I didn’t hear the familiar pop of the hip joint dislocating as I twisted the leg into a contorted position during the operation. Not that I would have noticed since it had been almost 20 years since I did a posterior dislocation of a hip with an acetabular fracture.

The woman was crushed when her house collapsed on to her back as she crouched for protection. Although initially paralyzed, the function of her legs returned but because of the awkward position of her hip and the pain, she would become permanently crippled unless we did something.

The operation required much of the newly bartered equipment from yesterday. A partial hip replacement turned out to be a critical component of the surgery. Though we finished in under 2 hours, time moved slowly.

But to be out of one’s own routine will slow time down. The way I awake and shower and brush my teeth in the morning is significantly different here than at home. How I eat and what I eat is sporadic, unfamiliar and inconsistent. My routine at this hospital is unlike anything I would do at home.  So it is no wonder that some of the events from even a few days ago feel as if it occurred several weeks ago. My time has been stretched and elongated by the unfamiliar and the change in my environment.

For different reason, my nights are long.  Despite being pretty tired, I’m awoken not only by the noises of the chaos around me but similar noises within me.  Whether it is from the fear of surgery that is unfamiliar and without adequate equipment or the fear of caring for a very sick postoperative child without an ICU, these noises are loud and also stretch my perception of time.  I feel as if I have been here far longer than my 4 days.

But for our patients, it hasn’t been 4 days; it’s been 30 days. They have had their routine disrupted. I’m sure the noises they hear at night are louder and sharper than mine. I’ll be returning home in a few days with these stunning memories of slow motion. For the Haitians though, like a dream of being chased where your legs don’t seem to move, I can’t imagine their endless night.

The drive to Port au Prince is not for the young or old. Sitting on the raw steel plates in the back of an old ice truck, fully enclosed and insulated to swelter in 95 degree weather is not comfortable. Add to it 2 hrs of traveling on unrepaired roads and traffic filled with thousands of other people who have the same sense of urgency as you, and feelings of suffocation and claustrophobia can be strong.

Our goal was to obtain specific supplies we needed for our surgeries. Armed with the only currency that is meaningful here we planned to visit 3 other medical units in Port au Prince for trade and barter.

With the Project Hope Mission we traded anesthesia medication and morphine for 4 femoral rods and a 7.0 mm cannulated screw system. Street value: $30,000. With another outfit, we accepted 4 paralytic unstable spine victims and got 10 Kuntchner rods, 3 blade plates, 1 Austin Moore, and 10 packets of antibiotic cement.  Finally, for agreeing to return Thursday to run an orthopedic clinic for 3 hours we got 30 walkers 4 IV poles and 1 empty dressing cart.

The equipment will help our patients immediately but for those of us who sat around the negotiating table, we walked away with a reinforcement of the reasons why we came here in the first place. These reasons vary for each of us, but as we all walked away from the table satisfied, we were pretty content.  I’m not a 100% what my own reasons are but I’m sure it was a sense I had when I was young that I’m only rediscovering as I’m older.

Footnote: thank you to the surgeons of Project Hope and the Canadian team of surgeons from St. Joe’s Hospital for your incredible support.

It’s far from comfortable here in Haiti. 2 hours north of Port au Prince, Pierre Payen is dry, arid and hot. The dirt roads have been pulverized to a fine dust that permeates everything. The dust is in your clothes, your hair, even your teeth when you talk. It’s also on your bandages and in your operating rooms.

Your daily routine would never work here. With running water or regular electricity, simple things like brushing your teeth or going to the bathroom require extra thought.  Surgery requires even more thought.  Because there is no infrastructure, every aspect of our advanced procedures has to be provided by our team including preparing our instruments and sterilizing our equipment to IV’s, blood tests, anesthesia, transport, and recovery.  Even giving medications, changing dressings, cleaning up diarrhea and showing a patient how to use an inhaler.  As an orthopedic surgery team, we’ve diagnosed and treated pneumonia, congestive heart failure, and probable parasitic infection.

We had been about to start an unstable leg fracture case when we were told about a child just carried to the hospital.  He was clearly sick and listless. Young children can have spontaneous infections in the hip and it appeared that was what he had.  After bumping our trauma cases and positioning him for surgery, we noticed that he was so swollen and infected that his scrotal areas had been obstructing the flow of urine for the last 3 days. In surgery, we couldn’t even place a tube to release the urine.  With nowhere to turn, an emergency circumcision was performed which allowed the placement of the tube and a release of almost a quart of urine.  We could then proceed with the operation to release almost a quart of pus from his hip muscle, which isolated a probable tuberculosis infection.

Although not comfortable here in Haiti, it is rewarding.

Haiti Day 1

An early morning start to meet our jet at 3 am was uneventful. The jet, generously donated by Ariel Corporation, served our needs well. With over 600 lbs of equipment, we needed the cargo space more than direct access to a private landing strip. Even if a commercial flight had been available, we would soon learn about the tight control over air space at Port au Prince and its strong military presence.

First impressions of Port au Prince are numbing. The airport is filled with the chaos and intimidation of military jets and helicopters punctuated with confetti dots of healthcare workers sprawled over the tarmac waiting to leave.  As we unloaded our carefully wrapped surgical equipment the Gulfstream jet next to us unloads their cache of fresh Domino’s Pizza.

The roads, as well as the infrastructure are clearly fractured. Tents and huts made of permanent indestructible plastic garbage line the road.  Limping dogs and goats give glimpses of the lives their owners must live behind these sheets of plastic. Because so much of the plastic is cheerfully orange and blue, it’s an ironic kaleidoscopic ride through town. In a blur, you would be reminded of the disaster only by the ubiquitous smell of burning garbage and diesel.

The hospital is intact and functional. Today, 22 patients are recovering. Still, many are untreated from the initial quake. Dust from the dirt road permeates the operating room with no signs of antisepsis.

Although there seems to be ample supplies there is little organization. Every team has been generous with their supplies but with the urgency to operate, it’s been difficult to manage an effective system. Working on this may be our biggest contribution.

X-ray rounds revealed some major cases that need to be done. Perhaps spine, perhaps pelvis, but definitely femurs, shoulders, and ankles wait for our team to unpack and work.

Event: 5K Run/Walk or 2K Fun Walk

Location: OhioHealth Westerville Medical Campus, 300 Polaris Parkway, Westerville, 43081

Date: Friday, January 1st, 2010

Start Time: 11:00am

Registration/Packet Pickup: 10:00am

Packet Pickup: Begins Saturday, December 26th at NOON through Thursday, December 31st at 2:00PM at Fleet Feet Sports. Fleet Feet Sports is located just off Polaris Parkway at 1174 E. Powell Rd. in Lewis Center.

Registration Prices:

$25 thru Dec. 19.  $30 after the 19th and on race day
FAMILY SPECIAL $15 EACH (4 OR MORE)

For more information and to register online CLICK HERE

I have never encountered such a stark difference between two cities in any one country as I have seen between Beijing and Shanghai.  Whereas Beijing instills the weight of history with Tiananmen Square, the Forbidden City, and the Great Wall of China, Shanghai is modern, organized, and expansive.  People here will say that if you want to see China the way it was in the past, go to Beijing but if you want to see where China will go in the future, go to Shanghai.

Even the public bathrooms at the hospital demonstrate this difference.

A typical traditional bathroom in Beijing

The typical Shanghai hotel bathroom with heated seats and power bidet

The hospital I visited had 1100 beds with almost 2 million patient visits every year.  They perform 27,000 surgeries a year.  The orthopedic service has formal rounds with a full team of attendings, residents, all nurses, and all therapists twice a day.  Yet, to keep costs controlled, they employ traditional interventions.

A bamboo splint for a low cost option

Their medical experience is different from ours.  Neither is better but without question, China’s experience is vast.  Both their medical teams and their patients demonstrate stoicism, perseverance, and discipline.

This applied discipline appears to begin early and continues in nearly everyone I have met.

2nd grade recess in the school yard

For complicated reasons, I found myself at a street side noodle shop at 2:30 in the morning with an equally hungry 30 year old man.  I am in my business suit and he is in his hip torn jeans with an equally hip polo shirt.  He tells me he makes socks.  I wonder if he works in one of the many narrow alleys I’ve seen around the city.  Rather, he makes socks for the US.  He makes all the socks for the US, including those for Walmart, JC Penny, Target, and Nike.  He owns a large factory outside of town and employs 300 people to make socks.  Armed with 2 cell phones and a laptop, he constantly monitors the price of cotton in Turkey and Yemen to remain competitive and worries over the timeliness of his container ships crossing the Pacific.

I leave wondering if he is typical of every 30 year old man in Shanghai.

China Day #1

As many of you may have know from my frequent twitter and facebook posts, I had an upcoming trip to China.  I thought this would be a good way to launch our social media efforts.

With a new Blackberry phone, equipped with all the latest Twitter and Facebook add-ons, I was prepared to Tweet and Facebook my way through China and Taiwan.

The surprise of course was to discover that neither Facebook nor Twitter is available in China.  It is available almost everywhere in the world but not here.  For many reasons, most of which are outlined in every weekly copy of Newsweek and Time magazine.  As progressive and modern as China is, there are certain freedoms and liberties that do not exist here that we enjoy daily in the US.

My last twitter post summarized the difference between a coach seat and a business class seat.  Hope everyone caught that.

It was a long flight.  For anyone who may not have braved a transpacific flight, unless you have a great backlog of fiction books, a full iPod of songs, and 2 powerpoint presentations to produce, do not attempt this alone.

The flight map of a long trip

Once you land in a foreign country, it’s disorienting.  In addition to being sleep deprived, a queasy sense of nausea, and a constant mild headache, none of the signs make any sense.  Exiting the airport, you want to find baggage claim and a taxi but they’re no where to be found.

Even the signs out don't make sense

Wisked away to a business dinner surrounded by well meaning Chinese orthopedic surgeons, we dig into dinner. Smells great, looks great but no one can tell you what it is.  The most common comment was ”it not chicken”.

Really good food if you knew what it was

Given that I’ve been here for only 5 hours, I have a few thoughts.

Traveling is an adventure.  It is tiring and should be enjoyed when young and not old.  The subtle differences are thrilling but thank god that there are a few things that are constant……or is this a good thing?

The KFC by Tianemen Square

A typical dessert stop for the average Chinese

Just steps for Chairman Mao's tomb. I think he would be proud.