As we loaded up into the van and said goodbye to our new friends, we suddenly had a little more work to do.  A beautiful 5 year old girl in a pretty dress showed up with an acutely injured elbow.  We asked the driver to wait and we went back to work.  Xrays showed a badly displaced supracondylar humerus fracture.  We fired the OR back up and Adam and Larry put in a nerve block.  We were able to reduce and pin  the fracture, put her in a splint, and then leave about an hour later. Because of traffic and our lateness we weren’t able to check out parts of the city as originally planned, but getting this little girl treated was more than worth it.  What a satisfying end to our time at Double Harvest.

There is still much Orthopaedic work left to do in Haiti.  Many of the fractures are healing poorly, due to infection, poor nutrition, HIV and hardware failure.  Unfortunately there are many impending malunions because of limited or no early treatment. There are several individuals that we asked to come back for a future team to treat because we simply ran out of time.

 As we found out most of  the  Orthopaedic cases encountered now are more difficult than average.  In the future surgical cases will take some planning ahead  in terms of equipment and surgical staging. There is no doubt that the OAM teams  were of a tremendous benefit to the injured Haitians.  I saw evidence of it every day.   Each and every individual involved in some way, either as part of a team or as behind the scenes support, should be congratulated for their efforts in this important cause.  I know that I couldn’t be more proud of  Team 8.  Our expectations were high, and I think this team exceded them.   My thanks to all of them.

 Although future visits aren’t officially planned yet, I’m aware that they are in the works.  OAM has responded to the need, and I foresee that we will continue to do our best to help.  Sometimes doing the right thing is inconvenient and uncomfortable, but we must always strive to do what is right.  So far we’ve done the right thing in Haiti.

Regards,

Robert DeMaagd

 Rob and Diane have been very busy with the clinic and  in treating a bowel obstruction, a woman with an acute stroke, and a young man with an acute onset of seizures.  We have a mini ICU going (bed 3 and 3a).  There have been multiple babies born as well.  Shelly has been invaluable.  Everyone on the team has performed with dedication and intensity which makes me proud to be associated with them.  Tomorrow we have a few cases, including possibly a visiting plastic surgeon to do some facial reconstruction on a child.  We are arranging to transfer our last inpatients.  This will accomplish our goal of having no inpatients by the time we leave on Friday.  We have enjoyed meeting and treating the Haitian people. They are truly grateful for everything we do.  It’s an honor for us to provide some expertise and care that they otherwise would not get in this country.

Robert DeMaagd MD

Orthopaedic Associates of Michigan, P.C.

Rldemaagd@oamichigan.com

Monday was a very busy and difficult day with a very busy clinic and surgery schedule.   At 8 am the benches and waiting areas were overflowing with patients waiting to be seen.   Surgically we completed skin grafts on a young child and did 5 other cases mainly involving infected hardware. 

We admitted 2 more infected hardware patients for surgery today including a failed gastric flap with exposed tibial plates.   Another patient that was seen has a healed though badly displaced tibial plateau fracture.    I think this could only be treated with a knee fusion or a total knee in a developed country.   She’s unable to walk currently. 

We were suprised by 2 men carrying in a man with a fractured spine who was hit by a car yesterday.   He has a T12 burst fracture and is now paralyzed.   We were unable to provide surgical care for this and finding appropriate places to send him is proving to be difficult. 

One thing I’ve noticed is that the patients with chronic infections and unresolved Orthopaedic injuries are understandably depressed and appear shell shocked.   These people had nothing before the earthquake and now even their ability to walk or do daily activities has been taken from them.   We are doing the best we can to help them but we wish we could just make it all go away.   The sad part is that we can’t. 

Bob DeMaagd

We were able to finally walk around the property a bit after surgery today and saw this amazing setup for ourselves. We feel spoiled to be working here. Some of us played soccer and hoops with the kids, which was a nice change of pace. You’ve heard it before, but the kids here have great smiles.

We’ve taken to Watson, who is an 18 month boy who weighs about 15 pounds and is unable to walk or talk.   He lives in a tent with his mom on the property here, but spends most of the time laying on his back in the tent. We took him on our walk, and on the way we rehydrated him from our water bottles. Within an hour he went from hot and listless to alert and interactive. We all wish he could come home with us.

We have been given the task of trying to wind our acute OAM presence down, which is quite difficult given the continued need. I plan on meeting with Joe VanWingerden at the end of the week and try to help formulate a longer term plan. We will try to come up with an inventory list and a needs list which should be helpful for future groups. We also plan on securing appropriate followup for our more acute patients.

Thanks for all your concern, and please keep these wonderful Haitian people in your prayers.

Bob DeMaagd

As I write this we are en route back home to Grand Rapids courtesy of the Whirlpool Corporate Jet.  That fact alone is no small achievement today as the drive from Double Harvest to the airport was interesting. The rainy season seems to have begun in Haiti and about 100 yards from leaving the gates of Double Harvest we were promptly stuck in the mud! This happened a few more times but fortunately we had another truck nearby carrying our luggage that repeatedly hauled us out as needed.

While we did not see Team 8 at the airport we know that they promptly unloaded and headed off to Double Harvest.

 Hopefully in a vehicle with 4 wheel drive!! They should be busy as our census became progressively more complex as the week went on. There are plenty of patients we left that will need further care in the next few days.

Due in large part to C- arm, a fracture table and a committed presence Double Harvest  has earned the reputation of being very capable of managing difficult Orthopaedic problems that others in Haiti simply can not do.  It is now somewhat of a referral center as several clinics were sending us Orthopaedic surgical cases by the end of the week.  We did the very best we could with what we had and, I hope, helped many patients.

We had a great team!  Sharon W. And Sharon F. worked so hard all week in the PACU. Sher and Bev filled many roles and did whatever was needed to be done without complaint.  They are all a credit to nurses everywhere. Brent and Matt also wore many hats. They were indispensable in the clinic, the PACU and the Operating Room Paul and Honorio kept people comfortable and asleep while Gene and Mary ran the Operating Room’s flawlessly. Mark and I had it easy working with this team. I am very proud to count them all as friends.

The disparity from the world and people we just left to the lives we are returning to is unsettling. We are blessed with so much at home that one easily loses perspective. This trip has helped to refocus and serves as a reminder of that which is truly important and essential.

I am very proud to have been part of a larger group of individuals from West Michigan fulfilling the responsibility to help those who are in such desperate need.  In the garage/patient ward at Double Harvest remains the message “Grand Rapids was Here” written in chalk on the wall. That is a testament to those who came before and established our  collective presence and a calling to continue to give freely of our time and capabilities.

Pete Theut.

We were greeted by 3 awesome nurses who have been invaluable in getting us settled in. Team 7 left Double Harvest nicely organized, making for an easy transition for us.

We started with a closure of a machete wound to a hand, and followed with a closed IM femoral nail on an individual who showed up with a 5 day old displaced fracture.

Also of note was the arrival of a woman who delivered her child and then walked 1 hour to us, with umbilical cord and placenta still in place.  Baby and mom doing well.

5 cases on for tomorrow, including a tibial nonunion.
A good first day.
Robert DeMaagd MD

We continue to be  very busy at Double Harvest.  We were surprised by a group from Ohio showing up rather unexpectedly today. They are going into Port-au-Prince tomorrow and plan on leaving Thursday.  

Overall cases keep coming in.  There are a few new fractures and many interesting cases as well as a lot of  follow ups.  We are seeing several cases of infections as well as delayed unions.  We’re also seeing “come back in three weeks for removal of external fixators”  and rarely see enough healing to take them off.   I think this has to do with both operating conditions and malnutrition.   It is Haitian custom to decrease movement for nearly three months after any sort of surgery.  Because of this custom we are seeing stiff joints that need manipulations.    The cases that need surgery tend to be a little more complex and are complicated by the small C-arm and the small OR’s.  

I can’t even begin to tell you how great our team has turned out to be.  Honoria our anesthesiologist keeps us (and the Haitians) laughing throughout the day.   Paul our CRNA is his more reserved side-kick.  They’ve been unbelievable.   Honoria has ventured out to the markets and we’re all trying some Haitian foods which has proven to be quite an adventure.  The PACU has been expertly run by the two Sharons and the utility player Sher.  They certainly make us comfortable  knowing that our post operative  patients will have great care and do their best to work with Haitian nurses.  

Matt and Brent cover all aspects of patient care.  They have taken over the clinic after our triage extraordinaire Bev has streeted or treated and assisted in the OR.   Every patient is taken care of appropriately from first encounter to discharge whether surgical or clinical.  Both Bev and Sher assist wherever needed. 

Gene has worked hours both in and out of the OR making sure we have all the equipment we need.   Both Mary and Gene have spent countless hours looking for lost pieces of equipment and sequestering everything from roungeurs, pic-ups and trash bags.  Mary has proven quite nimble ducking under the fracture table and looking for necessary equipment in the storeroom. 

Pete is just great.  He sacrificed his body to check the functionality of the c-arm.  He is great to work with in the OR.  His love for humanity knows  no depths.  He suffers me silently. 

Mark…”we desperately need orthopedic surgeons in Haiti”  - seven simple words from one old friend to another and what a profound effect those words have had on so many lives.   We have witnessed an unbelievable catastrophe and many of us have seen that first hand.  One can not come to Haiti and not be filled with hope.  

Regards,

Mark Asperheim

To sum it up, today has been a learning day.  First of all we weren’t quite sure if we were on daylights savings time or not.  A few of us were ready to go round at 6am….after a quick google search we realized we could have slept another hour! 

We all realize how hard it’s been not having OAM at Double Harvest for a 9 or 10 day interval. It has taken us awhile to get back to where the last group left off.  The Manhattan group was good at giving us the basic lay of the land, but we have now figured out staffing, charting, the clinic, patient supplies and contacts. 

After a night together on the floor of the vocational building, we moved all our supplies to the clinic and were soon immersed in an onslaught of patients.  Our Xray tech was late and we could not figure out how to start the Xray machine, but we could start the C-arm.  The morning started out with a few masses that Dr Theut removed, a few External Fixation follow ups . I must say that every one of the returning patients brought their follow up plan papers back with them. 

As the clinic was not too surgically busy, 3 of us were able to take a tap-tap to the University Hospital and re-establish contacts there.  We had the chance to meet Gabe, but pretty much every other nurse and physician was new on the job.  Patients now have to pay for care at the University hospital so that makes care even more chaotic.  While we were there we took off casts with our bandage scissors, and removed some foreign bodies from a patients arm that a brand new pediatric ER doc could not find.  Otherwise we saw some patients and changed some dressings, we were able to let them know that if necessary we could pick up some patients on Tuesday. The ride into and out of the city is wordless.  Words are not invented in our language that can convey the profound devastation and both the hope and hopelessness that you see among the people.

Today started out with rounds, an I& D of a foot, and then drainage of a scrotal abscess.  We were able to take inventory of stock and to get a good grip of what is and is not available.  Sundays are slow days and we were able to take a few walks around the country side.  We were also able to get in touch with Partners in Health at Cange and they will be sending patients with Hip fractures our way.  Again, these patients fractures are a week old, and I have no doubt they would have already been fixed if we could have had continued care. 

Also we were greeted by 2 new nurses and a nurse practitioner, somewhat of a surprise. We are very happy to have them join the team as they will be able to overlap care with the next team on the 19^th. 

 Tomorrow promises to be quite busy.  We have a great group here, a great mixture of personalities and talents. 

Until tomorrow,  Mark Asperheim

We have all arrived safe and sound. Spending the first night in the vocational building with plans to move up to the clinic tomorrow. Did get to make rounds with the Manhattan (Kansas) group, but mostly OB-Gyn and ENT. Three of us will be going to the University Hospital tomorrow to round up patients and to make contacts. Heartline has a dwindling number of patients to send to us.
There is a sense that the need for Ortho is decreasing, but all have expressed a strong need for a general surgeon as well as OB. We would gladly accept either or both now, and would suggest they be part of the next team.
We are all very anxious to take over the clinic and get started!
Our best to all.
Mark Asperheim

Started the day by waking up to a failed generator. “Pancake Steve” flipped breakfast for all. We made rounds with Diane Cable.  Had to take Jolanda (AKA) back after her wound opened up, it’s probably colonized (infected).  We used our first real VAC.  Valeri is still under weather so adminstration canceled the clinic, but not until Dr. Tim evaluated a probable thyroid cancer with airway compromise and mets to the lungs.  The team started focusing on palliative care.  They crammed all 10 of us and all our bags into a single tap-tap (an over-sized public transportation van) and headed to airport. There was no room for a translator so we didn’t know our driver had dropped us off at wrong entrance. The team ended up hiking with all our bags for about a mile, walking on the side of a busy Haitian street.  We boarded uneventfully and flew to Miami where we said goodbye to our team members from North Carolina (Bryan and Tara, both CRNA’s). They were incredibly hard workers and I can’t imagine doing all we did without them.  Guessing we did over 60 cases.  We will miss them.

There will be no OAM presence at Double Harvest for 10 days, but we hope to get some follow up on our patients, who have become our friends.

Virtually every member of the clinic lost family and friends in the earthquake. But the take-home lesson came from the Haitian pastor at one sunrise service.  He held up a 100 dollar Haitian bill and asked who wanted it. Naturally, everyone said “yes.”  He crumpled it in is hands and asked the same question. Again, same answer.  Finally he threw it in the dirt, stomped on it and asked it again. Again the same response. Everyone wanted the money. It didn’t matter that it was dirty, that it was broken. It still had the same value as when it was new. The same goes for the Haitian people, and all of God’s people.  Their value, our value, doesn’t change no matter what has happened to them, or to us.  It is a powerful life lesson.

We are all changed, but hopefully in a good way.  We are grateful for having been given this opportunity. We are happy to be home but each of us left a part of ourselves in Haiti.  Yet we all were given gifts far exceeding what we gave. “Merci beaucoup.”

God Bless,
Tom and Team 6B