New Record at HAH
During the month of October we performed more surgeries than ever in the recorded history of HAH.
Two girls with tibia osteomyelitis become best friends
Our staff crushed the previous record from April 2018 when we did 101 cases. (That was with the help of a high powered visiting team)
Last month we did 121 cases and these were all done by our own doctors and nurses. We did 63 ortho cases, 15 general surgery and the remainder mostly OB/Gyn. Now, in reality we have the capacity to do much more, but given the political situation in Haiti it is absolutely remarkable that our hospital is rising to new levels during these tumultuous times. Many other hospitals are barely functioning if at all. It is not easy to keep functioning when every bit of infrastructure around us is deteriorating. “Peyi Lok” or Operation Lockdown has been in full force throughout the country of Haiti this last month. Stores are mostly closed, public transportation is scarce, fuel is in short supply, utilities are even more unreliable than usual and gangsters have seized control of major thoroughfares.
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- Dr. Alexis with Florence finishing up one of the tibia osteomyelitis cases
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- The morning commute
Several times this past month we were down to just a few gallons of diesel fuel to keep our generators working.
Going to sleep
But one way or another it all worked out.
The Lord’s blessing on our work here is palpable. Along with that I would like to put a big shout out to our staff who have kept working in spite of adversity. They have had to traverse burning roadblocks, avoid gunfire, and often come to work on foot due to lack of public transportation. Our head nurse had her phone robbed at gunpoint on her morning commute. The bandit held his gun to her chest on a busy street and told her to keep quiet and give him her phone. So she did.
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- After placing a SIGN nail and repairing the radial nerve
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- Vanessa prepares for another case
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- Gunshot wound to the humerus. We don’t ask if they are the bad guy or the good guy. We just take care of them. We like to take care of innocent victims, but we also don’t mind being on the good side of the gangsters.
It is impressive to see the commitment, unity and religious zeal that everyone has for the work at HAH. While strife outside our walls increases, stories of healing at HAH are multiplying. Credit does not only go to our OR staff but also to our administration and ancillary staff who do the behind the scenes work to source oxygen, fuel, food and other key supplies. The goal of the gangsters is to squeeze all commercial and government functions until the society implodes and the government steps down. This poses danger to the garbage truck dudes. Trash pickup lapsed for 4 weeks until Clarens our CFO was finally able to negotiate a deal with the city to haul off some rubbish. They came at 11pm on a Saturday night to do an undercover job in order to avoid the gangsters.
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- Yves Marlene our financial counselor. Resources are scarce for most of our patients but she is able to talk to each one of them and reach fair agreements in order to avoid turning anyone away.
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- They call this guy Blan. That means white guy. Not sure exactly how he acquired the name, but he mops floors. I was told that the other day a patient did not have enough money to pay for their lab so he gave them his own money to make sure they were taken care of
As one of the only fully functioning hospitals in Port au Prince, more and more people are coming to HAH during this humanitarian crisis. We are needed more than ever. Thanks to our staff, to our supporters and to God, HAH is setting new records.
New Limb Lengthening Technology Arrives in Haiti
Naika was born with a short leg. The condition is known as congenital femoral deficiency. There are all different levels of severity which affect not only the length of the bone but also the function of the knee and hip. For Naika the issue was not a huge problem when she was a little girl but these short legs stay in proportion meaning that the difference in length between her legs gets bigger as she gets bigger. Now at the age of 17 she has a leg length discrepancy of 3 inches and walks with a significant limp. This is not a common diagnosis but for one reason or another I have attracted quite a number of these challenging cases over the years.
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- Naika before surgery.
Lengthening of bone especially for congenital issues is fraught with complications and not considered a mainstream part of our profession. Fortunately I have had some great mentors and for better or worse have had personal experience with a lot of the complications. As time goes on I have become better at avoiding them. Many times I am faced with scars and complications from previous failed attempts when these cases present. But Naika had never before had the resources to find treatment. This was a good thing.
X-ray showing subtle dysplasia in the R hip needing correction before attempting to lengthen the leg. If this is not performed the forces of lengthening can sometimes dislocate the hip.
I would never wish a congenital deformity on anyone, but I have to admit I was secretly excited about this case. It was a challenging one but not overwhelmingly so. A new implant was developed and became available in 2011 that revolutionized our ability to perform bone lengthening. This magnetically driven distraction rod negates the need for external fixation and is much better tolerated by patients. The price of these implants is about $19,000 and is sometimes difficult to get approved even by US insurance companies.
Thinking about how great it would be to be able to offer this treatment to Naika I sent a quick message with a photo of Naika to my Nuvasive sales rep Al Thomsen in San Diego. He said he would work on it. As good of a guy as Al is I did not get my hopes up. People have busy lives and Haiti is not always on one’s mind when trying to deal with first world problems.
But Al and his company got back to me in 2 weeks and said they would be happy to donate an implant and they would personally deliver it and participate in the case just as if we were at LLU!
The case was scheduled and airline tickets were purchased. Al did not waver when reading news reports about civil unrest and fiery protests in Port au Prince.
Since I have become the “go to” for any piece of broken equipment at HAH, two days before Al’s trip, I was faced with the need to replace a unique 1/2’’ copper union on our central oxygen system. This is a bit beyond what you would expect to find at Home Depot, but I called to see if Al could source the part. I followed with a text a few minutes later asking him to warn me when he was going to the store so I could be available for trouble shooting. He said he was already at the plumbing store. This was only 10 min after I had made the cold call request!
Anonymous good Samaritan plumber in southern California sweats essential copper joint.
They did not have quite the right part so he went to another place and found it. But the pieces needed to be sweated together by a professional plumber. Five minutes after that he texted me that he met a plumber in the parking lot who donated his services on the back of his mobile plumbing truck and got the job done.
Al and Craig Decker from Nuvasive arrived well, minus the implants that were placed in a suitcase that went missing at the Port au Prince airport. Fortunately that situation got resolved, albeit with a bit of stress. The case went well. I won’t bore you with the details but if you are interested I previously published a short YouTube video of the Precice® Nail Surgical Technique. The plumbing part also fit perfectly and for the first time in 4 months our oxygen system was back up and running. I also found out that Al is an experienced electrician and he was able to help me install and fix a lot of other stuff.
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- Central O2 system distributes oxygen at 50psi to our 3 operating rooms and recovery room.
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- The nail is locked with screws at the top and bottom and then the bone is distracted through the crack that is made at the time of surgery. New bone fills in the gap.
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- Inside of the Precice® Nail.
A big part of the success of limb lengthening cases lies in proper physical therapy. In fact this is so important that at Loma Linda University many of our patients who are coming from distant locations to have this surgery performed are required to stay in town for 1-3 months during the lengthening process.
Al Thomsen multi-talented Nuvasive sales rep fixes scrub sink faucet.
At HAH it is wonderful to have Dr. Irma Henry who trained at LLU and her capable team provide this same high level of rehab service. Naika is enrolled in PT 5x per week and working hard to maintain knee and hip motion in order to have the best result possible.
For Naika this is like a miracle. Many of us wonder why “miracles” don’t seem to happen like they did in Bible times, but I would argue that they actually do. Jesus commissioned the disciples to go out, proclaim the kingdom of God and perform miracles in His name. Today, those of us who were born with resources, and educated in the health care profession have a similar commission. To Naika, this is a miracle. Yes maybe we do understand how that magnetic gear works, and even atheists could perform the operation, but the miracle of new bone filling in the gap and building strength with time is not something that any of us can take credit for. Watch for follow up images of this modern day miracle in future posts.
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- Irma introduces Naika to the external remote control. This device is placed on a specific location on her thigh for about 7 minutes each day (divided into 3 sessions). Two large magnets on the external device force the internal magnet in the nail to spin 210 times for each millimeter of lengthening. The process is painless and performed in the comfort of her home.
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- X-ray at 2 week follow up showing distraction with a light cloud of bone in the gap.
THE WEEK IN PHOTOS:
Hôpital Adventiste
Although our hospital continues to improve, the situation beyond our walls continues to deteriorate. The streets are a mess, protests and gangster control have locked down the country. Schools are closed until January, banks and businesses are only open intermittently and getting supplies is very difficult. Trips across town and airport transfers are made with trepidation. So far the ambulance has only suffered a few hits from rock throwers. All of this has significantly affected patient flow, but in spite of that, volume overall this year is up from previous and the hospital is surviving financially. We continue in our efforts to restore the hospital. On our campus people are working and getting paid for it. The work here provides jobs for people in need, teaches new skills, and gives a sense of accomplishment. We are all working with a sense of enthusiasm and loyalty for the mission of this institution. The result is a beautiful and peaceful environment where we can share God’s love, peace and healing power which is needed more than ever in this country.
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- Restoration in action.
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- The work team pitching in to get a bit more cement poured before quitting time. We have no cement mixer so the cement, sand, and gravel gets put on the ground and thoroughly mixed with shovels.
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- HAH parking lot before (photo taken 2 weeks ago).
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- The new curb and landscaping.
Jonathan Euler and his crew are largely responsible for this. He and I watched a few youtube videos on how to make curbs before we launched the project. Normally curbs are not something that you probably have ever noticed but everyone is pretty excited about this as the job was quite a challenge
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- No matter how nice we try to make it nothing compares to God’s artwork.
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- A small flowerbed by the chapel that was previously a patch of weeds and convenient place to throw trash.
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- Plumeria trees in front of the ER. Previously a weed mound.
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- Sweet 14 year old boy who comes to HAH with a crooked leg (photo May 2019)
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- Sylvance after surgery. He still has his fixator on. There were some issues with follow up and compliance but he is back on track and the leg is healing nicely
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- Rodolpho comforts little girl before going to sleep.
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- The hallways are crowded with patients representing both growth and the need to make the process more efficient.
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- Jaden a surgical tech from Loma Linda and his girlfriend Angel made their first trip overseas to help out this week at HAH.
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- Our instrument trays get organized. Thank you to Jaden, Angel and staff.
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- Little girl in clinic with Volkmann’s ischemic contracture. She came to us 3 months ago with a supracondylar humerus fracture. She had a well performed operation. 6 weeks later the cast was removed and she had a beautiful result. We told her she could start moving her elbow normally. She was then taken to a local voodoo healer where a hot poultice was applied with a constrictive dressing. It was extremely painful and now she has chronic wounds and a permanent deficit.
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- Jonathan goes to town on Wednesday to get supplies and has to negotiate multiple barricades.
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- HAH drone evaluates situation down the street on Thursday.
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- Dumptruck breaks down in front of our hospital after delivering rocks for construction projects. The poor guys spent half of their profits to pay off gangsters at barricades in order to make the delivery and then their truck breaks down.
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- A few more gallons of diesel. Our generators are working 24/7 now since we have not had power from the city. We burn about 8-10 gallons per hour in order to produce 200kw. The trash pile continues to grow in the background. The trash truck has not been able to make it to our hospital for over one month. We are working on an initiative to eliminate Styrofoam containers from our hospital and more efficiently manage our waste.
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- Dr. Alexis operates with Haitian intern who has been volunteering at the hospital.
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- A mushroom spontaneously grows out of our patio table after all the tropical rainstorms.
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- Mackenson our HR director and his wife after church. We can hear the people singing Blessed Assurance at the church next door punctuated by the sound of nearby gunfire.
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- Universitie National Adventiste d’Haiti (UNAH) our next door neighbor.
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- More beautiful nature at UNAH.
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- Salle d’Urgence at night.
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- Hôpital Adventiste welcomes nightfall.
Hôpital Adventiste: Standing Strong Amidst Political Crisis
Monday I arrive at Port au Prince Aéroport Toussaint Louverture. Michel our hospital driver is running one hour late. Normally he is always on time but today he had to take a more circuitous route than normal to avoid the fiery barricades and mobs of people that have taken to the streets.
Monday arrival with fires burning on the horizon.
People are riled up because the president is trying to install a prime minister accused of a string of corrupt deals. Luckily I make it through customs OK with four heavy bags of equipment for the hospital. This was facilitated by an eager baggage handler who put my bags through an x-ray machine and quickly stacked them back on my cart while whispering something in my ear. I knew what it was about. As soon as we got around the corner he wanted $50USD. I smile and give him $10, which I justify as a tip for handling the bags rather than a bribe for customs. Before long Michel arrives, and we set out from the airport taking the back streets across town. Each time before making a turn Michel looks down the street to check for barricades. When we see smoke, flames, or mobs we take the alternate street, sometimes going in the desired direction. With minimal traffic on the road we arrive at the hospital a little faster than usual.
Jere Chrispens, our CEO is not able to fly to the US on Tuesday after a fire breaks out in the airport gift shop, coincidentally about the same time the president of Haiti is supposed to depart for the UN general assembly. Flights already in the sky out of JFK and FLL are diverted and all arrivals and departures are cancelled for 24h. This is great for me because I get an extra day to work with Jere on hospital administrative issues.
Wednesday arrives. The ortho clinic is almost empty except for all of the faithful moms who bring their babies each week to the clubfoot casting program. There is almost no public transportation, there are fuel shortages, and the economic situation only continues to deteriorate. But nothing can get in the way of a mom watching out for her baby. They might not have food or means for anything else in life but they still show up to the clubfoot clinic so their babies won’t grow up disabled, ridiculed and disregarded in an already challenging life. Thankfully most of our employees live close to the hospital and loyally show up for work, albeit in some cases having to bypass rock throwing and gunfire.
Thursday is unusually peaceful except for some trauma cases that arrive including a 6 year old girl with an elbow fracture. I specifically mention her for a few reasons. It’s not because the case is so rare or amazing, but I am excited that she showed up to our hospital only one day after suffering a type 3 supracondylar fracture (Type 3=bad). In the past our hospital has had a reputation of being elitist and inaccessible. When hospital finances were tight prices were raised and poor people were turned away. In addition to not taking care of the poor, hospital finances continued to struggle. It has not been easy to show how lowering prices and creating accessibility can actually improve hospital finances, not to mention our bigger reason for being here. But this is happening.
6 year old girl after having surgery on her elbow.
It is by a combination of factors, not the least of which are the blessings that come from generosity. We started something called “Pwogram Ijans Aksidan” which means something like program for urgent accidents. This is a package deal that gives a 75% discount to trauma cases that present less than one week from the time of injury. In the quest to give the best treatment to the most people with a set amount of resources it makes sense to take care of injuries soon after they occur. We have many cases that present months after injury with complications or neglect. Instead of coming to our hospital at the time of injury, they went elsewhere or nowhere at all because they could not afford our hospital. Now out of work for months having spent whatever they may have had elsewhere, they need help. So this little 6 year old girl shows up at our Salle d’Urgence (ER) with an acute injury and I am excited. Her dad was processed through our new financial counseling office, given an affordable price and she got a 20 minute operation that will avoid a lifetime of disability. Multiple factors have impeded this process from gaining traction, but finally we are seeing the fruits of our labor. We would love to give it all for free, but there are other implications to that… too complex for this discussion. In any case we now have a system to make treatment possible for all and to avoid turning people away. It still has glitches but these are getting less and less.
Motorcycle accident in the Salle d’Urgence. Time for a Friday night operation. All turned out well.
The political situation continues to escalate throughout the week with plans for the most massive destruction ever to take place on Friday. People are demanding that President Jovenal step down. He gives a small speech – at 2am on Friday, no one seems to pay attention. People are angry about double digit inflation, fuel shortages, no electricity and billions of dollars that are unaccounted for. They take to the streets. Banks are closed, schools are closed, all major businesses are closed and the city is locked down. I see a couple of major fires already burning downtown when I go for my 6am run. Fires, road blocks and destruction persist throughout the day.
At the hospital things are eerily calm but we are safe. We do surgery and then I have time to tend to my many other responsibilities. Finally Friday night arrives and I have enough time to enjoy dinner before getting called to the salle d’urgence.
On Sabbath afternoon I take a walk down by the bay with Patrick to visit some of our patients. The conditions down there would be shocking to even the hardiest of missionaries. We see Jervens who previously had a colostomy after getting clogged up on cement that he ate, we see Michena who had burn contractures on her foot, and Jackson who had a life threatening infection, all of whom were treated at our hospital. I hear repeatedly “Bonswa blan” (good afternoon white) “Mesi mwen blan” (thank you my white). Then they bring me to see a 3 day old baby. The parents again thank me profusely for saving the mother’s life and for their baby. At first I don’t know what they are talking about, I am an orthopedic surgeon. But then I realize they had come to the hospital with mom in distress a few days before. They had no money. So I directed them to our new financial counseling office and they got treated. The system is working!!
Boot Camp Blast!
I wake up on Sabbath morning to enjoy a few peaceful moments under the mango tree, reflect on the events of the week and read a chapter in my French Bible. Sabbath is the only morning that we don’t have to hear the recently donated gas leaf blower start up at 620am. I also slept in a bit later than usual due to the absence of at least one outspoken rooster who routinely wakes up at 3:45am…
I contemplate the busy week of boot camp activities, wondering if the medical students have been as inspired by the experience as I have. We kicked off most days with a morning run, either a 5am run at the track or a 6am sunrise jaunt up the rugged dirt road hills returning through the chaos and pollution of Port au Prince rush hour traffic. Hospital worship starts at 730am sharp – a hymn, prayer, hymn, Psalms, devotional, special music, benediction, announcements and the salutation. It is good chance to practice French comprehension and greet the staff.
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- Sarah, Mackenzie and Jenny
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- Aurriel and Brianna prepare to see some exciting operations
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- James and Sarah Appel stand in front of a wall that needs to be painted
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- Painting the wall was maybe the least cherished of the experiences, but even that was enjoyed by some
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- Sarah gives Emily and Aurriel a lesson on gurney repair
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- Colorful taptap riders
We then gathered around the table under the tree with our boot camp family to hear Sarah tell a story about working in a bush hospital – always with a spiritual pearl. The work strategy of the day was briefly discussed. Teams A, B and C – 3 students each take turns on different activities. The surgical service includes going to clinic, doing rounds, observing surgery, washing instruments, and organizing the OR. Sarah’s team roams the hospital looking for patients and projects that need attention. Their activities include caring for patients in the ER, transporting them to the OR, facilitating x-rays and labs, reorganizing the pharmacy, cast room, multiple storage rooms, working with nurses, repairing gurneys and wheelchairs. We also had a maintenance and grounds team which spent most of the two weeks putting a fresh coat of paint on our 300 foot wall. Lots of graffiti was eliminated, but more came in the night almost as quickly as the paint dried. Luckily there was time to repaint those parts of the wall and we now have two days of no graffiti in front of our hospital. Probably a new record.
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- Jenny, Mackenzie and Ruth make new friends
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- Patrick and his brother host the foreigners
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- Jenny, Emily and Elijah take Dr. Lamberton on a home visit
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- Eric and Elijah shopping for food
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- Harrison teaches Creole class
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- Street life in Carrefour
Projects stopped at 4pm for the afternoon Kreyol class. Harrison is the professor and he did an excellent job. Everyone also got a chance to experience the hardships of life in Haiti by doing some home visits. Dr. Lamberton, chairman of the DMA program, came from Loma Linda to join us during the last several days. His sense of adventure found him on the back of a motorcycle taxi going on a home visit with some of the students. After dinner each night testimonies and experiences were shared and the answers to some difficult questions were discussed. Everyone went to bed tired.
Click the video above to see Dr. Dan Smith mellifluously insert an intramedullary nail.
James and Scott at work on a TSF
Dr. Dan Smith and Dr. James were able to do a much awaited for operation on a young boy who lives in squalor with a colostomy. He ate some cement a few years ago and plugged up his colon which resulted in 6 operations and a colostomy. The operation this week will once again allow him to have normal bowel function. This is a whole story of its own. No time now. But it is one of the many miraculous and providential events happening at HAH.
After finishing his surgery on Wednesday afternoon James and the students decided to chase the rooster down and chop his head off with a machete. The med students who just finished their anatomy class plucked him and used their knowledge to remove the liver, heart, gizzard and other innards. The rooster was then prepared with some spices from the bunkhouse and served as an hors d’oeuvre. Even the vegetarians and animal rights activists joined the occasion.
All of these events run through my head as I sit under the mango tree. Birds chirp, a gentle breeze blows, and the sun rises. After enjoying a few moments of peace I come back into the house to get away from the mosquitos, when suddenly I hear a loud boom and shattering glass. I run back outside to see James coming out of the duplex across the yard in a stupor. I find Sarah sitting inside on the floor relatively unharmed by the oven that just exploded. She is in a daze but still has a smile on her face and is chuckling about the event while holding her head. A thick smoky haze fills the house and oven parts are strewn about the kitchen. The oven was 18 inches out from the wall and the top looks like the open hood on a taptap. The blast blew out the kitchen window, shattered glass all over the porch, but the screen intact. Sarah only suffered a minor head injury from some unknown projectile. The flame had gone out while baking banana bread. Thinking the tank had probably run out of propane she tried to relight the oven. These Haitian ovens can be finicky and we learned that it is not good to relight them after the flame has gone out. Evidently the learning lesson was not clearly communicated to the students who were later cooking dinner and noticed their flame had gone out in the bunkhouse oven. Later in the day when Greg and Brianna try to relight the oven BOOM! Another blast, albeit slightly less forceful than the first. Hairs were singed, no windows blown out. Unlike the first oven this one might be repairable, or we will consider replacing with something of higher quality.
We wanted boot camp to be an authentic experience – not one that would just be called fun or enjoyable. Nonetheless it seems that everyone had a blast and thankfully it all ended well.
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- Brianna, Aurriel and Emily create map art marking the location of Adventist hospitals around the world
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- Ruth and friends admire a brand new human life less than 1 hour old
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- Gregory and Mackenzie make friends in the salle d’urgence (ER)
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- Map is hung on the wall near the pharmacy
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- Narrow streets in shantytown
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- Eric learns about orthopaedic implants and organizes cannulated screws
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- Hospital chauffer diplomatically navigates arriving boot camp participants around the political protests that reached a climax during the first week of boot camp
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- Morning rounds
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- Sutures nicely organized in the OR by Sarah and team.
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- Dr. Fenison from Loma Linda spent week 2 helping with cases and teaching his daughter Aurriel a bit about orthopedics
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- Aurriel helps with the C-arm while her dad, Dr. Anthony Fenison fixes a tibial plateau fracture
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- Brianna prepares to help remove some external fixators
Good times with Greg
Boot Camp in Action
The tropical night rain just started to fall as I enjoy a few peaceful Friday night moments after an incredible week. The week was concluded with an wonderful meal, worship service, and some amazing stories from James and Sarah Appel about their 15 years in Chad. It is truly an inspiration to hear stories about James’ and Sarah’s work in an African bush hospital. HAH could be considered the Ritz Carlton compared to the places they have lived and worked. However, the boot campers have not been coddled… we are now in full swing. I think it might be more tiring for me than the boot campers, but nonetheless they have been working hard and getting all kinds of experiences. This is an incredible group of focused, energetic, and committed individuals.
The first day we had them organize themselves into three teams of three. One team is on the maintenance and construction crew. Another is on the ortho/surgery service, and the third is under the mentorship of Sarah Appel who is integrating them into the ER, lab, pharmacy and other areas of the hospital.
Yes, we have a little red tape around here as well. Eric Drinhaus and Elijah Yap at work as the sergeant supervises.
We also appointed several leaders to delegate tasks amongst them. One person is in charge of finance, one in charge of food, one communication, and another for organizing activities. I am impressed by how adventurous, hard-working, and resourceful the students are. Experiences have included morning runs, home visits, storage room organizing, gurney repairs, OR observation, cleaning instruments, clinic observation, morning rounds, pressure washing and painting the front wall, lectures, Creole class and evening debriefing sessions amongst other things. They go out to the open markets, experience the street scene, and negotiate the purchase of fruits, vegetables, and other items that I never knew existed.
There has been no lack of boot camp activities. Keeping enough tasks lined up to keep everyone busy is not an easy job considering the efficiency and work ethic of this group. I was quite pleased today when we discovered a nursing storage room that needed a lot of attention. Sarah and the students made friends with the nurses and then really got going on the job.
They discovered a lot of OR equipment stashed away that I had not been aware of. Two days ago we were using some bad suction canisters in the OR which did not have a shut off safety to prevent blood from getting suctioned up to the wall. I asked the orderly to throw away those bad canisters but he said we had no more and brought them back into the room. Not knowing for sure if it was my bad French accent, I made it very clear once again that the canisters needed to be thrown out as we did not want to jeopardize the expensive suction pump installed downstairs. Finally the order was carried out. Well, today we unearthed about 50 brand new ones in the nursing storage room upstairs. Part of doing good surgery, making the most of donors funds, and creating sustainability at a mission hospital is knowing what you have and having it ready when you need it. In spite of my pro-active approach to inventory management, I am still discovering more storage rooms after all this time here!
Boot Camp Safety Briefing
The DMA Boot Camp kicked off today in spite of political unrest in Port au Prince that threatened cancellation of this event. DMA stands for “deferred mission appointee” which is a loan repayment program run by the Adventist church for medical students interested in long term mission service. When students enter the military loan repayment plans they go to the reserves and do training. So why not have a similar orientation for our aspiring mission doctors wanting to do long term international service?
The boot camp was conceived when I was in Chad, Africa in February 2018. I would like to take credit for the idea, but in reality it is Dr. James Appel who deserves the credit. My experience working with him in Chad last year was a true boot camp. Immediately upon arriving on the African continent we took a 12 hour drive across the desert to the eastern border of Chad and worked nonstop. Work started early and continued late each day. I was put in a small vault where I slept on the floor without any proper facilities. My immune system was strengthened with exposure to a new set of antigens, but not without paying a price. In spite of the discomforts the experience was a mutually beneficial learning experience for two doctors who had spent years in overseas service independently facing many of the same challenges. Voila! Mission boot camp was conceived.
Drill sergeants Dr. James and Dr. Scott with 9 boot campers in front of HAH. Caleb and Micah Mahoney also joined in the fun.
James and Sarah are here with us in Haiti for two weeks. We are joined by eight first year medical students and one nurse married to a first year medical student (her husband is in Mozambique on a different trip). I am humbled by the aspirations of this energetic group each of whom have a strong desire to serve God and make the world a better place. Most are specifically interested in long term medical service in austere and limited resource environments. We are also joined by Dan Smith who is a general surgeon that is doing a global surgery fellowship at LLUMC. This is a program that gives general surgery graduates more in depth skills in a variety of surgical specialties and prepares them for overseas service. Dan is planning to work at a mission hospital in Lubongo, Angola starting next year where he will move with his wife and 8 kids.
Last night James gave us a Biblical safety briefing. I can elaborate on that more in a future post but in summary he reminded us that the safest place for us to be is to be where God wants us to be. There was some deliberation about whether to allow eight students and a nurse to be sent to a country with a level 4 travel advisory. My compliments to Loma Linda University for prioritizing a focus on mission service and allowing this trip to occur. That is not to say we are not taking all necessary precautions. It is not to say that we are depending on our angels to rescue us from irrational behavior. But we are all safe and in a place that we should be.
Total Hip Replacement at HAH
The infrastructure required in order to do total hip replacements safely is significant. Implants are also very expensive. Many of our patients needing this type of surgery are young and have suffered trauma or other untreated conditions of the hip. These surgeries are often difficult and the implants used must of the very best quality given their need for longevity. Launching this program has been a dream for many years and last year we were able to get it off the ground with a couple of trips to perform hip replacements. We were just graced by the visits of Paul Burton and Travis Scudday who did 7 total hip replacements over the last few days. In the future we hope to accommodate even more surgeries on these trips as we create efficiency and new standards in our program. A big shout goes out to the Renovis company who generously donated the implants for these cases. Because of their great generosity and the two excellent visiting professors, all these cases turned out great – with some patients going home on Post Op Day 1. Our therapist Irma also deserves a big shout for that as she gets them up and moving in order to regain strength quickly and avoid blood clots.
Below are several posts and pictures from Dr. Paul Burton…
Day One: Clouds Over Haiti
Just saw a birth via c-section. Here is the new guy!
Scott and Travis are fixing an ankle and we will do a THR next on a man who fell 3 years ago.
Here are the pre and post op xrays of a very difficult THR we did today with Dr. Travis Scuday . Injury years ago with disabling arthritis. Has a new Kyocera hip now!
Day 2: Round 2
Was exhausted last night and slept 9 hrs. Have brought along Mikayla on this trip -a pre-med student and daughter of a friend. She is very excited to be here.
Went to the market and bought supplies. No hospital work today as this is the Adventist Holy day. We went on a 5 hr hike and saw amazing views and also massive infrastructure failure with trash everywhere. 
Day 3
We did 4 THRs and 2 ankle fractures today. Long days as the staff are unfamiliar with THRs.
It was Mother’s Day here so we paid the nurses a bonus to come in. They only make $15 a day so in addition to that we paid them another $30- they were very pleased.
Day 4
A new baby came:
And we saw my pt from yesterday whose hip was gone from a previous tumor resection and now his leg lengths are equal and he can walk:
Did more challenging hips and made dinner for all who are coming over to “the bunk house”:
We taught Mikayla how to scrub and she was so excited:
Day 5
Visited a school and the children were so polite and beautiful!
On my way home. It has been a very rewarding trip and blessed to have been able to have participated in this amazing ministry of Dr. Scott and Marni Nelson!
Thank You...
Leaving this am and have immense gratitude to all of you for making this possible and transforming lives over a very memorable Memorial Day weekend. Three OR days, 14 cases, one long hike with Scott and Marni and some hardy staff here, 7 THRs with a few being quite challenging for Travis and I.
An enormous thank you to:
>> All my partners for giving me this time to go. Special thank you to Ronny for seeing my patient at St Bs.
>> All of Kyocera/Renovis and John and John Paul for donating the THR instruments and implants.
>> Jose and his team for packing it all together
>> Jim and Ronny for the supplies, TXA, Ancef, suture, gloves, etc. and Suzie for ordering it all.
>> All the OR staff at the hospital here, especially to the nurses and anesthesiologists who worked on Sunday which was Mother’s Day here. Many of them are mothers who were away from their children and families.
>> Travis for all the work and coming and giving his time away from his family and to the Hoag Foundation for supporting him.
>> Mikayla Carlson for her work and enthusiasm!
>> Scott and Marni for their immense hospitality and for doing this amazing mission work. There are rewards in places beyond for these two!
>> Sally and Bloom in the Dessert Ministries for prayers and support.
If I missed any, I apologize and thank you!
Kafou: Past Present and Future
Kafou, pronounced as written, is the Creole spelling of Carrefour. French words always have a bunch of unpronounced letters and the R’s have to come from down in the throat which is not easy if you are not a native French speaker. Haitian Creole has simplified all that. Kafou/Carrefour is the name of the suburb where we live, just 4 miles from the center of Port au Prince.
Haiti, once a popular tourist destination.
It literally means crossroad. This is a sprawling area with about a half million people that once was a peaceful retreat from the bustling downtown area. Our main street was formerly called Boulevard des Amandes (almond) with almond trees that beautifully lined each side of the street. People came and enjoyed tropical resorts along the Rivière Froid (cold river), and just a few minutes down the road, sugar cane fields hid the unspoiled tropical beaches.
In the early 1900’s the Adventists bought a large area of land in Carrefour and built a university and a medical clinic. And in 1981 construction on Hôpital Adventiste d’Haiti was completed and the doors were opened for service. The hospital was well designed, constructed to the highest standards, and furnished with quality equipment. There is a central atrium area which was created to pull fresh air through the building as warmer inside air rises and exits out top of the atrium. The original layout included kitchen, cafeteria, laundry, workshop, morgue, lab, x-ray, storage, administration, physical therapy, outpatient clinics, emergency room, and several inpatient areas.
Entrance to Université Adventiste d’Haïti circa 1930, adjacent to the current location of Hôpital Adventist d’Haiti.
One can only imagine the glorious day of that grand opening. I am sure the visitors were impressed with the walk in refrigerator/freezer in the kitchen and all the beautifully crafted orange and white cabinets in the OR.
OR storage room 2010.
OR storage room 2019.
The new Adventist mission hospital soon gained a national reputation for high quality services. Nostalgia is probably not reality and I am sure there were many of challenges that existed back then. Nonetheless there must have been a spirit of service and mission zeal that built the early reputation of the hospital.
The verdant entrance to HAH in 2008.
I first visited HAH in 2005. I remember being impressed by the peaceful campus of the hospital where nature was, and still is relatively well preserved. With massive environmental destruction in the overpopulated city of Port au Prince, the open space and shady trees of our hospital are a welcome respite. When I look through old photos of my years visiting and working at HAH it is interesting to notice the changes, some major improvements, other things that need attention, and some things that were fixed up and now need another round of major work. In the tropical climate, paint peels, metal rusts, and mold grows. But that is OK, because when I see the old photos of myself 10 years ago, I also realize that there has been some deterioration.
Construction on Kafou bridge. With billions of dollars unaccounted for by the government, the project has made no progress for several years.
Well, we have a lot of work to do… but a lot is getting done. In spite of the natural tendency for deterioration, things are improving little by little at Hôpital Adventiste. Yesterday in our radiology department I was mesmerized when I saw a painting by a local artist depicting a utopian Port au Prince.
Utopian Haiti. The folks pushing carts in the streets and tap taps still providing transportation adds a bit of reality.
Note the modern elevated metro coming into the Martissant Train Station. (Martissant, our neighboring suburb now notorious for gang violence, surpassing cite de soliel as one of the most dangerous areas of urban decay in the western hemisphere) Notice the green grass and clean blue fountains flowing forth with fresh water. Just imagine someday boarding the metro at the Carrefour station for a 20 min ride to Aèroport International Toussaint Louverture where today that 7 mile commute can sometimes take a couple of hours. We might not have the ability to help make all that possible. But with the Lord’s blessings and all of you supporters, the utopian Hôpital Adventiste can be a reality. And it can be a place where people come for healing and a place where people experience a piece of God’s kingdom.
Haiti, still called “Pearl of the Antilles”.
Haiti Update
Thank you all for your thoughts, prayers and concerns for our work and for the country of Haiti. Things have been tense over the past several weeks with violence and protests aimed at overthrowing a corrupt government. Police are in a particularly precarious situation as many of them are in agreement with the aims of the protesters yet are being asked to maintain law and order. The upheaval has disrupted life at every level. People have not been able to move freely about the city, markets, banks and petrol stations were closed for over a week and since have only been open intermittently. People are unable to access basic necessities. Fear and lawlessness is becoming the norm. This has had a negative impact on hospital census and income.
In this gutsy 6 minute episode of Vice https://www.youtube.com/watch?v=3eNzEGEsxr0 one can get a quick overview of the situation which exposes a lot of unanswered questions. The unfinished bridge scene at 2 minutes is 1/2km from Hôpital Adventiste and marks the home stretch of my morning running route.
Additional fury was created when some heavily armed US mercenaries were caught red handed by the Haitian police in an unmarked vehicle that belonged to top Haitian government officials. These ex-navy seal snipers who specialize in top level security jobs had barely made it out of the airport on their ill-fated mission when they were apprehended by the Haitian traffic police and then thrown into the local slammer. Some unknown negotiations between the US embassy and the Haitian government allowed them to return to PAP airport in shackles. American Airlines required them to be unshackled prior to boarding and then they were set free when they arrived at MIA. News of the botched operation has gone viral and basically ruined any future clandestine security opportunities for these questionable characters. In the meantime the president denies having anything to do with them.
Dr. Alexis was unable to come to the hospital for over a week due to all the roadblocks and manifestations. Most of the employees live in the local neighborhood and were able to make it to work, although for several days we did not even have a single patient make it to clinic or surgery. I held down the ortho service during this time – which was not difficult. We took advantage of the situation by doing a lot of spring cleaning and organization of materials in the OR. Food and fuel stocks ran low, but thankfully never completely ran dry.
As for danger – there have not been any direct attacks aimed at us or unnerving events at our hospital or the immediately adjacent area. We do often hear gunfire and yelling down the street and off in the distance. There is no question about the dangers and dramatic affects this situation has had on everyone. Thankfully the loss of life has been rather limited. Nonetheless, with level 4 alerts from the state department, missionaries are being evacuated and all non-essential embassy employees are being sent home. I am not sure I understand the logic of all that, as missionaries are needed more than ever, and it may not be that much more dangerous than the all the of the subtle influences of the United States.
A woman walks past tire barricades set ablaze by demonstrators protesting in Port-au-Prince against Haitian President Jovenel Moise Feb. 10, 2019. Credit: Hector Retamal/AFP/Getty Images.
On one particular day we had to take to the airport in the heat of the riots. This occurred the morning after an apathetic speech from the president who will not step down. One of our patients asked if there was any way we could take him to Delmas in the ambulance and since Jere was going to the airport that day I arranged for the patient to go along. Patrick and Michel wanted me to come and bring an oxygen bottle and box of medical supplies so we looked official. Without that I don’t think we would have made it. We almost took our patient back to the hospital just so we could make it back ourselves. We had to navigate multiple road blocks and at one point this guy in a red shirt whose smile was almost as big as his muscles started running 50 feet in front of us clearing the way and negotiating passage with the barricade ring leaders. Some were quite stern and were armed. They looked inside the ambulance very carefully to make sure it was really functioning as an ambulance. Fortunately it was… We had to navigate a lot of smoke and fire leaving a burned rubber smell on our clothes. Once the road cleared a bit the guy in the red shirt and his buddy held on to the outside of the vehicle until they were chastised by some police officers. We had to let them go, but then after we let Jere off at the airport we went back and found the them and proceeded to Delmas to drop off the patient. Then Patrick had another prayer which the escorts appreciated. We gave each of them 500 gourdes ($7) and took down their phone number for future reference.
In any case maybe not more dangerous than navigating your way by all the shopping malls and fast food joints on a trip from Loma Linda to LAX!
The past several days I have been in the US on a previously planned trip. Dr. Alexis has been able to make it to work on most days and has taken care of several gunshot wounds. He said one of the days demonstrators were pouring oil all over the streets as he drove to the hospital from his home near Petionville. In Martisant (corridor between hospital and center of town) there were two citizens killed in one day and on another day a police officer was shot and killed by the bad guys.
For those of you planning trips… predicting the situation is equally as difficult as predicting tropical storms. Forceful storms come and go rapidly as burning tires in the streets. I do imagine that until a major change in political power occurs that the situation will remain quite volatile.
Scott Nelson, MD
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