McDoc

Just another Medical Humanities Blog

First Things First

Posted by mcdoc on April 12, 2010

There was a lot to take in on my medical mission to Haiti last week. The people, the languages, the weather, the terrain, the flora, the architecture, the socio-economics, the medical problems, the damage, the injuries, the interventions, the recovery.

I traveled with Boston Healing Hands to Port-au-Prince, from Boston via Miami. We made it through immigration and customs, got our bags and headed to the Healing Hands for Haiti compound. We ate, slept, and hit the road on Easter morning, in three teams headed to different locations. I was in the team assigned to St. Boniface Hospital in Fond-des-Blancs. After a four-hour journey, we arrived in a rural locale that had largely been spared of significant earthquake damage.

How did the patients we were going to be treating wind up in Fond-des-Blancs? Most of them had been evacuated to and treated on the USNS Comfort (T-AH-20). Once medically stable, the next step was discharging these patients to rehabilitation. The medical infrastructure in Port-au-Prince and the surrounding area were badly damaged and severely stressed. The solution that developed was to find undamaged hospitals capable of caring for a cohort of complex patients. These patients were given a limited choice of such hospitals to opt for locations nearer to family support structures.

As I said, most of the group of earthquake injury patients at St. Boniface Hospital had been evacuated to and treated on the Comfort; most, but not all. One patient, a 12-year-old boy, who I’ll call V, was injured in the earthquake with spinal fractures from T12–L3, producing a spinal cord injury resulting in symmetrical paraplegia (Specifically, on my exam, T12 ASIA C). Tragically, V’s mother was killed in the earthquake. In the chaos of the initial rescue efforts, V was evacuated to the Dominican Republic. While there, V received no surgical intervention for his spinal fractures. They healed resulting in a significant kyphotic deformity of his back. He was repatriated to Haiti, and subsequently referred to St. Boniface Hospital.

Lateral view of V's thoracolumbar kyphotic deformity

So, calling all cars, calling all cars. If you know any spine surgeons, please point them in this direction. I have digital plain films of V’s spine for their perusal. V’s father, who is frequently at bedside, is in favor of pursuing surgical solutions for V’s deformity.

To me it doesn’t matter if V comes to the United States or Canada for treatment, or an Orthopedic or Neurosurgery team goes to V to treat him in Haiti. V needs this surgery.

To be clear, the likelihood of any meaningful neurological recovery resulting from such an intervention at this point is nil. He needs it to prevent complications of severe thoracolumbar kyphosis, e.g. respiratory problems, compromised upper extremity biomechanics, and to prevent pressure ulcer development in a very vulnerable anatomical location, what with lungs and kidneys a few centimeters away.

Update:
I was able to get JPEGs of this patient’s A/P and Lateral T- & L-Spine Plain Film XRs

T- & L-Spine, A/P-View, Plain Film X Ray from 3/22/2010

T- & L-Spine, Lateral-View, Plain Film X Ray from 3/22/2010

Please stay tuned for the next installments of McDoc goes to Haiti.

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