Dr. Joel Hurt and his wife Ashley, champions of the Austin Medical Relief for Haiti efforts, are leaving PAP today to return to Austin. Here's an update from Ashley:
We are so sad that we are leaving today. It has been a full three days and flown by so fast. Life here is different and wonderful. Church was amazing! The singing is beautiful and the Haitian people really get into the music. Yesterday we oriented the team to the clinic and did a major overhaul on supplies. Trying to get organized and situated. There are A TON of supplies. A blessing and a curse. There is a cirus tent full of supplies that are spilling out of. The school house still has tons of supplies in it, a huge hoop barn that was set up for supplies is now half way full and we have central supply room in the clinic stocked with supplies. It is a daunting task and we will now staff people on our weekly teams just to be a head of it and master it. Supplies are expiring and now unable to use simply because we don't know what we have. What a waste.
AC and water pressure are two things I miss. Our shower drips and is often filled with cockroaches at night...ugh, gross. I kill them and then do an icky dance before I'm able to pick them up and flush them. Last night I was greeted by a mouse when I entered the room. EEK was truly my response. I couldn't see a hole in the wall so I'm pretty sure he slept in our mattress with us.
The sun rises at 5 am daily. By 530 it is bright! Sets around 630. This is pretty much unchanged year round. We went into a local city near MOH for lunch yesterday. It was good Haitian food and they people were lovely.
Yesterday we changed Job's dressing and found his skin graft on his orbit to be necrotic so we removed it. Poor guy has two skin graft sites on his thighs with nothing to so for it. This is the second failed graft. We decided to sedate him to do the procedure which was much easier on everyone. He left this morning for Dell in Austin. Smider the baby with hydrocephalus was on the same flight. We put a lock, IV, in Job yesterday so we could give him a sedative for the flight. I went down at 645 to check it. It's patent and working. His "mommy" was bathing him and getting him dressed in his church clothes. He looked so handsome and was so proud. He's never worn anything like this before. He had slacks and a long sleeve yellow shirt with shiney black shoes that were probably 2 sizes too big. He jumped down and did a little dance for us in his new shoes. All the kids from the orphanage came by to see him off. We took a picture. Please pray for his flight home. Two amazing men, middle aged, no medical training, will be flying with Job and Smider to Austin. They tried to get Joel and I on their flight but it was full. The mommies are so sad to see their babies go and asked to bring them new babies to care for. They loved Job and Smider but understand this is the best for them.
Monday, March 29, 2010
Sunday, March 28, 2010
3/28/10 - Team 10 is on the ground!
Team 10 is on the ground at MOH today!
Tom Jackson, MD - emergency physician - Austin
Ann Soo, MD - internal medicine, retired - Austin
Sara Khanzadeh, PT - wound care - Austin
Rosie Wustrack, MD - orthopedic surgery 4th yr resident - San Francisco
Joined by Mercy Ships team of nurses - Melody Phelps, Mary Cade, Denise Piper, and Judy Teague, paramedic Bonnie DiSalvo, physical therapist Helen Day (UK-week 2!).
This is Dr. Nathalie Fiset's (Canada) last week at MOH.
Bob Kertcher, paramedic with Halton Medics in Canada will join the team Tuesday.
Lastly, this weekend marks the first rotational weekend of our leadership physicians. Dr. Hurt and Ashley Hurt arrived at MOH this past Friday to assess current needs and help form the ongoing strategy for medical services at MOH. They will return to Austin tomorrow.
Tom Jackson, MD - emergency physician - Austin
Ann Soo, MD - internal medicine, retired - Austin
Sara Khanzadeh, PT - wound care - Austin
Rosie Wustrack, MD - orthopedic surgery 4th yr resident - San Francisco
Joined by Mercy Ships team of nurses - Melody Phelps, Mary Cade, Denise Piper, and Judy Teague, paramedic Bonnie DiSalvo, physical therapist Helen Day (UK-week 2!).
This is Dr. Nathalie Fiset's (Canada) last week at MOH.
Bob Kertcher, paramedic with Halton Medics in Canada will join the team Tuesday.
Lastly, this weekend marks the first rotational weekend of our leadership physicians. Dr. Hurt and Ashley Hurt arrived at MOH this past Friday to assess current needs and help form the ongoing strategy for medical services at MOH. They will return to Austin tomorrow.
Monday, March 22, 2010
We Live in Good Times
Post provided by Barbara Bergin, MD
It’s really amazing to see all the external fixators being used in Haiti. That surgical procedure has revolutionized the treatment of open fractures (broken bones which have penetrated through the skin or have had something penetrate the skin to contaminate them).
I can remember in my residency (early 1980s) we were treating open fractures in traction or with casts. We would cut big holes in the casts so we could have access to the wounds in order to clean them. We had to fashion little doors out of the cast material so we could get to them a couple of times a day. The little “doors” were needed because if you just left a hole in the cast, the injured skin and muscle would swell up into the hole, like rising bread, and then you’d have a bigger mess on your hands.
I can tell you that there were a lot less open fractures back then. We just didn’t see the number of high energy trauma cases we see now; motorcycles and high speed car accidents were not as common. We also did a lot more amputations! Without external fixators, we just couldn’t take care of the wounds like we can now! External fixators were in the making though. Orthopods are tinkerers and we would put big pencil-sized pins through the bones above and below the break and then hold them apart by making outriggers of twisted plaster over wire, or whatever interesting polymer we could find around the operating room or the mechanical room in the basement of the hospital.
While I did my rotations at the Veteran’s Administration hospital, I saw many veterans of WWII with chronically infected wounds they received while fighting in the European and Pacific fronts. Sometimes, instead of having amputations, they would opt to keep their legs, but the exposed bone would have become infected. If the bone healed, despite the infection (most of the time infected bones won’t heal) then they would just spend the rest of their lives with pus draining out of their leg. They would walk around with big dressings covering the hole in their leg in order to absorb all the liquid that poured out! It was really quite incredible. Our veterans were in their 60s then! Imagine young men suffering those wounds in their 20s and living with them that long. They would keep that leg along with all its problems, rather than have an amputation.
Then to add insult to injury, chronically infected wounds are susceptible to getting a form of skin cancer, so we always had to check them for that. By the 80s, those veterans had been walking around with their wounds for about 40 years!
Now just because we can put external fixators on the unfortunate folks in Haiti, it doesn’t mean they’re all going to get to keep their legs. Nor does it guarantee them to be free of the potential for infection, but it sure gives them a better chance than if we weren’t using them. We do live in good times.
It’s really amazing to see all the external fixators being used in Haiti. That surgical procedure has revolutionized the treatment of open fractures (broken bones which have penetrated through the skin or have had something penetrate the skin to contaminate them).
I can remember in my residency (early 1980s) we were treating open fractures in traction or with casts. We would cut big holes in the casts so we could have access to the wounds in order to clean them. We had to fashion little doors out of the cast material so we could get to them a couple of times a day. The little “doors” were needed because if you just left a hole in the cast, the injured skin and muscle would swell up into the hole, like rising bread, and then you’d have a bigger mess on your hands.
I can tell you that there were a lot less open fractures back then. We just didn’t see the number of high energy trauma cases we see now; motorcycles and high speed car accidents were not as common. We also did a lot more amputations! Without external fixators, we just couldn’t take care of the wounds like we can now! External fixators were in the making though. Orthopods are tinkerers and we would put big pencil-sized pins through the bones above and below the break and then hold them apart by making outriggers of twisted plaster over wire, or whatever interesting polymer we could find around the operating room or the mechanical room in the basement of the hospital.
While I did my rotations at the Veteran’s Administration hospital, I saw many veterans of WWII with chronically infected wounds they received while fighting in the European and Pacific fronts. Sometimes, instead of having amputations, they would opt to keep their legs, but the exposed bone would have become infected. If the bone healed, despite the infection (most of the time infected bones won’t heal) then they would just spend the rest of their lives with pus draining out of their leg. They would walk around with big dressings covering the hole in their leg in order to absorb all the liquid that poured out! It was really quite incredible. Our veterans were in their 60s then! Imagine young men suffering those wounds in their 20s and living with them that long. They would keep that leg along with all its problems, rather than have an amputation.
Then to add insult to injury, chronically infected wounds are susceptible to getting a form of skin cancer, so we always had to check them for that. By the 80s, those veterans had been walking around with their wounds for about 40 years!
Now just because we can put external fixators on the unfortunate folks in Haiti, it doesn’t mean they’re all going to get to keep their legs. Nor does it guarantee them to be free of the potential for infection, but it sure gives them a better chance than if we weren’t using them. We do live in good times.
3/21/10 - Team 9, Day 1
Update from Sheryl Lucier, PA:
Good evening from Team 9 MOH Haiti. We arrived late today, after getting in to San Juan at 3am!! But we were so glad to be at the mission. Lindsey gave us the tour of the compound at 3pm, so we are hoping for a good night sleep so we are ready for a busy clinic tomorrow. There seem to be an abundance of supplies….but a lot of organizing, inventorying needs to be done. There is no formulary, so we will just have to ask tomorrow to see what is available. There is a very small group here this week compared to past weeks…but more will arrive during the week.
The city of POP is much less congested as compared to before the earthquake, due to so many deaths, and people leaving the city to live in tents because they lost their homes or they are afraid to be inside them, or because that is where the food comes.
On Sunday afternoon the children from Hope House come to the guest compound to play ….so there are many children around tonight.
Good evening from Team 9 MOH Haiti. We arrived late today, after getting in to San Juan at 3am!! But we were so glad to be at the mission. Lindsey gave us the tour of the compound at 3pm, so we are hoping for a good night sleep so we are ready for a busy clinic tomorrow. There seem to be an abundance of supplies….but a lot of organizing, inventorying needs to be done. There is no formulary, so we will just have to ask tomorrow to see what is available. There is a very small group here this week compared to past weeks…but more will arrive during the week.
The city of POP is much less congested as compared to before the earthquake, due to so many deaths, and people leaving the city to live in tents because they lost their homes or they are afraid to be inside them, or because that is where the food comes.
On Sunday afternoon the children from Hope House come to the guest compound to play ….so there are many children around tonight.
Sunday, March 21, 2010
3/21/10 - Team 9 is on the ground!
Team 9 marks a transition in Mission of Hope post-earthquake medical care. Going forward, our operative weeks will occur once per month, followed by a week of recovery for inpatient care and finishing the month with a focus on primary care and community health.
Team 9 volunteers arriving in Haiti include:
ER physician: Ashley Kumar, MD (Austin-Dell Children's)
Physician Assistant: Sheryl Lucier, PA (Georgetown-Dermatology)
Ann Parsons, RN (San Antonio-Home health)
Dawn Hallock, RN (Virginia-ER nurse)
Helen Day, PT (UK-coming with Mercy Ships)
Nicky Chovaz, paramedic (Canada-Halton Medics)
Dave Ryckman, paramedic (Canada-Halton Medics)
They are joined by Team 8 team members who are staying on at Mission of Hope for another week:
Nathalie Fiset, MD (Canada)
Bridget Russell, RN (Austin-St. David's NICU)
Team 9 volunteers arriving in Haiti include:
ER physician: Ashley Kumar, MD (Austin-Dell Children's)
Physician Assistant: Sheryl Lucier, PA (Georgetown-Dermatology)
Ann Parsons, RN (San Antonio-Home health)
Dawn Hallock, RN (Virginia-ER nurse)
Helen Day, PT (UK-coming with Mercy Ships)
Nicky Chovaz, paramedic (Canada-Halton Medics)
Dave Ryckman, paramedic (Canada-Halton Medics)
They are joined by Team 8 team members who are staying on at Mission of Hope for another week:
Nathalie Fiset, MD (Canada)
Bridget Russell, RN (Austin-St. David's NICU)
Friday, March 19, 2010
Refuge in the Haiti Hills
Poem by Maggie El-estwani, RN:
Early morning solitude in the hills -
earth browns, ochre reds, limestone white
and dotted with dusty shrub and grasses.
Cradling coffee mugs and
sitting in companionable silence and low voices at breakfast.
Some in prayer and meditative reading.
The bright sun rises over the hills.
The wind blows mimosa branches briskly
in the stone courtyard.
Through the quarter-open gate,
wilderness and a glimpse of the city and sea,
and our EMS ride Haiti One.
And I remember why we've come,
this Lent to join a mission of hope
to Haiti after the quake.
Intertwined white and fuchsia bougainvillea
are splayed over the simple wrought iron fence,
backdrop to aid worker tents.
Later in the morning the children will fly kites
and mount wild ponies
to scramble on the rocky paths;
And at the ward and clinic,
the women will break into song.
The hills join in chorus -
gather your strength, your inner joy and deep faith.
Morning breaks again.
-Tintayen, Haiti
March 2010
Early morning solitude in the hills -
earth browns, ochre reds, limestone white
and dotted with dusty shrub and grasses.
Cradling coffee mugs and
sitting in companionable silence and low voices at breakfast.
Some in prayer and meditative reading.
The bright sun rises over the hills.
The wind blows mimosa branches briskly
in the stone courtyard.
Through the quarter-open gate,
wilderness and a glimpse of the city and sea,
and our EMS ride Haiti One.
And I remember why we've come,
this Lent to join a mission of hope
to Haiti after the quake.
Intertwined white and fuchsia bougainvillea
are splayed over the simple wrought iron fence,
backdrop to aid worker tents.
Later in the morning the children will fly kites
and mount wild ponies
to scramble on the rocky paths;
And at the ward and clinic,
the women will break into song.
The hills join in chorus -
gather your strength, your inner joy and deep faith.
Morning breaks again.
-Tintayen, Haiti
March 2010
Thursday, March 18, 2010
Just How Do You Fix a Broken Bone?
Post provided by Scott Smith, MD
Orthopedic surgeons treat many types of problems with the human body. One of the most common is a fracture commonly known as a broken bone. In Haiti or any where else for that matter; when a rock house falls on a leg, bones are going to break. A large part of the work done by physicians in Haiti has been "fixing " these fractures. Well just how do you "fix" a fracture?
Bones have an inherent capacity to heal. Typically this occurs more predictably and faster if the fractures are stabilized or held still. The most effective pain relief for a broken bone is to prevent it from moving. There are many ways to do this. We all know about a cast. This is some sort of rigid material (plaster or fiberglass) wrapped around the arm or leg to provide the support needed. This works great for hand and foot or ankle fractures but not so great for thigh or arm fractures. Also if a bone is displaced or aligned incorrectly then it must be reduced or replaced and held there. Casts can't always do this. If the bone has broken through the skin, or if there is skin damage then a cast is less then ideal as it does not allow access to clean and care for the wound.
At this point frequently an external frame is assembled and used to stabilize the bones. Essentially the external fixation entails using large (5 milimeter) pins or screws and drilling them into the bone above and below the fracture. Then attaching a metal bar external or outside the skin to the pins. This frame acts as a new skeleton to stabilize the broken parts. It also allows the skin wounds to be cleaned and dressed without destabilizing the fracture. Another advantage is that no further "damage" is done to the soft tissues by actually cutting around the fractures to expose the bone for the placement of plates and screws directly on the bone also known as internal fixation. The advantage of internal fixation is the bones can be precisely aligned but open incisions must be made to do so. This is sometimes not advisable due to the risk of infection and problems with open wounds.
Another older technique is traction. Just like it sounds, traction is a method of fracture stabilization where a pin is placed through a bone and a weight is hung from the pin to provide a pull on the bone holding it "still". This is a rarely used technique in modern medicine, but still has its place in some injuries.
In Haiti, due to the type of injuries (crush) and difficult living conditions (high infection risk) many fractures were treated with external fixation. These frames will probably stay on for >3 months and then be removed. Hopefully with most of the fractures healed. If they have not healed, reconstructive surgery with bone grafting will be necessary.
Each fracture has its own personality. Each orthopedic surgeon has their own "style" or preference for fracture management. There is always more than one way to get the job done . God has designed a pretty good system for healing injuries so usually function can be restored by these techniques.
Bones have an inherent capacity to heal. Typically this occurs more predictably and faster if the fractures are stabilized or held still. The most effective pain relief for a broken bone is to prevent it from moving. There are many ways to do this. We all know about a cast. This is some sort of rigid material (plaster or fiberglass) wrapped around the arm or leg to provide the support needed. This works great for hand and foot or ankle fractures but not so great for thigh or arm fractures. Also if a bone is displaced or aligned incorrectly then it must be reduced or replaced and held there. Casts can't always do this. If the bone has broken through the skin, or if there is skin damage then a cast is less then ideal as it does not allow access to clean and care for the wound.
At this point frequently an external frame is assembled and used to stabilize the bones. Essentially the external fixation entails using large (5 milimeter) pins or screws and drilling them into the bone above and below the fracture. Then attaching a metal bar external or outside the skin to the pins. This frame acts as a new skeleton to stabilize the broken parts. It also allows the skin wounds to be cleaned and dressed without destabilizing the fracture. Another advantage is that no further "damage" is done to the soft tissues by actually cutting around the fractures to expose the bone for the placement of plates and screws directly on the bone also known as internal fixation. The advantage of internal fixation is the bones can be precisely aligned but open incisions must be made to do so. This is sometimes not advisable due to the risk of infection and problems with open wounds.
Another older technique is traction. Just like it sounds, traction is a method of fracture stabilization where a pin is placed through a bone and a weight is hung from the pin to provide a pull on the bone holding it "still". This is a rarely used technique in modern medicine, but still has its place in some injuries.
In Haiti, due to the type of injuries (crush) and difficult living conditions (high infection risk) many fractures were treated with external fixation. These frames will probably stay on for >3 months and then be removed. Hopefully with most of the fractures healed. If they have not healed, reconstructive surgery with bone grafting will be necessary.
Each fracture has its own personality. Each orthopedic surgeon has their own "style" or preference for fracture management. There is always more than one way to get the job done . God has designed a pretty good system for healing injuries so usually function can be restored by these techniques.
Picture: Drs. Hurt, Le, Smith and Joseph putting on an external fixator
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