Team Paley Day 5 in Haiti by Dr. Paley

Our Team

I feel very privileged to have come here with my amazing team. Most surgeons are coming here come alone. I came with a team that can run the entire ortho department and is very self sufficient. Dr. Scott Nelson, our host, has threatened to kidnap the team when I leave. This environment has brought out the best in all my team. It has made all of us be ‘all that we can be’. Back home PAs, Ortho techs, etc are much more limited in what they are allowed to do. Here however there is no one to do all that is needed.

Mark Smith our ortho-tech runs the ortho clinic all day long taking off and putting on casts, removing fixators in clinic, making special splints for contractures, and triaging cases to the PAs, Dr. Nelson or myself. Mark has made all our lives manageable here by looking after so much that would have taken our time away from surgery. I was so impressed at how well Mark worked independently. Despite the language barrier Mark managed to communicate through his warmth and caring to all the patients. Mark was so reliable that all the nursing staff knew him by name and called him first for all the clinic cases.

 

Servando Gutierrez who is a physician’s assistant spent his time staffing the orthopedic consults in the Emergency Room and Ortho Clinic, doing rounds on postop patients in the hospital and in the outside tents and helping in the operating room. Because of Servando and Mark we were able to see 50 patients a day as well as operate from 8AM till 9PM. Normally, Dr. Nelson would have to do all of this work himself. While our staff was here they took over the running of the clinic and ER and allowed Dr. Nelson to operate more and do many of his other functions in running the orthopedic department. Servando and Mark were challenged by seeing patients with residual fracture problems from the earthquake to dealing with problems we never see at home such as Tuberculosis related ulcers of the limbs, elephantiasis, gout, and many other problems. When a patient came in with a congenital femoral deficiency while we were here it was a welcome respite for our diagnostically challenged brains. Servando, as at home, made rounds earlier than anyone and could be found at night checking up on all the postop patients while the rest of us were already in bed.

Jennifer Pinsky who is a physician assistant also assisted in the clinic every day. Her main job however was in the operating room. Jennifer first assisted me on most of my cases while Servando first assisted Dr. Nelson on his cases. Jennifer also acted as a radiation technologist running the image intensifier fluroscopy machine. When we lost our scrub tech Angela (who had to go back to the DR) Jennifer doubled as the scrub tech and helped organize the cases. Jennifer prepared every case for surgery, brought the patient into the room, and got them positioned and prepped and draped. She also closed every incision on the cases she was scrubbed on. I don’t know how we would have done the surgeries we did without her.

 

Terry Dinovi, an operating room nurse prepared for every surgery, helped the anesthesiologist, got all the instrumentation ready and circulated every case. Terry never stopped all day, and due to her diligence we were able to do a huge number of surgeries. The team work between Terry, Jennifer, Mark and Servando is what made everything hum. I never heard the word no, or I cant do this, or this is not my job, etc. everyone worked incredibly hard for very long hours. There was no job beneath any of us.

Aviva Paley, my daughter who is finishing her freshman year at the Maryland Institute College of Art in Baltimore volunteered on this trip during her spring break from College. Aviva spent time as a play and art therapist for the children and adults giving them coloring books, soap bubble bottles, beads to build necklaces etc. This experience has been such an eye opening one to us all but especially to Aviva at her stage of life.

Jonathan Paley, my son came on this trip to film a documentary in support of CURE International and the Adventist Hospital. This film will be used to raise awareness and for fundraising for this hospital.

Finally, let me comment on our host Dr. Scott Nelson. I have known Scott for many years. He worked with me in Baltimore as a fellow for a few months. Scott is from California and for the past 3 years has worked in Santo Domingo as an orthopedic surgeon in a hospital run by CURE the organization under whose name we are here. Scott and his family are Adventists and came to the DR on a mission for the past three years. Two days after the earthquake Scott arrived in Port au Prince and began operating. He has been here ever since. What we are doing for 6 days is his life for six months. Scott was planning on returning to work at Loma Linda University. He has delayed his return in order to help set up a system here that will continue after his departure. Due to his efforts the hospital has an administration from Loma Linda which works with Dr. Arshay the Haitian medical director here. Due to Scott’s efforts there is orthopedic equipment of all sorts from plates to nails to external fixators to insturments. Due to his efforts these materials are organized in the storage room here. Due to his efforts there is now an xray machine and an image intensifier machine. The set up allows almost all types of orthopedic surgery to be performed. I don’t know how Scott does it. We are all exhausted from one week of the schedule here. He does this day in and day out. Scot is truly a remarkable person. If all of us had a bit of what makes Scott tick the world would be a better place. Scott exemplifies what in Judaism is called ‘Tikun Olam’ (fixing the world). Orthodox Judaism believe that if there is enough Tikun Olam the messiah will come. Most religions have similar concepts. I have incredible admiration for Scott and what he has done. The entire team has found it an honor to work together with Scott.

Dr. Nelson praying over his patient

Keith Dowell is a general surgeon who retired a year ago and spends some of his free time doing volunteer work in developing countries. Keith was on the same flight as us and has participated as part of our team. He assists us in surgery and in the clinic and will do any job assigned. While he has not done much orthopedics before, his general surgical skills offer us an expert pair of hands and a tire Keith Dowell is a general surgeon who retired a year ago and spends some of his free time doing volunteer work in developing countries. Keith was on the same flight as us and has participated as part of our team. He assists us in surgery and in the clinic and will do any job assigned. While he has not done much orthopedics before, his general surgical skills offer us an expert pair of hands and a tireless work ethic. His presence this week has been much appreciated and his easy going personality and team player approach to life made him easy to adopt as part of our team.

Andrew Haglund is the Commander in charge of the administration of the hospital. Andrew a professor at the School of Public Health at Loma Linda dropped all that he was doing to come out here and take on the mission of putting this hospital in order to meet the new challenges presented by the earthquake disaster. Andrew a good friend of Scott’s was called by Scott to come out here and help him. What he has done in his short tenure is nothing short of a miracle. We could not have accomplished nearly as much if the environment of security, hygiene, supply, maintenance, facilities etc was not running as it is. With almost a militaristic take over and a discipline needed for this crisis Andrew transformed this sleepy, understaffed underproductive underfunded undersupplied hospital to the premier health providing institution in Port au Prince today. He is leaving to go back to teach the spring semester at the end of the month. His legacy is safe in that he has put in motion an organization that will continue to function according to the guidelines and mechanisms he has organized.

His presence this week has been much appreciated and his easy going personality and team player approach to life made him easy to adopt as part of our team.

We could not have accomplished nearly as much if the environment of security, hygiene, supply, maintenance, facilities etc was not running as it is. With almost a militaristic take over and a discipline needed for this crisis Andrew transformed this sleepy, understaffed underproductive underfunded undersupplied hospital to the premier health providing institution in Port au Prince today. He is leaving to go back to teach the spring semester at the end of the month. His legacy is safe in that he has put in motion an organization that will continue to function according to the guidelines and mechanisms he has organized.

Volunteers man every department of this hospital. We are but a handful of the entire machinery that make this hospital function. They come from all over the US and the world speaking a multitude of languages. It has been wonderful for me as a polyglot to converse in French, English, Italian and Spanish on a constant basis. We owe a great tribute to this revolving door army of volunteers and we hope they will not stop coming even when the acute crisis is over. I know that my team is committed to return next year.

Finally to the Hatian staff of doctors, nurses, etc. These are the backbone of this hospital. They are the future of this city and country. All of our efforts will only succeed in the long run if we continue to support and educate the Hatian medical establishment. They are wonderful people whose language creole is French with smile at the end of each word. They are humble and grateful, yet capable and willing. This visit has been a bridge building one between our team and them. They are perhaps the only ones we will see on our next visit here. To Dr. Arshay the medical director (obstetrician) and his staff we owe a great deal of gratitude for hosting us in a most gracious and appreciative manner.

 

Tomorrow, the Sabbath for Adventists and Jews, we will only do emergency surgery. We are scheduled to go for a tour of the city to see the destruction and perhaps some of the reconstruction efforts. We are excited but leery for this experience. The time spent here has brought a lot of tears to our eyes and sadness for these people to our hearts. Despite this all we have seen is smiles on their faces and such appreciation. While we may feel sad they are hopeful. This is definitely a country of people whose cups are half full and not half empty.

As we begin to think of going home I am reminded of how good we have it. This trip put it all in perspective. It is so easy to lose that perspective in the land of milk and honey (USA). We will all be coming home much more appreciative for all of our blessings, thinking of how much we have rather than how much we don’t have or want. I for one am so appreciative for the team of skilled, caring, supportive staff that surrounds me and makes me be able to help so many children and adults around the world.

It is now 7:00 PM on Friday night. I have been asked to light Sabbath candles and to give an oration for the Sabbath. What a special time and place for such an event.

Dror Paley, MD

While on rounds in the tents surrounding the hospital we had an unexpected emergency with a woman who was having severe back and neck pain. She had suffered a previous amputation and was living in the hospital compound and needed urgent medical attention.

Dror Paley MD

 

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