Archive for June, 2016
28
Jun

Lending a Hand in Hinche

An M2 Perspective:

Having a dog bite on your right palm should mean that assisting a surgeon in an OR is off the table right? How was I going to learn about being a surgeon now? Lending me a hand, Dr. Srinivasan found a way to get me scrubbed into a patient case and actively participate in the surgery. Though I felt very lucky that I could assist in a left inguinal hernia repair, I only really started to understand the bond that a surgeon and patient share outside the OR.  My first patient was a lively older gentleman, who laughed at my broken medical creole, trusted me to listen to his concerns, followed my guidance to help him get back to on his feet. As soon as the surgery was over, we both became immediately dependent upon each other. I needed him to let me know almost every thing that was going on in his life. From him passing gas to knowing his eating idiosyncrasies, I needed any information I could get to make sure he went home safe as soon as possible. I had not previously realized how bi-directional the relationship between a surgeon and a patient is until the patient is discharged. This point was made very clear when dealing with my first pediatric patient. I was assigned to manage the care of a very irritable four year old boy who needed a simple but very immediately necessary urologic procedure. To help get the boy to the operating room and home safely, I was totally dependent on his cooperation to get his vitals and conduct a physical exam. It seemed like a nightmare at first to even find the pulse on a screaming child. With a developing patience, I learned how to work with him and learned how I could give has as much to my relationship with his sick child as I could. After getting very close with both my older and younger patient throughout the day, I felt I was really starting to learn what it meant to be a surgeon taking care of a patient. I can’t wait to help discharge these patients, knowing that I aided in patient care from beginning to end!

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Uday

27
Jun

Hitting the Ground Running

Today marks the first operative day of our second week here at Hospital St. Therese.

After a weekend with a little more sleep and bolstered by our new bright-eyed and well-rested compadres, we took on the new week in strides. The day started with a tour of the compound, the OR, and our supplies. By 9am the clinic was in full swing again and by 10am our anesthesiology team was putting our first patient to sleep. Throughout the day we shifted our schedule over the typical hurdles with much more ease and completed four major cases and one minor procedure.

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No lights, but the internet works again!

Our second week contains a mix of veterans and newbies; some are here for their 5th or 6th time while some are new even to medicine itself. The freshly minted M2 students have taken this charge with high spirits. The M4s have reciprocated this enthusiasm for learning with an enthusiasm for teaching by pairing with M2s, assisting with pre-op consenting, IV placement, scrubbing/gowning in to surgery, and post-op care.

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Beth, an M2, assisting for the first time

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Goodnight all!

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26
Jun

Week 1 down!…ready for round deux

We finished our first OR week last year with a total of 21 cases at Hospital St. Therese in Hinche and 9 cases at Hospital Bienfaisance in Pignon. We saw 87 patients in clinic, including 9 follow-up patients from previous years. We also performed more challenging cases this year including a hemithyroidectomy, nephrectomy, and (reportedly) the largest prostatectomy in Haiti! We also had a patient with significant blood loss that unfortunately was only able to receive 1 unit of blood from the blood bank (due to per patient restrictions) and required an epinephrine infusion (titrated by counting the drops per minute) throughout the night. The students received a crash course in ICU care and fortunately, all of these patients are recovering well.

We celebrated the end of a great week with an annual tradition of a team talent show at the local bar, Holly Wood Night Club (formerly named Crystal). We have an array of talent among our crew. Dr. Roser read one of his favorite poems “Casey at the Bat,” Dr. Parker serenaded us with his banjo, Maddie (M4) drew a homage to our attendings, several people gave their best Dr. Carney impersonations and Annie (M3) wrote a poem featuring some favorite memories from the trip:

 

“I remember finally getting an IV in a patient,

I remember being embraced by the staff here,

I remember ‘if I stay here any longer I may go to Haitian jail,’

I remember playing street soccer with little kids,

I remember the deep deep grace our patients have shown us.”

 

As we move forward into the next week, we look forward to welcoming a new team to Hinche–some strong returning members and many new faces, including the M1s! Dr. Srinivasan and Dr. Broecker will lead the operative team and Dr. Caridi-Scheible will lead the anesthesia team.

Some highlights from this past week:

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Working alongside our Haitian counterparts

Parker

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Reposing after a long day

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Amir had a great time with his patients

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But not so great a time with his bug net!

 

Thank you Team 1 for an amazing week!

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Team 2 let’s go!

23
Jun

Day 4 No Drugs

Another day complete! The team is getting into a good flow with clinic, the OR, and the wards, even though we are still without the medications that we brought down with us…

Today, we made it through 4 operations: a nephrectomy on a patient with a large renal tumor, a small bowel anastomosis on a child with a prolapsed ileostomy, a prostatectomy, and an inguinal hernia.

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In clinic today we saw 19 new patients, several of them being pediatric cases. One patient that particularly stands out is an infant with phimosis who has been unable to urinate. We are planning to take him to the OR tomorrow, aiming to greatly improve this kiddo’s quality of life.

This evening was filled with a bit of nice R&R, including an introductory ashtanga yoga session led by Dr. Haack! Who knew yoga could feel so, so good.

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We ended the day with a group lecture about prostatectomy post-op care and the usual team meeting prepping for tomorrow. What do you get when you combine a pediatric surgeon and a urologist? Well, we’re not sure, but here ya go:

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Annie, signing off

22
Jun

A New Day in Clinic

Hey everyone,

Clinic was busy as usual today, but things are finally coming along. As our first week progresses, we are finally putting our heads together and  developing a more efficient system in clinic. Forms ready in this room, prescription pads placed here, surgical candidates and appointments set up with the clinic leader of the day. It’s crazy how far we’ve come in a few days: from complete pandemonium to a beautiful sense of order. And here we are now reaching our 60th patient! In the OR we completed a hemithyroidectomy, an orchiectomy, a urethral dilation, two prostatectomies, and an inguinal hernia repair + circumcision.

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On a side note, I witnessed a fascinating trend in clinic today: the power of the testicle. From infancy to the end of life, today I saw firsthand how much of a part in a man’s life. As I explained to a 70 year old man with metastatic prostate cancer that he may need a bilateral orchiectomy, he gave me a befuddled look and started speaking in Creole with the translator, both of them laughing. “Cut off my balls?” he said. “I love sex. I don’t want to be less of a man. That’s what they do to the pigs they breed here in Haiti, not the men!” he chuckled.  Later in clinic, we were discussing with a mother that her child with cryptorchidism may need a unilateral orchiectomy. “Will it make him half a man? Oh no, I don’t want him not to be a man,” said the hesitant mother. As I witnessed these conversations, common in urology and often discussed with jokes and laughter, I realized the power that such a hidden, protected part of the male anatomy plays on male psyche and well-being, from birth to death. Such stories show me how complex male sexuality can be and how little we understand it. With the extreme prevalence of prostate cancer, we have a great opportunity, both in urology and medicine in general, to study and further understand the intricacies of male sexuality, whether in suburban Atlanta or rural Haiti.

Ok, no more philosophy about testicles. Here is a picture of my favorite patient, hungry and vigilantly guarding his bowl of rice and beans. Look at that face: “Amir, I like you. But you better back off my rice and beans, you dubby!”

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Ok, time for night call.

Au revoir,

Amir

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21
Jun

Smooth Sailing?!

Howdy friends, family, and followers (hi mom!),

Today was another busy day at Hopital St-Therese. It was a day for ironing out any kinks in the machine, and we are proud to say we’ve made huge strides since yesterday. After a long meeting last night, we went into the day with plans to improve flow through clinic, in the operating rooms, on the wards, and out of the supply rooms. We spent the night improving the flow through someone’s clotted catheter bag in order to get in the proper flow mindset. We are all about flow.

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Dr. Carney and Dr. Osiris, the Haitian urologist, probably talking about flow.

We were able to get our hands on some medications from the local stash to hold us over while our medications are still being held hostage in Port-au-Prince. This was a huge step in the right direction for booking patients for surgery and discharging non-surgical patients from clinic. We completed four cases today – orchiectomy, pediatric inguinal hernia repair, a pediatric urethral exam under anesthesia, and our first prostatectomy so night shifts will be in full swing with the ward quickly filling up. No one got electrocuted in the OR today! We are working on our Creole in order to keep the wards nurses updated – they have been incredibly welcoming and helpful, saving us from overflowing bedpans and q5min vital signs.

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No electrocutions! Exciting for our anesthesia attending, Dr. O’Reilly-Shah.

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Wen and Annie (BIRTHDAY GIRL) hanging out with Dr. Osiris and wards nurses.

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Another shot of the birthday girl, enjoying her birthday (also, Amir).

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M4s taking on clinic!

As always, a significant amount of energy went towards organizing our endless bags of supplies. With three supply rooms and only one key, it’s a constant pinball game to gather the supplies needed in order to discharge a patient, do a procedure, or prep for an operation. That being said, we are  really getting the hang of it.

Tomorrow will be a big day, as Dr. Sharma is heading off to explore another hospital in Pignon with Jesse(M3) and Luke. We will have to make some adjustments without our fearless leader, but we’re looking forward to welcoming Dr. Haack to Hinche!! Luckily, Dr. Haack is bringing a BP monitor so we don’t need to turn a med student into an OR BP-monitoring machine, and also don’t have to deal with shotty wrist-BP monitor that Jesse(M4) used.

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May be an inaccurate read, may be that he was just nervous, certainly might explain his headache.

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Safe travels to Pignon!

Note: all patients pictured in blog have consented to having their photo taken.

20
Jun

Day One in the OR Down…

Day One in the OR Down… without any narcotics. And that was only the first fire we had to put out.

Today was a day for practicing the art of flexibility and thinking on our feet. We started the day by learning that two suitcases full of antibiotics, anxiolytics, narcotics and other pain medications that we’d brought with us the day before would be staying in Port Au Prince while we procured some surprise paperwork. Lucky for us, we also brought a stellar anesthesia team who looked forward to facing the challenge of being without most medications. What they did not forsee was the “shocking” nature of the general anesthesia equipment… they were literally shocked every time they touched the thing.

Meanwhile, most of the medical students worked to set up on our first real day of clinic on the other end of the hospital compound. It was a bit rocky at first, but soon we were able to set up a triage system that suited us and the flow well. We managed to see 37 patients (3 of whom were follow-ups from last year) and schedule 15  procedures on our first day in clinic!

New this year, through the ingenuity of one Luke Philipp, we have developed a way to take images of cells we acquired through Fine Needle Aspiration. We were able to better assess a patient with a thyroid goiter for the potential for cancer.

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On the bright side, Amir brought enough bug spray for the entire team. And we only sweat through our scrubs a few times each.

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19
Jun

Gang’s All Here!

In preparation for a big first week, the M4′s divvied up the work – the fearless team leaders spent the morning making last minute adjustments to the travel and housing arrangements while the rest of the students worked on making some important phone calls both to follow up on last year’s patients and to ensure that the patients seen over the weekend would return to Ste. Thérèse to be seen by the surgeons during the upcoming week.

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With most of the final tasks completed, there was not much left to do but buy a few cold beverages in preparation for the reunion with the entire team in the evening. Unfortunately, the search for Prestige, Haiti’s premier lager style beer, was foiled by a regional beer shortage. It seems that this year’s millet harvest, the grain used to brew the beer, was meager at best, leading to some harder times for Haitian farmers and a scarcity of Prestige in the region.

http://www.haitilibre.com/en/news-16286-haiti-agriculture-millet-plantations-ravaged-huge-loss.html

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(A valiant attempt to find beer by one of our interpreters, Des)

But the search for Prestige led the team to discover some of the local sites, and before heading back to the hospital for the evening, a nice walk down to the river was had:

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The rest of the week 1 crew arrived to Ste. Thérèse this evening without too much trouble

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Gang’s all here and excited for the upcoming week!

 

 

 

18
Jun

Byenveni nan Hinche, Haiti

Today’s our third day in Hinche. We spent the morning preparing for everyone’s arrival tomorrow and the afternoon unpacking and organizing our supplies into the supply room at the hospital.

After we finished, we explored more of Hinche. Hinche is the capital of the Centre department in Haiti and is relatively close to the border with the Dominican Republic.The center of town is only a 5-10 minute walk from the hospital. Most of the roads here are unpaved, and small bars/restaurants and stores line the streets. Many buildings and some churches are under construction, but the completed ones are painted in the brightest colors. Goats, chickens and dogs wander around amidst the lush trees. Before we headed back to the hospital, we made a pitstop at Eben-ezer Market for the essentials: snacks and $5 wine.

View outside the hospital complex

View outside the hospital complex

Bar in Hinche

Bar in Hinche

Street in Hinche

Street in Hinche

Liquor store in Hinche

Liquor store in Hinche

Eben-Ezer Market

Eben-Ezer Market

The sun setting outside the hospital complex

The sun setting outside the hospital complex

Packing in Clurb Supplies

Packing in Clurb Supplies

Hinche

Hinche

Hinche

Hinche

The rest of the team arrives tomorrow, and we’re very excited to see everyone!

Signing off,

M4s

17
Jun

Bienvenue nan L’hopital St. Therese

We arrived yesterday to our home base for the next three weeks: Hospital St. Therese in Hinche, Haiti.

Hospital St. Therese is a public hospital in the central plateau region of Haiti, one of the poorest regions in Haiti. The hospital is affiliated with the non-profit Partners in Health/Zanmi Lasante, but otherwise is government funded. As such, the hospital is limited in the services it can provide patients. Laboratory work is usually limited to basic labs such as H&H and creatinine and imaging is limited to X-ray and ultrasound. EKG is available but costs patients $11 US dollars ($1 is about $60 Haitian gourde). IV fluids and oxygen are limited in supply. There is no blood-bank in-house and cross-matching is limited to ABO compatibility. Patients stay in open-air wards, and bring their own sheets, bedpans and food for their stay.

We have partnered with Hospital St. Therese since 2008 and have seen significant changes to the hospital during that time. Dr. Prince Pierre, a previous Haitian senator who also completed cardiothoracic surgical training in Canada, became head medical director of the hospital about two years ago. Since that time, the hospital has developed an ICU and upgraded the OR from two to four rooms. Dr. Prince has hired several new surgeons to work at the hospital as well. And, one of the first nurse practitioner students in Port-au-Prince is continuing to work in Hinche while she completes her degree. We have also encountered new faces this year from the US including a nurse practitioner from UCSF who is helping to develop nursing education for the nursing staff at the hospital, and an internist from UChicago who has been working for several months in the internal medicine clinic. We have also encountered many friendly old faces whom we have worked with before including Dr. Prince, several members of the nursing staff, and our partners at Project Medishare including our translators and Dr. Rony, the medical director for Project Medishare. We look forward to again working with and engaging the various hospital team members and expanding upon our partnerships.

 

Hospital St. Therese

Hospital St. Therese

Dr. Desirald and Dr. Prince

Dr. Desirald and Dr. Prince

 

Men's surgical ward

Men’s surgical ward

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renovated OR

renovated OR

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Emory Medishare