Jimani Update: 1.22.10

Dear Family and Friends,

First of all, I deeply appreciate all the love, prayers and support you are sending my way. I feel very honored to receive such grace.

So today from chaos, some order. We got up with roosters making noise just before sun-up. Mike Cobb and I were in the OR by 7:30 AM and worked together until about 6PM. We made up for yesterday’s frustration thanks to my new hero, Dr. Ben an ortho/hand surgeon from Boston (last names hard to come by here). Looks like Harry Connick, Jr. so Ben Hollywood could do. He arrived yesterday, and was stymied by the lack of an OR for him to use. Within hours he happily accepted his new calling in life to run the OR schedule for 5 operating rooms, 11 orthpaedists, 2 plastic surgeons and an unknown number of pending patients. Without picking up a scalpel he did more than enough to credit him with the gold star of the day. We sent our #1 OR ortho nurse, Danya from Omaha/Creighton , to the orphanage/hospital to line up surgeries since she understood our capabilities. Patients have to be moved by ambulance the 200 yards from orphanage to hospital. Lots of bumps, dust and heat. Lots of lifting up and down, carrying stretchers. No one complains. Ben said we did 58 surgeries (still without Xray) with only one cranky surgeon from CA giving him a hard time. So do we feel well accomplished? I just don’t know how to even measure progress here.

As we worked along thru the day we heard various reports. Some are checking in with CNN, some have family sending odd news reports asking if we can confirm. Luke, I saw your note about US support. I hope your “tree shaking” reaches the right person. So from “rumor” the USS Comfort is either full or not doing anything. The U of Miami has a field trauma unit at the airport in PAP, and may take some critical patients from us, but the critical probably can’t handle the car/truck ride. Clint/Dave Vanderpool/Luke are all pushing for help to get patients moved out of here, we all wonder which agency is going to step up to the plate.

We still saw patients today who had no significant care since their injuries. I honestly don’t know how they are getting here. One was a 70 year old lady for whom Mike did external fixation for a femur fracture, completely by feel, since no Xray. We are all amazed by the strength they show. They have tolerated so much pain, and frankly we sometimes just look at each other in the OR wondering HOW DID THIS PERSON SURVIVE THE LAST 10 DAYS? The Haitians look after each other quietly and with dignity in the most bare of surroundings. We had one woman today whose right arm was cut off to get her out of the rubble. Mike revised the amputation and has her lined up with plastic surgeons from Gainesville for skin grafts on Sunday. She never stopped smiling, never complained, yet I am sure she is in pain. And there are far more just like her.

I have so many stories, I may not be able to keep them straight. Some are just too terrible to put to writing. This is a small part of one, with a lot omitted that goes into the too terrible category. Our OB-GYN professor from Lincoln Memorial Medical School in TN saved a young woman’s life early today. Dr. John Williamson has been coming to Jimani with Clint for years. A nurse came looking for him late last night. The patient was about 20 weeks pregnant when she was crushed in the quake. The baby died and she appeared here out of nowhere with high fever. I really don’t want to go into the medical issues, but when John told her husband emergency surgery was needed at 2AM, he agreed without question. When John said, “Do you understand how serious this is?”, he replied “Because you are doing it now at 2AM I know it is very serious and you are doing the right thing because no one in my country would ever have an operation at this time”. Clint was there for the whole surgery, and I know he will have much more to say about it.

There was a very minor tremor here about dark, none of us felt it but the patients and their families lying on mattresses on concrete floors did and ran out of the orphanage into the parking lot area. I did not see this, but 2 patients with IV’s jumped from the second floor. 3 docs went to check them out. Danya was just getting things in order again, putting people back to bed, when we felt another, bigger jolt. This is the first thing I have noticed so I am now in our bus typing away for awhile. I’ll go check on my post-op patients in a little bit.

When we occasionally stop and look beyond the Jimani Project at the surrounding views, this is a beautiful spot. There is a large lake with vistas to green cliffs in the distance. Hawaii is the only place I can compare this to. But, it is much hotter than Hawaii! Must have been 100 degrees in the sun at midday and 90 in the OR. I consumed well over a gallon of fluid today. I can’t imagine how this adds to the stress on our patients, we keep pushing fluids and using antibiotics far more easily than I ever would at Twin Rivers. Thank God we have all of that we need.

The CRNA’s (nurse anesthetists) working with me have kept my patients magnificently pain free with little of our usual 21st century devices. We can’t even monitor oxygen levels appropriately. Bill Ragon who came with us from Jackson, TN “trained in” 2 new arrivals from Knoxville today during surgeries Mike and I were doing. There we are in a OR with screens covering open windows, doing surgery, while Bill quietly gave his replacements (I do believe it will take 2 to replace him) his advice given our resources. By the way, I have not heard a patient crying in pain in the recovery area immediately post-op. The anesthesiologists and nurses running the recovery/post-op areas are just incredible. We keep pushing them to discharge patients so we can bring in more. They have 6-8 patients on cots in small, hot rooms plus patients in the hallways, the laundry room, and every alcove available. They have never said a sour word doing the toughest of jobs.

Speaking of jobs, I really love what I do. My Dad said he enjoyed 20% of what he did in dentistry, and that made up for the other 80%. I have always felt fortunate to enjoy 80% of what I do, more than making up for the other less enjoyable 20%. And come to think of it, at this moment, I don’t know what the 20% I thought I didn’t enjoy is anymore!

The volunteers here are just amazing. Not just the docs and nurses, but everyone. I just met Caleb Pal from Huntsville. Luke, he is the man (I swear he looks 13 and has never shaved) Troy Moore got to come down to hook up the satellite link. I decided his IQ is too high for me to count to. He put a blow up bubble on the roof with the dish inside and is working on a second. He brought a black box smaller than a carry on suitcase that will be a cell tower giving a mile radius for our phones to connect to it. We can then call US through any cell provider one would have just as if in US. He says we are a “cell service provider”. He’s working on how to call in to Jimani right now, next to me here in my dorm room. I am sure he hasn’t had any time to think about why he got into this. I think 99% of volunteers are here because they felt called by God. This is one of our usual discussion topics over power bars and bottled water. I met a young surgeon yesterday on his arrival. He was so arrogant the nurses told me they wouldn’t work with him. But today he was crying along with the rest of us, his eyes the “Jimani red”. And he started asking for advice in the OR, which I guarantee never happened before. And he does great work! He did a “free flap” of skin from the abdomen to a calf wound for one of my 11 year old patients to cover a huge, painful open wound in record time. And within minutes had figured out how to use orthopaedic hardware to fix a 7 year old’s jaw, that was broken in 2 places. So I guess he just didn’t know where the phone call that got him here originated from until today. We are all being changed by our time here, but it was incredible to see this man become so different so fast.

Several of us rode our bus into the town of Jimani tonight. The local hospital looks more like a bus depot to me. 40 people milling around outside, tiny windows, little light. Would not pass for anything medical in the US except a warehouse. We just gawked, speechless. I have truly led a sheltered and charmed life, and assure you all of my pals here feel exactly the same.

So we now have enough orthpaedic surgeons here that I feel comfortable leaving. I had always planned to return 1/23, but with the reservation that I couldn’t if I was needed. Mike Cobb came planning to stay for 2 weeks. We both feel comfortable about going since we have more than enough colleagues to hand off to. The humanitarian crisis may be more apparent on CNN, but so far we all agreed the many (over 100, 58 the last 2 days I think) patients we put external fixators on have to stay here. Where can we send them with pins and bars on their legs? They can’t walk on these and many have both legs injured and can’t even use crutches, which we actually do have. And some need further surgery.

So far we’ve had by one count 500 patients here at one time. We just have no next place to send them, so many will stay and limit the input of more. Clint won’t turn anyone away, he has faith that his pleadings will hit the right ears soon.

Everyone is heading back into the buildings now, but our bus driver, Francisco, is keeping me under protective custody on the bus for a while longer. I don’t think I can get off!

If you look at a map of Haiti and the Dominican Republic, Jimani can be found due east of PAP, just inside the DR. I am told evacuees can’t go south to Jacmel on the coast because the roads are impassable and the same to the west. Most will head east? We all wonder, another topic of usual discussion.

This is disjointed due to several interruptions to check patients in recovery, plan a last minute surgery for someone else to do in AM, try to convince Clint to go to bed (took 3 of us on that one), and calm a young journalist shaken by the jolt we got. Francisco finally allowed me off the bus and we’ll let her sleep there. I actually have a bed tonight for the first time! With a nurse anesthetist waiting to take over in the morning when I leave.

So tomorrow I get back on Chuck Strickland’s jet for our trip back to Knoxville. I have hugely mixed feelings about leaving but I know this was only Phase 1, I can’t imagine not coming back some day, especially since Clint has learned I know how to get here.

Again, thanks for your thoughts and prayers,

Love,
Dad/Ed

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