1) Doctors from Partners in Health arrived in Haiti on January 16th, 2010 to provide medical relief after the devastating earthquake. They were sent to St. Nicholas Hospital, 80 miles from Port-au-Prince, which was overwhelmed with over 200 untreated earthquake victims lying on the floor without necessary medical supplies or equipment.
2) Over the next two weeks, the doctors performed 216 earthquake-related surgeries and procedures with only basic resources, and established a triage system to prioritize the many severe injuries. They also trained local staff. Unfortunately 12 patients died from their injuries.
3) The doctors continued their relief efforts in Haiti and hope to maintain a long-term presence to help the thousands of
Fishing in the Dark: Retrieving Broken Instruments during a Spinal Lumbar Dis...CrimsonPublishersOPROJ
Fishing in the Dark: Retrieving Broken Instruments during a Spinal Lumbar Discectomy by Dello Russo Bibiana* in Crimson Publishers: Orthopaedic research journals impact factor
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
The earthquake in Haiti in 2010 was catastrophic to a country that w.docxbob8allen25075
The earthquake in Haiti in 2010 was catastrophic to a country that was already struggling in numerous areas. I traveled to Haiti to work as part of a medical mission trip in November 2009. When we heard that the earthquake struck in January, we immediately thought, we should go help! We had just been there and had so many contacts. So 2 days after the earthquake struck, a small team of about 10 people headed to Haiti. We had miracle of miracle just getting there as well as getting back out. So, this topic is near and dear to me. We spent about 5 days on the ground providing medical care near Carrefour and Port au Prince which was close to the epicenter of the earthquake.
Primary prevention in Haiti in regards to healthcare is very, very limited. People live with chronic and acute illnesses for a long time without treatment. There is very limited medical care and it is expensive for the people who live there. Primary prevention would fall under the preimpact stage of disaster planning. In theory, if people were in better health prior to a catastrophic event such as an earthquake, they would recover better from injuries sustained in the disaster. Health Education would be one nursing intervention I would use with this population.
Secondary prevention is also quite limited in Haiti. Even more so after a disaster like an earthquake. For example, we had a patient with a dislocated hip and potential fracture of hip and/or femur. Without xray capability, we had to guess. This type of problem would fall under the impact stage. A nursing intervention would be Pain Management. We had limited options for pain control. We were literally working on a small side street. The hospital in Carrefour was badly damaged and we had no way to facilitate transport to another facility for this man. So, we gave him the strongest pain medicine we had which was tramadol and we tried to reduce his hip dislocation. We were not successful. His friends were carrying him, and we advised them where to try and go. I’m not sure if he ever made it. In subsequent days, as relief agencies got up and running, he may have been able to seek treatment. One big relief agency, MSF, also known as Doctors Without Borders was on the ground in Haiti before the earthquake struck but were dealing with damaged hospitals and limited staff.
Tertiary care would fall under the post impact phase. There were many injuries that I personally witnessed that would have long term implications if survived at all. Many fractures and head injuries. And the delay in treatment and inadequate treatment perpetuated the need for long term care. A nursing intervention that I would utilize in this population would be Hope Instillation. The devastation of the earthquake was all around. Loss of life and of infrastructure was paralyzing. A people group with such limited resources to begin with were faced with such terrible loss.
There are actually quite a few agencies working in Haiti in a long term way. On.
Fishing in the Dark: Retrieving Broken Instruments during a Spinal Lumbar Dis...CrimsonPublishersOPROJ
Fishing in the Dark: Retrieving Broken Instruments during a Spinal Lumbar Discectomy by Dello Russo Bibiana* in Crimson Publishers: Orthopaedic research journals impact factor
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
The earthquake in Haiti in 2010 was catastrophic to a country that w.docxbob8allen25075
The earthquake in Haiti in 2010 was catastrophic to a country that was already struggling in numerous areas. I traveled to Haiti to work as part of a medical mission trip in November 2009. When we heard that the earthquake struck in January, we immediately thought, we should go help! We had just been there and had so many contacts. So 2 days after the earthquake struck, a small team of about 10 people headed to Haiti. We had miracle of miracle just getting there as well as getting back out. So, this topic is near and dear to me. We spent about 5 days on the ground providing medical care near Carrefour and Port au Prince which was close to the epicenter of the earthquake.
Primary prevention in Haiti in regards to healthcare is very, very limited. People live with chronic and acute illnesses for a long time without treatment. There is very limited medical care and it is expensive for the people who live there. Primary prevention would fall under the preimpact stage of disaster planning. In theory, if people were in better health prior to a catastrophic event such as an earthquake, they would recover better from injuries sustained in the disaster. Health Education would be one nursing intervention I would use with this population.
Secondary prevention is also quite limited in Haiti. Even more so after a disaster like an earthquake. For example, we had a patient with a dislocated hip and potential fracture of hip and/or femur. Without xray capability, we had to guess. This type of problem would fall under the impact stage. A nursing intervention would be Pain Management. We had limited options for pain control. We were literally working on a small side street. The hospital in Carrefour was badly damaged and we had no way to facilitate transport to another facility for this man. So, we gave him the strongest pain medicine we had which was tramadol and we tried to reduce his hip dislocation. We were not successful. His friends were carrying him, and we advised them where to try and go. I’m not sure if he ever made it. In subsequent days, as relief agencies got up and running, he may have been able to seek treatment. One big relief agency, MSF, also known as Doctors Without Borders was on the ground in Haiti before the earthquake struck but were dealing with damaged hospitals and limited staff.
Tertiary care would fall under the post impact phase. There were many injuries that I personally witnessed that would have long term implications if survived at all. Many fractures and head injuries. And the delay in treatment and inadequate treatment perpetuated the need for long term care. A nursing intervention that I would utilize in this population would be Hope Instillation. The devastation of the earthquake was all around. Loss of life and of infrastructure was paralyzing. A people group with such limited resources to begin with were faced with such terrible loss.
There are actually quite a few agencies working in Haiti in a long term way. On.
"...On 29 September 2006, Eric Noji (Stanford, 1977) delivered a lecture on the public health consequences of disasters, at the University of Pittsburgh’s main campus. However, this wasn't an ordinary lecture delivered to a packed auditorium of scholars and students. Eric’s lecture was Webcast around the world. It was expected to reach more than 1.5 million viewers, the largest academic lecture in history. Instead they had more than 3 million! Unfortunately, this exceeded the number of global access portals the university and its 12 global telecommunication partners had anticipated. Internet pioneer Vint Cerf (Stanford, 1965), was at Eric’s lecture and managed to wirelessly contact several friends around the world who opened up enough additional access points to allow another 50,000 viewers to log on—just 10 minutes late..."
- Stanford Magazine, JULY/AUGUST 2007
Challenges and Resources for Nurses Participating in a Hurrica.docxzebadiahsummers
Challenges and Resources for Nurses Participating in a Hurricane
Sandy Hospital Evacuation
Nancy VanDevanter, RN, DrPH1, Victoria H. Raveis, PhD2, Christine T. Kovner, RN, PhD3, Meriel McCollum,
BSN, RN4, & Ronald Keller, PhD, MPA, RN, NE-BC5
1 Professor, New York University, Rory Meyers College of Nursing, New York, NY, USA
2 Professor, New York University, College of Dentistry, New York, NY, USA
3 Professor, New York University, Rory Meyers College of Nursing, New York, NY, USA
4 PhD Candidate, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
5 Senior Director of Nursing NYU Hospitals Center, New York University, Langone Medical Center, New York, NY, USA
Key words
Nurse’s disaster experience, nurses’ disaster
preparedness education, Superstorm Sandy
Correspondence
Dr. Nancy VanDevanter, New York University,
College of Nursing, 433 1st Ave., New York, NY
10010. E-mail: [email protected]
Accepted May 13, 2017
doi: 10.1111/jnu.12329
Abstract
Purpose: Weather-related disasters have increased dramatically in recent
years. In 2012, severe flooding as a result of Hurricane Sandy necessitated
the mid-storm patient evacuation of New York University Langone Medical
Center. The purpose of this study was to explore, from the nurses’ perspec-
tive, what the challenges and resources were to carrying out their responsibil-
ities, and what the implications are for nursing education and preparation for
disaster.
Design: This mixed-methods study included qualitative interviews with a
purposive sample of nurses and an online survey of nurses who participated in
the evacuation.
Methods: The interviews explored prior disaster experience and train-
ing, communication, personal experience during the evacuation, and lessons
learned. The cross-sectional survey assessed social demographic factors, nurs-
ing education and experience, as well as potential challenges and resources in
carrying out their disaster roles.
Findings: Qualitative interviews provided important contextual information
about the specific challenges nurses experienced and their ability to respond
effectively. Survey data identified important resources that helped nurses to
carry out their roles, including support from coworkers, providing support to
others, personal resourcefulness, and leadership. Nurses experienced consid-
erable challenges in responding to this disaster due to limited prior disaster
experience, training, and education, but drew on their personal resourceful-
ness, support from colleagues, and leadership to adapt to those challenges.
Conclusions: Disaster preparedness education in schools of nursing and
practice settings should include more hands-on disaster preparation exercises,
more “low-tech” options to address power loss, and specific policies on nurses’
disaster roles.
Clinical Relevance: Nurses play a critical role in responding to disasters.
Learning from their disaster experience can inform approaches to nursing ed-
ucation and preparation.
Weath.
Challenges and Resources for Nurses Participating in a Hurrica.docxketurahhazelhurst
Challenges and Resources for Nurses Participating in a Hurricane
Sandy Hospital Evacuation
Nancy VanDevanter, RN, DrPH1, Victoria H. Raveis, PhD2, Christine T. Kovner, RN, PhD3, Meriel McCollum,
BSN, RN4, & Ronald Keller, PhD, MPA, RN, NE-BC5
1 Professor, New York University, Rory Meyers College of Nursing, New York, NY, USA
2 Professor, New York University, College of Dentistry, New York, NY, USA
3 Professor, New York University, Rory Meyers College of Nursing, New York, NY, USA
4 PhD Candidate, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
5 Senior Director of Nursing NYU Hospitals Center, New York University, Langone Medical Center, New York, NY, USA
Key words
Nurse’s disaster experience, nurses’ disaster
preparedness education, Superstorm Sandy
Correspondence
Dr. Nancy VanDevanter, New York University,
College of Nursing, 433 1st Ave., New York, NY
10010. E-mail: [email protected]
Accepted May 13, 2017
doi: 10.1111/jnu.12329
Abstract
Purpose: Weather-related disasters have increased dramatically in recent
years. In 2012, severe flooding as a result of Hurricane Sandy necessitated
the mid-storm patient evacuation of New York University Langone Medical
Center. The purpose of this study was to explore, from the nurses’ perspec-
tive, what the challenges and resources were to carrying out their responsibil-
ities, and what the implications are for nursing education and preparation for
disaster.
Design: This mixed-methods study included qualitative interviews with a
purposive sample of nurses and an online survey of nurses who participated in
the evacuation.
Methods: The interviews explored prior disaster experience and train-
ing, communication, personal experience during the evacuation, and lessons
learned. The cross-sectional survey assessed social demographic factors, nurs-
ing education and experience, as well as potential challenges and resources in
carrying out their disaster roles.
Findings: Qualitative interviews provided important contextual information
about the specific challenges nurses experienced and their ability to respond
effectively. Survey data identified important resources that helped nurses to
carry out their roles, including support from coworkers, providing support to
others, personal resourcefulness, and leadership. Nurses experienced consid-
erable challenges in responding to this disaster due to limited prior disaster
experience, training, and education, but drew on their personal resourceful-
ness, support from colleagues, and leadership to adapt to those challenges.
Conclusions: Disaster preparedness education in schools of nursing and
practice settings should include more hands-on disaster preparation exercises,
more “low-tech” options to address power loss, and specific policies on nurses’
disaster roles.
Clinical Relevance: Nurses play a critical role in responding to disasters.
Learning from their disaster experience can inform approaches to nursing ed-
ucation and preparation.
Weath ...
Slides from Prof Dan Pratt presented at the Teaching to Teach Workshop in Boston, MA, May 1-2, 2009;
Massachusetts General Hospital, Harvard Medical School.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
Mission To Haiti, January 2010
1. P A R T N E R S O R T H O P A E D I C
Trauma Rounds
Case Reports from the Mass General Hospital and Brigham & Women’s Hospital
A Quarterly Case Study Volume 1, Summer 2010
Mission to Haiti, January 2010
R Malcolm Smith, MD, FRCS on the floor on thin mattresses or blankets. All had four-day
old untreated major injuries with open fractures, severe soft
George Dyer, MD tissue crush syndromes, spinal fractures with paraplegia, mul-
tiple dirty open wounds and closed fractures. The smell of in-
People often ask, “How was fection and flies were everywhere. Several patients with spinal
Haiti?” For a while, we found it injuries were lying on the doors and ironing boards upon which
the most difficult question to an- they had arrived, all had already developed pressure ulcers.
swer. While on one hand we saw
an unrivaled toll of human suffering, on the other we probably
made the most valuable contributions we will ever make.
Perhaps the best answer is that it was a privilege; it was a privi-
lege to treat the patients and a privilege to work with a team
that proved to be the most resourceful, well motivated and su-
perb group of clinicians we could hope to meet.
On January 12, 2010, Haiti was devastated by the worst human
disaster for generations. Volunteering with Partners in Health
we arrived in Port au Prince on the evening of January 16th
crammed in a small airplane with sleeping bags, survival kits
and boxes of all sizes packed with every medical item we could
borrow or acquire. We were met by a small truck, unloaded the
plane ourselves and left. No officials knew we were there, what
we were carrying or where we were going.
Above: Patients and families were lying on the floor on thin
Outside the airport we saw streets of collapsed concrete build-
mattresses and blankets. Below: A plea for help.
ings and everywhere there seemed to be people walking about
aimlessly. Since the main hospital in Port au Prince was barely
functional, we were sent to St. Nicholas Hospital - a small pub-
lic hospital 80 miles to the north in St. Marc - where we became
the only relief service for a large and isolated group of earth-
quake victims.
St. Nicholas Hospital was undamaged by the quake, but by our
standards barely functional. The wards and emergency room
were essentially bare rooms without basic necessities such as
sinks, toilets, or functioning nursing stations. Only a few local
staff remained, none of whom had trauma experience, all were
totally overwhelmed by the situation. We estimated that there
were at least 200 patients and an equivalent number of family
members in the wards when we arrived. Nearly all were lying
See previous articles: AchesAndJoints.org/Trauma
Trauma Rounds, Volume 1, Summer 2010
1
2. P A R T N E R S O R T H O P A E D I C T R A U M A R O U N D S
The hospital had two operating rooms - neither of which was Unfortunately, cur-
useable by US standards. The anesthetic machines didn’t work. rent estimates sug-
Their simple autoclaves were just large enough for small in- gest there are
strument packs and our large trauma sets did not fit. The re- thousands of new
covery room and adjacent corridor were unused and full of amputees in Haiti
crates and broken boxes. There was a single x-ray room where and a large num-
we could take basic x-rays that had to be hung to dry in the sun,
ber of people will
and there was no intra-operative x-ray capability. Fortunately,
face significant
our team was resourceful and there was lots of willing help to
complications fol-
clean, tidy, organize, translate and help care for victims.
lowing their inju-
The next day one operating room was functional and we began ries.
work. We established a triage system to prioritize treatment and
We are still closely
to maximize the use of our scarce resources. For many patients
involved with the
we could only give fluids and supportive care while waiting for
care of patients in
transfer to a better-equipped facility. [Unfortunately, our first
Haiti. To date, four
helicopter support did not arrive for another week.] Over the
of our original
next 2 weeks, we performed 216 earthquake-related procedures
team have re-
- 136 in the OR and 80 complex dressing changes on the
turned to help
“wards” under anesthesia. Trauma unrelated to the earthquake
with the ongoing Above: Taking her “second, first steps.”
still happened, so we performed 7 surgeries on new major prob-
relief effort. We
lems and helped in other ways while the operating room was
hope to maintain our presence in the months and years to come.
used for multiple Caesarian sections. While we were essentially
alone for the first week, we soon had additional volunteers and Dedicated to the people of Haiti, and all those who care for them.
were later reinforced by a terrific team from California.
Dr Smith & Dr Dyer were part of the initial relief effort in Haiti in
Twelve of our patients died with earthquake-related injuries. January, while Dr Harris continued our effort in early February.
Most of these patients died from very severe injury and from
conditions we rarely see in our practice such as tetanus and
Dr Michael Weaver joins our Faculty
acute renal failure after crush syndrome - the latter is typical
after an earthquake and untreatable without dialysis. All other We are pleased to announce that former Harvard Orthopaedic
patients survived, probably because of our aggressive policy of Resident and Trauma Fellow, Michael Weaver, MD, joined our
surgically treating crushed open wounds to prevent further in- team in August 2010 as attending Orthopaedic Trauma faculty.
fection and death from sepsis. It was an old lesson relearned Dr Weaver's practice will be based at Brigham & Women's Hos-
pital. You may contact Dr Weaver at (617) 525-8088 or
that without treatment a severe open fracture is a mortal injury.
mjweaver@partners.org
During the first 2 weeks we were forced to perform 11 amputa-
tions, mainly of the lower limb. All but one survived. One pa- www.massgeneral.org/ortho
tient became the first earthquake victim in Haiti to get a pros-
www.brighamandwomens.org/orthopedics/
thesis and while we were there took her second “first steps.”
Trauma Faculty Michael Weaver, MD — 617-525-8088 Editor in Chief
Mark Vrahas, MD — 617-726-2943 BWH Orthopedic Trauma
Mark Vrahas, MD
Partners Chief of Orthopaedic Trauma mjweaver@partners.org
mvrahas@partners.org David Ring, MD — 617-724-3953 Program Director
Mitchel B Harris, MD — 617-732-5385 MGH Hand & Upper Extremity Service
Suzanne Morrison, MPH
Chief, BWH Orthopedic Trauma dring@partners.org
(617) 525-8876
mbharris@partners.org George Dyer, MD — 617-732-6607 smmorrison@partners.org
R Malcolm Smith, MD, FRCS — 617-726-2794 BWH Hand & Upper Extremity Service
Chief, MGH Orthopaedic Trauma gdyer@partners.org Editor, Publisher
rmsmith1@partners.org Arun Shanbhag, PhD, MBA
Please send correspondence to:
David Lhowe, MD — 617-724-2800 Mark Vrahas, MD / Trauma Rounds
MGH Orthopaedic Trauma Yawkey Center for Outpatient Care, Suite 3C
55 Fruit Street, Boston, MA 02114
dlhowe@partners.org
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Trauma Rounds, Volume 1, Summer 2010