McDoc

Just another Medical Humanities Blog

Posts Tagged ‘Physical Medicine & Rehabilitation’

Steps in the Right Direction

Posted by mcdoc on April 27, 2010

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.

Posted in Haiti, Healing Hands for Haiti, medical humanities, medical mission, Physical Medicine & Rehabilitation | Tagged: , , , , , , , , , , , , , , , | 2 Comments »

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.

Posted in Haiti, Healing Hands for Haiti, medical humanities, medical mission, Physical Medicine & Rehabilitation | Tagged: , , , , , , , | Leave a Comment »

Update #2 to Help Send McDoc to Haiti on a Medical Mission

Posted by mcdoc on February 21, 2010

When last we left our hero, he had been waiting for the rescheduling of the Boston Team meeting for the Healing Hands for Haiti mission in April.

Since then, the forecasted snowcopalypse 2010 did not materialize for us up here, but rather steered due east through the mid-Atlantc. The re-scheduled meeting was also ultimately canceled due to a weather forecast that did in fact materialize as predicted in a substantial, high-rate snowfall, just in-time for rush hour. While it was no catastrophe, it would have made for a long, miserable and slightly unsafe trek out and back.

Meanwhile, our steering committee staff has proceeded with logistical planning. They have since revised the costs downward, with the round-trip airfare to Port-au-Prince via Miami, and the room and board at $600.80 and $200, respectively.

The air fare is now paid. The room and board check is written and submitted.

NB: The revised fund-raising goal has decreased from $2200 to $1500. This then means that we are now 56% to goal, versus being 38.2%!

Also the dates have been changed and the medical mission shortened by a day, from April 5th – 13th, 2010 to April 3rd – 10th, 2010.

The re-re-scheduled team meeting is set for 7pm, Sunday, February 21st, at the Quincy Medical Center, Conference Room A.

I’ll file an information update from the team meeting, once back from it.

Posted in Haiti, Healing Hands for Haiti, medical humanities, medical mission, Physical Medicine & Rehabilitation | Tagged: , , , , , , , | 2 Comments »

Update to Help Send McDoc to Haiti on a Medical Mission

Posted by mcdoc on February 10, 2010

The update that I have tonight is that I do not have an update to my previous post Help Send McDoc to Haiti on a Medical Mission.

The Boston Team meeting was canceled due to winter storm warning issued by the National Weather Service yesterday. This afternoon the winter storm warning was downgraded to a winter weather advisory. Our team leader will be announcing the new time, date and location once confirmed.

On a related note, today at our resident didactic conference I presented journal club [Journal club as fun as it sounds is not a club. Journal club is medical training jargon for an organized presentation reviewing an academic journal article in a group]. On the article Chiou-Tan FY, Bloodworth DM, Kass JS, Li X, Gavagan TF, Mattox K, Rintala DH. 2007. Physical medicine and rehabilitation conditions in the Astrodome Clinic after Hurricane Katrina. Am J Phys Med Rehabil. 86:762–769. Full text is here. It documents the demonstrated need for PM&R expertise in a mass-evacuation, disaster-relief situation. Every disaster is different. The disaster in Haiti is dominated by trauma with fractures and crush injuries in the thousands. Unfortunately, many of these injuries either acutely or then developed into cases requiring one or more amputation of one or more limb. Credible estimates exceed 2,000 amputations.

Amputation is half the battle to saving a patient’s life with unsalvageable limbs. Assuming an uncomplicated post-op recovery, amputation has grave consequences in terms of changing and limiting one’s occupational options, productivity, social role, social status, independence, freedom and self-esteem. This is doubly true in a developing country that lacks wealth, resources, technology and advocacy to enable or provide meaningful, ready employment for people with impairments.

A residual limb and the rest of the patient need early and comprehensive rehabilitation in order to prepare for a prosthesis, and to prevent complications. Foregoing rehabilitation is a recipe for disaster, opening the door to development of a weak, swollen, contracted residual limb with hypersensation, prone to pressure ulcers and unable to be fitted for, or to tolerate a prosthesis. Here‘s a good run-down of amputation rehab.

Posted in Haiti, Healing Hands for Haiti, medical humanities, medical mission, Physical Medicine & Rehabilitation | Tagged: , , , , | Leave a Comment »

Help Send McDoc to Haiti on a Medical Mission

Posted by mcdoc on February 6, 2010

I am preparing to make a medical mission to Haiti, and I could use your help. Please read on:

Healing Hands for Haiti is a not-for-profit, non-governmental institution with no religious or political affiliation, which fosters and respects diversity within its organization. For over 10 years, Healing Hands for Haiti has worked in cooperation with governments and local organizations for the benefit of the Haitian people.

Healing Hands For Haiti supports and encourages the Haitian people in providing quality physical rehabilitation services for themselves in a spirit of self-determination, independence and human dignity with a focus on empowering Haitians with disabilities.

Healing Hands For Haiti has created opportunities for rehabilitation professionals and other volunteers willing to freely donate time and resources to our activities in North America and Haiti. Healing Hands For Haiti is committed to conducting all of its affairs, both domestically and internationally, according to the highest moral and ethical standards. The Healing Hands for Haiti Blog documents their work going on in-country, now.

Healing Hands For Haiti is set up in 10 regional interdisciplinary rehabilitation teams across North America. To volunteer, one needs a valid passport, up-to-date travel vaccinations, and to submit an online application. One is also responsible for funding their portion of the mission costs.

I am preparing to make a 9-day medical mission in April with the Boston team, scheduled for April 5th – 13th, 2010. I will be attending my first meeting Wednesday evening, February 10, 2010. At which time a $200 mission deposit is due.

The individual cost-share for the 9-day mission is approximately $1500 (I expect a more exact figure to be given at the meeting on Wednesday). There are other expenses as well, please see below. Also, while it is true that I am a physician, I am still a resident and so don’t yet roll in dough; otherwise I would just absorb the cost myself.

Here is a run-down of my expenses thus far to prepare for this medical mission: $354.12.

$180.26 for Passport expenses:
Conversion of my passport card into a passport book, $75 + on an expedited basis, $60 (my conversion took 4 working days, your tax dollars at work) + with overnight return mail, $14.96 + express mail mail-in cost, $18.30 + passport photos, $12.

$61.35 for Prescriptions:
Malaria prophylaxis, chloroquine phosophate 500 mg tabs, 1 tab by mouth once weekly, starting 1 week prior to trip, then once weekly during trip, and then once weekly for 4 weeks upon return, for a total of 7 tabs = $20. As needed traveler’s diarrhea treatment, levofloxacin 500 mg tabs, (Levaquin®, no generic available, prescribed due to nation-wide shortage of ciprofloxacin), 1 tab by mouth daily, for 3 days, for a total of 3 tabs = $35. As needed symptomatic treatment for diarrhea, loperamide 2 mg caps, 2 caps, after each loose stool, up to 8 times daily, for a total of 20 caps = 6.35.

$112.51 for Kreyòl ayisyen (Creole language) instructional materials:
Haitian Creole for Health Care: Keryòl ayisyen Pou Swen Sante by Marc Prou and Mel Schorin = $18.50. English Haitian Creole Haitian Creole English Word to Word Dictionary by Fequiere Vilsaint and Jean Evens Berret = $24.50. English-Haitian Creole Medical Dictionary by Maude Heurtelou, Fequiere Vilsaint = $14.95. Creole Made Easy by Wally R. Turnbull = $16.66. Creole Made Easy Pronunciation Guide, CD Set by Wally Turnbull = $18.95.

I am currently taking a free, once-weekly class in Haitian Kreyòl for Health Care Providers offered by the Office of Enrichment Programs/Division of Service Learning, Harvard Medical School.

$373.85 for stuff yet to do or get:
Electronic Basic Disaster Life Support™ (eBDLS™) = $200
SteriPEN UV water purifier = $99.95
Chlorine Dioxide Water Disinfectant = $24.90
Mosquito Netting = $23
Permethrin Spray for Netting = $15.50
DEET Repellent = $10.50

So, that’s $527.97 for stuff, $200 for training, and $1500 for the trip.

Please help me make this mission by making a donation. You can do this by clicking on the “Donate” button up there on the left. Or click here to go directly to the PayPal account.

Posted in Haiti, Healing Hands for Haiti, medical humanities, medical mission, Physical Medicine & Rehabilitation | Tagged: , , , , , , , , | 5 Comments »

 
%d bloggers like this: