HAH is Not on Autopilot
The challenges of working in a foreign country where resources are limited and political strife continues to threaten may never allow us to be on autopilot or operating by remote control. Hôpital Adventiste d’Haiti is a complex machine and we are not on a short or easy journey. Strong headwinds slow us down and at times we have to navigate turbulence. Thankfully we have been blessed in so many ways this year which enables us to have the energy and resources needed to move forward in the right direction.
I love construction projects and we have had a lot of them lately. These help to reflect the quality of the care we give our patients and create a work environment that is effective and organized. We also have worked hard on a number of less visible projects this year which involve meetings, spreadsheets, and planning. All of these efforts are continually kept in context with our mission to continue the healing ministry of Jesus Christ by providing quality care to all classes of people. The end result is measured when you see patients rolling out of the operating room, clinics overflowing with people, and life changing differences taking place in the lives of those we serve.
A brief chronology of events over the last 6 months begins with our return to Haiti in early July several days after the PAP airport opened up. It had been closed for 4 months. C19 in Haiti peaked in late May and has since been relatively dormant. More recently we have only had a trickle of new cases and the per capita death rate is only about 1/50th of that in the US. Travel has been by and large trouble free without any significant restrictions between Haiti and the US. Although less than normal, we have still hosted students, orthopedic residents, and other visitors coming to volunteer at the hospital. Ironically you might be safer coming to Haiti now then if you stay home.
In August Tim and Annika Cleveland moved here from New Mexico to join our team. Tim is an orthotics and prosthetics technician and is restarting our O&P program in collaboration with the Loma Linda University School of O&P. This program previously existed for the first 5 years after the earthquake but eventually lost momentum due to financial constraints. Tim is talented in a number of areas and has been a huge help with our renovation projects and repairing all types of equipment around the hospital. Annika is an ICU nurse and clinical educator. Her skills are being put to use organizing our nursing department and launching our intensive care unit with Jorielyn which will hopefully become a reality in 2021. We have an amazing family of long-term volunteers, each with unique skills. Stay tuned for subsequent blog posts that will introduce you to them.
In September we moved our physical therapy department to the polyclinic building. In the masterplan this building will eventually be replaced by a new hospital ward. It was quite run down, but with a couple weeks of cleaning and painting we fixed it up as a temporary home for rehabilitation services which will include orthotics and prosthetics.
In October the dilapidated modular structure that housed PT was demolished and two shipping containers that were behind the building were moved into the volunteer housing area. Tim is working on turning these into two small container houses. This is all in preparation for the construction of a new rehab complex. We are now finalizing contracts for that project which we hope can start in early 2021.
In November Irma Henry our physical therapist, Corey Fuller LLU ortho surgeon and I took a trip to the Cure Hospital in Kijabe, Kenya. We taught a limb lengthening and deformity correction workshop for the Cure surgeons in order to train them on some specialized techniques using hexapod external fixators. During this time we operated on a number of difficult cases. Overall it was a rich learning experience for all of us. Cure currently operates about 8 children’s surgical hospitals mostly in Africa. Their mission to heal the sick and proclaim the kingdom of God is impressively implemented. It was an inspiration for us to work with their doctors and staff. Although the short trip was a bit exhausting, we returned with a renewed energy, set some new goals, and had a renewed sense of gratitude for some of the unique blessings that we have at our hospital.
Now in December the year is coming to a quick end. JT Haas and my dad came to work on our electrical system and data network. JT is an excellent electrician who has been here a number of times in the past. The complexities of running a mission hospital in the modern world require the expertise of many people. My grandfather working in Africa in the 1930’s only needed to know enough about electricity to turn on lightbulbs. Now we have issues to solve that involve 3 phase electricity, 200KV diesel generators, solar panels, lithium battery packs, inverters, and backup electrical systems to protect sensitive electronics, servers, and imaging equipment.
In addition to the rehab building project and creation of an ICU we have several other significant projects prioritized for the upcoming year. These include relocating the ortho clinic, creating a reception area in the front of the hospital, solar and backup power installation, employee bathhouse, and renovating our nurses stations and patient rooms. In addition, we are working on some less visible projects such as streamlining our stockroom and purchasing processes, quality improvement initiatives, health and wellness programs, and augmenting our spiritual life department. Most importantly we hope to take care of even more patients next year and allow our hospital to grow in volume and quality. This is not a fundraising appeal, but if you are looking for an opportunity to make a meaningful difference then we can help. You can be assured that your donation will be carefully used and bless the lives of many in need. See www.amistadinternational.org and designate Scott and Marni Nelson fund.
As you can see with all the great help and support of generous donors many exciting things are happening at Hôpital Adventiste d’Haïti. I would like to express my gratitude to all of you who are part of this effort. With all the setbacks of 2020 your generosity takes on an even greater significance.
Merry Christmas 🎄
“Kowonaviris” Care Package is distributed to HAH employees
A light breeze blows every few minutes giving just a brief respite from the heat and humidity of this Sabbath afternoon under the mango tree. There is a fuel crisis and we had to turn the generator off. The little bit that we have in our tank we are saving for emergency surgeries and intermittent essential activities. We are in the process of trying to upgrade the hospital electrical system which will include solar and a battery backup that can partially alleviate these issues. Our water system also needs some upgrades to allow for running water during power outages. A cool shower can help a lot when there is no fan or AC. I should not complain because most people around here have none of that.
I would like to pass on a huge 🙏🏾🙏🏾🙏🏾👏🏼👏🏽👏🏽👏🏽 thank you, merci beaucoup, mèsi anpil from all the employees at HAH to those of you who participated in the pandemic care packages. Just like everywhere times are tough in Haiti, but unlike some places they were tough before all this began and there is no margin for reserve. Many of our employees had to take unpaid leave due to decreased hospital revenue and patient volume. In an attempt to ease the strain on our employees and their families, Jonathan Euler had the idea of preparing some care packages. These are not your average Christmas baskets with a few luxury items but rather 50lb bags that include a large quantity of various staple food items.
We had a Calimesa church vespers on the lawn a few weeks ago and I was given the opportunity to talk a bit about the exciting things going on at HAH and some of the needs we have. A few days later our pastor called and said our members had given $5800 for the corona (kowona in Kreyòl) care packs. This combined with the resources from a few other donors brought us quickly to the $10,000 goal needed to fund this project.
Then came the complicated part. Jonathan had to turn that into 240 care packages that weighed about 50lbs each. If you do the math that is 12,000lbs of food. He did his grocery shopping and was able to talk the store into making a delivery. He was able to divide all the ingredients into beautifully prepared packages. Distribution was the next step… fortunately our COO Mackenson organized this process. Many times giving out gifts can get quite complicated around here and sometimes good intentions can create unexpected results. We heard that certain people may be offended by a gift of rice and beans and others may try to get more of their share. How were people even going to carry this thing home? Walking up the hill where a lot of our employees live is not easy even with your hands empty. With so many other urgent things to attend to at the hospital I was wondering if it really was a good idea after all.
The results were unexpectedly beautiful. From the generosity of our church family in California to the amazing gratitude of our employees. Everyone got one – nurses, doctors, gardeners, cashiers and lab workers. The distribution was well organized and the hospital employees understood that this was a token of appreciation for their hard work. They appreciated the thought and preparation that went in to selecting each and every surprise item. And most importantly they expressed their gratitude towards those in our global church family who care about them.
Los Angeles to Port au Prince trip is successful with a few minor inconveniences
During the past few months we have all had to learn not to become too attached to our plans. On March 19 the Port au Prince airport was closed. At the time, it was inconceivable to think that our pandemic furlough would have lasted more than 3 months. Airline reservations were cancelled and changed so many times that there was no certainty of our return until we finally lifted off the tarmac at MIA on the final leg of our voyage to Port au Prince. It was so great to be looking out the window over the tropical Caribbean once again, I almost forgot about the mask itching at my face.
There were a few unknowns about the trip: rumors about quarantine, extra bureaucracy, and uncertainty about how we would be perceived at the hospital. Our group planned to travel on the same reservation to take advantage of some luggage allowances. The three complementary 70lb bag benefit allowed for certain frequent flyers on AA is somewhat of an empty reward given that most business people normally travel with only a carry on. Amongst the 7 of us we were able to check in 21 complementary bags of hospital supplies and equipment carefully packed and weighed to the maximum. A few bags were deemed oversize and the ticket agent asked me if they were “golf bags”? Knowing that this obviates the 62” rule, I agreed that this would be a good thing to call them and she put the PAP tag on them and called the guy with the special cart to haul them off. In spite of having to wear masks, the travel experience was quite acceptable. I do long for the days when we could ride airplanes and people are not putting trash bags over their seats, wearing full face shields and bunny suits, or acting so afraid of one another. But I did not mind driving into LAX at rush hour without slowing down and having 2 empty seats next to me on the airplane. When we arrived in Haiti they had us deplane on a stairway down to the tarmac and then crowd into a bus with social distancing signs suggesting that we separate ourselves from the people we had been on the plane with for the last 2 hours. Then we rode 100 yards over to the terminal entrance. The jet bridges appeared to be disabled “for health and safety reasons”. We filled out an extra form and had our temperature taken and then proceeded as normal. 20/21 of the bags arrived. The lost sheep was tracked in Miami and came the following day. The customs officials were quite interested in all the contents of our bags but after a confidential negotiation we were permitted to proceed.
The incidence of Covid-19 has been a bit blunted in Haiti and is now on the decline. Headlines predicted ominous disaster due to crowded markets, impediments to social distancing and a broken health care system. Fortunately the impact has not been much different than some countries in Africa where people live most of their lives outdoors, their immune systems are robust, it is hot, and the population is young. In Haiti less than 5% of the population is said to be over 65. Upon arrival we were quite impressed to see that the people seem to be accommodating to the situation relatively well. Businesses and stores require masks and at the Delimart you must wash your hands and have temperature taken, but there has been no evidence of negative reactions toward foreigners. At the hospital there were welcome back signs posted all over. Many were giving hugs and at a minimum an arm bump. Although not required, we all got tested for Covid-19 in order to assure our workers that we did not bring any corona to Haiti. Even without that they have not seemed overly worried. This is our first Sabbath here. Today there were no church services and the morning was unusually quiet without all the song services. Churches are allowed to reconvene as of tomorrow and will give the Sunday churches a 6 day head start on the Adventists.
In prior times returning to the hospital was quite an adjustment. Everywhere you turn there were issues to resolve, piles of rusty equipment, peeling paint etc. etc. There are certainly many things that still need attention and the first day back was pretty chaotic, but it was super exciting to come back after 3 months and see so much progress. Jonathan, Vaval and the whole maintenance/construction team have been totally focused on preparing the hospital for my return. Now certainly this is not required but Jonathan uses moments like this to motivate the team to kick into action. And the place really looks incredible. Palm trees are trimmed, grass is mowed and there is not a single piece of trash on our grounds. Ezekiel is our new designated waste manager and performs his duties with pride and passion. Yesterday we had clinic and I was impressed to see volumes approaching pre-pandemic levels. Like everywhere efficiency and revenue is down. Big challenges remain. The gourde has fallen another 20% over the last several weeks. It is now worth nearly half of what it was when we moved here 2 years ago. In spite of life becoming even harder here for the average person they have a positive attitude and are more eager than ever to work. Word has it that the gangsters have gotten together and made an agreement that they will not do any kidnapping for the next 2 months. Not sure if they are interested in a higher moral standard, trying to avoid Covid or if there is no money left to take, but whatever the case there is a bit of good news out there when you look for it!
On the afternoon of March 19 president Jovenal Moise of Haiti in a press conference announced the results of the first positive COVID test in Haiti. At that moment he declared the Port au Prince airport closed and not another commercial passenger airplane has landed since that time. I happened to be on a short now turned long trip to California where I had planned to work for a few days at Loma Linda University. After several attempts to return to Haiti and multiple reservations that continue to get delayed by the airlines I am still in California working on many hospital related projects, administrative initiatives, equipment acquisition and remote management of hospital renovations. Marni was in Haiti when the border was precipitously shut down and was able to return on a repatriation flight. So although many have expressed concern for us being displaced from our home in Haiti during the pandemic I assure you that no one needs to feel sorry for us at all. We have been graciously hosted in a beautiful and peaceful guest house of some good family friends in Redlands.
Most of the expatriate hospital staff returned to the states as there was mounting political unrest and threats towards foreigners that were viewed as vectors of the coronavirus. It was not without significant reluctance that the decision to bring foreign staff back to the United States was made. We have a wonderful team both foreign and local that despite being geographically separated have continued to work together in order that the medical outreach can continue at HAH. I continue to spend almost all of my time on HAH projects, meetings, planning, and acquiring needed equipment.
At present the number of COVID cases in Haiti is just under 4000 with 67 deaths which is quite low compared to other countries where the human immune system is more coddled than in the streets of Port au Prince. We certainly cannot attribute this low death rate to an advanced medical system that is accessible to all. At HAH an abundance of precautions have been taken and like many hospitals in the US, the census is low, outpatient clinics are slower than normal, and efficiency has declined significantly. This has had an obvious impact on revenue, which has mandated unpaid leave for many of our employees. Without government aid and personal resources this has created some incomprehensible challenges.
Jonathan Euler deserves great accolades for weathering the pandemic without missing a beat. He has remained in Haiti throughout and been a huge blessing to our hospital as well as the 15-20 workers who have been able to maintain employment during the last several months. With less than normal numbers of patients we have taken the opportunity to complete a few otherwise logistically difficult projects. We were able to shut down the food service for a several weeks in order to complete the remodeling of the kitchen. This has been a much needed project that included some electrical work, replacing a few appliances, some new tile, painting the walls and fixing lights and fans. The difference is dramatic and the cost for the entire kitchen and dining room makeover was less than what a kitchen remodel would cost at your house. The simplicity of the construction will make the kitchen easy to keep clean and maintain while standing up to the rigors of cooking hundreds of meals every day.
Another major project has been the resurfacing of the floor in the main corridor of the hospital. After great deliberation we decided that the practicality and look of the original green hospital tile was the best choice for this project. These tiles are made locally, are very robust and equal or less expensive than other options. The tiles are also less slippery and do not show dirt and imperfections like some of the more modern choices. The old flooring had withstood 40 years of abuse and been patched in various places. Our gurneys can now roll smoothly through the hallways without having to go over ½” drops where new and old tile converged. (No more yelps from our patients as they were jolted over these speed bumps while rolling down the hallway with fresh fractures.)
On the medical front Dr. Geneus has led the staff through appropriate protocols and precautions. A COVID ward has been established and hosted a handful of patients. Dr. Alexis has been doing excellent orthopedic work during my absence. He frequently sends me photos of complex external fixators and well done SIGN nails for patients with various deformities and traumatic injuries.
In order to help our employees and their families we are raising $10,000 in order to give each of our 200 employees a Covid Care Package. Each package will consist of approximately $50 of food and essential supplies that will help to feed their families for several weeks. This project is a team effort that includes: a select few hospital workers who will be volunteering their time to help put these packages together, Jonathan and Mackenson who are organizing the process, and the rest of us who are contributing financial resources. If you want to speak out for social justice without having to take to the streets with a picket, then go to www.amistadinternational.org and designate “Haiti Hospital Employee Fund” on the donation link to contribute to this project.
Look What Happened at HAH in 2019
These before and after pictures are just the beginning of the story. Hôpital Adventiste is undergoing a major transformation. With an effort to make the hospital look on par with the quality of services we offer some minor and major renovations were necessary. We want patients to have a small taste of the kingdom of God when they enter the gates of HAH. We want them to feel peace and have an environment conducive to healing. This is a stark contrast to the chaos, and destruction of nature that exists outside the gates of our hospital. For many years various projects have been done at Hôpital Adventiste and have improved it in a number of ways. But this past year we were able to organize a coordinated effort to systematically clean up, fix up and overhaul the institution.
In April of 2019 Jonathan Euler who works with a nearby sister organization helped us on a small project. His resourcefulness was so incredibly helpful that I asked him if he could help us on a full time basis. Work was going slow with his other organization due to political issues and so he was able to make himself available to supervise our work crew. He has been a huge blessing to HAH. His organizational skills and ability to get stuff done is unparalleled. I also owe a lot of gratitude to my dad Peter and his friend JT Haas who have made multiple trips down here this past year and lent their expertise and work ethic to the effort. My dad still likes to put in 10+ hour days and use his skills as a retired dentist to drill holes and fix just about anything. JT recently retired from Pacific Gas and Electric where he was in charge of power distribution for the central coast of California. We have had experts give advice and others come to do electrical work but never before has expertise and the ability to get a job done been so effectively combined.
In a country where people struggle to feed their family, where political turmoil has devastated the economy, and where people are suffering from illness and injury without resources to access care, we had to ask ourselves if painting the walls, landscaping and putting up light fixtures at Hôpital Adventiste made sense. The experiment began with a few small jobs here and there. Workers were begging for more work. We provided it. The hospital needed painting and volunteers said it was too dangerous to come to Haiti so we hired local workers. Workers learned new skills, they got paid, and they fed their families. The workers and hospital employees started developing a zeal for the work and a sense of pride for well-done projects. Everyone was encouraged. Now I see our employees, patients and other visitors taking selfies in front of the hospital. Donor funds are not getting used just once, they are getting used over and over. Money is used to pay workers, the hospital gets fixed up, workers are trained in new skills and their families are getting fed. This allows us to operate our hospital more efficiently than ever and create more accessibility for patients in need. The pictures that follow portray some of the more cosmetic aspects of the hospital makeover. It is a work in progress. Thank you all for your support, it is making a difference, a big difference. We have many more goals for 2020!!
Thank you to Jonathan, JT and Peter for all their hard work!
12 January, 2010
I finish a day of work at the Cure Hospital in Santo Domingo, jump on my motorcycle and head out for the evening commute. This involves winding in between gridlocked vehicles jumping the curb a few times and finding any small path to make the 2 mile commute a little more efficient. Horns are honking and buses are belching out black smoke. I stop by a café to answer a few emails before going home to see Marni and the boys. Suddenly the place begins to shake. In Santo Domingo it was already 5:53pm. (one time zone west of Haiti) My California roots keep me from acting overly alarmed in spite of the fact that a few others start to panic. It stops, I finish my business and then go home. When I arrive the answering machine is blinking indicating a message (amazing to think that land lines and answering machines were still a preferred form of communication 10 years ago). My friend from California called to ask if I was OK. Wow! What just happened? Could it be about that little shaker that I just felt? I turn on the news. They are talking about Haiti and showing some satellite images. There is no communication with anyone on the other side of our island. News reporters just keep repeating the same lines and we keep listening to it hoping to hear some new information. The worst is feared. Thousands likely dead.
I made many trips there before and know the challenges of life in Haiti. As an orthopaedic surgeon living just a couple hundred miles away there was no choice but to go. Should I go immediately or wait until we get more information and make a plan? Marni says to go. I have no choice. I gather my team and supplies at the Cure Hospital and by Thursday morning everything is in order for a chartered flight across the island. The Port au Prince airport is collapsed and things are getting chaotic. Just as we are about to leave Santo Domingo we get word that that the American military has seized control of PAP airport closed it to all inbound aircraft. We go anyway. We had no idea what would happen, where we would get our next meal, our next shower or where we would lay our head to rest. That was not really important. When we arrive our worst fears our confirmed. We stop by a few hospitals to assess the situation. There are hundreds of patients all over the place. They are all over the parking lot, all over the lawn, in the courtyards and a few brave ones in the hallways. Almost all of them are orthopedic cases. Some seriously injured, some dying, others already dead.
Today at HAH we had a service to remember that tragic day – one of the deadliest earthquakes in the history of mankind.
Every person in Haiti over about 13 years of age remembers exactly where they were at that moment. Almost all have friends and family who perished in that disaster that took the lives of more than 200,000. Unfortunately it sometimes takes a tragedy to remind us about what is most important in life. This is true for many of us on a personal level, but it was also true for Hôpital Adventiste d’Haiti. Prior to the earthquake this “mission” hospital, was suffering from financial issues, a declining reputation, and no ability to care for poor people. The last decade has brought unprecedented donations and expertise to our hospital. In the aftermath of the earthquake this allowed an outpouring of services for those with no means to pay. Now 10 years later this still remains a priority. In addition our hospital has provided services never before possible in Haiti and is now the most advanced center for orthopedics in the country. Our laboratory, imaging center, emergency room and operating room are also offering some of the best services in the country. I thank our staff for their compassion and their devotion. I thank our volunteers and I thank our donors for all that they have made possible. And most of all we can be thankful for God’s rich blessings on this hospital. As we enter the next decade I know that there are even greater blessings in store as long as we can continue to do our part.
How Hôpital Adventiste Makes the Most Out of the Donors Dollar
As of early December the S&P stock index posted nearly 25% returns for 2019. At HAH it is our goal to give you an even higher return on your investment. Perhaps it can’t be measured in terms of an objective percentage, but I would like to share with you how we are maximizing returns on the donor dollar. The Bible says you should store up your treasure in heaven and some donors consider that done once the check is written, but others are interested in knowing how their dividends are being maximized. Either way we take the honor of managing donations seriously and want you to be able to know exactly how they are being used. Since I have put a significant amount of my own resources into this project I can assure you that the this money is being managed as if my own. The responsibility of managing all that people have committed to this project was one of the big motivating factors for us to move to Haiti full-time. It is important that these resources are used in the most efficient and effective way with the goal of ultimately giving life-changing love, hope and healing to those in need.
In order to create sustainable accessibility for patients and offer high quality care we invest donor funding into building infrastructure rather than for the never-ending burden of operating expenses. One example is the installation of a digital x-ray system. Since we installed this in 2018, we now have no overhead for the cost of chemicals and film. If we need to repeat a film, we can do it at no cost to ourselves and no cost to the patient. This means better quality, more revenue and a lower price for the patient.
We recently invested in the installation of a CT scanner. This machine is in excellent condition and was donated by AdventHealth in Orlando. The infrastructure to properly run this machine is quite complex, but we were able to do it for a fraction of the normal cost. This now provides another revenue stream for the hospital. We have also built the best lab in Haiti, financed by donor funds, which now supports not only itself but provides additional support for other parts of the hospital. Solar power is another area that we are looking into as this would relieve another $10,000/month of operating expense. We are in the midst of renovating a number of areas of the hospital and also have some new construction planned. By funding capital expenses from outside sources we are able to keep our patient fees as low as possible and maximize quality.
You may be wondering why we have patient fees at all. This is a complex topic and can be explained in another post. But be assured that our goal is to take care of everyone who walks through our doors. We have established a financial counseling center in order to meet the needs of our patients in a caring and equitable fashion. We have a fund set up specifically to support this program. Please go to the donate tab if you are interested in donating directly to the indigent patient endowment fund. We have also designed discount programs to encourage patients to come in before their condition progresses to the point where it is difficult, if not impossible, to treat.
The formula seems to be working. Patient volume is at an all-time high. People of all classes are receiving care. The hospital is breaking even on routine operating expenses for the first time in years. Employees are getting paid on time and morale is better than ever. By focusing on our mission to give the highest quality care to everyone, especially those lacking resources, the Lord is blessing this hospital in immeasurable ways.
Here are a few examples of how this works.
- Orthopaedic implants are typically a major hospital expense. At HAH we spend almost nothing on implants. Many implants are donated by visiting teams. Many instrument sets were donated in the aftermath of the earthquake and we continue to maintain and use these. Many items like external fixators can be reprocessed and used like new. The external fixator in Figure 1a is a Taylor Spatial Frame and this particular construct would typically cost around $15,000 in the US. At HAH – no cost. The fixator in Figure 1b shows a kickstand that we built with a few extra blue connectors ($400ea in the US) and carbon fiber rods. This is to hold the leg up and prevent pressure sores. In the US we might forego the luxury of this due to the $2000 price tag, but in Haiti we can build these as fancy as we want using reconditioned parts
2. We spend a lot of time sorting and organizing inventory. We don’t want to spend money on something we might already have. It is important to know exactly what we have and know where it is when it is needed. (Fig. 2)
3. This is our radiolucent OR table. I had it constructed 10 years ago in the Dominican Republic for $300. It goes up and down and does almost everything its $150,000 American equivalent can do. (Fig. 3)
4. Never let a pound of baggage allowance go unused! (Fig. 4) We try to support the local economy by purchasing as much as possible locally, but certain items must be imported. Shipping is expensive and we only use shipping services when items are too big to be placed in checked luggage. A recent piece of equipment needed to be taken to the US for repair. It weighed 80lbs so I partly dismantled it prior to packing in order to avoid overweight charges.
5. Local laborers are eager to work. They get a lot done and are learning a lot of new skills. Most of them work for less than $15 a day and this feeds multiple family members while beautifying our hospital. Our hospital provides employment for nearly 200 people. (Fig. 5)
6. Foreign staff at our hospital work either completely as volunteers or survive on a very modest stipend. (Fig. 6a) Joseph Mahoney is starting our CT scan program and provides training and administration in the department of radiology. (Fig. 5b) Joseph’s children volunteering their services (child slavery not endorsed).
7. When equipment needs to be fixed we make phone calls, we watch DIY videos on YouTube, and read instruction manuals. Often the surgeon does more than surgery. (Fig. 7)
8 Notice the lack of disposables in our operating room. (Fig. 8) We use cloth gowns and drapes and reprocess almost everything including suction tubing and electrocautery pencils. This is good for the environment as well as the unemployment rate in Haiti. And it saves money. “Pas de gaspillage” Means “no wastage” in French. The nurses know that these are some of my favorite words and find it intriguing why some American guy is so concerned about avoiding waste.
9. This is our safe drinking water project. It cost about $3000 to set up and saves the hospital a couple hundred dollars each month. (Fig. 9)
10. We have eliminated more or less all the piles of equipment like this. (Fig. 10) We either fix stuff or properly dispose of it. In the past there was often a lack of resources and ability to fix things like this. When a wheel would break on a gurney the whole thing was put outside and left to rust. After a few years someone would donate another one. The rusty one would remain in the weeds. Now we spend the extra $50 bucks, fix the wheel and keep our gurneys rolling.
I would like to give a big thanks to all of our supporters. The success of HAH depends on resources, leadership, and collaboration between a lot of people with different skills. Anyone who supports our program or is interested in supporting our program can feel free to contact us for further specific financial data and information on donating.
There is a lot of exciting stuff going on at HAH. The Lord is blessing our feeble efforts in many ways. Jonathan and his men worked like a Formula 1 pit crew this month in order to move some major projects forward. Jonathan used my arrival from a 2 week trip to Loma Linda to motivate the team and they really impressed me. Many times after a trip arriving back can be a bit overwhelming but I have to say it was exciting to get back and see all the progress. In spite of my absence for two weeks surgical volume remained just below last month’s record high and exceeded all previous months. Here are a few November highlights.
New Record at HAH
During the month of October we performed more surgeries than ever in the recorded history of HAH.
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.
Several times this past month we were down to just a few gallons of diesel fuel to keep our generators working.
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.
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.
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.
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.
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!
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.
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.
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.