6 Months Later...

It has been six months since the earthquake and the need still continues. Some experts are predicting that it could take up to 20 years to remove all of the rubble. The U.N. estimates that 1.5 million Haitians are currently living in camps. Loma Linda University and AHI continue their work with Hopital Adventiste d'Haiti.

"Out of the Rubble" premiered at the General Conference session in Atlanta, GA. It will be making it's broadcast premier later this year on KVCR. We're also working on a "Sebastien cut", which will focus more on our friend Sebastien. We're hoping to send that version off to film festivals. Until then please continue to share "Out of the Rubble".

Out of the Rubble from Loma Linda University on Vimeo.

Dr. Nelson goes back to Haiti

This post was authored by Scott Nelson, Director of Orthopaedics at Hopital Adventiste d'Haiti who returned to HAH on Sunday.

Return To The Mission

After a much needed 2 week hiatus from the chaos of the ongoing disaster relief efforts at Hopital Adventiste d'Haiti I returned yesterday to face the challenges. In spite of several recent events regarding reintegration, sustainability, and international communication breakdowns, today was an especially productive and reassuring day. The clinic was filled with patients, 3 operating rooms ran simultaneously, experts from around the Americas worked busily, and administrative meetings reaffirmed the commitment to our mission of serving those in need.

The acclaimed reputation of our hospital from years past has been restored and enhanced because of the excellent services and long term stability that this hospital has provided to the victims of the earthquake and others with urgent and often neglected medical problems. The inherent institutional political challenges after a tragedy of this magnitude have resulted in the following scenarios at other local institutions:

• Well reputed hospitals have had to completely shut down due to lack of income to pay normal operating expenses and repair damaged infrastructure
• Attempted survival while refusing the continued expertise of well intentioned foreigners offering free services and destroying the economic norm of local doctors and hospital operations
• Completely expatriate operated institutions created by foreign NGO's. Some of which have terminated or diminished services due to difficulty with long term sustainability and rapid turnover of volunteers

A mission hospital is by no means immune to institutional politics. Quite the opposite. Many times they are political hotspots due to factors of finance, religion, communication barriers, racial issues, power struggles and small numbers of people working long hours in adverse conditions. In spite of many "challenges" and the inevitable hospital politics we continue to focus on our mission of serving those in need.

We owe our successes to several unique aspects of our institution. First and foremost is the grace of God who has enabled each one of us to serve here with a mission for our fellow man. Many visitors have been impressed that we have both the Haitian staff and our foreign volunteer staff have working together which they have not seen at many other locations around the city. In spite of the fact that we are the closest major medical facility to the epicenter of the earthquake our building did not suffer any significant damage. Although some pre earthquake deterioration had occurred, we have one of the best facilities in the region and have already accomplished major improvements to the physical plant and upgraded many needed pieces of equipment. The commitment of several long term volunteers combined with the efforts short term experts has allowed capacity, excellent services, and stability. We thank our supporting organizations such as the Adventist church, Loma Linda University, CURE International and other collaborators for financially supporting the operational costs during this time when extra services have been provided for thousands of patients who have no ability to pay.

God is with us.Syringofibroadenoma - Before
26 year old girl who suffered for years with a foul smelling tumor on her R foot is doing well after excision and skin grafting. Thank you to Dr. Dror Paley - surgeon, Dr. Craig Zuppan LLUMC pathologist who provided the diagnosis, and the LEAP plastic surgery team.

Facility Improvements

The post below was authored by Scott Nelson, MD, Director of Orthopaedic Surgery at Hopital Adventiste d'Haiti.  Hopefully this will give donors an idea where their hard earned dollars are being spent. 
However, it goes without saying that the needs are great and more funding is needed to further renovate this facility.  Please consider donating to the project here.

This post also demonstrates the need for qualified nonmedical volunteers.  Please contact LLU Global Health to determine if HAH could use your services.

Volunteers donated US $1 bills to each of the young boys who filled a trash bag with the loose trash that was strewn around the campus. As the donations begin to run out before all the trash was collected the participants were glad to pick up 2 bags per dollar. Our campus is now clean.

Rooms in the southwest wing were never finished after the initial construction phase 5 years ago.

Plumbing fixtures and painting was completed by Dr Peter Nelson and Arpad Soo from San Luis Obispo, CA. The rooms are now ready for patients. We thank the generous donors of Amistad International for the plumbing hardware that was purchased locally as well as in the US.

One of the biggest challenges in preparing these rooms was fixing the sewer system which had been plumbed to drain the toilets onto the front lawn. Arpad, Jerry and crew worked day and night digging trenches around the raw sewage and placing the appropriate drain pipes. 

Another peculiarity is why the toilet inflow was plumbed into the hot water pipes. Thank you to the expertise of our plumbing crew and their hard work most of these problems are now resolved.

Arpad worked most nights until after midnight repairing leaks and faucets around the hospital. 

This very important sink in which we scrub our hands before surgery now has new foot pedals thanks to a donation from Ferguson Enterprises in Santa Maria, CA. It is important to use high quality materials as the elements are intense and these sinks sustain a high volume of use.

Liz Dickinson, RN, Vice President of Nursing at Loma Linda University Medical Center transformed our operating room with her friend Sylvia. We thank LLUMC and Liz for her hard work and the amazing improvements that were made.

Before this past week, there were still cupboards stuffed with instruments from years past. Liz, Sylvia, and the Haitian nurses sorted through all of them.

Some sterile packaging of unused instruments dated back to 1952.

The "before" shot below of the central sterilization area.

The "after" shot below. The newly painted cupboards are awaiting placement of well organized instruments.

New shelving was placed in the sterilization area after relocating the decontamination sink to a separate room.

In spite of our very low infection rate, measures are being taken to continue to make safety improvements for our OR. This decontamination sink had its faucets and drains replaced this week and it was placed in the decontamination room where instruments will be scrubbed prior to bringing them into the sterilization area for final wrapping.

Peter Nelson, DDS (on the right below) poses with Kyle Fiess of Maranatha. He used this hammer drill to make approximately 60 holes in the 10 inch walls of the southeast wing through which the entire plumbing system will be replaced. Prior to the earthquake the low pressure partially functioning water system delivered water to various plumbing fixtures, many of which were in disrepair. With the installation of a high volume inflow system and increased water pressure many leaks became apparent. This was causing a loss of approximately 7000 gallons of water per day into the walls, foundation, and electrical system of the hospital. 

LLU Strategy For Hopital Adventiste d'Haiti

Loma Linda University (LLU) and its partners are continuing to work to support the Hopital Adventiste d'Haiti in Port-au-Prince.  LLU is not alone in these efforts.  Together they are pooling their resources and are working closely with Park Ridge Adventist Hospital/AHS, Florida Hospital, CURE International, Life Enhancement Association for People (LEAP), and Adventist Development and Relief Agency (ADRA).  

The following strategy update was posted yesterday on the Global Health Institute website.

• The need for additional medical teams continues, but as we move forward the composition of these teams will change to reflect current needs at the hospital.  Keep in mind the needs change almost daily.
• As of April 20, 2010, the "Dream Team" includes:
  
  
  • 1-2 Orthopaedic Surgeons
  • 1 General Surgeon
  • 1-2 Anesthesiologists (MDs and CRNAs)
  • 1-2 ER Physicians
  • 1-2 Pediatricians
  • 4-8 RNs of whom 2-4 with OR and ER experience
  • 1-2 Physical Therapists and/or Occupational Therapists 
  • 2 Pharmacists
  • 2+ Central Supply Personnel
  • 2 Utilities and Maintenance Personnel
• We also welcome applications from OB-GYNs, PAs,NPs and other health care professionals.  We would like to keep the number of our teams to about 25-30 people on any given week. 
• The teams will work at the Adventist Hospital.
• The current strategy is to send in teams for at least a 9 day cycle (Teams arrive on Friday and leave on Sunday.)  A longer term of service is preferred.     
• LLU will maintain and manage the schedule of the various teams and provide them with information about their trip and tips about what to bring, etc. 
• Selection and composition of the particular teams will be done with input from all the partners mentioned above in close consultation with the administration at the Adventist Hospital of Haiti.  It is very important that we send essential personnel in an organized manner so as to not strain already limited support resources.
• LLU and our partners are committed to support our hospital in the months to come.  These efforts will build on local available resources under the leadership of Lesly Archer, MD, Medical Director for the Adventist Hospital and supported by Orthopedic Surgeon, Scott Nelson, MD.
  
  Reposted from haitibones.org - thanks Jim

Stateside

Well if you haven't figured it out yet, I am no longer at the hospital in Haiti, I've been home now for just a little less than two weeks.  Coming home has been an emotional roller coaster to say the least.  It has been wonderful to be able to see my wife and boys on a daily basis rather than a month or more in between.  But it has been very hard to re-inculturate to life in the developed world and all of the daily luxury that we take for granted.  It's been even harder to hear of continued and in some cases increased challenges at the hospital and feel so far away and unable to help.  That said, I have actually been able to assist the hospital and those working there from afar in a number of different ways since my return to the states.  I have spent many hours over the past 10 days meeting and debriefing with AHI management and LLUGHI support staff to try and improve our overall effectiveness in helping the ongoing mission at the hospital.  I have also continued work with a number of our partner organizations to foster additional donations of supplies and medical equipment.  While I don't know if, or when, I will return to the hospital, I assure you my work there will continue for the foreseeable future.

Loma Linda University and AHI's continued involvement
Early this morning a team of LLU/AHI administration and support staff arrived at Hopital Adventiste for a hospital board meeting and exploratory visit.  The team is:

Dr. Richard Hart - President AHI & LLU
Jerry Daly - Asst. VP LLU GHI
Mo O'Reilly - Project Manager GHI
Kenneth Breyer - Asst. VP LLU Construction Services
Nathan Lindsey - Potential Long-term volunteer for HAH

Please keep this team and the entire hospital board in your prayers over the next few days.  The issues they will be debating in this board meeting will define the immediate and long-term future of Hopital Adventiste d'Haiti.

This blog and others
I will try to continue to update this blog with news from the hospital, albeit with even less frequency.  That said, here are a couple of other blogs from folks currently at the hospital or those that have visited recently:

Cure Caribe by Dr. Scott Nelson - Currently working at HAH

Haitibones by Dr. Jim Matiko - Visited HAH two weeks ago and plans to return soon

DavidinHaiti by David Harris - College student volunteering at HAH spring & summer of 2010

The Translator Tribute

Greetings from the Hopital.  While we continue to see untreated earthquake related trauma from the Jan. 12 quake, we are functioning more like a hospital and less like a disaster response unit every day.  We do still have approximately 40 patients outside in tents but, have the entire 2nd floor NE wing devoted to and filled with in-patients.  The 1st floor SE wing is also filled with patients in our pre-op and two post-op rooms.  At any point in time we are housing about 50 patients inside the main hospital and another 20 or so in the in-patient pediatrics and obstetrics wards in the polyclinic building.  We continue to staff and support a very active 24x7 emergency room, as well as OB/GYN, Ortho, and Medicine clinics Monday - Friday.  The operating room remains very busy averaging 15 surgical cases per day, 8 - 10 orthopedic/reconstructive, 2 - 3 OB, and the balance general surgical cases.  The stream of volunteer medical staff continues to flow into the hospital here thanks to the efforts of our coordinating body at the LLU Global Health Institute.

On Wednesday morning seven of our translators–a group of handsome, strong young men–surprised us at our morning briefing by giving a heart-warming thank-you and tribute.  They had it all planned and staged and even had made special wooden plaques that they gave to some of our long term volunteers.  The plaques read, "Thank you for helping us in Haiti, together we move."  The translators have been a God-send.  They are always friendly and eager to help (and their help is much needed).  Communication has been a big challenge, since the majority of volunteers speak neither french or creole fluently.  Imagine 70 english-speaking volunteers trying to communicate with hundreds of patients, family members and the 100+ Haitian hospital staff on a daily basis–impossible without the devoted help of these really amazing guys.

  The O.R. translator team and Dr. Chandy

Thanks all around

OCC Coloring Books in Haiti

My good friend Irene Naesse, a geography teacher at Orange Coast College (OCC) sent me the following email a little less than a month ago:

I am going to challenge my students to each bring in a coloring book and crayons to send to you in Haiti for the kids.  I have about 300 students this semester....so that is a lot of crayolas! 

Well about 10 days ago Irene delivered 4 Xerox copy-paper boxes full of coloring books and crayons to my house so my wife Laurel could bring them with her to Haiti this last weekend.  While Laurel could not bring them all, she did pack a couple dozen books and crayon sets in with the medical supplies she carried in her luggage.  The remaining coloring books and crayons will be carried in by other volunteers heading here over the next few months.  Below are some pictures of the OCC coloring books bringing joy and healing to the kids of Haiti.

Merci beaucoup to Irene and the OCC Geography students.

CURE Intl - Orthopedic Excellence

The quality of the reconstructive surgical program we have today is a direct result of the collaboration with our partner CURE International.  CURE is a christian organization that operates nearly a dozen teaching hospitals in developing nations around the world with a focus on surgical treatments for children with disabilities and deformities.  Their experience in operating hospitals in the developing world and providing top quality care in challenging environments has been invaluable in our earthquake relief efforts.  CURE has provided world renowned experts in reconstructive surgery to serve the needs of earthquake victims.  We have developed a reputation in the country of Haiti as a tertiary referral center for a variety of complex orthopedic cases.  CURE's Haiti Medical Director Dr. Scott Nelson is also a Loma Linda University School of Medicine clinical faculty and alum.

CURE has had an orthopedic program in Haiti for a number of years prior to January's earthquake.  The existence of this program pre-quake benefited us greatly by providing in-country knowledge, experience, and resources.  CURE has provided invaluable logistical and supply resources such as:

• In-country logistics coordinator (Mr. Phil Hudson)
• Air and ground transportation
• Shelving units
• Orthopedic surgical equipment
• Surgical nursing staff from their Dominican hospital
• Multiple international volunteer teams
• Volunteer coordination (Erin, Heather, Robbie)

L - R Phil Hudson, Dr. Nelson, Loubins Labiche

THANK YOU CURE INTERNATIONAL for all of your help here at the Hopital Adventiste!

Maranatha here at the Hopital

Maranatha International is here with us at the hospital providing assistance in a couple of different ways.  Back in early February Maranatha contacted LLU about the possibility of sending in some volunteers to provide boots on the ground assistance with our work at the hospital.  On February 19th six Maranatha volunteers arrived at the hospital for a full six week stay to serve in anyway we needed them to.  These six people have been the force behind the amazing transformation of our central supply from the piles of boxes and bags to the well organized HAH Depot Central.

 Before

 After

 L - R Marcello Martinez, Bob Chase, Ashleigh Cohen, Dan Patchin, 

Myrlene Honore (not pictured Marilyn Patchin)

In addition to their work in the Depot Central, each of these volunteers has contributed in his or her own special way around the hospital.  Ashleigh has served as our base camp manager and also doubles as a social worker helping to find orphans homes and debriefing volunteers on their departure dates.  Myrlene has filled many gaps due to her Haitian background and language skills.  Bob has used his carpentry skills to build a number of custom shelves in various rooms around the hospital.  Marcello has taken on the responsibility for maintaining the oxygen supply in all departments of the hospital managing 16 D and E size bottles and 20 large M tanks.  And Dan has served as the Supply Unit Leader for the operations committee.

1 Day Church Structures

Maranatha has also sent in a team to build us 5 of their 1 Day Church Structures to be used anyway we see fit.  The first of these has just been completed and is planned to be volunteer housing.  Structures number 2 and 3 will be done shortly and will be used as volunteer housing and out patient pediatrics.  4 and 5 will go up next week and will provide shelter for urgent care/triage and an ER expansion.

The Donor's Dollar

By Dr. Nelson

Disaster relief is typically one of the most inefficient uses of the donor’s dollar. Think about it. Premiums are paid to purchase last minute items, overnight deliveries are made, volunteers are buying last minute air tickets, and extra funds are used for security and support of volunteers in a situation where there is no infrastructure. Due to lack of communication, urgency, and constantly changing needs, heaps of materials arrive that are not always needed. We experienced all of this. (BTW the breast implants and total knee replacement parts that were sent down were not needed at any point during the disaster relief) When the relief efforts are over many of the expensive pieces of donated equipment sit idle, deteriorate or are scavenged. This is not to be critical, many of these factors are uncontrollable and the job has got to be done. It is just the nature of the situation.

At the Hopital Adventiste we are doing a lot more than just disaster relief and because of this, your donations will have much more than just a transient effect. For a short period of time we were buried under the heaps of stuff that was generously provided. But, thanks to Dan and Marilyn Patchin from Portland, OR as well as many other Haitian and American volunteers it is now well organized and we are working efficiently with the needed supplies to offer a top quality level of care to those we serve. The donor’s dollar is also multiplying as we take advantage of synergistic collaborations with other organizations who are interested in our vision for a long term program with the highest of standards. We were very fortunate to receive an autoclave from Hope Force International as well as a portable digital x-ray machine from Americares (see photos).

We thank these organizations for their generosity as well as each and every one of our donors who have generously given. Some of the ongoing weekly expenses that we are currently supporting are:

• Diesel $3000 for electricity
• Oxygen $600
• Transport of equipment and supplies $500
• X-ray film and envelopes $750
• Housekeeping, maintenance, & repair supplies $1000
• Lab supplies $500

One time capital expenses include:

• Water main $4000
• Translator honorarium (30 people x 6 weeks) $2700
• Shelving $5000
• Generator parts $1000
• Repair of perimeter wall $5000

In addition, payroll is about $42,000USD per month. All our services are currently offered for free. Without an income source this is not easy to come by, but we must pay our employees as they re integrate back into the workforce.

We want to again thank all of you who have contributed. The challenges ahead are great. But with God’s guidance and power we continue to give our all and not get discouraged.

We're making progress

 

Welcome to the Hopital

Greetings on a beautiful bright and sunny morning here in Haiti.  After a quiet weekend of overcast skies, fog, and rain, Monday morning has brought us a cloudless sky and beautiful sunshine.  While we continue to face many challenges around the hospital, significant progress is being made and I would like to highlight a few of those areas with some pics.

 

Patients waiting in the main hallway on a not so mad Monday

 Depot Central d'Haiti

  

Pharmacy stock room

  

 Tent distribution for discharged patients

Thank you all for your prayers and support.

The C-Arm arrives

Post Authored by Dr. Nelson



It was an emotional moment when our OEC 9600 C-arm arrived today at the Hopital Adventist d'Haiti. It was on the night of Jan 14 just after my arrival in Port au Prince, less than 48 h after the earthquake that I sent Dr. Jim Matiko a brief message that he should start looking for a C-arm and get it down here as quickly as possible. For those of you who do not know - this is a machine that can give us instantaneous radiographic images. Since their inception in the 1970's they have revolutionized orthopaedic surgery. Seeing the magnitude of the orthopaedic problems, and knowing the time involved in making a transaction of this nature I knew it would be important to initiate the process ASAP. Now less than 7 weeks after the 7.0 we will be able to greatly expand our surgical spectrum. We have a 75 year old man named Albert who was admitted 2 days ago with an intertrochanteric hip fracture who will be the first beneficiary of this new technology tomorrow morning. Even before the arrival of this machine we have been able to do procedures available at few other hospitals in Port au Prince. Because of our long history, our current operations and stability as well as our long term vision we are increasingly becoming a center for advanced orthopaedic procedures. Thanks to the Arrowhead Orthopaedic Group and other donors we have now taken a major step towards fulfilling our vision as a center of excellence.









It was quite a task unloading this monolith. The first image taken was a thumbs up of my right hand. The Haitians were amazed by the technology and one said "where ever the Americans are people will live". We also have a beautiful printer to print the images which the patients keep with their medical record for follow up care.

A Sabbath Days Rest

Scott and I decided to take our first Sabbath off here in Haiti.  It seemed that after 6 weeks largely stuck int the hospital, a road trip was in order, so we headed to Jacmel on the southern coast of the island.  Jacmel is a quaint little village by the sea with lots of French influence.  While there is some earthquake damage in Jacmel it is not nearly as widespread as it is here around Port-au-Prince.  The journey there took us up and over some very deforested yet picturesque mountains and through a number of little towns.  Below are some of the sights from our trip.

 

An Adventist Church by the road in Leogane

 

Leaving the Port-au-Prince basin

 

Landslide that completely covered the main road

 The French influence

 

The U.S. influence

  

Jacmel wharf with relief teams in place

 

Total Destruction

  

fires burn everywhere in Haiti

 

We stopped at the Hotel Cyvadier Plage for lunch

 

The Chief

 

The I.C.

 

East of Jacmel, looking towards the D.R.