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Lending a Hand – An article about our trip to help the Haitians

July 20, 2010

Here is a link to an article in TOWN & VILLAGE, an online newspaper for Manhattan that was recently forwarded to me.  The author, Sabina Mollot, interviewed Dr. Melone back in February.  Click on the article title to view read it.

“Lending a Hand – Beth Israel Upper Limb Specialist Team Goes on a Mission of Mercy”

Unity for Haiti Fund Raising Video

March 25, 2010

Click below to watch a short video assembled from footage taken in the Dominican Republic during our medical mission to help the Haiti Earthquake victims.

Click here to make a donation to Unity for Haiti.

Day Five: Leaving Contreras

February 10, 2010

This morning we woke early, as we had been doing for the past four days.  But this time we would not be going to Dr. Dario Contreras Hospital to see patients…to see our patients.   We’re heading to the airport to board a Continental flight back to New York.

While on some level I’m sure we’re all glad to be free of the appalling conditions of that hospital and the nightmarish horror of the people lying in the beds and hallways of that place.  But I also know that the doctors and their team wish they could stay longer, help more people, and look after the ones they already have helped.

We’ll all go back to the lives we had before this mission, but what we’ve seen here and done here won’t be forgotten quickly, if ever.  Words like these in situations like this always sound over dramatic, but when you’ve lived something like this, seen something like this, it stays with you. Hopefully it makes you a better person.  Hopefully it makes you a more caring person.  But an experience like this definitely changes you in some way.   In different ways for different people perhaps, but it does change you.

Some of us may go back again or maybe some of us will do a mission like this again, but in some other country after some other unspeakable catastrophe.  But it will, of course, be different. This was a special group.  And we have become friends, bonding in a way that happens when a group of people share an experience like this.

I wish our patients well.  I wish the doctors and nurses of Dario Contreras well – for they should be commended for stepping up and helping out their fellow islanders despite their divisive history.  I wish our team well – Dr. Melone, Dr. Garvey, Barbara, Peter, Joel, Alet, Roy and my wife Francesca whom I saw in a different light on this trip, as a healer saving people.

But most of all I wish the people of Haiti well, both those who were injured in the earthquake and those who lost loved ones.  Like us, their lives will never be the same.

DONATIONS:

If you are interested in making a donation to Unity for Haiti please click here.  Any amount would be greatly appreciated.

Day Four: More Tragic Stories. More Successful Surgeries.

February 9, 2010

WARNING: This posting contains VERY graphic images of some of the Haitian earthquake victims.

Dr. Melone focuses on his patient.

The day started with Drs. Melone and Garvey doing rounds to follow up with the patients that they treated the previous two days and to see the patients they would be operating on today.

Dr. Melone stopped by to see how Diego’s hand was healing and was met with big smiles from both Diego and his family.  Dr. Melone had him wiggle his fingers which he did, a sign that the nerves had been successfully reattached.

His father wanted to say words of thanks to the camera for me to share.

Dr. Garvey stopped by to visit Ritha, a young woman who’s lip and left cheek had been ripped apart resulting in nerve damage and facial palsy, to see how she was feeling.

Her face was still swollen and she was in some pain, but she beckoned the doctor closer to her and whispered “merci…merci” over and over.  Joel then translated the rest from her native Creole.  She was so grateful to Dr. Garvey.  She is a devout Christian and she said she would pray for him forever.

I stayed with her for a bit after Dr. Garvey, Joel and Francesca continued on and held her hand and tried to communicate with her as best I could.   She asked me to sit down on her gurney and stay with her.  It pained me to tell her that I couldn’t and that I had work to do.  It is so sad because many of the Haitian patients have no family with them in the Dominican Republic and they just lie on gurneys all day in a cold hallway.  I stayed for a few more minutes then gently pulled my hand out of hers, patted her on the forehead and went to join the others.

Ritha crying tears of gratitude for Dr. Garvey.

I caught up with Dr. Melone and Francesca who had run into a couple of Russian doctors and were trading notes about patients.  They couldn’t speak any English and we couldn’t speak any Russian so we settled on French as our lingua franca and Francesca and I tried our best to remember our combined ten years of French in school in order to translate for Dr. Melone who was hoping they might have some patients that would require a hand specialist as the Russian doctors were all general surgeons.

It turns out they did have a young Haitian girl with nerve damage in her hand, but they sent her home because it’s not an operation you can do without a microscope which this hospital does not have.  They suggested that maybe Dr. Melone could take her back to New York to do the surgery, but when Dr. Melone told them he could do it without a microscope they were quite skeptical.  I had my laptop with me and was able to show them photos of Dr. Melone’s unaided micro hand surgery.  Their jaws dropped and they said they would go and try to get the girl back to the hospital.  Then they turned on their heels and vanished behind a set of double doors.

Both Dr. Melone and Dr. Garvey had a full slate of patients lined up for their ORs.

Francesca wheels a young Dominican boy with multiple arm fractures into the operating room. He was a tough kid and wasn’t scared at all.

Dr. Melone had several arm fractures which required a “reduction” and an “ex fix”, an external rod held in place by screws which is preferable in many cases to inserting plates under the skin.

Dr.  Garvey had two cases that were truly heart breaking.  The first was a thirteen year old Haitian girl from Port au Prince who told Alet that she had been trapped under the rubble of her house for eight hours before being pulled out.    Her left leg was crushed, which required surgery and a skin graft.

Orthopedic surgeons from Columbia Presbyterian had previously fixed her leg fracture and did their best to apply the skin graft, but they were not plastic surgeons and did not have the necessary materials and expertise to do it properly.  Dr. Garvey had her anesthetized and with a joint team from both our group and Dominican, nurses and anesthesiologists from Dario Contreras Hospital he re-did her plastic surgery with a skin graft from the back of her thigh.

Machine used to harvest skin grafts.  It looked a lot like a meat slicer to me.

She was very scared before the surgery and Francesca held her hand and spoke calmly to her as Roy was putting her under anesthesia.

I had never before witnessed a skin graft being harvested and it is definitely one of the most shocking procedures I have ever seen.  I don’t think I will ever understand how these medical professionals can anesthetize themselves to these horrific sights, but thankfully for their patients, somehow they do.

While it may not look pretty to the lay person, this is actually a very successful skin graft.  The perforations are intentional to help the new skin breathe and drain.

All hands on deck.

Dr. Garvey’s next patient was Darly, a young Haitian man of twenty-two who was very bright and chatty before his surgery and spoke English well.  He explained that he was studying on the ground floor of a university building in Port au Prince at the time of the earthquake and that both his legs were crushed when the floors above collapsed.  His left leg was already beyond repair and had been amputated just above the hip, but the right one could have been saved had he received proper medical attention sooner.

As it was, by the time he was seen by western doctors in the border town of Jimani in the Dominican Republic it was too late and his second leg was taken off just below the knee.  His brother told us that during the three days after the quake that Darly had waited to be taken to Jimani, he was limping around on one leg helping other people who were in worse shape than he was.  Truly heroic.

Darly did not seem bitter though.  On the contrary he considers himself very lucky to have survived as many of his university classmates did not.  Plus he told us that he had already had a benefactor who promised him a set of prosthetic legs and he was very excited to walk again.  Dr. Garvey didn’t mention this to Darly, but an individual cannot walk using prosthetics with two above the knee amputations so Dr. Garvey and his team would be fighting to prevent having to remove more of Daly’s right leg.  The operation required carving away some of the existing bone to allow the skin to be pulled over to enclose the knee.

Peter works with the hack saw to cut off some of Darly’s tibia.

Dr. Garvey and his team cut, hammered and sawed in preparing Darly for a clean reconstruction of both his leg stumps.   During the procedure the hack saw and the gilgli saw broke attempting to saw off a piece of leg bone so they then used an osteotome (essentially a hammer and chisel).  Out of all the horrific injuries and complicated surgeries that I have witnesses and photographed these last few days, I believe this was by far the most difficult operation for me to watch.

Tools to the trade.  And no, it’s not carpentry.

While it is too early to tell if Darly’s leg will accept the reconstruction Dr. Garvey thinks things went very well and is hopeful that Darly will be able to walk again with prosthetics.

Later in the day I returned to check on Ritha only to find the hallway overcrowded with people and a cameraman about halfway down the hall.  I assumed it was either another group of foreign doctors documenting their experience like us or a disgruntled family member who had alerted the press to the condition of one of the criminal patients handcuffed to the gurney.

But as I edged through the crowd to reach Ritha I looked up to see none other than Angelina Jolie floating towards me.  She had been conversing with a young Haitian boy who had lost his leg and was now making her way out of the pediatric ward with her entourage.  I made room for her as she passed by.  I was tempted to tell her what we were doing and ask for a donation, but fearing assault from her body guards if I made any motion in her direction I demurred and lowered my gaze as the guardian of distressed children in foreign lands flowed past. Click here for People Magazine’s article on her visit.

Then I stayed with Ritha a while, holding her hand.

Both surgeons had several more operations today and I went back and forth capturing them all as video and still photography.  I told the team on the flight over that their patients come before any filming or photos and that I would gladly do any task they requested of me.  I was pleased that not only was everyone very accepting of having a photo journalist in their OR (they all understand the importance of raising awareness for “Unity for Haiti” to help finance future medical team trips), but they also called on me to help out in a number of situations and it felt good to be useful to the team in a context that directly helped the patients on the operating tables.

I’m using my camera to back light the x-ray so Dr. Melone can see it during a procedure.

It was another long day and we all filed out of the OR together at 12:30am Tuesday morning.  We were exhausted, but we took the time to take a group photo, something we had been talking about doing from day one, but just never had the time.

We got back to our hotel around 1am and then shared one drink in the hotel bar to toast the earthquake victims we’d met and tried to make more comfortable.  Then we headed off to our rooms for a couple hours sleep before our ride to the airport at 4am.

Day Three: Pray for the Children

February 8, 2010

There is no sound more pleasing to the ear than a child’s laughter, no image more heartwarming than the smile of a little one.  Conversely there can be no sound more heartbreaking than that that of a child crying out in pain and no picture more frustrating than that of a tear rolling down a child’s face.

Today we got to experience both the sadness and joy with the Haitian children staying at the Dario Contreras Hospital’s pediatric ward.  You just want to hug them and take all their pain away, but you can’t because even a tender hug will inflict pain on their broken bodies.

There are over 45 Haitian children at the hospital and all are casualties of the devastating earthquake in Port au Prince and its surrounding towns.  Some are infants who’s parents perished in the earthquake.  They need mother’s milk so some Dominican women graciously offer theirs to feed these hungry babies.

Mothers, Haitian and Dominican alike, take turns holding these crying infants and rocking them to sleep.

When Alet found this little baby girl who had lost her right foot when it was crushed when her house collapsed he was heartbroken.  But when he inquired in Creole as to who the mother was he couldn’t believe his eyes when a young girl of no more than thirteen stepped up and said with pride “she’s my daughter”.

Then he looked down and saw that her leg too was gone just above the knee.  She showed no signs of depression though and he could tell by the way she touched her daughter and looked at her that she loved her dearly.

This little girl (above) sustained injuries to her head and spine.

This boy had his leg amputated as a result of trauma he sustained during the earthquake.  He was very despondent and was refusing to eat.  His parents were distraught and were begging our team to help them.

This little boy lost his right arm at the shoulder and hurt his hand.

This boy broke his arm and injured his head and face.

I wanted to add a quick clip of the child in the first photo above as she cried for her mother.  While some might think it inappropriate to do so I think, on the contrary, that the more we can bring back the reality of what happened in Haiti the more of an impact we will have had here.

Later in the day some of us got the opportunity to see big smiles on the children’s’ faces (many of the same faces who had been crying earlier that day) when we delivered toys, coloring books and clothing.

Donations from the Real Estate Ladies.

As mentioned in a previous posting many residents of New Jersey responded with incredible speed and pulled together a toy and clothing drive for Francesca and I to take down to the injured Haitian children.

Today we slung those duffle bags and hand bags over our shoulders and marched to the pediatric ward to play candy stripers.

Seeing their faces light up was the best reward we could ask for.

If the child was asleep we left something next to him or her for when they woke up.

Here is the little girl who injured her head and spine very excited about her toy.

Here is the little boy who lost his right arm and scared his hand cherishing his new toy.  It doesn’t look like he has a care in the world.

This little guy has a toy donated from one of the residents of New Jersey and one of my Duke Soccer Camp T-shirts that I had saved since I was his age.  My wife is trying to train me to not be such a hoarder and I couldn’t think of a better way to get rid of my old sports t-shirts.

Peter and Joel distributed the two duffel bags of donated children’s clothing.

The parents were so thankful as many of them lost all but the clothes on their backs after the earthquake.

It was amazing to see how good Alet was with the children and you could tell how heartbreaking it was for him to see his countrymen and their children in such devastated condition.  But he really enjoyed the afternoon and we had to pull him away when it was time to head back to the operating room.

As we were heading back to the OR we grabbed a quick photo opportunity with the head nurse in the pediatric ward and a nun who helps care for the children.

I want to thank once again all of the people involved in the clothing and toy drive with special thanks to Sue Lemkau for volunteering to organize it and all of the representatives of Lois Schneider Realty, Bergdorf Realty and Coldwell Banker Realty.  Your efforts under a tight timeline were appreciated by these kids and their parents more than I can describe in words.

As a tribute to you all I have put together a little slideshow of all the smiling children who received your generous donations.  Make sure you have your sound volume up for this one.

If anyone would like to donate to Unity for Haiti to help send down more doctors please click here and find the “donate” button in the upper right corner.

Day Two: Fixing People

February 7, 2010

WARNING: This blog posting contains some graphic photos of injuries to Haitian earthquake victims.

Alet and Dr. Garvey operating on a Haitian patient.

Today we got to fix people.  I had never been inside an operating room before (other than as a patient under anesthesia) and as a layman it was fascinating to see how it all works.  The collaboration involved is reminiscent of a sports team where there is a captain (the surgeon), but everyone has a specific role and is counted on to perform their best.  Only in the case of surgery the stakes are much higher than a game won or lost, as I would find out later today.

Francesca and Joel clean the wound of a Haiti earthquake survivor while her parents comfort her in her pain.

I could sense the anticipation from the medical team the day before as they were triaging potential patients.  They were itching to get into the operating room, the surgeons like caged lions, hungry for the kill.  I have heard it said that surgeons just like to cut and so I assumed that it would be simply a numbers game, get ‘em in, get ‘em out, cut, cut cut.  But I learned a lot about surgeons today and the medical profession on the whole.

Francesca, Dr. Garvey & Dr. Melone operate on a Haitian girl.

I learned that surgeons do care deeply about their patients and watching Drs. Melone and Garvey consult, plan, prep and, yes, cut they displayed a compassionate side that was truly moving.  These two doctors and their teams performed limb saving surgeries that these patients would not have received if Dr. Melone’s team had not been here.  No disrespect to the medical staff at Santo Domingo – they do a wonderful job with what they have – but often they will choose to amputate because they don’t have the equipment, the time or the experience necessary to save an appendage.

Not the same ORs as in New York.

The conditions under which the team had to work were like nothing any of them had experienced before.  They did not have all of the drugs, supplies and instruments that they needed to perform these surgeries nor did they have many of the high tech machines that they have come to rely on back home in New York.  Further complicating matters is the language barrier.  While there are three members of the team fluent in Creole, the native language of Haiti, if they are busy elsewhere or when communicating with the Spanish speaking Domincan staff of Dario Contreras Hospital, it was extremely difficult to get a patient’s history or communicate what was needed in the OR.  We often rely on their pigeon English or our pigeon Spanish or French (sometimes understood by Haitians).

A brief video clip of Joel translating Dr. Garvey’s post op care to a patient’s father into Creole.

But despite these obstacles, the team was able to fix up six patients in a day that started at 7am and ended around two in the morning.

Roy and a local anesthesiologist sedate a patient.

I want to share the stories of two of today’s six patients whose operations illustrate well the degree of devastation with the Haitian earthquake survivors and the ability, focus and determination of the surgeons and their teams to do everything they can for these people.

The Story of Diego

While the team’s primary purpose is to treat victims of the disaster in Haiti, it is also their goal to help out the staff of our hosts at Dario Contreras Hospital by occasionally treating Domincan patients if they have a need for our team’s particular expertise.  This frees up the Dario Contreras surgeons to focus on other Haitian patients with lower extremity injuries such as femur fractures, of which there are a lot here.  [Previous and future Unity for Haiti trips will have orthopedic surgeons from the US as well].

Dr. Melone fixes Diego’s hand assisted by Peter, Alet and Barbara.

Diego (not his real name to preserve patient confidentiality) is from the Domincan Republic and had his left hand sliced up severely by a man wielding a machete, which, we have come to understand is a common way of settling disputes here.  Diego had several severed tendons and extensive nerve damage in his hand.  This type of micro surgery requires a microscope to perform and since they don’t have this type of machine at Dario Contreras they would typically have no choice but to amputate.  But Doctor Melone, one of the world’s best hand surgeons, did not want to see that happen.  He had spoken to Diego’s father and sister in the waiting room and seeing the concern on their faces and hearing the desperation in their voices he decided to attempt the operation without the aid of a microscope, which, he confided to me later, he had never attempted before.

The operation lasted over five hours and required intense concentration and teamwork from Doctor Melone and his team; Peter, Barbara, Roy and Alet as well as a few local anesthesiologists.

I stood and watched in amazement as Dr. Melone sorted through dozens of structures in the hand to locate both ends of the severed nerves, a task made more difficult by the fact that they did not have a proper tourniquet to keep blood from flowing back into the hand.  It is difficult for me to describe in words the sheer awe I felt watching these steady hands sewing together two nerves the size of a small string with a micro needle and sutures.  Simply amazing.

The hands of a surgeon and his PA.

When he was finished at 1:30am Doctor Melone walked through the steel double doors into the waiting room to inform Diego’s father and sister that the operation was a success.

They were clearly overjoyed and thanked Dr. Melone profusely although I am not certain that, with the language barrier, they knew just how close their son had come to losing his hand.

The Story of Laurette

Francesca and Joel were walking the hallways and rooms performing triage, sorting through all of the broken femurs and head injuries, looking for suitable patients for doctors Melone (hand specialist) and Garvey (plastic surgeon) when they came across Laurette (not her real name) an eighteen year old girl from the town of Leogane near Port au Prince who had been trapped in the rubble of her house when it collapsed during the earthquake.

Francesca works up Laurette in the overcrowded hospital hallway.

The list of her injuries was extensive.  She had a fractured hip, a high break on her left arm and a hole the size of a quarter in the back of her head.  In addition, a large chunk of her back and shoulder had been torn away when her house collapsed on her.  She was fortunate enough to have been airlifted to the Dominican Republic, but had been left sitting on a guernsey for several days by the time we  brought her into Dr. Garvey’s operating room.

An chart showing the break in Laurette’s arm.

Dr. Garvey meets with Laurette in the hallway while Alet translates in Creole. I wonder if this beautiful eighteen  year old girl was scared having this strange man who doesn’t speak her language cutting her open.  Of course she had no way of knowing her stroke of luck that Dr. Garvey was in town that day.

Of Laurette’s injuries, her shoulder and the hole in her head were the ones that required plastic surgery.  It was a very difficult surgery and Dr. Garvey spent a good portion of the three hour procedure trying to figure out the best way to go about fixing Laurette’s  shoulder.  After first considering a skin graft from her leg he decided to attempt to fix her by using a flap technique whereby he initially cuts the shoulder even further and then stretches the flap over and stitches it up.

The massive trauma to Laurette’s shoulder before surgery.  The procedure was made more complicated by her broken arm which limited Dr. Garvey in how he could manipulate the shoulder as he operated.

Dr. Garvey was able to close up the gaping hole in Laurette’s arm without using a skin graft.

I had bonded with Laurette before her operation trying to keep her spirits up and her mind off the unspeakable tragedy that had befallen her.  I explained to her that I had been in Haiti when I was her age and showed her some photos from 1985 that I had brought with me.  She smiled through her pain and said she knows the school where my group spent our time playing with the children and painting murals on the walls.  She also lied and told me my paintings were very good.

While Laurette still has the issue of her broken hip and arm to deal with, and will certainly have some scaring on her shoulder, she faired quite well under the circumstances and I was proud of the team for what they had accomplished.

The team was exhausted, but felt good about the work they had done today.  It is clear to me that these individuals came to work and they are determined to help as many victims of the disaster in Haiti as possible.  While most of these victims consider themselves lucky to just be alive they can now look forward to an even better quality of life than they otherwise would have had.

We won’t get much sleep tonight, but the team is eager to get back into the OR tomorrow.

Day One: Surveying the Damage

February 6, 2010

The team arrives in Santo Domingo

The team arrived safely at Santo Domingo airport in the Dominican Republic and proceeded to transfer ourselves and our medical supplies to our hotel in the center of the city.

Beautiful road into downtown Santo Domingo

As we drove along a sun drenched stretch of palm lined roadway next to a gleaming blue ocean many of us were thinking to ourselves how incongruous this beautiful scenery is to the ugliness of the disaster in Haiti and the horrific images we were expecting to find at the hospital.

The shuttle from the airport

Many of us were also pestered by feelings of guilt for the manner in which we arrived for our mission (a private jet – donated by the immense generosity of a New York based family who asked for nothing in return, not even public recognition) and the relative comfort of our hotel compared with that of the truly dismal conditions we found our patients in – lying on guernseys in an unsterile environment the hospital hallways .

Peter checking a patient

I suggested to the team of medical professionals with whom I was traveling that these comforts did not render their commitment to helping these people any less noble.  It is not necessary for them to suffer just as their patients are suffering (although I have no doubt there will be some kind of psychological or emotional toll).  They should all be highly commended for taking time out of the busy lives, their jobs (where their patients back home depend on them) and their families.

Here is a brief introduction to the medical team on this tour:

Dr. Charles Melone, Surgeon (hand specialist)

Dr. Richard Garvey, Surgeon (plastics)

Joel Bastien, Licensed Radiologic Technologist, OAP*

Roy Berenholtz, Anesthesiologist

Barbara Diedrick, Surgical Technician

Francesca Yango Jahns, Physician Assistant

Alet Michel, Registered Nurse*

Peter Perou, Physician Assistant*

* Haitian / Creole speakers

After we checked into our rooms it was already late in the afternoon, but the team was eager to get to the hospital and take stock of their patients and review the facilities and equipment that they would be using for the next four days.

Barbarians at the gate.

We were driven by mini van to Dario Contreras Hospital about forty minutes away and knew as soon as we approached the imposing black wrought iron gates with guards to open the padlocks that we were not in New York City anymore.

What follows is a pictorial of our first day at the hospital.   While the slideshow is perhaps the easiest way to show the images it does not begin to describe the horror stories attached to many of these individuals (like the young Haitian woman who was paralyzed from the neck down and just wanted us to help her keep the flies off of her face) and the indomitable spirit of youth (like the young Haitian boy who proudly showed off the bandaged stump where his arm had been before the earthquake and beamed for the camera).

WARNING: This slideshow contains some graphic photos of injuries.

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The stories of these courageous people and the generous and talented medical professionals who are here to help them will be fleshed out in this blog over the coming days.