When we arrived at Hospital Adventiste in Haiti it became blatantly obvious that people are continuing to suffer from neglected injuries brought on by the horrific earthquake four months prior. We saw many malnourished children with non-healing wounds who were more than likely nutritionally compromised prior to the earthquake. The combination of neglect, lack of readily available supplies and minimal access to food and water for our patients can be discouraging. As healthcare providers traveling internationally to devastated areas, we can only hope that medical supply companies will stand by our side and assist in providing aid to the impoverished world through generous donations of supplies.
With the help of KCI Wound V.A.C. therapy, many of our grateful patients have been given a chance to rebuild their lives in spite of the physical obstacles surrounding them. Read the rest of the story here on the Behind the Lens blog.
For the fifth day now, Lubin Rosenie waited in the sweltering hallway of Hôpital Adventiste d'Haïti's emergency department, patients buzzing in and out as she held her gut. Dressed in a spotless blouse and crisp denim skirt, her misery was only betrayed by her undone belt and the way her face tightened as she described her worsening symptoms, how the hospital wouldn't remove the fibroids growing in her uterus unless she paid $400. If Rosenie had only come before July 12, the six-month anniversary of the earthquake, when the Haitian government lifted its mandate that all medical care be free, she might have gotten her surgery.
Parts of Rose Monsillac's body seem locked into place, even though she's not paralyzed.
On January 12th, the earth convulsed beneath her and her neighbors homes in Carrefour, Haiti, burying her beneath both. Her leg and finger were crushed, her head gashed open, and she anguished in the hospital hallway for five days before it was her turn to see the doctor.
Now Monsillac, 56, lives inside a tent in the Adventist Hospital's front yard, her muscles rock-hard from being cot-ridden for six months with an external fixator bolted to her leg in three places. More perplexing, her right ring finger has become the source of constant pain even though it no longer exists. It was amputated a week after the earthquake.
Her other four fingers operate perfectly, but to her brain, the missing one seems stuck open, rendering her entire hand useless.
Dr. Altschuler flew into Haiti on Monday with the group Unified for Global Healing, towing 200 one-pound mirrors that cost $16 each, to demonstrate how the low-tech equipment could be used to relieve what’s known as “phantom limb pain."
On the evening of January 12, 2010, a massive earthquake hit Haiti, destroying large chunks of the country and its capital, Port au Prince, killing hundreds of thousands of Haitians, injuring hundreds of thousands more, and leaving millions homeless. Doctors Without Borders/Médecins Sans Frontières (MSF) had been working in Haiti since 1991 and was thus already on the ground. Moments after the earth shook, in fact, MSF staff was treating patients.
And, in the time since, MSF's efforts in Haiti have not let up. Here, they both look back and look forward at the medical and humanitarian needs in Haiti and MSF's activities in the country, focusing in particular on surgery and post-operative care, access to primary care, access to specialized care, and living conditions. Our staff and donors have made possible a response unprecedented in MSF's history of responding to medical emergencies. But we proceed knowing that a great deal of work remains to be done.
Another moving portfolio of Haiti images can be accessed here. The photographer is Tim Freccia who spent the first part of 2010 documenting Haiti’s 7.0 earthquake.
Tim has produced still photography and motion pictures for a number of NGOs and organizations including the UN, CARE, Human Rights Watch, World Vision and the German umbrella fund raising organization Aktion Deutschland Hilft, in Europe, Asia and Africa.
A week after the devastating earthquake hit Haiti, Khalid Mohtaseb of Next Level Pictures was hired to shoot footage for two international networks. This is a montage of personal footage he shot of the aftermath during his spare time, in and around Port au Prince. He was in Haiti for a total of 6 days in which 2 of those days were spent traveling to and from Santo Domingo, Dominican Republic.
Due to the situation on the ground, all the footage was shot in 2 days, under direct sunlight and a great deal of pressure. As demanding as it was, it taught him how to pick shots on the fly, and in "not so perfect" lighting or shooting conditions.
For the techies in the audience, the video was entirely shot with a Canon digital SLR camera.
Two Vancouver, Washington doctors, a husband and wife team, are working to change lives in Haiti at Hopital Adventiste. Doctor Allen Gabriel is a plastic surgeon. Doctor Cassie Gabriel is an anethesiologist. They operate on young Haitians who suffered horrible injuries during the earthquake more than 6 months ago.
Click here to view another interview with Southewest Medical Group team members.
Six months after the January 12 earthquake that devastated Haiti, people still struggle to live. Medecens Sans Frontieres continues to provide a wide range of medical, mental health, and hygiene assistance.
Gary Frykman, an orthopaedic surgeon from Loma Linda/Redlands, Ca, volunteered at HAH earlier this year. Gary travelled to Haiti with his son Eric Frykman, Director of Public Health, Riverside County, CA and Sang Le, an orthopaedic surgery resident from Loma Linda. I had the privilege of spending two weeks at HAH in June and was able bring an outstanding senior resident in orthopedics Sang Le and Rosemary Sullivan OTR an excellent hand therapist from the Loma Linda VA. I was concerned she would not have enough to do but with her energy and ability to be flexible she was plenty busy. She had been a member of the chronic wound team at the VA so she became our lead wound care person especially changing wound VACs. I found that it pays to be adaptable, creative and volunteer to do anything that is needed is the best attitude for any volunteer. Being an upper extremity surgeon I even learned to inset a SIGN nail in the tibia. We even learned to use the complex and sophisticated Taylor special frame used to correct limb deformities.
Sang Le MD with Taylor Special frame on tibia
The Haitians have suffered loss and devastation we would never think of in our worst dreams. Our orthopedic clinic assistant was a teacher, Max, who lost his 425 student school, his house and car in the earthquake. His money he has not been able to get out of the bank since the earthquake. He has four daughters who have just started school again after the earthquake.
An example is the young lady whose forearm was crushed for two days before rescue
Several observations stand out about concerning HAH: The large variety and skills of volunteers sometimes overwhelms logistically the hospital. To their credit, Global Health has worked very with so many and varied organizations who have sent large teams. The day we arrived a group of 16 volunteers from Children’s Hospital Oakland also came, we met a large group from Ukiah General Hospital who had been there for a month. While we were there a group of General surgeons from Brooklyn Hospital came, and a large Jewish Group from Mt Sinai Hospital, Baltimore. We did not have our own expat scrub nurse so we did not get a scrub nurse except for one case. I recommend a surgeon bring his own scrub nurse and anesthesiologist. A strong senior resident also makes life at HAH more livable. The Haitian anesthesiologist only came in at noon so we could not get as many cases done as OR time available.
Even though we were there five months after the earthquake there are still many neglected orthopedic injuries from the earthquake such as three dislocated shoulders, and three dislocated elbows- each dislocated in a different direction, one medial, one lateral and one posterior. We had time go put two of them back surgically. We also took care of traumatic bunion with fractures and dislocations of all the toes and another with a dislocated ankle.
5 month old posterior elbow dislocation
I advise taking pictures of any orthopedic cases you see including the x-rays as the portable digital machine used in clinic does not print films and the images are lost each day after clinic. Incredible more patients are showing up in clinic with CDs of their x-rays from another hospital. You need a laptop in clinic to view the images. We had three patients in one day alone come to clinic with discs with x-ray images. You wonder why but it is cheaper than x-ray film.
The OR was quite well equipped with much excellent Synthes trauma sets including eight Small Fragment sets. We thank especially Synthes for donating millions of dollars of implants and equipment to the HAH along with their ongoing replenishment of sorely needed implants Even so, sometimes the implants had to be modified as seen below cutting a hip implant shorter to fit the intended patient.
NEEDS: The OR did run out of scrub brushes, shoe covers and hats. I recommend getting a pneumatic tourniquet such as the Zimmer one we use every day for safety. We used only the Esmarch but did not know the pressure. I do know of one case we had a post op tourniquet palsy temporarily probably due to prolonged and excessive pressure by the Esmarch.
Although short term volunteers can make a difference in the lives of a few patients, the real difference is made by the long term staff such a Brooke and Luke and Scott Nelson and now my friend Mark Perlmutter, orthopedic surgeon from PA. who have made long term commitments. HAH is being recognized as a facility that can take care of difficult cases. We were seeing many referrals of complex orthopedic cases to HAH on a daily basis. God willing, the real success of HAH will be the long term dedicated staff supplemented by some short term enthusiastic and capable volunteers. I believe HAH has the potential to become the leading reconstructive surgery hospital in Haiti.
Sylvia Kohler is a Registered Nurse who spent time volunteering at Hopital Adventiste in April of this year. The excerpt below is from her blog A Story of Haiti.
As I traveled to the airport past the rubble and devastation, the enormity of the need and unimaginable loss was overwhelming. And I could not help but wonder about the road ahead for the people of Haiti. Mother Teresa’s words came to mind; “We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop.”
The following post was authored by Dr Scott Nelson and further affirms the effectiveness of the VAC technology in wound therapy and the vital role it has played for the orthopaedic patients of Hopital Adventiste.
The benefits of V.A.C.® (Vacuum Assisted Closure®) Therapy, also known as NPWT (Negative Pressure Wound Therapy) are widely known. This relatively new technology became available in the United States the 1990's and has revolutionized the way we do wound care. Now this technology has arrived at Hopital Adventiste d'Haiti where we have one of the busiest orthopaedic and reconstructive services in the city of Port au Prince. We thank KCI for their generous donation of 10 VAC devices and the accompanying disposables. Our goal is to provide top quality care to the patients we serve and this donation brings a major advancement to the treatment of the many chronic wounds and bone infections that we are seeing due to the Jan 12 earthquake as well as subsequent trauma. It is exciting to give the very best to our patients who have suffered so much.
The stories speak for themselves - these are a few of the many.
Guillame above is a 4 year old girl who had severe osteomyelitis of her right forearm. A large amount of dead bone had to be removed however the prognosis is good and with the VAC therapy she only needed to be in the hospital for 1 week.
Luckson is a 21 year old male pictured above with his sister and Rosemarie, an occupational therapist from Loma Linda, CA. Luckson had a severe open fracture in the earthquake and was treated elsewhere with a tibial rod which became infected. The implant was removed as well as all infected material, the bone was stabilized with an external fixator and at a later date bone grafted. The VAC has played an essential role in the salvage of his leg which may have been amputated given other circumstances.
It even works for the little ones like this 2 year old girl above who suffered from osteomyelitis of the tibia and was going to need several sophisticated operations to treat her large wound until the VAC came along and it completely healed her without further surgery.
This young lost his R leg in the Jan 12 earthquake but because of the VAC and a skin graft we were able to save the knee and an adequate amount of bone below in order for him to have a much simpler below the knee type of prosthesis. He is seen above in a tent in front of the hospital.
Pictured above is Mirlanda, an 11 year old girl that is well known at our hospital as we have been battling a very severe infection in her R femur that was fractured in the earthquake. The VAC has played a vital role in her healing.
The VAC has become a badge of honor amongst our patients and they often ask before surgery "are you going to give me one of the machines?".
Thank you to KCI and the wound care nurses and surgeons who have been instrumental in helping bring this technology to those in need.
The following article was written by Alyssa Jeffers and was recently published in the Baltimore Jewish Times. Team Sinai returned from a volunteer stint at Hopital Adventiste earlier this year.
“We take for granted what we have here — food, clean drinking water, state-of-the-art medical equipment, even oxygen,” says Dr. Aaron Zuckerberg. “They don’t have any of that, and yet they don’t complain.”
Last January, a magnitude 7.0 earthquake rocked Haiti, a poor Caribbean country the size of Massachusetts. Approximately 230,000 people died, and there was widespread damage, particularly in the capital of Port-au-Prince. Since then, relief has poured in to Haiti from all over the world, including a recent volunteer group from Sinai Hospital of Baltimore.
Dr. Zuckerberg and Dr. John E. Herzenberg, along with 16 other Sinai-affiliated doctors and health care workers and volunteers, as well as some of their family members, traveled to Port-au-Prince to help take care of injuries sustained in the quake. They were there from June 11 to 17.
Getting to Haiti was not easy because of airline restrictions, according to participants. Not allowed to transport crates, extra bags and narcotics, they said the team worked around the clock to pack three bags per person — for food, clothing, and necessary gear and supplies.
Upon arrival in Port-au-Prince, they said they immediately saw tents lining the streets and roads covered in sewage. Trash removal was provided only by wild pigs roaming the areas, they said.
Dr. Herzenberg, head of pediatric orthopedic surgery at Sinai and director of the International Center for Limb Lengthening, said Haiti was “orders of magnitude worse” than what he has seen on 13 other relief missions. He said Haiti was “three levels worse” economically than prior to the disaster.
The Sinai team was based at Adventist Hospital in the capital. During 6 1/4 days, they performed 54 surgeries, on little to no sleep. Dr. Zuckerberg, a pediatric anesthesiologist/intensivist who is director of the pediatric intensive care unit at Sinai, performed anesthesia on 31 of the patients, while Haitian medical personnel anesthetized the rest.
“Normally, [anesthesiologists] get the day off after a late night, but not here,” said Dr. Herzenberg. “Aaron would work all day, get a few hours of sleep, and be up again bright and early the next morning. He personally saved the lives of two patients. He went above and beyond what he was trained to do and performed two very important surgeries. With any other anesthesiologist, those two patients would have died.”
The team grew particularly close to an 8-year-old girl named Mia (pictured below).
“Every mission I go on, there is one patient that sticks out in your mind,” said Dr. Herzenberg. “[Mia] had been struck by a car and broke her femur. Her leg from the knee down was completely dead. She had a fractured femur that was completely infected. She was very anemic, with her hemoglobin down at 3.5 [the normal value is 15].”
The Sinai team operated on Mia four times. “She needed blood, but it was taking too long,” said Dr. Herzenberg. “My wife [registered nurse Merrill Chaus] donated her own blood in order to receive blood for Mia. During the transfusion, Mia began bleeding profusely. She had citrate poisoning, meaning her blood wouldn’t clot. That night we decided to operate, even though we had wished to do it the following morning.
“I was convinced she was going to die on the table,” he said. “Thankfully she didn’t, and we successfully amputated her leg. We took her back two days later to redress her and see how things were doing. There were bits of dead tissue we missed the first time, so we went in to clean them out. Suddenly, the femoral artery burst and was spewing everywhere. With the team working together, we saved her. The next morning, we went to check on her before we left, and she was sitting up brushing her teeth.”
Despite language and cultural barriers, the team communicated with Haitians “through smiles and laughter,” as Dr. Herzenberg’s daughter, Brittany, put it to Dr. Zuckerberg.
Team members were particularly impressed by the Haitians support for each other. They said nearly every patient had at least one family member with them at all times, and if a patient did not have any relatives, a stranger would step in to help. In addition, the team members said they were impressed by the Haitians’ commitment to their faith system and respect for other religions.
“The Haitian nurses and doctors pray before every operation and have a prayer service every morning,” said Dr. Zuckerberg, who was one of the shomer Shabbatteam members. “They tried incorporating Judaism into common practices, making it very workable. There was an understanding that life-saving operations fell under the umbrella of work allowed on the Sabbath.”
At the end of the trip, all of the team members were in tears. “We were all very touched by this,” said Dr. Zuckerberg. “We were all crying when we left. We all want to go back. The question isn’t if, it’s when.”
Dr Nelson and his family are back in the United States and he recently wrote the following update regarding the continuing orthopaedic coverage at Hopital Adventiste.
We won’t call it the “final return” as we already have a trip planned to work again at Hopital Adventiste d’Haiti in August. Nonetheless, the one way ticket symbolizes the close of an era where Hispaniola was home, and the beginning of another, where now we will be merely short term volunteers or tourists when returning to the Dominican Republic and Haiti. The freedoms of lawless driving, inner city living, and caring for gracious Dominicans and Haitians will be on hold.
We leave behind friends who have taught us to value love and relationships as much as the American ideals of performance and production. The difficulties of adaptation will hopefully be softened by our ability to hold on to these world views and remain strong in our intentions to live conscientiously, not forgetting the hardships, suffering and love that we have seen during the past 5 ½ years.
December 30, 2004 En Route to Santo Domingo (NYC subway station) - Chad 7, Alex 5
July 6, 2010 Arrival Los Angeles - Alex 11, Chad 13
I would like to strengthen LomaLindaUniversityMedicalCenter’s position as a referral center for patients with complex limb and spine deformity. Developing a center of excellence for the correction of congenital limb deformities, limb lengthening, and pediatric spinal deformity, as well as post traumatic limb deformities, bone deficits and nonunions will provide a unique service to patients in the region who often have very few options. This will also form a strong foundation for the education of the orthopaedic residents interested in a variety of subspecialties.
Cure Dominicana continues with the medical leadership of Dr. Ted Beemer. Later this year plans are in place for transitioning his responsibilities to Dr. Dan Ruggles who is a previous resident of mine and subsequently did a pediatric orthopaedic fellowship in Los Angeles. They will continue to need the support of short term specialists as well as those willing to donate their time and resources. The success of that program and the children who have had life changing surgical treatment at that hospital have depended on the expertise and sacrifices of all of us.
The more recent collaboration since the earthquake at Hopital Adventiste d’Haiti continues on as well. A current transition from large volumes of short term earthquake relief volunteers towards a model of medium and long term volunteers with local staff integration is in progress to develop a sustainable program. The hospital has developed a reputation as a premier center for orthopaedic and reconstructive surgery. Orthopaedics is currently being staffed by Mark Perlmutter MD who will hopefully be staying until November when Terry Dietrich MD and his wife Jeannie RN, come to serve on a long term basis. Nathan Lindsey from Loma Linda is serving as assistant administrator along with the tireless work of Brooke Beck RN who continues to provide an essential service at the hospital.
The following post was penned by Dr Nelson and documents an unfortunate turn of events with respect to volunteers transporting medical supplies. Please reconsider our previous recommendation in light of this new information.
All volunteers coming to the Dominican Republic and Haiti please be aware of heartless airline agents that will cancel your flight if you are not packed in the appropriate containers.
Whether you're traveling to visit loved ones or making one last business deal, we want to make sure that your checked bags arrive at your destination with you this busy travel season. For that reason, American Airlines and American Eagle will implement limitations on checked baggage and boxes from June 5 - August 24, 2010.
For the destinations identified below, boxes† and excess, overweight (more than 70lbs.), or oversized pieces will not be accepted for transportation. Bags weighing 51-70 lbs. will be accepted with the collection of the applicable charge.
Passengers will be allowed to check a maximum of two pieces which must be within the size and weight limits as follows (dimensional measurements calculated by adding the length, width and height of an item):
1st piece - up to 62 dimensional inches and 50 lbs.
2nd piece - up to 62 dimensional inches and 50 lbs.
†A "box" will be defined as a six-sided container of any size, constructed of cardboard, wood, plastic or metal, which is either square, rectangular or cylindrically shaped and is not normally used for the transportation of items associated with air travel. Plastic tubs/containers and/or coolers are considered to be boxes.
This is a plastic "suitcase" with handles and wheels - acceptable
This is a plastic "box" with handles and wheels - not acceptable
This is a Pelican suitcase with handles and wheels - who knows??
In spite of the six sided and shape definition above it is still unclear what really makes a suitcase a suitcase and a box a box. Maybe it is names like Samsonite and American Tourister instead of names like Rubbermaid and Plano that make a difference. If you want to really be safe cover it in canvas.
The following post on Team Sinai was writen by Dr Scott Nelson, Director of Orthopaedics at Hopital Adventiste.
Without using superlatives at the risk of offending our many other wonderful volunteers that we have hosted Haiti, I will say that the recent visit of "Team Sinai" was one of the most impressive to date. This team of 18 people from the well known International Center for Limb Lengthening at Sinai Hospital in Baltimore was led by Dr John Herzenberg and his wife Merril. Although their stay at Hopital Adventist d'Haiti was only a brief 7 days their volunteer activities started long before and still continue. Due to their extensive trip preparation they came knowing what to expect, properly equipped and even speaking some Creole phrases.
From patient nutrition to clocks on the wall, they came prepared with all the details. The extensive array of surgical equipment and medical supplies that they brought were essential for performing a variety of surgical procedures. During their stay more than 50 surgical cases were realized. In addition to the surgical accomplishments, they enhanced the entire infrastructure to support our patients before and after surgery, and assure good outcomes. Merril even risked a trip across Port au Prince in a taptap to donate her own blood for one of our critical patients.
In spite of volunteers subsidizing the once a day meal cost for our patients, proper nutrition in many of our critically ill patients has still been a challenge. Merril was able to acquire a large supply of Plumpy Nut which the team Sinai members used to top off all of their baggage to the maximum weight restrictions. She also procured the donation of a similar product Medika Mamba which is produced in Haiti and was delivered in a large quantity to our hospital during their stay. Our Haitian patients found both of these products to be quite appealing and made significant progress on their nutritional status and wound healing.
Cases during the week included open reduction of fractures, pedicle screws for a spine fracture-dislocation, hemiarthroplasties for femoral neck fractures, percutaneous pinning of femoral neck fracture, SIGN interlocking nails for acute and old tibia and femur fractures, osteotomies for malunion/nonunion, bone grafting of nonunions, growing rods for osteogenesis imperfecta, external fixator cases, Ilizarov bone transport, wound debridement, VAC changes, and elective clubfeet surgery.
Dr Herzenberg, who is sought after internationally for his treatment of clubfoot chiefed our Wednesday clubfoot clinic. Mothers who had traveled across Port au Prince, patiently waited for hours, then departed graciously after their children were casted. Although content and thankful little did they know the world class service that they were receiving.
The shared belief of the Jews and Adventists to remember the Sabbath day was a highlight of the week. At sundown on Friday night candles were lit in the Jewish tradition and time was taken to rest. Several emergent cases were necessary to perform on the Sabbath holiday, but this special time of the week helped us to reflect on the real reason we are here to serve - for the our love of God and our fellow man.