That's a [bandage] wrap - for now!


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Published: March 26th 2018
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This final blog entry will be a bit brief. Half of our group, including myself, did not make the connection in Montreal back to Halifax so I am already behind the eight ball in returning to normal life and do not have time for a big entry. I do, however, want to put some finishing statements on the trip.



Tuesday in Haiti was a big day for me. Jodi and Dr. Coles (my trauma fellowship preceptor) left that morning to return to Halifax. They had some other commitments so had to get home a bit earlier than the rest of us (turns out that was a good idea, since they might not have made it!) That meant that I was left as the staff surgeon for the day. I am fully certified in Canada to work independently as an orthopedic surgeon, I just have never been the one *fully* in the hot seat up to this point. I have run my own operating room cases for the day, but there has always been a staff surgeon around to poke their head in to check on things, and there is always at least another orthopedic surgeon in the hospital to call for help if I needed back up. Not this Tuesday. I was it! (with Daryl, my awesome resident, of course). It was a cut of one more strand of the cord holding me to my "learner" status.

On Monday when we got back from our day at the fancy hotel, it still was not clear what would be on the slate for the next day. I went to bed with some apprehension what Tuesday would bring, if anything. It delivered.

When we woke up we discovered a trauma patient had been brought over from another hospital. He had, interestingly, the same complex pattern of multiple fractures as our earlier poly-trauma patient had. A fairly rare combination of fractures, and now we had seen two in our week in Haiti! At least we knew we had all the equipment we needed to manage him. Well, sort of. As usual, we had to "make do" because we had already used some of the plates and nails that we required, but I was able to make slightly larger and smaller sizes work for the task. While we were getting him stabilized and sorted out, Daryl and I took a different patient to the OR and plated a both bones forearm fracture (a break of the radius and the ulna in the middle of the bones. It needs two incisions to get to each of the bones to put them back into place, then plates and screws are used to hold them there). That patient also had a proximal humerus fracture (broken shoulder) on the other side which we were going to treat in a sling, but we decided to take some extra xrays while she was asleep. It is a good thing we did, because we discovered her shoulder was dislocated! That can be hard to see if you do not get just the right xray views. Once we made the diagnosis, we were able to pull/push on her shoulder to get it back into joint. One interesting addition to that case was the fact that she had a gigantic goiter, which made the process of intubation quite challenging for the anesthesia team.
TBE HalifaxTBE HalifaxTBE Halifax

(minus Chad and Jodie)
They conquered the challenge like champs, though.

Next it was on to the trauma patient. He had 3 major fractures of his leg which we had to address. He also had an open, smashed jaw. Thank goodness Dr. Leblanc was there because that was an urgent situation which needed immediate attention to minimize risk of infection. Marty was able to plate the jaw while we were banging around down at the leg. He never complained once that we were moving the patient too much. He is such a joy to work with! Justin got to be his surgical assist, which he quite enjoyed. All went very smoothly and we even finished in time to make it to dinner with the rest of the group! I was pleased. (OK, I was soaked with sweat and exhausted physically and mentally and relieved and proud). I hope he heals up well.



And then that was that! On Wednesday morning we packed up our personal belongings then Daryl and went to round on all our remaining patients, with Monique helping out with translation for post-op instructions. Interestingly we picked up on some screening bloodwork that one of our patients had syphilis so we ordered some penicillin for him and arranged for his wife to come to his follow up appointment so that she could be treated as well.

Then we loaded our gear into a cub van and us into a mini bus and said goodbye to Bernard-Mevs, for now, at least. Off to the airport to start the journey home.

--

I truly believe we did good work while we were in Haiti. They were lacking in many, many things but the infrastructure at Bernard-Mevs was still much better than I was expecting to find. I would have been proud of all of our cases if I had produced those xrays in Canada. My big concern is whether our surgical sites develop infection once we are gone. That is a big risk with implanting hardware, especially in these sub-optimal sterility conditions. I hope that the local ortho team and the upcoming team from Barrie, ON will be able to report back to me about how the patients have been faring. I heard that the local students really enjoyed our teaching, but I still think there is room for improvement there. I think next time I will do daily fracture rounds where we discuss surgical decision making. I did not get a chance to talk about decision making as much as I would have liked with them. Always room for improvement - I plan to be back to Port-Au-Prince again! Thank you to Team Broken Earth for the opportunity to work in Haiti and for continuing to provide care and support for the hospital and the health care workers there. xo

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