilliant orthopedic surgeons in the world doing the toughest arthroplasty that I have ever seen under extremely adverse conditions. In fact, one could say he was operating under the jaws of death.”
Text updates from Dr Parker via Chris Merrell:
Pts seen today:
2 hip replacements
hip spica on a 10 month old
2 endo prosthesis
debreided stump wounds
"lots of action"
Haitian orthos are up and running again
Still many malaigned fractures from earth quake
2 femurs and tibia tomorrow.
Lots of wound care surgery.
2 surgeries lined up for next week.
Still need RN's. Dr Parker feels ward will be full the next week.
Update from Haiti and our prosthetics team:"Chase just texted me that the meeting he had with the government, WHO/ICRC and Helping Hands went incredible!! The Government has not only give us a big green light, but they have asked Chase and MOH to help make the Prosthetics Standards for the NATION!!! WOW." So exciting!! Our prothestics clinic is scheduled to open April 3rd.
Wednesday, March 3, 2010
3/2/2010 - Team 6, Day 3
Update compiled by Kristen Damery, PT from Team 6 members:
Our communication has been sparse secondary to a spotty connection with email and phones. We are all safe and busy! We are all going to contribute tonight!
Anesthesia system is pretty complete and we are able to take care of everything we need.
-Dr. Dave, Anesthesiologist
Ambulance needs some air conditioning! To his family, he misses you and is safe. Everyone is really great and a really good bunch of people to work with. I just hope my wife doesn’t have too much snow to shovel!
-Rick, medic
-Experience of a lifetime. Misses her family but not the snow.
-Denise, nurse
Can’t believe how great the OR team is. Met Dr. Greg, a retired thoracic surgeon, still demonstrating great surgical skills, a tremendous help. Have a new X-ray tech named Wicky (Haitian). Injuries are bad, we are able to help some but not all. Tomorrow morning we are doing wound cases and Haiti 1 is going to pick up fractures for tomorrow afternoon.
-Dr. Brad, orthopedic surgeon
Haiti one had a mishap in route yesterday, apparently the local population doesn’t recognize an ambulance.
-Pauline, medic
Very unique and rewarding experience. We have a great team that gets along together and works well except there are too many Texans. Haven’t been able to do any coronary bypasses yet, the TSA wouldn’t let me bring my bypass pump on the plane!
-Dr. Greg (cardiovascular surgeon form Chapel team)
Finally finding where everything is at in the OR. Have dish pan hands from washing instruments.
-Jeff, orthopedic tech
I really enjoyed working with Dawn from the Chapel team in post-op today. She is great to work with and we are thankful for the teams from Indiana and Canada (although we try not to talk about recent international hockey games). Despite searching very hard for a fax machine I was unable to locate one to fax the order to the pharmacy prior to giving meds. This was a huge bummer…NOT. Actually it is great to focus on patient care and being with the people here, they are very grateful and fun to be around. I also enjoy the random turkeys and goats that walk by the clinic. One baby goat actually walked in the clinic but we could not see anything medically wrong with it so we shooed it away.
-Eric, nurse
Today was a slower day for wound care so I was able to assist a little while in other areas which were fun to experience. Yesterday was madness, a steady stream of patients for wound care coming in all day. The Haitians were all so grateful. They are beautiful people. Our team is working well together, everyday is better than the day before. The patients are all so diverse; some are still recovering from wounds secondary to the quake. Their stories are unbelievable. They have experienced things that we can not comprehend. Miss everyone. Good things are happening here in Haiti.
-Kristen, PT
Melissa is currently working nights at the ward! What a blessing she is to the patients, unfortunately she is not here to contribute. She is an angel.
-Heidi, nurse
We had a new team from Austin today. Very happy to have them here. They are working on setting up a prosthetics clinic. When up and running many, many people will benefit from this service.
Our communication has been sparse secondary to a spotty connection with email and phones. We are all safe and busy! We are all going to contribute tonight!
Anesthesia system is pretty complete and we are able to take care of everything we need.
-Dr. Dave, Anesthesiologist
Ambulance needs some air conditioning! To his family, he misses you and is safe. Everyone is really great and a really good bunch of people to work with. I just hope my wife doesn’t have too much snow to shovel!
-Rick, medic
-Experience of a lifetime. Misses her family but not the snow.
-Denise, nurse
Can’t believe how great the OR team is. Met Dr. Greg, a retired thoracic surgeon, still demonstrating great surgical skills, a tremendous help. Have a new X-ray tech named Wicky (Haitian). Injuries are bad, we are able to help some but not all. Tomorrow morning we are doing wound cases and Haiti 1 is going to pick up fractures for tomorrow afternoon.
-Dr. Brad, orthopedic surgeon
Haiti one had a mishap in route yesterday, apparently the local population doesn’t recognize an ambulance.
-Pauline, medic
Very unique and rewarding experience. We have a great team that gets along together and works well except there are too many Texans. Haven’t been able to do any coronary bypasses yet, the TSA wouldn’t let me bring my bypass pump on the plane!
-Dr. Greg (cardiovascular surgeon form Chapel team)
Finally finding where everything is at in the OR. Have dish pan hands from washing instruments.
-Jeff, orthopedic tech
I really enjoyed working with Dawn from the Chapel team in post-op today. She is great to work with and we are thankful for the teams from Indiana and Canada (although we try not to talk about recent international hockey games). Despite searching very hard for a fax machine I was unable to locate one to fax the order to the pharmacy prior to giving meds. This was a huge bummer…NOT. Actually it is great to focus on patient care and being with the people here, they are very grateful and fun to be around. I also enjoy the random turkeys and goats that walk by the clinic. One baby goat actually walked in the clinic but we could not see anything medically wrong with it so we shooed it away.
-Eric, nurse
Today was a slower day for wound care so I was able to assist a little while in other areas which were fun to experience. Yesterday was madness, a steady stream of patients for wound care coming in all day. The Haitians were all so grateful. They are beautiful people. Our team is working well together, everyday is better than the day before. The patients are all so diverse; some are still recovering from wounds secondary to the quake. Their stories are unbelievable. They have experienced things that we can not comprehend. Miss everyone. Good things are happening here in Haiti.
-Kristen, PT
Melissa is currently working nights at the ward! What a blessing she is to the patients, unfortunately she is not here to contribute. She is an angel.
-Heidi, nurse
We had a new team from Austin today. Very happy to have them here. They are working on setting up a prosthetics clinic. When up and running many, many people will benefit from this service.
Tuesday, March 2, 2010
More on Amputations
Post provided by Barbara Bergin, MD
We’ve all been talking a lot about amputations. It’s an operation that doesn’t get much attention in this country. It’s not very glamorous and it’s certainly not cutting-edge technology. We’ve been doing amputations pretty much the same way for a hundred years. In the United States about 40,000 below knee amputations (BKA) and 35,000 above knee amputations (AKA) are done every year! About 70% of those amputations are due to disease, the main culprit being diabetes. About 20% are due to trauma. Those statistics have been gradually changing over the past several decades because of advanced technology with regard to treatment of traumatic injuries of the lower extremities. We learned a lot about the importance of cleaning contaminated wounds in Viet Nam. Just getting a contaminated broken bone cleaned and temporarily stabilized with an external fixator (like the ones you see in the pictures from Haiti) has made dramatic increases in the number of limbs we save here in the U.S. and in other industrialized countries. But again, in Third World countries, amputation remains the mainstay of treatment for these kinds of injuries.
Now an amputation isn’t a simple operation. If not done properly, with adequate bone coverage and just the right amount of muscle padding, fitting and ultimate use of a prosthetic limb can be a problem. So a lot of planning goes into the performance of this operation. And when there is adequate, healthy skin and muscle, this can be done with a relatively predictable outcome.
But traumatic amputations are a whole different ball game. A limb smashing into pavement from a motorcycle accident or being crushed by a collapsed building, such as thousands suffered in Haiti, almost never gives the surgeon an opportunity to perform a textbook amputation. There is always some degree of contamination, torn muscle, stripped skin and exposed bone. This can leave the patient with thin skin and a poorly padded stump, which then can be difficult to fit into a prosthesis and will almost always result in some functional disability and pain. Surgeons want to make every effort to give a patient a BKA because of the energy requirements it takes to function with an AKA (see Dr. DeHart’s blog from 2/22/10). We will often do skin grafts and muscle transfers to cover a little stump of bone in order to give a patient a BKA.
This is doubly important in Haiti, where a BKA instead of an AKA could make the difference in a patient’s ability to work and support him/herself. Many patients are refusing to have second and third operations in order to make improvements to their stump. I can’t blame them. It’s a huge pill to swallow even under ideal circumstances.
Barbara Bergin, MD
Texas Orthopedics
We’ve all been talking a lot about amputations. It’s an operation that doesn’t get much attention in this country. It’s not very glamorous and it’s certainly not cutting-edge technology. We’ve been doing amputations pretty much the same way for a hundred years. In the United States about 40,000 below knee amputations (BKA) and 35,000 above knee amputations (AKA) are done every year! About 70% of those amputations are due to disease, the main culprit being diabetes. About 20% are due to trauma. Those statistics have been gradually changing over the past several decades because of advanced technology with regard to treatment of traumatic injuries of the lower extremities. We learned a lot about the importance of cleaning contaminated wounds in Viet Nam. Just getting a contaminated broken bone cleaned and temporarily stabilized with an external fixator (like the ones you see in the pictures from Haiti) has made dramatic increases in the number of limbs we save here in the U.S. and in other industrialized countries. But again, in Third World countries, amputation remains the mainstay of treatment for these kinds of injuries.
Now an amputation isn’t a simple operation. If not done properly, with adequate bone coverage and just the right amount of muscle padding, fitting and ultimate use of a prosthetic limb can be a problem. So a lot of planning goes into the performance of this operation. And when there is adequate, healthy skin and muscle, this can be done with a relatively predictable outcome.
But traumatic amputations are a whole different ball game. A limb smashing into pavement from a motorcycle accident or being crushed by a collapsed building, such as thousands suffered in Haiti, almost never gives the surgeon an opportunity to perform a textbook amputation. There is always some degree of contamination, torn muscle, stripped skin and exposed bone. This can leave the patient with thin skin and a poorly padded stump, which then can be difficult to fit into a prosthesis and will almost always result in some functional disability and pain. Surgeons want to make every effort to give a patient a BKA because of the energy requirements it takes to function with an AKA (see Dr. DeHart’s blog from 2/22/10). We will often do skin grafts and muscle transfers to cover a little stump of bone in order to give a patient a BKA.
This is doubly important in Haiti, where a BKA instead of an AKA could make the difference in a patient’s ability to work and support him/herself. Many patients are refusing to have second and third operations in order to make improvements to their stump. I can’t blame them. It’s a huge pill to swallow even under ideal circumstances.
Barbara Bergin, MD
Texas Orthopedics
3/1/10 - Team 6, Day 2
Update from Brad Parker, MD:
Just got email. Things going great. Busy today and more people learning about MOH. Surgery working well. Massive thigh I&D, revision wound vac, fem nail revision, open shoulder for chronic dislocation.
Orbit debride on Job was difficult for all. Previous surgery failed for the little guy. Tomorrow, open tib fib, then osteo with questionable septic knee. Tell all that there were a large number of follow ups and I thought the previous surgical work was excellent.
Picture: Job traveling to USS Comfort
2/28/10 - Team 6, Day 1
Update from Brad Parker, MD:
Internet has been down. First and mainly to let all the loved ones know everyone is doing great, no issues at present.
Quick Notes:
-uneventful day
-4-5 OR cases scheduled tomorrow-General wasn't aware there was another OR team coming this week so some pts got sent home. They plan to do more PR to get these pts to MOH this week.
Internet has been down. First and mainly to let all the loved ones know everyone is doing great, no issues at present.
Quick Notes:
-uneventful day
-4-5 OR cases scheduled tomorrow-General wasn't aware there was another OR team coming this week so some pts got sent home. They plan to do more PR to get these pts to MOH this week.
Update from Dave Bryant, MD:
The greatest part of our long day of traveling was the flight from Miami to Haiti. On board was a native Haitian, King Wa Wa, that was returning home after being in the states for 10 years. He so happens to be a fantastic musician and had the whole plane singing as he played in the aisle! Unreal! Once we arrived in Haiti we hit the ground running. The Canadian nurses worked all night in the ward and this morning we began sorting through the supplies that people have so generously donated. We explored where all the supplies are kept and are ready to begin bright and early tomorrow morning. Dr. Parker got to travel on Haiti 1, our ambulance, with Pauline and Rick, our medics. We have our first case lined up for the morning but when he found out he was coming here to have surgery he turned up missing. So…an I & D of a thigh abscess that came from General will be our first case tomorrow and several more are set to come. It has been very hot today, lots of water and lots of sweat. I think we might have even gotten a sun burn. Haiti is beautiful. The people are beautiful and loving and most importantly grateful. We are surrounded by mountains and you can see the ocean from the mission. The resiliency of the Haitian people is amazing considering the stories we have heard just from the people here at the mission. Eric arrived today from Miami. We are so grateful to finally have the whole team together. Some of our team went into the city today and told us about the chaos of the living conditions. The streets are lined with tent cities and the roads are clogged with everything you can imagine. We just finished up with mac and cheese and hot dogs for dinner and the mosquitoes are out. You better believe we have gotten an ear full from the Canadians about their team winning. We are all looking forward to tomorrow and hope all is well there.
Picture: Kristen, King Wa Wa, and Heidi
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