That delicate radiation exposure glow

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Saturday started with a plan to operate all day again. After a bit of a late start (it’s a weekend in a developing country – this was not unexpected) our first case took much longer than we had expected. We were just going to “pin some broken toes,” basically, but it’s much harder to hit tiny little bones with tiny wires than you would think. To add to our woes, our drill that pushes the wires in continually stalled until it died all together, then we literally used the drill as a mallet to impact the wires in manually. Quite aggravating. I’m also pretty sure I now glow in the dark after exposure to the radiation from all the xrays we are taking! We wear protective lead, but at home I have circumferential lead and here I just have front protection. We also have shockingly good quality images, which suggests that the radiation used for each individual shot is HIGH! Ohhh well. It’s just for one week. I’m actually quite pleased with the quality of fluoro (xray) that we have, and I will take a bit of extra radiation if that’s what is required. I wasn’t sure if we would have intra-operative xray at all, so this is a win. Part way through the foot case, though, we ran into some xray trouble. Normally there are three screens which display imaging. The main monitor console can be rolled around to a position that is most convenient for the surgeon, and it contains two screens to show images. One shows the picture just taken, and the other shows the picture before it. That way if you change something (move a bone, advance a screw, etc) you can compare the two. There is also a tiny screen on the xray machine itself which is for the radiology technologist to use to see the shot so they can adjust the position of the machine, called a c-arm, as needed to center the area of interest. Part way through this case, the monitor that displays the current image stopped working. That meant we could either look at the tiny screen, or take 2 shots each time so that the “current” xray would show up on the “last image” xray. This was tedious, to say the least. But, we made do.



Our day was halted when a special patient arrived by ambulance (which was painted to say that it also serviced the morgue, if you are in need) to the emergency department. A young boy of 9 or 10 had been involved in a terrible motor scooter crash and his abdomen had been torn open, with his bowels fully exposed. We call this “evisceration.” This little guy was an absolute champ. I don’t think I am divulging too much personal information by saying that on scene, he was a complete stalwart. Apparently as he lay on the ground (bowels showing!!) he calmly asked a bystander if they could call an ambulance and his mother, and provided his phone number!! I believe he had been to another hospital before he was eventually taken to ours. The local general surgeon was called but was going to be about 30 minutes before he was able to arrive. We were able to rush him into our operating room and perform a tertiary survey (where we check top to bottom for other injuries that might be missed) while our anesthesiology team put him off to sleep. Then the local surgeon arrived and got to work fixing him up. The Haitian general surgeon was excellent. Technically great and our nurses reported he was a pleasure to work with. He and Dr. Leblanc fixed the little guy up and the anesthesiology team took him to the pediatrics ward. As far as I know, he continues to do great.



While everyone else was working on the little boy, Team Ortho went about the less than glamorous task of counting and inventorying orthopedic sets to record what is available for teams coming down, and what replacement parts are required.



Eventually we got back in to the OR and finished another case for the day. Then it was off to dinner again! This time we went to “Visa Lodge,” which was where our supper was delivered from two nights prior. I felt so badly for the staff because we showed up quite late. I’m sure they had to stick around just because we arrived. They were showing some Olympic highlights on TV and we all lamented that we were missing them. Food was good, though. Then we piled back in to the truck and headed home.

Have I described lately how we travel? There is a sort of a pickup truck/van hybrid with a cover on and some benches in the back. Initially we were taking two trips to transport our group of 16, but it didn’t take long to do away with that. Now we travel with 2-3 in the front and the rest thrown in to the back. No one wants to be left behind to wait for trip #2 and we are starting to be quite a tight-knit group, so why not?



On Sunday we, you guessed it, operated! I won’t bore you with details of cases.



I should, however, reiterate that not all of our group works in the OR all the time. We have members working in the ICU, emerg, and pediatrics. They are more shift based, but the shifts are still usually 10 or 12 hours long and include overnight shifts. Everyone is working hard.



I am a bit nervous because at this point we have pretty much had the opportunity to fix all the patients we have seen who need surgery. Everyone who has been seen and booked for surgery has been operated on. Tomorrow we have a “day off” where we are going for some R&R so we will not be able to see patients and book them for surgery. Hopefully Dierdre is able to see some patients on our behalf because I am quite keen to operate on Tuesday, our last full day in Haiti.



Have I mentioned Dierdre yet? She has been a lifesaver. She trained originally as an orthopedic surgeon in Saskatchewan and is keen on doing international work. She came down a few weeks ago when Team Broken Earth Saskatchewan was down, then stayed down until we came. She was able to smooth the transition for us when we showed up, help us in clinic, and keep some patients in the wings for us to operate on. She is coming back to Canada with us when we are done and then she is heading to SYRIA for 3 months with Doctors Without Borders! Yikes!! As I was in Haiti I was getting emails from MSF about 13 clinics being attacked in Syria and I was like “Deirdre, are you sure you want to do this?” She assures us that is happening in a different part of Syria, but I am still worried for her. Proud of her, too, though! Afterwards she plans to locum (like substitute teaching but for surgeons) in Canada for a bit to make a bit of money, then the hope is that she may be able to pay a more permanent role in Haiti with Team Broken Earth. I think that would be great.





Tonight we went back to the place with the live music for dinner. We thought it might be calmer since it was a Sunday instead of Friday… we were wrong! It was bumping! It was totally full of Haitians (upper class Haitians, obviously) and the local band was putting on a good show. There was a point, however, when things REALLY picked up and we noticed that everyone at the patio restaurant had their phones out and was filming. It seems a Haitian pop star had taken the stage for a couple of songs and people were pumped! Our food had been extremely slow to arrive and we had been hitting the Haitian rum and Prestige (local beer brand) a bit ourselves, so we were pretty pumped as well. Much dancing occurred. Videos were taken. Fun was had by all.

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Photos

Reaming a femur
The Haitians have been really healthy with very strong bone. I had to use all kinds of problem solving and sweat to get the reamer to even enter the femur, but I got it in the end!

Superstars!
The OR nursing team was absolutely fantastic. I can't say enough about them and the great work they did.

Checking sets
Inventorying and planning equipment for the next cases. This is the kind of surgical pan I am talking about when I talk about an "orthopedic set."

"Corn pops"
Mmmm breakfast