Final Thoughts

As we sit in the Turks and Caicos airport, it is difficult to articulate our experiences from the past week. We learned so many things on so many levels while trying to bridge gaps that were at times very hard to overcome. We were able to assimilate into a culture that we were not familiar with and learned what may be possible; the mind and heart must be open and you must not come to Haiti imposing personal expectations or making any assumptions about the culture.

Working with a people doing its best with what they have (which is not much) was a gift to us. When water and food are limiting factors, delivering health care seemed virtually impossible. Despite these challenges, everyone on our team gave all they had to the patients, family members and our Haitian healthcare counterparts.

We were fortunate to have a great team who grew closer each day and often thanked one another ….just for being together each day…..shoulder to shoulder like the Konbit Sante name. The longterm goal of building a partnership with the Haitian people will continue to be a challenging process. The Konbit Sante staff should not give up their hope for change.

One thing is for certain, we will not take what most consider the little things for granted: toilets that flush, clean water to drink, a place to sleep where you don’t have to worry about cockroaches or rats, a roof over our heads that doesn’t leak (well that part may be a stretch at OA).

In closing, it was a privilege and honor to spend the week with our new friends. Although our hearts were breaking at every turn there were so many moments of happiness and laughter. The smiles from the children were priceless.

And to whoever returns, remember Linda’s words, “underwear is overrated”. There were converters! Immodium is priceless. Remember the 3 oz rule.

Au revoir

OA Haiti Team

Finis

We continue to wonder if our efforts this week have made any difference; perhaps only for the short term, but we are hopeful that if this becomes a long term commitment that over time we can teach the Haitian staff at the Justinian hospital that there are other ways to provide healing. It doesn’t always have to hurt so bad as they go through the healing process.

Matt, Sam, and March took a trip to Milot this morning and visited the hospital, Sacre Coeur (Sacred Heart). In some respects it was a bit depressing to realize that the Justinian Hospital has such a long way to go. Sacre Coeur has a charting process and a central supply system; documentation is clear and concise. They have 3 operating rooms with a PACU unit to monitor patients post operatively. In Cap Haitian patients are monitored for a short time outside of the OR and then they are either discharged home or sent back to the surgery ward. Sacre Couer is funded by outside sources (donations from Catholic Churches) while Justinian is a public facility with no funding to speak of. Clearly that makes a huge difference.

Matt returned to assist Dr. Pierre-Louis with an open tibia and fibula fracture on a dancer. She was injured in Port au Prince during the earthquake and originally was placed in an external fixation frame. With clean wounds, she was now ready for internal fixation (plate and screws). Dr. Louis took out bone graft from both hips to put into the fracture site to assist in the healing process. Like most cases here, it was filled with lots of challenges along the way. With no way to take an intraopertive x-ray to confirm adequate alignment, much of what is done is simply guesswork. Linda (aka angel of the OR) now is the person who the staff uses as a resource and she scrubbed the case from afar.

Marietta spent the morning in the wound clinic while Linda and Joanne rounded on the surgery ward changing pretty complicated wounds. Joanne had an interesting experience that she may share when we return home. Nothing today seemed straightforward. Large burns and multiple open lower leg wounds. For some reason it was particularly difficult emotionally.

March attended an English class that was held for the Haitian Physicians. Marietta and Joanne had a shorter day. They each had patients that “sucked them dry” today. They took a stroll to the market after their showers to purchase some items to bring back to family. Don’t worry Juliette we took care of your kids!

We split up for dinner; surgeons went out with the docs from the hospital and the nurses went out to a 'burger joint' with Nate Nickerson. There was a lot of debriefing and discussion about how to make this relationship grow for months and years to come. Konbit is a wonderful organization employing a thoughtful model of collaboration with the Haitien people. We now understand how critical it is for the people of Cap Haitien that this partnership succeed.

Dr Broaddus' Letter Home

Below is a letter from Dr Broaddus sent to the Konbit Sante office giving his perspective of things here in Cap Haitien and at Hospital Justinien.

Dear Wendy,

I’m sorry I haven’t written you sooner but I have been very busy with more clinical work and logistics than during previous trips. Internet connections have also been spotty. I want to give you and Konbit Sante members and supporters some idea of what it has been like here in Cap as the KS surgical team leader, now 4 weeks after the earthquake. These are just a few of my observations, thoughts and opinions; please excuse me if I sound a bit scattered. If you were here, you would understand.

On the surface, Cap Haitien appears similar in appearance and organized chaos to previous trips. Both Nepalese and Chilean UN troops remain encamped in the city, along with Haitien National Police and some US military. There is lots of NGO activity; foreigners coming and going at the Christophe Hotel where we are staying. The Justinien Hospital is busier and the wards are very crowded, particularly the surgical wards,
20 patients tightly packed in large rooms with no privacy. The emergency ward remains hectic; I haven’t seen any ambulances, just private transports. Many of the ward patients have severe orthopedic injuries, fractures and some have significant postoperative wound infections following field surgery in Port au Prince. Dr. Matt Camuso, our orthopedic surgeon from OA Centers for Orthopaedics in Portland, and his 2 assistants, Joanne LeBlanc, RN and Linda Ruterbories, ANP have been partnering with the Haitian orthopedic surgeon Dr. Pierre Louis, and have now completed a number and variety of orthopedic reconstructive surgeries. Matt brought a great deal of orthopedic surgical equipmentdonated by OA and Maine Medical Center and has been integrating this into the OR inventory here. He has been a perfect match for Dr. Pierre Louis; they have both served as military surgeons, Matt’s personality is calm and reassuring, and I predict a long-term relationship. That is what we all need to be thinking about as we transition to the long haul of rehabilitation and reconstruction.

What is becoming very clear to me, particularly as I make rounds here and see the types of surgical cases evolving over the next few weeks to months is that there is no quick “Earthquake Relief.” The visual scenes we all observed in the days after the quake don’t do justice to the protracted nature of recovery in a country like this. There are hungry families here in Cap, there are many internally displaced persons with no place to go, there are so many hundreds, no thousands of people with severe injuries and deformities in a society where even a minor debility can equal a major struggle. Matt, Linda, and Brad Cushing went Monday to a small clinic where 6 paraplegic patients had been sent to help off-load the logjam from the hospital in Milot. What will happen to these patients in a country ill prepared for a natural disaster of this magnitude? What will happen to the 12-year-old boy on the surgical ward, exposed bone with an insensate arm after a crush injury? After his inevitable amputation days or weeks from now, how will he become a productive member of society? What about the woman admitted to the ward today with a fractured femur now a month old and a wound infection that needs debridement, who delivered a newborn baby 2 days ago. What is the future of that child if the mother dies? These are but a few examples that are being repeated in all parts of Haiti in numbers too large for me to get my brain around.

Our 2 wound care nurses from Maine Medical Center have been angels. March Truedsson and Marieta Atienza have been ministering to the worst of the infected wounds with enthusiam, kindness and attentiveness. Patients have responded with smiles and many thanks. Brad Cushing, Chief of Surgery, at Maine Medical Center continues to help us with process and administrative skills that help all of us see the big surgical picture. As many ofresidents from Justinien Hospital in 2008 for 6 weeks each to come to Maine to help them improve their surgical skills. We also brought the Justinien chiefs of Surgery, Anesthesia, and the surgical residency to Maine in 2009. Clearly, we have reconnected with many old friends and there is great hope that despite this great calamity, there will be a new day for Haiti in the future. One of the surgical residents who came to Maine in 2008, Dr. Jerry Bernard, is now a general surgeon at the hospital in Milot. After the quake, his hospital handled several hundred patients airlifted from the quake zone. In speaking to him yesterday, he told me how much his experience in Maine added to his ability to care for injured patients over the last month. So many of the medical residents have lost family members and friends in the quake. Dr. Marie LeConte, the Chief of Anesthesia, told me that everyone she knows has lost a loved one. Sadness permeates our work environment, but what else can you do as a Haitian? “Give up” is not part of the lexicon here.

As for me, I have spent time with the urology residents and nurses trying to maintain some sense of normalcy. Performing some urologic surgery, daily teaching rounds, instruction in ultrasound, PowerPoint presentations about routine urological problems. I think there is something helpful to everyone’s morale with routines and schedules. Everyday sickness and illness have not disappeared among the citizens of Cap Haitien. Men still develop urinary retention, women are still going into labor, children are still getting sick from malaria and childhood diseases. Perhaps, there are more sick people among the populace than before the earthquake; nobody knows. What is different are the increasing numbers of people from the South, from Port au Prince and its surrounding towns, who are now part of the landscape here. How will these people be fed, and clothed and sheltered over the coming months? And what about those closer to Port? Do they return to a city ruined by the quake, with only a hope, and not much more, of rebuilding their homes and shattered lives? And the 12-year-old boy with the big smile but the dead arm. He will haunt me. I try not to think about the big picture too much. This is just the beginning of an arduous road to recovery; Konbit Sante members and supporters need to understand that “Earthquake Relief” is long-term, very long term, not a quick fix “CNN moment.” It will be ongoing, difficult, and complicated for years. It will be easy to get discouraged and depressed about how long this will take.

For me, right now, I need to focus: think about what I can do, think about how I can best use my time and skills. Here now, sitting in the OR at Justinien Hospital in Cap Haitien, Haiti, there are 4 more surgeries this afternoon. Time to get back to work. Time to help. Time to re-focus.

Please convey my appreciation and thanks to our many supporters and donors. Konbit Sante is well respected in Haiti, particularly because so many people, with so many skill sets, are part of our organization. I also want to repeat what many have said before me: Nate Nickerson has worked incredibly hard on our behalf and Haiti’s behalf, particularly since the earthquake. I have seen him in action here and you should all be very proud. There is much work to be done.

My best,

Sam Broaddus, MD

Can We Make A Difference?

The day started with our daily walk to the hospital. We could hear the kids singing from their classrooms. They are impeccably dressed in their uniforms. Each school has a different color uniform. The little girls are adorable. Some of the old local architecture remains, but in very poor condition.

Marietta and March spent the morning in the wound clinic. They saw and treated 25 patients in a half day. Linda and Joanne spent time in the surgical ward changing dressings. It took some negotiating to be allowed to help today. We are only assuming that they are tired of our presence. Our interpreter Eddy had to negotiate our way on to the floor by bringing the director and charge nurse together to discuss the plan. We were not present for the conversation, but we trusted Eddie to make it work. They are in desperate need of our supplies and extra pair of hands, but they are proud people. Every step needs to be taken carefully and thoughtfully to avoid insulting what they do.

Most of the wounds we are dealing with are deep and down to the bone. Again, all of these dressings are changed without any pain medication on board. A 19 month old was being taken care of by her cousin; not sure his age, but he was super attentive. The little girl fell asleep during her dressing change. An 8 year old boy, who we have seen already, needed another dressing change. This time, his cries for Mama were heard as lo and behold she was in the next patient bed beside him. She was not there 2 days ago. Marietta and Joanne were in the wound clinic for a short time in the afternoon when a young man walked in with his arm wrapped in a shirt. He was clearly bleeding. After removing his shirt we discovered several wide and fairly deep lacerations. We promptly began cleaning them out and in conversation through our interpreter we learned that he had been cut by his brother with a machete. This is Haiti…

Joanne and Linda failed to mention that they spent time today around some nasty critters. It started in the AM when they saw their first cockroach. By midday, they had changed dressings with worms and found lice infestations in various crevices. Now they can't stop itching. Linda felt the need to check Joanne for contamination.

Matt spent most of the day with Dr. Pierre-Louis building a relationship as they scoured numerous instruments to prepare for a case tomorrow. They had to use a bolt cutter to get into the orthopedic cabinet that Dr. Pierre-Louis had not used in some time. Surprisingly enough there is a universal language when it comes to orthopedic instrumentation. Matt drew pictures and showed his pictures via laptop of previous cases. All of this without an interpreter. They spent many hours sitting on the floor in the hallway discussing cases.

The team continued their quest for organizing the OR supply rooms and we are pleased to report that we are finally able to walk in the room and fit more than one person at a time. Dr. Marie Laconte seems quite pleased with our efforts. Time will tell if this will last.

Dr. Sam Broaddus spent 3 hours in the operating room removing a kidney from a young boy. (8 or 9) Staff from the OR brought the kidney to the family to show them what had been removed. Sam tells us that this is a practice of showing that the bad spirits have been removed.

As we were leaving the hospital for the day, Joanne gave a young boy a pair of groucho marx glasses. He was accompanied by 2 other young children and several adults. All were waiting for a family member in the OR. The kids burst out laughing and happily shared the glasses. We took great pictures. Nice way to end our day.

Tomorrow we have plans to visit the neighbor hospital in Milo- we hear it is an amazing site. Matt is scheduled to be in the OR around 11am. More wound care and the last bit of sorting through the supplies before we go out to dinner for our last night in Cap Haitian. If we don’t get a chance to check in on Thursday night it is because we are out on the town! Since we have a long day on our return home we will be sure to check in and document our last day.

Love to all

OA Haiti Team

Trying to Make a Dent

A little late with communicating tonight as the internet has been down. The day seemed to be “the usual” if there is such a thing. We all have seemed to settle into routines. Marietta and March made their rounds on the surgical wards taking care of wounds and changing dressings. Marietta dove right in and took care of 2 infections; one was on a breast and the other was on a lower leg cellulitis. She used Qtips to drain out the infection with the hopes that they will seek further medical attention after we are gone. March and Joanne dressed a burn victim. This was her 3^rd dressing change by our group. She seemed pretty comfortable until the final dressing was applied. The only “pain” medicine that these people receive is Ibuprofen. That is just not enough when you have such bad burns.

Matt was in the OR doing a few cases. None were reported to be as difficult as yesterday; 2 hands and one ankle. Dr. Pierre –Louis was very excited to use a powered pin driver as opposed to a hand tool. Matt says the ankle was a one week old fracture/dislocation that went “well”. Actually his words were, “it was good”. For the surgeons back home reading this that must mean it was fine.

Linda was on standby to enter the OR as needed for support. In between she would be in the airless, windowless, supply closet with Joanne as we continued to try and sort through the numerous boxes of donations; some old and some new. Matt joined the organizing team in the closet when he was done for the day and helped to sort through the chaos. The girls did not do a very good job making room for all of the orthopaedic stuff we need space for. They will try harder tomorrow.

We ended our day around 5pm and walked back to the hotel. The scenery is unbelievable. So many sights and smells to experience. Very few people will speak to you as you are walking by unless you say hello first. Joanne likes to do that. No one else does. She hands out gum (they call them chicklets) and they follow her for blocks. We wish she would stop.

We all took great pictures today. Sam, Marietta, Matt and Linda took a walk to the waterfront where we saw the potential for a beautiful landscape and harbor. The reality was far more depressing with dirty ocean water, laden from the unfiltered sewage from the city. Amazingly though, we also saw children walking down the streets studying their schoolwork under the fading light of day, reciting memorized lines from their worn textbooks. It seems that education is the only way out of the poverty that surrounds us.

That’s all for now. Hopefully the internet will be back tomorrow so we can post this update. Love to all.

Pictures

As you can see, we've brought a lot of gear. A total of six bags each weighing about 50 lbs made it difficult to negotiate the airports. The orthopaedic equipment and dressings packed inside will actually get to the people that need them. As a result of the weight, the plane was a bit unbalanced and we had to sit at the front of the aircraft for the trip from Turks. It gave us a great view of the city as we flew in, you can see the town of Cap Haitien at the base of the mountains.

Once here, we ride in the back of the pickup truck if we have to travel anywhere far away. It makes for interesting trips and gives you an up close and personal sense of the surroundings. As dangerous as it looks, it is actually quite safe since you can't drive any faster than around 10 mph on these roads.

Lots more pictures to post, but no more time right now. Will try to post more tonight.

We had a mission

Our assignment for the day via Marie LeConte, anesthesiologist, was to organize their storerooms and unpack all of the supplies they received in donation after the earthquake. We came across boxes from Miami, University of Virginia, and others; they needed to be unpacked and reorganized within small store rooms outside of the OR's. We are in hopes that our efforts today will assist the Justinian operating room in maintaining some semblance of stabilization. 9 hours was spent by Linda and Joanne organizing the soft goods from anesthesia equipment, medications, and I.V. solutions to name a few. U.N. Chilean soldiers came in to take photos of the anesthesia machine and the C-arm to see if they could help repair very necessary equipment to run the operating rooms. For example, the C-arm( portable x-ray machine) has not been working for 6 months.

Marietta and March spent the bulk of their day on the surgical ward again changing dressings. The goal of their day was to better integrate with the nursing staff. They got to meet the ward nurses, the student nurses, and made a connection with the charge nurse. March relays that the singing from family members and people from the community really leaves an impression. They sing religious hymns that are supposed to help the sick.

It was challenging standing by in silence while certain solutions were placed in wounds that we no longer use in the U.S.-knowing that it destroys healthy tissue rather than help it grow. The 2 joined us in the afternoon to pitch in with the organizing of the supply closets. Dr. Cushing and his son Jay were also there throughout the day helping with organizing supplies.

Matt's job today began by unpacking all of the orthopedic equipment that we brought while trying to marry that with other ortho equipment that was sent by other donors. The OR's were ready to go by 9:30am and Matt joined with the local orthopod, Dr. Pierre-Louis to operate on a bad hip fracture. He came out of that one completely drenched. Of course there are no AC's. It is extremely hot and muggy. They were operating on a very small woman. The instrumentation to make way for the prosthesis was medium to large. There was a concern that they would fracture the femur while working, however there was quite a bit of fanfare finding the right size prosthesis; they did!

The next patient for the 2 surgeons to tackle was in a failed rodding of a femur. (all without C-arm/x-ray) The rod came out easily, however the fixation to follow was not as simple. In Matt's words "it would have been difficult even in the best of circumstances". "Ray, this one would have been a good one for you."(you know for him to say this it had to have been difficult) Please note, other entries regarding Matt have been the girls ad libbing...... he's been a good sport.

The rod resulted in plate and screws and because they only have one length screw, they had to cut them all with bolt cutters before they put them in. (Weak armed guys struggle with that!)

Marie, anesthesiologist, wants to open the maternity ward tomorrow so that the orthopedic cases can get done before Matt leaves on Friday. She has asked Linda and Joanne to go over and open up the operating room; now that would be a site since one of us had no idea what they are doing in the OR.....

By 5pm the majority of the team was walking back to the hotel, which takes about 15 minutes of navigating narrow and busy side streets. Several of us (Joanne and Linda) could not find their way alone yet.

It rained so hard last night and the streets were still full of puddles and quite muddy.

Sam Broadus was the diplomat all day long; he supported Matt in the operating room by assisting with translating.

We say goodbye to Brad and Jay Cushing who leave for home tomorrow. Brad is looking forward to returning to work the very next day (not!)

Please note photos are hard to send via this remote area; we think due to their size. Perhaps JP can give us some advice?

We say goodnight for now; time for our 2nd meal of the day. Wishing you sweet dreams.

Love you all!

OA Haiti Team