Team Paley Day 3 in Haiti by Dr. Paley

March 18, 2010

Today we all felt we knew our jobs here. The orientation was over; trial by fire. I started by operating on a 4 year old girl whose femur was broken in two places by the earthquake. The femur fractures had healed in a crooked shortened position. I rebroke her femur in two places through the old fracture sites. I applied an Orthofix external fixator and pulled one of the fractures out to length while the other one was left to lengthen slowly. When I first saw here in clinic I told the father that she would have a leg length difference which could be treated in the future. He asked me who would do the lengthening in the future. I could not answer him, since I don’t know who will be here. He begged me to do the surgery now so she would not have a deformity or leg length difference. He spoke excellent French so I could easily communicate with him. (my French has come in very handy here, although some of the patients only speak Creole; my Spanish has also been helpful since our scrub tech Angela is from the DR and only speaks Spanish).

I moved from this surgery to operate on a man with a humeral fracture that had not united and which had a radial nerve injury. We found the nerve in the fracture site and decompressed it. I am sure it will recover. I then fixed his fractured humerus with two plates. While they got the next patient ready I went over to ortho clinic to help Servando and Mark. In only 30 minutes I had booked an additional 4 patients for surgery. One of these patients had a type of TB that we will be operating on. The next surgery was a displaced tibial plateau fracture. I did a special procedure to split the knee joint to elevate the half of the medial tibial plateau that was depressed.

My last case was an acute displace supracondylar fracture of the humerus in a 2 year old girl. We reduced and pinned this fracture. While we were waiting to do her surgery a motorcycle accident victim was rolled in with a ‘pilon’ fracture (fracture of the tibia in the area of the ankle and another ambulance brought in a patient with an infected femur fracture that had been treated by volunteers a few weeks ago.

We are seeing so many complications of surgery that was done by previous volunteers. This is very humbling, given that we may be adding to this list. Every time we feel we are catching up and might finish the caseload more casualties come in through the ER or clinic. It is endless.

Today we did not manage to complete 4 of the planned surgeries. Part of the problem is the lack of anesthesia. Anesthesia is the bottle neck right now. There is one anesthesiologist who is leaving on Friday (Martin from Missouri). The Haitian anesthesiologist left early today in the middle of one of our surgeries to go to an appointment she had. We planned on doing more surgeries tonight but got bumped by an emergency appendectomy.

So here I am at 8:36PM finally going home because these cases were cancelled. Otherwise we would be operating till midnight. Well back to the hotel for a few hours of sleep and back for 7:30AM meeting to do all the cases we did not finish today and the many more that were scheduled for tomorrow. While it is a good feeling that we are doing good, there is a futile feeling that what we are doing is but a drop in the bucket.

Dr. Paley with patient right before he begun operating on her broken elbow

Dror Paley, MD

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Team Paley in action

March 17, 2010

Living with hope

 
 
Once again I am incredibly impressed with this countries ability to overcome adversity.  For example, several of the patients seen in clinic have been living with fractures that occurred during the earthquake.  Despite this horrible truth they manage to smile and laugh at my attempts at being funny.  
 
Servando Gutiererz
 

Haiti is full of triumphs, as a country and the individuals who make up the country. One person in particular touched my heart today. Marc Edward prides himself on being an English teacher. On January 12 he was teaching English to his class of eighty students. Then the earthquake changed his life forever. The building his class was held in collapsed. His was pinned down by a wall, which fell on his right lower leg. All he could do was pray for someone to help him. After four his prayers were answered. Although he survived only 10 of his students made it out alive. So as he is retelling his story he points to his external fixator and pleads for it to be removed. “I am an English teacher, teaching is my life, and all I have are my feet to get me to my jobs”.  Fortunately his fixator will be removed in one month and he will be able to return to teaching. I have never seen such an amazing smile as the one Marc had. I struggled with not breaking down into tears while Marc was retelling his tragedy. I am truly blessed to have the opportunity to be here helping these wonderful people. 

 

Servando Gutiererz     

 
 

Seeing for your own eyes

I’ve always been a window seat kind of person. Even at 30,000 feet there’s always something to see, especially when you’re flying over water. This was no exception as we descended, making our final approach for arrival at Toussaint Louverture International Airport in Port au Prince, Haiti.  I couldn’t help but wonder how anyone survived the devastation I was witnessing below, for as far as my eyes could see there was rubble intermingled with shanties, tents and a sea of blue tarps.

 

Upon exiting the aircraft, I flashed back to the last time I visited this airport as a young Marine. With the exception of the huge, newly acquired crack in the wall of the main terminal building, not a single thing has changed here. In fact, I’m pretty sure the guy with the orange sticks who guided the plane to it’s final resting place was the same guy who guided us in nearly 30 years ago. I could be wrong but he sure looks like the same guy.

Oddly enough, there’s much to love here despite the circumstances which have brought us here.

The sense of community is incredible. No one is above the person working beside them.

Doctors emptying garbage cans, nurses cleaning toilets. Truly a community!

Mark Smith

It took 4 days to realize my first truly heart wrenching experience.

A young woman carrying an infant was wandering the busy corridor where the makeshift orthopedic clinic was located.

Obviously in despair, she was talking to, or should I say, AT any aid worker who would listen.

She approached me pleading in a language of which I have no understanding.

Realizing I couldn’t help her, she moved to the next person.

Curious why this young woman was in such desperation, I asked the translator what she was saying.

What he said caused my heart to leap out of my chest and fall to the floor.

This young woman was 19 years old…her child merely a few months old.

Her husband was killed in the earthquake leaving her child fatherless and she without her beloved husband.

In a desperate attempt to give her child a fair chance in life, she was begging anyone and everyone to please take my child with you when you return to your home country…. please raise my child because I can’t do it alone.

This is one of those scenes from life that you recall vividly for the rest of your life.

Mark Smith

 It took 4 days to realize my first truly heart wrenching experience.

A young woman carrying an infant was wandering the busy corridor where the makeshift orthopedic clinic was located.

Obviously in despair, she was talking to, or should I say, AT any aid worker who would listen.

She approached me pleading in a language of which I have no understanding.

Realizing I couldn’t help her, she moved to the next person.

Curious why this young woman was in such desperation, I asked the translator what she was saying.

What he said caused my heart to leap out of my chest and fall to the floor.

This young woman was 19 years old…her child merely a few months old.

Her husband was killed in the earthquake leaving her child fatherless and she without her beloved husband.

In a desperate attempt to give her child a fair chance in life, she was begging anyone and everyone to please take my child with you when you return to your home country…. please raise my child because I can’t do it alone.

This is one of those scenes from life that you recall vividly for the rest of your life.

Mark Smith

I thought after the first day that there could not be any worst human suffering that what I was witnessing. Then today happened.  Dr. Nelson took me to the floor to see things from another perspective other than the Operating room.

I am still trying to come to terms with what I saw. The amount of human suffering was unfathomable, yet every one of the patients was still able to smile. That smile, I thought how with all their suffering are they still able to have such a beautiful smile.                         

Some of the patients we seen today included a man who worked with coal most of his life feel out of a tree and is now paralyzed, another patient was in his eighties and was under rumble for days before anyone found him, five year old who fractured her femur in two places when the earthquake happened came in.     

Terry Dinovi

 March 18, 2010

As I was on my way to our daily 730 am briefing, I was walking through hallways that were all filled on both sides with patients waiting patiently to be seen by the doctors, nurses or they were here to have a cast removed, someone to help them with broken bones, illness deformity birth, and so on. They were all patiently waiting for their turn. I found it amazing that out of all the chaos going on here there is such order. The patients some of them waiting all day for someone   to treat them yet not one of them getting upset or angry.   

We did nine surgeries today. I remember our first patient a young girl with a foot deformity Charcot Marie Tooth. I met her mom; they were so polite and grateful. I feel so privilege that I am able to be here.

 I remember thinking today how rare it was to even hear children crying, you would think with all this pain and suffering that’s all you would hear. Yet even when you are trying to put an IV in, which you know hurts more than a pinch, you will only hear a small whimper. 

On the happy side after less than a week I have made many friends here, one particular person a nurse in the operating room. Her name is Angelia, I had been calling Angelica, she barely speaks English and I do not speak Spanish but it is amazing how good we worked together without knowing each other’s language. We became friends in a short time.

She works three jobs and works over 70 hours a week. Unlike it is back home with people including myself, never grumpy always helpful and cheerful. Today is the last day I will see her, she goes home to the Dominican Republic. I am pretty sad to see I go. She has been a try asset to our team.  I call her angel. Thank you!!!

Terry Dinovi

 

Aviva Paley brings color and her warm smile to children

Coming from no medical background, there is still a shocking amount for me to do here in the hospital.  I have become a woman of all trades:  OR assistant, supply organizer, and my favorite, children’s art therapist.   When I’m not helping the doctors, I have gone on adventures into the tents around the hospital and in neighboring areas to hand out art supplies to the children of Haiti.  These supplies range from coloring book pages and crayons, to beads and strings, to various foam sticker activities.  Handing out one sticker to one child turns into a mob of fifty children in a matter of minutes.  Since these children have so few resources they are grateful for just about anything I hand to them.  Today was extremely fulfilling for me when I went into one particular tent that I had visited previously and the child started cheering in excitement knowing that there was a new craft project being brought.  I am extremely grateful to have this opportunity to lend whatever help I can, but in the end I recognize that what our team is doing is only making a small dent in the adversity that the people of this country face. 

Aviva Paley    

 
 

Building it Better

Building it Better

Haiti wasn’t exactly a wonderland before the earthquake. Decades of corrupt dictators, civil wars, and foreign intervention have left the country with little economy and virtually no infrastructure. Despite the tragedy of the quake, it has presented Haiti with a huge opportunity, not just to recover to where they were before, but to build it better.  The U.N. has estimated that it will take over $5 Billion in aid to achieve that goal, with only just over $1 Billion pledged so far. But the rebuilding has already begun. Roads have been cleared and then widened to two and three lanes. People have gone back to work and colorfully painted taptaps (busses) cruise the streets. The markets are abuzz and people everywhere are trying to get back to their regular lives. This may be the most critical part in Haitis recovery as foreign governments start to pull out and NGO’s begin the long transition of handing the hospitals and infrastructure back to the Haitian people. Yet the distinct feeling of hope is in the air. Breathe it in. Build it better.

Jonathan Paley

It’s easy to lose sight of the big picture when you’re elbow deep in surgery with a half dozen other patients waiting their turn. But Hopital Aventiste is a tiny corner of a small neighborhood in a big city in an even bigger country. In the hospital you feel safe, you’re in control, and when you’re working life isn’t altogether that different from back home. It’s when you step outside the gates that things get really humbling.

Jonathan Paley

 I was able to take a trip today into downtown Port au Prince where I got a small peak at the big picture. The earthquake and its two major aftershocks leveled an estimated 60,000 buildings. There is no better symbol among these than the National Palace. The expansive white building sits behind austere green gates separating it form the sprawling tent cities that have sprung up across the street. The building was by no means demolished, but simply collapsed in upon itself with the central dome now sitting just above the palace steps. Kids from the neighboring tent city hang around the gates waiting for aid workers snapping pictures and shout “you, YOU!” repeatedly, begging for food and money. 

Jonathan Paley

Around the corner is what’s left of the National Cathedral which didn’t fare nearly as well as the Palace. The building stands in ruins with its roof collapsed along with most of its walls. Still standing is one retaining wall with a perfectly intact stained glass window. As the sun shone from behind the cathedral it projected colored shards of light through the window and onto the neighboring plot of land already being cleared with bulldozers and backhoes for reconstruction.

Jonathan Paley

Once again I am incredibly impressed with this countries ability to overcome adversity.  For example, several of the patients seen in clinic have been living with fractures that occurred during the earthquake.  Despite this horrible truth they manage to smile and laugh at my attempts at being funny.  

Jonathan Paley

 

 

Team Paley Day 2 in Haiti by Dr. Paley

March 17, 2010

Dr. Paley reaching out to the people of Haiti

We started the day with the group meeting on the stairs of the hospital. There were about 100 people at the briefing. After a prayer the group commander made the daily announcements organizing the days work for all departments. He bade farewell to the groups that were leaving and welcomed the new groups.

We then reviewed the days surgical cases. My first case today was a Liss-Frank fracture dislocation of the foot. It was the most difficult type where the first ray dislocated medially with the medial cunieform and the lateral 4 rays dislocated laterally. There was a large diastasis between the rays. Not only is this the most difficult of the L-F fractures but this one occurred on the day of the earthquake (Jan 12). Reducing such an old dislocation is very challenging. I did a dorsal approach and was able to anatomically reduce both sides. I used 4 screws to fix this in place.

We were delayed from proceeding because of an emergency C-section in the other room. I therefore went to clinic and ran the orthopedic clinic with Jennifer while Servando manned the Emergency room. The volume of patients we saw was unbeleivable. At one point I thought clinic would never end. Most of the patients were here for followup of fractures that occurred during the earthquake. Several came out of casts and could start walking while many others had to be booked for surgery for this week. Many of the patients had fractures that were treated in the first three weeks after the earthquake. The equipment available was not what is available now. Many of these did not heal and we are now operating on them. For example one patient had an external fixator for his humerus which was removed 3 weeks ago. The humerus is not healed and the radial nerve not working.

The highlight of my day was the next surgical case. I treated a 22 year old woman with a dislocated hip from the time of the earthquake. This was an obturator dislocation which is when the hip comes out the front and dislocates towards the center. I went to see her in her tent. Thus far she has refused medical treatment. I met her in one of the tents on the campus of the hospital. I had a long talk with her in French to explain to her why she should have the surgery. She has not walked in 9 weeks. She finally consented and we did the operation. I opened the hip from the front and was able to reduce it successfully in about half an hour of surgery. It became immediately stable. She will walk out of the hospital.

All the patients we have operated upon to date had surgery under spinal anesthesia. This is the safest way to do the surgery here. Putting them to sleep is much higher risk. We have to operate quickly before the spinal wears off and we have to do so with minimal blood loss. There is no blood for transfusion unless the family donates for them. We are very careful since the rate of HIV infection is very high. We all wear glasses and take precautions not to puncture our gloves.

The next case of the day was the most bizarre. We treated a woman who had huge growths on the top of her foot. These were like the elephant man but only affecting her foot. We did not know what this was. We considered elaphantiasis vs, neurfibromatosis vs Proteus etc. I excised the lesions removing all of them from the top of her foot. This left the top of the foot without skin. She will have skin grafts put on the foot next week by a plastic surgery group that is coming in.

We did two more smaller cases; debridement of infected pins from an external fixator and removal of a screw from a nail. We finished this last surgery around 8 PM and then during dinner met with all the new teams that had arrived that day.

Our day ended by coming back to the hotel where some of us were staying and jumping into a pool, having a beer and eating fried plantains. The camaraderie of the group and Dr. Nelson has been one of the highlights. Each member of the team has played a central role. Dr. Nelson complemented the team and asked us if he could keep them here after I went home. Today Mark once again ran the cast room and was busy non stop with casts. Last night he finished in clinic at 11PM. Terri has been our OR planner and circulator. She gets all the equipment ready and makes everything run smoothly. She works with the Dominican scrub nurse Angela who only speaks Spanish. Jennifer and Servando rotate their jobs from the OR where they  perform small procedures or do all the closures, to working in the ER and the ortho clinic. They round on the ward, write orders and are amazing team players. No job is too large or small for them. Aviva my daughter helps in any way she is asked. Today she organized the equipment in the store room and helped Terri. She also made rounds in the tents to visit with recovering patients giving out visors, coloring books, etc. Jonathan spent the day filming a documentary about this mission.

Terri Dinovi & Aviva Paley

This has been an amazing experience so far. Although we are only helping for a short time and can only change the lives of a few people we feel good that we have in a small way contributed to the recovery of these people and this country. They have managed to touch our hearts and to make us appreciate what we have.

Dror Paley, MD

Team Paley’s day one in Haiti

March 16, 2010

 

We left Florida at 9:45 AM March 15, 2010. The team consisted of: Dr. Dror Paley, Servando Gutierrez physician assistant; Jennifer Pinsky PA-C, Mark Smith Ortho Tech, Terri Dinovi RN, and Aviva and Jonathan Paley. Jonathan Paley is 23 and is a documentary filmmaker. His role is to document this trip. Aviva is an artist and is on spring break from college. She brought art supplies to work with the children on arrival.

We arrived in Port au Prince at 11:30 and were met by the people from CURE and from the Hospital Adventist. The drive to the hospital was educational about the history of Haiti and about the relief efforts going on. The poor in Haiti have not been able to get health care until the earthquake. With the earthquake disaster health care became free because of all the volunteer organizations coming in. While in the beginning the attention was to the injured, now all of the people who could not get health care are coming and getting health care for free. Many of the cases we will see are not injuries from the earthquake but rather neglected problems from before the earthquake. On the ride to the hospital we saw entire tent cities of refugees. Over 1 million people of the 10 million living in Haiti are living in tents. We saw destroyed buildings, rubble and people everywhere.

At the hospital we registered, got oriented to our room and then were put right to work. Dr. Scott Nelson a former fellow of Dr. Paley’s was our host. He is running the orthopedic department here. He must have built up the visit of Dr. Paley since so many people came by to ask about us. Dr. Paley’s book was sitting in the operating room for quick reference.

Dr. Paley operated on a man with a neglected femur fracture on the left and an open fracture dislocation of the ankle on the right. The femur fracture was very challenging because it was comminuted and began at the lesser trochanter. Dr. Paley had to use some special tricks to get this fracture nailed. The hospital is equipped with the SIGN nail system. This is a solid nail that can be done without flouroscopy. We did have an image intensifier to our surprise. After the difficult nailing we operated on the left side. This was an open fracture dislocation of the ankle. There were three wounds all of which were not healing. We debrided a lot of bone and soft tissue. Finally Dr. Paley decided to fuse the ankle and remove the fibula. By shortening the leg we were able to primarily close the predominantly transverse incision.

While Paley was operating assisted by Jennifer, Servando ran a room on his own removing an ex fix frame and removing internal fixation. He then did an osteomyelitis debridement all on his own with supervision.

After an exhausting evening we all retired. Morning orientation is at 7:30 AM