The team consisted of 12 volunteers with 2 surgeons, 2 anesthiologists, 1 CRNA, 1 medical student, and 6 registered nurses. Everyone was from the US except for one surgeon who joined us from Egypt.

Cho Ray Hospital is the largest hospital in the South of Vietnam. It has 1700 beds and 2800 patients. The burn center had 112 patients the week were there. Some rooms had up to 10 patients with stretchers parked right next to each other.

Thirty-nine of the patients had been admitted for surgery by the SVI team and the rest were recovering from recent burns. In spite of the crowded conditions the patients all were receiving excellent care from the Vietnamesestaff. Daily baths and dressing changes were the norm. The unit is clean and tidy.

Due to a Vietnamese National holiday on Monday we did not begin operating until Tuesday. Even with the shortened week we were able to provide surgery for every candidate we screened on Saturday.

A total of 39 received life changing surgery during the week. Many patients had severe burn scar contractures of the hand that made it impossible to perform even the simplest of tasks. We also did several neck and axillary contractures.

One patient had burn scars that had left his legs in a sitting position. Hopefully he will now be able to walk.

I would like to once again thank our hosts and the Volunteers. The week was one of hard work,excellent care and compassion for those suffering from debilitating contractures.

The first part of the protocol will be implemented in Cairo this year

We believe that as a result of providing presurgical orthopedics, we will have:

1. Less invasive surgeries
2. Better healing time
3. Decreased amount of revisions required
4. Decreased amount of complications

Additionally, we are making an effort to improve our patient tracking system. Part of this tracking system will include systematic record taking, which will allow us to conduct outcomes assessments on how we can best serve the local population.

Another area of need is teaching the local health care practitioners the newer techniques in cleft care. We are increasing our emphasis on teaching, and hoping to provide visiting scholarships for local doctors to visit some leading Centers in the U.S.

What exactly is presurgical orthopedics?

There are 3 components of presurgical orthopedics, and depending on the severity of the case, each component may or may not be employed

1. Extra-oral taping. This is done for the cleft lip, and:
Gently guides soft tissues and bone into a better position for a cleft
lip repair under less tension.
Allows one to approximate the soft tissues of a cleft lip
Allows for a controlled force to re-position the prolabium and premaxilla to allow for a less invasive surgery
May eliminate need for early lip adhesion surgery.
Relieves tension on sutures when used post-operatively.

2. Alveolar molding. This is done for the cleft palate, and:
Decreases width of palatal cleft
Decreases amount of scar tissue
Decreases likelihood of oro-nasal fistula
May help in feeding by acting as an obturator

3. Nasal stent. This is done for the nose/columnella, and:
Improves nasal tip, nasal symmetry, and columnella length
Decreases deformity of the nasal cartilage

This information was partially taken from the following website, which also has before and after pictures:
http://www.canica.com/dynacleft.asp

You can also become a sponsor

$40 provides extraoral taping and nasal stent for a patient
$30 provides nasoalveolar molding for a patient

If you would like to help in this effort, or if you have any questions or comments you are welcome to contact:

Mairaj Ahmed, DDS MS
Assistant Professor, Mount Sinai School of Medicine
Section Chief, Orthodontics & Dentofacial Orthopedics
Cleft/Craniofacial Team Orthodontist
Mount Sinai Hospital
One Gustave L. Levy Place, Box 1187
New York, NY 10029-6574
Tel: 212-241-0300
Fax: 212-996-9793
mairaj.ahmed@mountsinai.org

We have finished most of the palates, as it is better to do these earlier in the week incase they have any postoperative problems with airways.

The haitian nurses, who have been our scrub nurses on this trip, are doing very well and are improving daily.

The TCH pediatrician who is also here with us, Elizabeth Montgomery, has been spending the days at the “Sean Penn” camp, in their pediatric clinic/hospital and happened to deliver a baby girl today! She is seeing a lot of the illnesses here that we learn about but never really see in the states, like rickets, and also a lot of GI illnesses and scabies.

Out host, Lance, returned home today. He is an American businessman who employs 500 haitians in his factory that makes small electronics. When the earthquake happened, to help these people keep their jobs, he provided full meals for his employees when at work, including one to take home for their families.

Today we woke up and realized the beauty of where we are staying. The view is gorgeous and there are avocado trees and wild orchids growing off trees. Very peaceful and quiet.

At 8 am we went down to the hospital for patient screening and prepping the ORs. There are also two inpatient areas, in addition to the ORs and recoveery rooms. About 50 patients were waiting… Mostly with cleft lips. The screening took the entire morning. Patients had traveled from over 5 hours away. One little girl had on a white party dress with white eyelet socks and dress shoes. Adorable. We had to say no to a few patients, mostly patients with vascular malformations, for which we did not have the right treatments. We will definitely bring some sclerosing agents on the next trip. The other patients that we couldn’t offer treatment for were those that were too small- younger than 9 mo or 20 lbs.

Things began to wind down and we were gathering our belongings, when we noticed that a bench we had been sitting on 10 minutes earlier was now occupied by a small body covered in white sheet. It’s one thing to see a picture of it and it’s a completely different thing to see it.

We have 36 on the schedule for this week and will start operating tomorrow AM.

In December, 2009, I was lucky enough to be invited by Tom Flood to accompany his organization, Surgical Volunteers International, with the help of Smile Train on a mission trip to Port Au Prince to repair cleft lips and palates. On January 12th, our plans changed. Within days of the earthquake, Tom assembled a team of health care providers from all over the United States. They included a plastic surgeon from San Diego, an orthopedist from North Carolina and his wife, an RN, a CRNA from New York and another from Dallas, nurses from Seattle and Houston, one of whom is a native Haitian, Tom who is a retired OR nurse, a professional photographer and bodyguard, and myself. I am an anesthesiologist, 5 months from the conclusion of my residency training in Dallas and I had never experienced anything like this before.

Tom worked tirelessly to arrange travel for the 10 of us to Haiti. Though he has become extremely experienced and capable of coordinating trips to third world countries, I suspect this trip posed a new challenge. The Port Au Prince airport was closed to commercial travel. There was no electricity in the city and the few hotels with generator power that were still open were full. Taxis were not running, rental cars were out of the question and hospitals had few to no supplies or electricity. Despite these odds, Tom coordinated commercial flights for 10 people from every corner of the United States to Miami, most arriving within an hour of each other. We met at the airport and drove 2 hours north to Ft. Pierce, home to Missionary Flights International, an organization that flies groups on mission trips all over the world. Here, we boarded a donated charter plane and 2 hours later, we landed in Haiti. We were greeted at the airport by an American named Lance who has lived in Haiti for 30 years. His home and car were not damaged and in a selfless act to help contribute to the relief effort, Lance provided us with transportation, food and shelter.

It was late in the day when we arrived in Port Au Prince, and we only had time to drop supplies off at Bernard Mev hospital and begin to set up for the week. The facility is well known to Surgical Volunteers Int. They have used it in the past on cleft lip trips, but the scene we witnessed when we arrived was far from familiar. Rotary International had set up a dozen tents in the courtyard for patients to sleep in. These were all full of Haitians, most of whom had suffered severe trauma during the earthquake and were recovering from emergent amputations. Others had closed fractures and had been placed in traction until a more permanent treatment could be provided. Still others laid on mattresses, outside on the ground with a wide array of medical and surgical conditions. It was immediately clear to everyone that we had our work cut out for us.

Dr.’s Bloem and Peters made rounds of all of the patients and identified those who would benefit from surgery. Others were placed in temporary traction, or had their traction improved and revised. Charts were started on patients and medical histories obtained. The operating rooms were prepared. Tom, Young and Emily (our two phenomenal CRNAs) brought equipment to provide general anesthesia, regional anesthesia, sedation, post operative pain medication, antibiotics, surgical instruments, dressing supplies, sutures, and the list goes on. Supplies for hundreds of patients were neatly packed into a half dozen trunks and checked all the way from the United States. The organization this required was mind boggling, but these three carried out their tasks with remarkable ease and efficiency. Within an hour, 2 fully stocked operating rooms, a recovery room and supply area were established and Bernard Mev was ready for surgery.

During the first 2-3 days after the earthquake, thousands of Haitians had amputated limbs. The majority of these operations were done quickly, without anesthesia and by under or unqualified people. These heroic measures saved countless lives but by our arrival on day 10, wounds were becoming infected. Stumps were done in a way that would not accommodate  prostheses or skin grafts and once again, thousands of patients needed surgery.

We began operating on day 2 and our surgeons worked tirelessly to help all of our patients. Wounds were debrided, stumps were closed, skin grafts were placed, and external fixation devices were placed on broken bones when possible. Our nurses, Kristi, Yvrose and Jacklyn changed hundreds of dressings. They worked harder than anyone in our group and knew every patient in the hospital backwards and forwards. They identified more people who would benefit from an operation, followed them all after surgery, administered medications, bathed them, changed bedding, delivered food and water, and perhaps most importantly, listened to their stories.

Throughout the city, there were hospitals and clinics set up by different relief organizations from all over the world. I met teams from France, Greece, Jamaica, Israel, the United States and others. The equipment and personnel at each facility differed greatly and for patients, it was difficult to know where to go. As the week went on, we noticed that word was spreading that Bernard Mev and its team of doctors and nurses was very well equipped. We had surgical capabilities, x-ray, medication, food for patients, and tents for them to sleep in. As patients were treated and discharged, more arrived. A nearby orphanage brought two severely dehydrated babies to the hospital to get IV fluids and medications. More than a dozen babies were born at the hospital during the week, including at set of twins that Tom helped deliver in the back of a truck outside the front gate. Two women were in active labor the night before our departure and the team stayed to help deliver their babies, both of whom were severely hypoxic and required resuscitation at the bedside

As I write this, I have been home for just 5 days but I have had some time to reflect on the experience. First and foremost, I am extremely sympathetic to the current situation in Haiti and the turmoil its people have endured. I was amazed to find smiles on the faces of our patients, many of whom had lost family members, friends, limbs, their homes and their way of life. I gained an appreciation for the ability of this culture to endure hardship. Not even this devastating earthquake that destroyed much of the country was able to rid them of their spirit. I am also tremendously grateful for the opportunity I had to work side by side a group of 9 incredible people. It was their selfless sense of sympathy and duty that brought this group together and I am humbled by their dedication to less fortunate. Finally, I am amazed by the outpouring of aid from all over the world and the generosity of people everywhere. Before January 12th, this tiny island country was little more than an afterthought to most but it suddenly found itself at the center of the world’s attention and with record speed and strength, the world responded.

I want to thank Tom Flood, Surgical Volunteers International, Smile Train and the wonderful members of this mission team that made this trip possible. It truly was a life changing, unforgettable experience

We arrive in Port Au Prince on Saturday night, and the following morning, three Haitian nurses and two Haitian nursing students join our group.  Interestingly, the three nurses were previously nursing students on Mr. Flood’s last Haiti mission, returning yet again to help their fellow Haitians.  That morning, we screen around sixty-five patients.  As mission’s purpose is mainly cleft lips and palates, we could only schedule forty of the sixty, as some patients required a higher level of care.  Mr. Flood makes plans for many of these remaining patients to return in February, 2010 – his next mission, when he will have a craniofacial expert.   That afternoon, after the screening, Mr. Flood takes us a tour of Port Au Prince, which is our first introduction to Haiti’s enchantingly beautiful culture, juxtaposed against its disturbingly abysmal poverty.

On day two, we operate.  Our facility is a quaintly small hospital with two operating rooms.  As expected, the equipment is rudimentary and supplies limited.  Yet the group’s members quickly show their expertise: amazing is the care quality they give, rivaling that in the United States.  The Anesthesiologist and Nurse Anesthetist work proficiently and efficaciously in concert, one turning over the first operating room while the other works with the surgeons in the second.  Their compulsively compassionate care insures no significant complications on our mission.  The patients expediently move from the operating room to the pre- and postoperative care area, where our nurse tends to not only their needs, but the concerns of their loved ones – providing total and complete care.  Our office manager organizes and governs the mission’s administrative functions, and with a myriad of checklists, she expeditiously dots all the I’s and crosses all the t’s.  She also adds a motherly touch to its members, insuring that we are fed and hydrated as we consume ourselves in patient care.  The Haitian nurses and nursing students work expeditiously, not only helping in surgical care, but also with translation and cultural intricacies.  I help the plastic surgeon, witnessing his deftly creative skill with the scalpel — a true master of his art.  More than just at surgery, he is a true Master of education, with the untold patience – he edifies and instructs, not just myself, but all those in his presence, especially the Haitian nurses and nursing students.  The entire group works together dynamically, united in its patient care goal.  Mr. Flood supervises the entire missionary process:  under his umbrella, there is no politics, no arguing, no conflict — only a unified purpose safe and efficacious patient care.

At night, we meet for dinner to discuss the day’s events and tomorrow’s plans.  Here, over dinner, I get to know the group’s members:  not just their medical knowledge and patient devotion, but who they are:  their interests, their beliefs – about their lives and their loved ones’ lives.  United by the uncommon trait of selflessly giving, and augmented by the trust each develops for the other during patient care, a strong bond increasingly develops among the small group’s members.  Respect, both professionally and ethically, grows each day, and friendships mature rapidly.  In a foreign country with the joint goal of helping those who suffer, compassion connects the group’s members, whose only reward is the knowledge of each others’ charitable humanity.  But I find myself entranced not just with the members’ humanity, but also their humility.

Not until I write this blog, performing research on the group’s members, do I appreciate their exceptional professional expertise.   Our plastic surgeon, humble in character but not in feat, is a decorated military veteran and highly published author in the plastic surgery literature. Participating in eight previous humanitarian missions, he is also a veteran at charity.  He was formerly Chief of Plastic Surgery at the Illinois Shriner’s Hospital for Crippled Children and an Associate Professor at Northwestern University Division of Plastic Surgery.  Our Anesthesiologist, with five previous missions and also published in his field, is Director of Pediatric Regional Anesthesia and Assistant Professor at the Workew Morgan Stanley Children’s Hospital of New York, Columbia University Department of Anesthesia.   Our nurse, who is actually a Nurse Supervisor at the University of Minnesota Community-University Health Care Center, is also missionary veteran, having completed eleven trips of charity.  Our CNRA, a member of the Department of Pediatric Anesthesia at Children’s Hospital of New York Columbia-Presbyterian Medical Center, is an expert at missionary pediatric anesthesia.   She has been on countless mission trips starting in 1992, completing four trips just to Haiti in 2009. She too is published, and her publications directly concern the topic of anesthetic care in developing countries — specifically the equipment and techniques to provide the safest, most efficacious missionary care.  Indeed, this mission’s members are unusually talented, yet surprisingly humble, humanitarians.

I cannot explain the sense of heightened being – a greater awareness of life’s purpose and a more grounded perspective:  the mission has greatly advanced me not just professionally, but spiritually emotionally.  With newfound direction, I understand our nurse’s words to me:  “on mission trips, you always get out of them more than you put into them.” I eagerly await my next chance to not join my colleagues and newfound friends on another mission; more generally, I look forward to my next chance to give to another.

Bauer