HAITI: DAY THREE

Source: Blog Post

THP Team doing first day of rounds with Dr. Alexi and therapy team.

Today was my first time rounding with the team in Hopital Advantiste. We hit the floor with the surgical, anesthesia, and therapy teams together.

Dr. Alexis and Dr. Gelfand discussing follow-up for our 7 yo radial clubhand patient.

One of my favorite moments was seeing my radial clubhand patient relaxing with good pain control, good physical exam, and finally able to smile (when prompted).

Post operative therapy with shoulder scope patient who was treated for SLAP tear.

Dr. Alexis providing post op instructions, and confirming that the patient does not play for the National Haitian Basketball team (actual questioned asked).

The funniest moment came from our basketball playing patient who underwent a shoulder scope. We asked him how tall he was, and he appropriately answered in Kreyol. I was having a hard enough time trying to convert Kreyol numbers to English numbers while converting from inches to feet, that I just told him to stand up so we could just acknowledge he was tall. Being able to round and set plans exemplifies the ownership the team takes in managing our patients each trip. Moreover, with rounding with our physician and other health staff partners, we ensure a continuity of care.

Lisa Marcoon with Haitian hand therapy technologists Confident Madeze, Joseph Rika, and Peter Alexandre.

 

Joseph Rika and Lisa Marcoon applying an orthosis.

 

Joseph Rika practicing molding.

 

I had the chance to be introduced to the local hand therapy technologist team. They have been working with Lisa Marcoon in evaluating patients and designing hand orthoses. I was impressed that they took the time to follow a patient into surgery today that they had been working with over the last week. Their patient had decreased elbow and wrist range of motion after having a severe elbow dislocation with a fracture of the radial head. We were able to perform a radial head resection with elbow capaular release which provided the patient with increase range of motion and the ability to get her hand to her mouth again. Having the local therapy team in the OR symbolized their commitment to life long learning and continuity of care.

Lisa Marcoon after treating a 4 yo with bilateral upper extremity arthrogyiposis.

 

Lisa has been keeping busy approaching patient therapy in a practical manner. She has utilized bags of beans to initiate densensitzation treatment for our nerve injury patients. We have encountered a significant amount of post injury and post surgery stiffness in our patient population. Lisa has a devised passive motion orthosis from stockinette material to help our most reluctant patients gain back finger range of motion.

Densensitzation therapy with bag of beans.

 

Stockinette assisted passive finger flexion.

 

In total we were able to complete 5 operations today. My favorite was our patient with a painful ulnar nerve neuroma in her wrist after she had a laceration. She had intense sensitivity to touch at the wrist and palm. Dr. Alexis and I did the procedure together, since Dr. Alexis wanted to learn more about nerve repair. We resected the ulna nerv wneuroma and acquired nerve graft from her ankle in order to repair the nerve and fill the gap.

Arrows pointing to ulnar nerve neuroma in situ.

 

After resection of neuroma, 4 cm gap was present.

 

Ulnar nerve repair with sural nerve cable graft.

 

While we were busy doing that case, Dr. Gelfand was busy addressing our patient with brain injury and severe elbow contracture secondary to heterotopic ossification. It was surprising to find that his normal soft tissue tunnel for his ulnar nerve had ossified was compressing the nerve. Dr. Gelfand was able to remove the bone, transpose the nerve and successfully release the elbow to significantly improve the patients range of motion.

Scissors tips on top of ossified Osbourne’s ligament.

 

Again another busy day with interesting cases and great teamwork. Thank goodness that every night ends with us with a big plate of rice and beans in front of us.