Day 7 - Frustration and Hopelesnes

Today was a tough day, for many reasons. With the full moon last night the animals were wild last night, dogs barking and roosters crowing all night long. Think I got about 3 hours of sleep.
We didn't stick around for Sunday mass because we were supposed to start in the or at 8 am. We piled into the truck and headed to town, it was amazing to see everyone dressed in their Sunday best heading to church. We passed many different churches on the way to the hospital. We had hoped to do a number of cases today, but when we hot to the hospital no patients were there! We waited and we waited, but no patients! So frustrating. The team that showed up yesterday, dr newfield and 2 nurses, headed to the er to see if there was any work to be done. We headed to the clinic to check on our postop patients from yesterday. Many were laying on a blanket on the floor in the hallway because there were no beds. What is upsetting is that the meds that we ordered for our patients, were not given to them. The nurses told the families that they needed to go buy their medications and pay for the postop xrags! There is a ton of donated medications and crutches that are to be given to the patients but are not getting there. Turns out that the nurses are getting the meds from the depot but don't give them to the patients, they are most likely selling them! Hard to believe that they are doing this!
When the patients finally started to show up, we got the ball rolling in the or. Some of us spent the morning rounding with Dr Alexi. To say it was overwhelming is an understatement. We saw so many unbelievable sites, from anthrax infections of the eye to infected amputations. We saw post op xrays from some of the other teams, some were great others were apalling. So hard to get things right without fluroscopy in the or. I don't blame the other teams, but at some point we surgeons need to check the work and fix what isn't acceptable. Too easy to just do the case and walk away and not spend the time following the patients. That is my greatest concern about this whole catastropy, we come in trying to help, but the system is overwhelmed and we as surgeons need to make the time to follow the patients. It is far to easy to just do the case and walk away or do another case. We need to spend just as much time following the post op patients ad doing the surgeries. The local docs don't have the time to care for all the patints in the hospital. I think the biggest problem is lack of leadership. If I can do nothing else
while I am here, I hope that I can at least organize the people that are here at our hospital to get everything done as efficently as possible. Ideally I could help to organize the other volunteers here at the other hospitals too, but it is hard because you don't want to take over from the hatians and make us look like arrogant Americans. Such a fine line to walk between caring for the patients and not overstepping your welcome.
There is still so much to be done. I'll try to post some photos, if you have a weak stomach you may not want to look.

this is a girl with anthrax of her eye!

This young man had compartment syndrome of his arm and a late fasciotomy, now with necrotic muscle of the majority of his forarm and no sensation in his hand.

this gentleman had his arm trapped when a building collapsed in PoP. Someone came by and cut his arm off with a knife. now he has an infected amputaion of what is left of his arm! Yummy

this poor woman we found on the ward today. as you can see she seems fairly happy. Despite the fact that she has an above knee amputation on the right. what you cant see is that she has a badly fractured Left femur fracture that no one is treating. We are going to fix that tomorrow so she at least has a leg to stand on. ( bad joke)

This is one of the wards, you can see all the family members there taking care and feeding the injured patients. These are the lucky ones that get beds, others are laying on the floor in the hallways.

Hello, my name is Mona and I'm working on steve's team as a recovery room nurse which I thought would be usefull but found out differently. I've ended up being an anesthesiologist assistant to our anesthesiologist because there is such a lack of equipment and no monitors to speak of therefore he needs more assistance than he would in the states. When I finally did bring a patient back to what should be a recovery room, the conditions were deplorable. We bring people to large wards of 20 or 30 beds and find that they are actually lucky to have a bed. I often bring them to a rolled out rug on the floor or a sheet layed out on the floor. Family members and not nurses are caring for Them if they are lucky enough to have anyone. I brought a female back to a ward today who had no family, her bed sheets were soaked with blood, there was no staff or supplies available to clean her up. It is very hard to leave these patients who's IVs have run dry, are having substantial pain and are not given pain meds, our docs are opening dressings and finding infected amputated stumps and wounds and finding that antibiotics hadn't been given. We can only do the best we can and hope that some good comes from it.

Day 6 - Not your usual Saturday!

I was ready to kill the friggin rosters last night. I need a pellet gun to scare them away! No one slept very well because of the noise. We headed to town early in the hope of meeting the seaplane that was bringing in supplies and picking up the Michigan team. But there was no plane in the bay when we got there. We headed to the hospital to get started on another busy day. Hector started off with a distal radius fracture, while I worked on a distal tib/fib fracture. Did I mention that we had no power and no airconditioning in the OR! Not fun! Ron, Mona And cynthia all pitched in to help get everythng done.

It goes without saying that both fxs were from January 12th, bad mal reductions. With what little equipment we have we were able to fix them. It was hard to take my patient back to his "room" only to find that his room was on the floor in the hallway! His family was waiting with food to take care of him, he had been waiting 5 days to have his surgery!
We tried to do as many cases as we could today. We saw lots of people between cases and were able to add on a few cases that really needed to be fixed.
The most heart wrenching was the cousin of Dr Alexi's. She was injured in PoP when she was crushed in a nuDilding collapse. She had it looked like she had compartment syndrome in her leg. She said at 8 days after the earthquake a doctor did fasciotomies to save her leg! for those of you who are not medical, compartment syndrome is when the muscle in your leg is injured and starts to swell, it swells so much that it kills the muscle and nerves in the area of the swelling. Normally we treat this within a few hours, after that there is not much we can do to save the leg. This poor woman is a beautiful 27 year old, but her leg was insensate from the knee down. Dr. Alexi was in a horrible position, someone did an ultrasound that showed the arteries still open, so they hoped to save her leg. It was fairly obvious that we would not be able to save her leg. He decided to try to save her leg. I worry that she will get septic, we will follow her every day to see how she does.
We fixed an infected comminuted femur fx and a 2 week old open humerus fracture. It didn't seem like we did enough but writing about it it does seem like a lot.
Another team showed up today, they are from Atlanta, turns out the Ortho guy did the same sports fellowship as me 2 years after me. Will be good to have more hands. Wish I could do something for the OR staff, they are really working hard and putting up with our team. I think this is more than they have ever done.
There are lots of rumors about what is going on in Haiti, the lack of housing for refugees seems like the most important. The rainy season is not to far away. The other disturbing story is about guys going around in trucks offering kids food and then abducting them, presumably for child slavery which is rampant here in Haiti.
Guess I'll head to bed, maybe I'll get some sleep tonight!

Day 5 - still lots to do!

Everyone said they slept better last night, not sure if it was because we were all so tired or we are just getting used to all the animal noises. We had another great breakast and as we were heading out to go to the hospital a patient showed up with a crush injury to her foot. She was in PoP working as a maid for a family, the whole house collapsed and she was trapped for a day in the rubble. Everone else in the house was killed. Such a common story!
After fixing up the lady we all piled into our open truck and headed to the hospital. It is always an exciting ride into town. Some people are still sleeping in the streets because they are afraid of earthquakes. We got to the hospital and split into groups again. Hector, Ron, Mona, and I went to work on a kid with an open tib/fib fractue that was from the earthquake in PoP. It was hard to fix since it was already 2weeks out and infected! We got it straighter with an ex fix, I hope it will heal now. Then we had another kid that was also injured in PoP, he fractured the distal femoral growth plate and the whole piece was displaced anteriorly 90%. we had to open it and take the whole fracture down, then pin it in place, knowing that his growth plate will probably fuse, very sad, but we couldn't leave it the way it was.
Between cases we were seeing patients in the parking lot. The stuff we see is usually badly displaced, open fractures, that are 2 weeks out and infected, arms, femurs, and tib/fib fractures.
Hector pinned a fracture on a 5 year old with a displaced finger fracture. Then we fixed a badly comminuted open patella fracture, as you could guess it to was 2 weeks old. There is still so many cases left to do! We hope they will let us operate tomorrow. It was sad to see the team from Michigan leave today. The left us lots of stuff and were able to teach us lots over the past 2 days. They will be missed.

While they were all operating in the morning, I (Karmen now writing ) worked in clinic treating infections and fractures- some rechecks from yesterday. Saw lots of nasty humerus fractures and one tough woman who had compartment syndrome of arm from crush injury from cinder blocks. Clinic went until 2 then headed to the OR to help with couple cases and saw few people in road.
All and all day was good. Was hard to go into the "recovery" rooms, especially the pediatric ward.
After a fun ride home in the back of the truck followed by a cold shower, we sit here around the big dinner table sharing stories while enjoying the molasses cookies my mom sent along.. Everyone was so siked when I hauled those out. Think we'll sleep well tonight. Thanks for all the thoughts and prayers.

Day 4- The Work begins!

It was great to get started today! We were all anxious to get going this morning. None of us slept great, not only were we nervous but the barking dogs and roosters crowing all night long kept everyone from a good nights sleep.
We had a great breakfast after the morning services by father Mark. then we headed out to the hospital about 8. We had to make a detour to go to the home of one of the staff. His sister came from PoP with an injured arm and leg. We went into his house to examine her, luckily all was well and she just had a bruised knee/hip and a stiff elbow. From there we went to the hospital.
Check out the sign on the eUntrance. We met the head of Southern Haiti's medical system Dr Loussaint. There was lots of confusion about who would be doing what. There was a team from Panama, a team from Michigan, and some internist from Spain all trying to help. We managed to to team up with the team from michigan. The Spanish team seemed very frustrated, but non of them were orthopedic surgeons so there was not much for them to do.




Karmen & I headed to Fracture Clinic with Dr Clay Peimer, a hand surgeon. He was great! He got us introduced to the fx clinic staff and we hit the ground running. We saw lots of pts, most with injuries from the Earthquake. Lots of fractures that were just splinted, or open fractures that are infected. We had a great cast tech, who was a whiz with the cast saw and very fast at putting on casts. What was hard was that not everyone had xrays, and at one point the xray department ran out of film! We managed to see over 50 pts in less than 4 hours. Think the nurse who was organizing the clinic was ready to kill me, at 1pm she just said we are done and went home! Makes me really miss Christy!

Meanwhile Cynthia was in the peds clinic and saved a 21 day old that came in almost dead from dehydration. She was able to get an iv and got the kid hydrated. She saw lots of other kids with many issues.

With clinic done we headed back to the OR to Join Hector, Ron and Mona. They had a busy morning, fixing femurs, amputating, and washing out wounds. I helped the local ortho surgeon with an open fracture on a 9 year old kid. It was interesting doing this with a makita drill and using my leatherman to cut the pins!

After a long day we headed back to espwa for a shower and an amazing lasagna meal. I bought a bottle of Haitian rum before we left the hospital, we all enjoyed a drink after dinner. Maybe tonight the dogs won't be too loud.

Here is a photo I forgot to put up top . This is the recovery room. We drop the patients off and then the family has to care for them and feed them.

Day 3 - Haiti

We finally made it here! We were up early again and at the airport by 7. We had to wait for our pilots and help load and unload the planes. We had to split up into two groups to get there. Not all of our bags would be coming on a third plane, hopefully. We had to try to pick out what we thought we would need the most.
It was an amazing day to fly. One plane was able to fly directly from Nassau to Cap Hatien, where we all had to clear customs. The plane I was on was smaller and we had to make a fuel stop in Great Inagua island before heading to Cap Hatien.
I had heard that Haiti was a beautiful country, but the view from the plane was breathtaking! Beautiful mountians tower over the coast. The view of Cap Hatien was amazing, there did not appear to be much damage, but the extent of poverty was amazing.

There we were met by UN officials who wanted to know what type of medical professionals we were and where we were headed. We cleared customs without any problems and were able to head to Les Cayes (Prounounced Lekai).
The flight over hati was amazing, more mountianous than I expected. We flew over isl de la guanave, were there are over 150,000 people that got all their supplies from PoP, bit have been without anything for 2 weeks. The pilots said when they land there the planes get swarmed by people looking for food. They say this is the unknown disaster!

Les cayes is the 3rd largest town in Haiti. It sits on the southern coast and looks idealic from the sky. We were met by father mark and our team was reunited. We headed to town to check out the hospitals. The drive into town was an eye opener for all of us! The extent of the poverty is worse than I have ever seen! The hospitals didn't appear overwhelmed, but they did seem busy. Looks like we will be working at the general hospital in Les Cayes starting tomorrow morning.





We then headed to the ESPWA orphanage, wow! What a great place! The guest house where we are staying is amazing. We had a great meal and had our first patient. A 3 yearold with a prolapsed rectum. Had to look that one up on Internet but Ron got it reduced! We taped the kids butt cheeks together and hope it stays!












Some of the teenage boys sang us a few songs they wrote, kids were good! We all decided to turn in early for what we hope is a busy day tomorrow.

Waitng to fly out

Now we wait!
We were up at 5 and to the airport by 6:30. Met with Bahamas Methodist habitat staff, Abraham and Cameron, they are responsible for coordinating all the pilots and flights to Haiti. They have been instrumental in getting supplies to Haiti and trying to organize a list of needed supplies from doctors and other relief teams. Methodisthabitat.org

At first we had thought that we would fly out at 7 this morning, but once we got to airport learned that the plane they thought would take us to Les Cayes had to stop and get others in Texas - leaving no room for all of us and our supplies. We hope that that plane will be fast enough to drop them and come back for us later today. Meanwhile, the delay has given us time to get more supplies. We have heard from people on the ground in Haiti, that they need more ex fix stuff.
Check out this photo taken yesterday of a makeshift ex fix using rebar and bondo:


We only brought what few pins we had from an old EBI set that was no longer being used and Mid Coast hospital donated to us. We decided to head to the hardware store to find stuff to improvise with. It is amazing what you can find to make up ex fix, we got some stainless steel screws, roof strapping, duct tape, and wire!

We've met some really interesting people in the short time we've been here. Our Driver, John McPhee was helpful at 6 am getting us and our equipment to the airport on time - not a guarantee in the Bahamas.

Waiting with us is filmmaker, Andrew Hudson- krop.com who has been here for several days making short films detailing what various organizations i.e. Rotary Club, Bahamas Methodist Habitat, Project Hope etc is doing to help. The above photo of the fractured leg fixed with rebar and bondo is his piece of art. The photos speak to the ingenuity of those helping in Haiti.

Day One -The Adventure Begins

Hi Everyone, I hope that we will be able to keep everyone updated on our trip to Haiti.

The Team:
Dr Cynthia Desoi- Team leader- Cynthia is a Nephrologist with Maine Nephrology in Lewiston. She has been working with Project ESPWA ( Project Hope) in Les Cayes in Haiti for a number of years. It is a orphanage that is about 100 miles south of Port o Prince. There are over 650 children there and at least 100 more on the way from PoP. Cynthia travels to the orphanage about every 3 months to help care for the kids.
Dr Ron Chicoine - Anesthesiologist from St. Marys Hospital in Lewsiton, this will be his first trip to Haiti, he has worked in Hounduras voulentering in the past.
Mona Theriault, RN - Recoveryroom nurse from St Marys, she has been there for 2 years, and has been to haiti last year working with Fonds De Blancs working at a hospital teaching.
Dr. Hector Rosquette - Hand surgeon from Coastal Orthopedics in Brunswick. This is his first time in Haiti, he regularly runs a clinic in Hounduras 2-3 times per year.
Karmen Blacstone, ANP,RNFA - She works at Coastal orthopedics, this will be her first visit to Haiti, but her experience in the Bahamas has proved invaluable already!
Dr. Stephen Katz - (Me)- I work at Coastal orthopedics, specializing in Sports and shoulder surgery. This will be my first visit to Haiti as well.

Today is our travel day we left early from Portland and traveled to JFK in NYC and then on to Nassau, bahamas. We were not able to get a flight to haiti today, but we just found out that we will get a flight at 7 am tomorrow! Everyone is excited and nervous. I hope that we will be able to continue this blog. I guess we will find out when we get there.
Thanks for everyones support and generosity donating supplies.
if you want to check out the orphanage look at freethekids.org