Haiti Surgical Team - October 2010

Mission Dates: October 8-16, 2010

The following reports have been edited
We all arrived in Port-au-Prince on the week-end of October 9-10, 2010 and started our week of work after a short welcome at the Diquini Hospital. Our group, which consisted of three orthopedists, two general surgeons, one anesthesiologist, one nurse practitioner, one OR nurse and one clinical nurse did a fantastic job.

We rented a "Tap-Tap" to taxi us to and from the hospital every day from our modest accommodations at the Auberge du Quebec Hotel. Most tap-taps are pick-up trucks, where the back side is open-air, with some wooden planks setup to accommodate seating for passengers. Upon our first arrival, we were surprised to see the level of organization at the Diquini Hospital. Having been here many times, I have personally never seen so much activity and interaction between hospital departments in Haiti. Efficiently handling transfers between the ER, clinics and different services is a new practice for this under-developed country. The homogeneity of the forms used by all Haitian hospitals and clinics surprised me. We found a level of organization that will certainly need refinement with time, but was very functional for our purposes. 
Each day started with a prayer at the Hospital Chapel followed immediately with rounds on all the orthopedic patients. I presume that the same mechanism was in place for the general surgical team. Physicians, nurses, therapists and other hospital employees were present during rounds to learn and discuss the management of each patient. Once rounds were over and typical instructions for discharge, cast change or dressing changes were given, a daily clinic with 30 to 40 patients was waiting for us.
After or sometimes during clinic, surgical cases were taken one after another to the operating room. Due to the high volume, we sometimes did not return to our hotel rooms until 8 or 9PM. Many of the Haitian orthopedic residents from the General Hospital in Port-au-Prince who worked with me through the Association of Haitian Physicians Abroad were present at my request to help us in achieving our mission.  Our lone anesthesiologist showed extreme dedication in trying to organize the operating theater that consisted of two functional rooms and helping us perform as many cases as it was feasible to handle. During only one afternoon did he receive support from a local anesthesiologist. 
Some of the many cases we attended to included infections, poor healing of wounds, failure of hardware, mal-unions, non-unions, congenital cases like osteogenesis imperfecta, cerebral palsy, hernias, thyroglossal cyst, scrotal mass, incarcerated hernia, bone tumor, tendon and nerve injuries, compartment syndrome, angular deformity, amputation, complicated fractures, external fixators, etc.
As part of the re-structuring process of this institution, a new wing will provide expansion to allow an Orthotic and prosthetic team already on site to implement a department capable of manufacturing devices to help the 3000 amputees of the country.
In conclusion, for us, this has been an experience of a lifetime that we will cherish.  At the end of our week of cooperation with the staff at Diquini Hospital, we graciously thanked them for their hospitality and the opportunity they have given us to work for the people of Haiti.
It has been a privilege to help the people of Haiti through this ICS sponsored Surgical Team. We want to thank the International College of Surgeons for allowing us to be part of this great experience.
This was the first surgical mission organized solely under the auspices of the ICS, US Section in years. The initiative and the site were carefully planned by Dr. Jay Bachicha, President of the ICS, US Section.
Site: Hopital Adventiste d’ Haiti (AHA), located in Carrefour, Haiti, a suburb of the Capital, Port-au-Prince, and epicenter of the January 2010 catastrophic earthquake that killed more than 250,000 people. The hospital was a 30 year-old facility manned by local and, mainly, volunteer medical personnel from the United States.
Pre-mission Coordination: The mission effort was meticulously coordinated by Dr. Jay Bachicha and Amy Russell of AHA. As Dr. Bachicha was unable to join the team, he appointed Dr. Maxime Coles as the team leader and Dr. Antoine (Tony) Jumelle as co-leader.
Team Composition and Specialties:
Dr. Maxime Coles, Orthopedics
Dr. Patrick Lecorps, Orthopedics
Dr. Geoffrey Miller, Pediatric Orthopedics
Dr. John Downey, Anesthesiology
Dr. Sharmila Dissanaike, General Surgery and Critical Care/Trauma
Dr. Antoine Jumelle, General Surgery
Elizabeth Leconte Hrico, RN
Michele Miller, RN
Monica Loelke, RN
General Information:
Amy Russell provided the team members with general information about AHA, the program participation fee of $15.00 per night per volunteer, the austere accommodations at AHA, the needed immunizations, a short travel medication list, a list of the needed supplies and medications for the hospital, the contact information for a nearby hotel.
Dr. Jumelle had a local contact visit and evaluate the accommodations at the Auberge du Quebec, at about 5-minute drive from the hospital without traffic jam. They were adequate for post-earthquake Carrefour/Port-au-Prince. The team members stayed at the hotel, but Dr. Dissanaike and Monica who stayed at the hospital. Lunch was served at the hospital Monday through Friday. Those staying at the hotel met for breakfast and, mainly, for supper.
Attire: casuals or scrubs
Hospital admission/procedure fees: free for children up to 5 years of age and all orthopedic patients. Patients in need of a general surgical procedure had to pay a fee in agreement with the hospital administration. Some of the patients seen by our surgical team could not have the needed procedure because they could not pay the fees.
Hospital Settings:
One-room ED
Ortho Clinic
Surgery Clinic/Outpatient wound care
One large room ward/preop area
One large room ward/postop area
Small X-ray Department area with one old X-Ray machine, old ultrasound, and old C-Arm
A few individual rooms on the second floor
Two “functional” operating rooms, one with a portable lamp: supplies as donated by previous teams.
Personnel Interaction: The local personnel, but the interpreters, seemed withdrawn from all these English-speaking volunteers.
The ICS, US Section, Team Work:
Dr. John Downey, Anesthesiologist, was the first member of the team to arrive in Port-au-Prince on October 7, 2010. He started working on October 8, 2010, organizing the anesthesia supplies, checking all the machines, cleaning up after the previous crew, and making sure that everything was ready for our team. John was the type of fellow who wanted things done the right way and provided optimum care with substandard equipment.   He made himself available all the time. He had participated on previous surgical missions. 
Dr. Antoine Jumelle, General Surgery, arrived in Port-au-Prince on Friday, October 8, 2010. He was given a tour of the hospital on Saturday. This is a holiday for Adventists, however he was asked to evaluate a 16 year-old traumatic-paraplegic girl from the earthquake, with multiple decubiti, for possible debridement in the OR on Sunday.   The patient needed appropriate wound care. Dr. Jumelle continued to perform and supervise the wound care throughout our mission. He provided an in-service on wound care and the use of the KCI wound V.A.C. device. At the time of our departure, the nursing staff was using his teaching to prepare PDF slides for the current and future nursing/wound care specialist staff. On Sunday, October 10, 2010, Dr. Jumelle evaluated patients in the surgical clinic for surgery on Monday.
Dr. Sharmila Dissanaike , General Surgery and Critical Care/Trauma, arrived in Port-au-Prince on October 10, 2010. A fellow of the College, she was enthusiastic about the mission. She stayed at the hospital and was available 24 hours a day. It was as if she was in her native Sri Lanka. A real delight to work with her! The nursing staff felt comfortable working with her. She and Dr. Jumelle worked as a team, assisting each other in the operating room, one covering the clinic as needed while the other one is in the operating room.   She made things happen. She excised a thyroglossal cyst in a 3 year-old patient. When the word went out, close to the end of our mission, that she was releasing tongue frenulum under local anesthesia, parents were hurrying up to get access to her. Sharmila demonstrated a genuine interest in this mission and, possibly, future missions, as well as in the future of our organization. 
Surgical Team Work:
Monday through Friday from 0730: staff meeting, OR, surgical clinic, wound care.
Surgical cases: 1 re-recurrent inguinal hernia
                           1 inguino-scrotal hernia
                           1 umbilical hernia
                           1 thyroglossal cyst excision
                           1 facial soft tissue mass excision
                           1 revision/debridement of infected BKA stump
                           2 hydrocelectomies
                           2 circumcisions
                           3 cases of release of tongue frenulum
Interesting cases evaluated , but not operated:
                          Thyroid goiter: incomplete work up
                           Incarcerated /strangulated inguinoscrotal hernia, one month post op: anesthesia not
Orthopedic Team Work:
See previous report by Dr. Maxime Coles.
Dr. Maxime Coles and Patrick Lecorps: Personally known to me. We attended same primary and secondary schools in Port-au-Prince, Haiti. We were inducted into the College’s fellowship in 1989. Hard-working fellows who care about their patients. Maxime referred a scrotal mass and the
strangulated hernia to the surgical team.
Dr. Geoffrey Miller: our cameraman! Always excited about the events!  Not a new comer to the surgical missions.  He had just completed a mission in Peru and, yet, he joined his friend, Maxime, to provide more care to the needy Haitians. 
Nursing Staff Contribution:
A special gratitude to Elizabeth, Monica, and Michele for their dedication! It took a team work to accomplish the mission and their contribution was most valuable. I would like to have them on my team in the future.
Challenges to Our Mission:
Patients evaluated by the surgeons and unable to afford surgery because they are poor. After all, we are volunteering to help the needy!
Lack of personnel: our team had one anesthesiologist for 5 surgeons
Supplies: Patient was not getting supplies for post op care from the hospital. They had to buy their own. They barely had the money to pay for their procedures! In future missions, we may need to dispense our supplies to the patients and not give them to the hospital unless we have a memorandum of understanding.
Was our Mission a Success?
Yes! You could see it on the face of our patients! They blessed me and they blessed our team over and over again. One could not help, but think that it was a worthy mission!
What Made our Mission a Success?
The personality and enthusiasm of our team along with the presence of providers, native to the country contributed greatly to the success of this project. The patients were happy to not just deal with English-speaking providers through interpreters, but through providers who spoke their language. Any future surgical mission must have such providers. By the way, the patients were happy to hear some Creole from our team.
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