Steps in the Right Direction

In my penultimate post I introduced a patient with a problem. This 12-year-old boy, gravely injured in the January 12th Haitian earthquake, orphaned of his mother, displaced, relocated, with a spinal cord injury and an orthopedic spinal deformity, without having had an operative intervention.

Another blogger/pre-medical student, and I have been cold emailing surgeons about the case. So far, no dice. Orthopedic surgeons and neurosurgeons have generally said that operative intervention is likely indicated, technically routine with a high likelihood of a good outcome. However, surgeons are only one piece of the puzzle.

It takes a highly skilled team to perform spinal surgery. It takes a pre-operative team, then in the O.R. along with the surgeons, there are the anesthesiologists, nurses, technicians, a Post Anesthesia Care Unit (PACU) team, a Surgical Intensive Care Unit (SICU) team; then there’s the step-down to the regular med-surg unit with all their staff, supporting functions and logistics and the physical plant, all of which implies a hospital. Then, there’s the rehabilitation facilities, associated inter-disciplinary team professionals, supplies and adaptive equipment. There is also always the possibility of complications and extra, unanticipated costs.

So, there are many, expensive, technical resources that have to be mobilized, and well, paid for. So, finding a hospital in the position to take on an involved, international, humanitarian, and thus pro bono case is an extra and pretty tall hurdle.

My department acting-chairman suggested a renown hospital affiliated with a voluntary, benevolent society. That particular one did not pan out. However, that suggestion and a positive association I have from my other life led me to make another contact.

Now, it’s time to reveal my dark side. I, along with my wife, so we, like to go to Women’s Flat Track Roller Derby bouts. The local league is the Boston Derby Dames. It all started in Detroit though with the Detroit Derby Girls. These events are held in big venues to accommodate the track, the teams, the officials, the MCs, a Buffer Zone of Safety, the stands, the refreshments, the facilities, the parking. In Detroit the bouts were held at the Masonic Temple Auditorium.

Here in Boston, they’re held in the Aleppo Shiners Auditorium in Wilmington, MA. Shriners, you know, men in fezes driving little cars in parades, oh, and the Shriners Hospitals for Children. I contacted them on April 19th with information about the case, and moved on.

Today, I received an email from the Shriners Hospitals for Children that a team at the Shriners Hospital in Philadelphia believes that on its face, they can probably help this patient, and that the hospital will accept an application for his care. Plus the Global Medical Relief Fund is offering to assist with travel for this patient.

Even if this does not all work out with this connection, hats off to all these fine folk and their organizations!

This is very preliminary, but very encouraging. So the gratifying part begins as I get the parties together. I believe that the medical and hospital details will go pretty smoothly.

The real challenge, like that of herding cats at a distance, will be negotiating the bureaucratic labyrinth in order for V to leave Haiti and travel to the United States for medical care. The word on the street is that the Haitian government generally errors on the side of not granting exit status to children for medical treatment in the United States. So, I expect that this will become a chapter in its own right of this saga.

Stay tuned for more.

First Things First

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.