The end of the trip

Just got back home to Minneapolis. I'm thankful for a lot of things one takes for granted - clean drinking water that doesn't taste like bleach, streets that don't have a lot of trash you have to wade through, being able to flush TP down the toilet ... but I'm more thankful for the opportunity to serve and to help some people out who just need a helping hand. As we all said our good-byes at Minneapolis-St. Paul airport after we arrived home earlier tonight, the contrasts struck me. We got into multiple cars. We were all full from dinner on our layover in Miami. All of us had all four of our limbs. It's understandable to feel guilty when you've just been to a place where people go hungry, where over 300,000 people died in an earthquake 16 months ago, where people walk through trash every day - but it's also an impetus to try and do more to help out. Everyone in our group was enthusiastic about going down again. It served to strengthen our resolve to do something about it, to not sit back and feel helpless.

What made this a little easier was the evidence that people can actually make a difference. Not just expat aid workers like ourselves ... but the Haitian people themselves most of all. There were a few striking examples on this past week's trip, our third time back. The trash situation, at least in downtown Port-au-Prince, was noticeably better. There were stretches almost a block long with clear sidewalks, no trash visible on them. Most of the rubble, again in downtown PAP at least, seems to have been cleared away. And perhaps most importantly, on the day before our departure, a new president was inaugurated - peacefully. Yes, there was violence around the election and runoffs. Armed UN troops and vehicles were on every major corner around the presidential palace where the inauguration took place, still in ruins. But the actual transfer of power went smoothly. A president voluntarily stepped down after his second term, obeying the constitution, and handed over the reins of government to his popularly elected successor - a first in 207 years of Haitian history as a republic. It gave us hope that things would continue to get better.

On a more personal note, we saw this week what one small, motivated group of people could do. Those of you who remember our last blog from November might recall us staying up all night with one poor lady who got admitted to Adventist with acetabular (hip socket) and femur (thighbone) fractures from a motorcycle crash. Despite fluid resuscitation and blood transfusions we thought she might not make it. Well, this lovely young lady survived - Jessica Scott and Elinor Shank kept us posted on her progress after we left. Her femur got rodded (kind of like shish-kebabing two pieces of bone together to stabilize them) by the team following us the next week once her hemoglobin stabilized. And as chance would have it, she came back to us this week! We operated on her Thursday to help treat an infection in her femur (we implanted an antibiotic cement nail into her femur). I talked to her beforehand, and she said she remembered us from last fall. Anytime someone asks me, "Don't you feel like what you're doing is just a drop in the bucket and so hopeless? How can you make a difference?" I'll just remember her ... and the difference we made in her life.

Over the past week I feel like we worked hard - multiple 14 to 15 hour days, power outages, operating with lead aprons on while working in 90 degree weather and drenched in sweat, sleeping on army cots and eating rice and beans ... but it was an infinitessimally small price to pay for the chance to make a difference in a few people's lives. We returned to the orphanage run by Franz's parents on Friday and delivered multiple large hockey bags' worth of toys, soccer balls, clothes, and shoes generously donated by churches, friends, and co-workers. As we played with the kids and saw the sheer joy in their faces (yes, we did play "changez mouvement" again this time!), it made us forget our own discomfort. It made us feel like whatever our own problems we might have had, which seemed so huge before, now seem so petty, so irrelevant. And in our own small way, for these kids just as much as for the people we operated on, we made a difference in their lives too.

It's true our contribution was relatively small. After all, we were spending the week working with Terry and Jeannie Dietrich, an orthopaedic surgeon and nurse couple who are in the middle of a year down there, and Nathan and Amy Lindsey, who run the Adventist hospital where we worked, and who are down there for already over a year. But as the saying goes, you do what you can. We all hope to go back sometime soon to this island nation with its natural beauty and its wonderful people. If you're reading this, at some point we hope to talk to you about our experiences in person. And we look forward to continuing to make a difference in a few people's lives, one surgery at a time.

Tom: "...it's only a dollar yo! Pat: ...bahahahaha, free yo!!!:"

We finally get a chance to sleep in today. Which means still getting up before 7 because we'd heard the night before that the power was going to go off at 7, so if we wanted to shower, we better get our rear ends in the shower earlier. We had made plans to take a personal day today and take a tour of the city and the mountains around Port-au-Prince, and were all looking forward to finally getting a chance to relax. We pack our bags, say a myriad of tearful goodbyes, and get on the van to go on a tour. Today also happens to be the inauguration of president-elect Martelly, so we see people swarming in droves towards the plaza outside the ruins of the presidential palace, where people have gathered to see the inaugural address. Rumour has it that Mr. Martelly had earlier promised to dance naked on the roof of the palace if he got elected ... never found out if he welshed on his promise or not. Everyone's wearing pink, because that's his theme color, which Heather has fortuitously chosen to wear as well. Martelly's nickname is "tete kalee," or bald head, which automatically makes him a favorite of Tom's.

Thanks Pat. Agreed; although we did get to "sleep in", as per usual, I was up somewhere around the butt-crack of dawn. I packed, showered, made fun of Chalupa as she was sleeping, thought about taking a video of Uno sleeping with her mouth open, spraying J.Bice with Steris foam and scaring her, or drawing ants on B, making her think she was being attacked. Instead, I took a cup of cold coffee, hauled myself up onto the roof of the hospital, and reflected upon the grueling week we've had. That was short-lived, as I spilled my coffee on my shorts, wanted to pop my blister, and realized I still had some beef jerky left. As Pat had said, we took a little R&R trip up into the mountains today, and I seriously have to tell you, it was the most amazing experience ever. Haiti is an absolutely beautiful country, and I think I'd like to come back...
Our bodies tapped, our minds burnt out, we witnessed history today, in a city that needs so much help...the innaguration of their new president. In case you didn't read Pat's last entry here...he's toatlly a favorite of mine...I'm passing the mike on to Uno...

Soooo, after several doses 0f Dramamine we head on our vacation day into the mountains. We started our day driving around Port-au-Prince. We photographed some gingerbread houses, graffiti, and the cathedral. We then went to the top of this incredible mountain where of course Tom asked 'what elevation are we at?' We dined at a restaurant where of course 9 our of 10 dinners came out as ordered. I know there is a language barrier but we have yet to receive a meal as it was ordered. We order a pepperoni pizza and we receive the 'special.' We did receive the rum and cokes as ordered. Are you supposed to be drunk after two sips? I was close to wasted. On the way back down the mountain we all pass out except for Beth. I feel she is still young and her P450's are still in their prime or she too would have been passed out. Aging does suck.

It's our last day and it feels unusually quiet especially since two of our groups members have left us. It would be nice for Adam Schuda and Paige Saunders to have been with us to the end, but unfortunately we are without our fellow teammates on our last night in Haiti. We worked extremely hard this past week and it has all gone by in a complete blur. It was nice to have one day and evening completely to ourselves to decompress after a week of hard work, a lot of memories, and a great time getting to know new friends...although we definitely miss our friends Adam and Paige on our last night in Haiti. As much as we are all excited to go home, I know I don't speak only for myself when I say that we all are a little sad to leave Haiti. We've helped a lot of people, we have created a lot of great memories, we have become closer friends, and we cannot wait to start planning our next trip. So from our last night in Haiti, good night, and thank you for all your support.

Ok, jess's turn...I'm going to start off by saying that i'm typing this at 11:47 so forgive my rambling. I was super excited for our "fun" day the guide, Jackie who took us on the city tour and up to the mountains was fabulous with all her local knowledge and insight on the haitian culture/history/people. It was also great to see another side of Haiti, the mountains had a much cooler(temp wise) atmosphere and the architecture was different from the crumbled and cramped buildings of the city. The farm feilds on the sides of the mountains are amazing and unfathomable how they get their crops to market. The greenery was refreshing. You could almost imagine vacationing in a place like this, the view was that good. So much more to tell but i"m loosing ste

Oh Yeah...Rolling With the Punches...

It's 7:40am...I've been up for three hours, after going to bed five hours ago. Like I said before, there'll be time to sleep when I get back home. The General (Adam "Schupa" Schuda) left yesterday, while we were up to our elbows in children at the orphanage. "P" (Paige Saunders) left at 5:30am this morning...we're down to six of us now. We've exhausted all of our surgical and anesthesia knowledge; after 32 cases, never working less than 10 hours a day (most were 14-15 hour days), we're spent...with pitting edema, ridiculous ant bites, and waking up in your own pool of sweat, it's time we relax for an entire day. We'll be heading up to the mountains today, to see aome more of this amazingly beautiful country. It would've been so so nice to not have to return from the orphanage yesterday and work, but there were cases to do...patients needed our help...we came here to serve, so we did just that. We adapted, we did what we could...we wanted to rest, to sleep, to eat...but when life throws you a curve ball (or a wrist shot in the 5 hole for you hockey fans)...you just roll with the punches.
We were informed late last night there might be a strong possibility the power would be out around 7am (imagine that). Alas, here we sit around a table full of laptops, drinking instant Starbucks, in air-conditioning...aahhh, the simple pleasures in life. =) I'm glancing around the table, and I see amazing women (Pat not included) who gave their time, their money, lots of their sweat, and their huge hearts. I couldn't have asked to be with such wonderful people...Schupa and P included. It takes a special someone to be a missionary, the right heart, and the right mind. As we get ready to relax, and explore the countryside today, I'd like to show you the awesome team I've been blessed with...these are the people that make it happen...all of you helped make it happen for all of us, and for that...we thank you. Take a look, and we'll talk to you later tonight...

Lead - it's not just for paint anymore

I'm not going to kid myself and think there are a ton of you who've missed us, but in case you're one of the few who really have nothing better to do on a Friday night than read our insipid ramblings, there's a good reason we haven't posted since Monday night... We've been busy! Tuesday and Wednesday we did 20 cases, and the power went out Wednesday night anyway so we couldn't post even if we wanted to. In fact, the we've been running around so much getting cases ready, turning rooms over, doing surgeries, and seeing patients that the past few days have been a blur. Unfortunately, it's turned us into such eating, drinking, working, and sleeping (OK well maybe not so much sleeping) automatons that we've had left little time until now for reflection. The days have blurred together a little bit, but these are the salient points I remember...

The power goes out here a lot. The hospital does have a generator which gets turned off every day. When this happens, there is battery backup power which now runs the OR lights (no more operating in pitch black like last time) and vital equipment like the ventilator (breathes for you while you're asleep in surgery) and the C-arm (yes, we can now take xrays in surgery!). What we can't run on invertor power is the air conditioning. Which leads us to ...

It's really hot here. Maybe not so much outside, which is just plain hot, but specifically the OR, which is really hot.. They do have one steam autoclave to sterilize our operating room equipment, and when they open it up to retrieve our instruments it gets the entire area hot. The employees can't open windows to let the heat out because of the problem we've had with flies and mosquitoes buzzing aorund the OR. There is an air conditioning unit in two of the three OR's, but it goes down of course for hours at a time when the power goes out. Somehow this always seems to be during the hardest case of the day when you're wearing your lead apron and already sweating your brains out. Spekaing of mosquitoes and flies ...

We've learned to be flexible. I know we've posted this in previous Haiti trip blogs, and I've mentioned this in talks about our trips to Haiti, but it's grown every time. No more freaking out when a mosquito or fly buzzes around and lands on the sterile field. Just try and make a note of everywhere it hits, and cover that area up or change it if it happens to be on your person. Sometimes this all happens in such quick succession that it's hard to remember it all. Yesterday it started to feel like a game of Twister - OK, Matt's left sleeve, my right glove, the patient's right foot, and the corner of the table here! The flypaper above the OR table has been replaced with a handheld fly zapper that zaps the animal into oblivion. I suppose that when you have an air conditioning unit that is blowing air, dust, and germs, onto tthe OR "sterile" back table, you have to have an understanding about some things.

Haitians are some of the happiest people on earth. Despite everything they've been through, from colonialism, a revolutionary war, abject poverty, violent transfers of power, earthquakes, hurricanes, and cholera outbreaks, they still retain a lot of optimism and believe that the future will be better. The patient who doesn't smile back with just the awesomest smille when you offer one is very, very, rare. We went to an orphanage today and saw the same kids we saw there on our last trip in November. We brought them toys (including a boatload of soccer balls donated by Nancy Wallentine from ortho clinic at HCMC) and they were in aboslute heaven as they happily played their new toys. No fighting, no whining about what they could have gotten, and no steaing toys they want from other kids. These were some of the politest kids I've ever seen. And somehow a cheap piece of plastic manufactured in China just made their day.

We are now finally done. Earlier tonight, about three hours ago, we finished our last case of the week, sat down, aired out our sweaty scrubs, and breathed a huge sigh of relief and satisfaction. Somehow, with all the stress of 15-hour days, physical demands of trying to operate on difficult cases while wearing lead and drenched in sweat while dodging mosquitoes and flies, we've all managed to get through the week - all 8 of us - without any major confrontations, no fighting, no whining (OK well maybe just a little), and no personality clashes (at least not that I'm aware of ...). I'm really proud of the team, each and every one of them, for the great job they did this week. Beth, Amy, Heather, Jessica, Paige, Tom, Adam, and I survived another week down in Haiti doing 10-surgery days in 90+ degree heat while wearing lead radiation gowns and when power would be down for hours at a time. And yet I feel like it's a small price to pay for the incredible opportunity to learn from these incredible people here... who paid reparations to France for the "privilege" of winning their independence... who sustained an earthquake that killed 300,000 people... who have had almost every transfer of government power marred by violence... and who somehow manage to always come to the doctor meticulously dressed, wearing the world's biggest smile on their faces, and who are simply thankful that you're there trying to help them.

The Return Of The 15 Hour Work Day

As I awoke at 4am in a kiddie pool of sweat, I thought how peaceful the air was. Knowing we had more than a day's worth of cases, I decided to shower before the other's did...and I figured a 4am start was pretty good. After Uno downed her oatmeal, Chalupa drank her coffee, Pat had his prunes, and of course Paige staring aimlessly at the wall, J.Bice, Adam, and myself begin preparing the supplies and instrumentation for the first cases of the day. Jeannie (Dr. Dietrich's wife) plays conductor, and orchestrates the patient flow. On tap first, a cast & pin removal on a very sweet 3 yr old boy. Then another cast removal & straightening out of a club foot on a 5 year old girl (club foot is essentially where the foot turns 90 degrees sideways inward, so basically you'd be walking on the outside of your foot). Again, it's amazing how a gentle hand, exam glove balloon, and a little stuffed animal can put a child at ease. This little girl was an absolute sweetheart. She clung onto J.Bice like Pat with tofu. After the removal of an antibiotic spacer on a 13 year old boy, and a quick knee scope, what proved to be the longest case of the day began...

With the proper implants, and more importantly, the proper instrumentation, an ankle fusion can be pretty straight forward. Did I mention the part about proper instrumentation? Yeah, here's where "rolling with the punches" really fits. When you're in someone else's house, you may not like their silverware, or their couch, or even the television for that matter...so is it in a third world country. From crutial screwdrivers which are manufacturer specific, to operating room tables (or lack there of)...missing instrumentation, missing medication "...ummm, what's the dosage of ketamine again?!?...", to patient x-rays, and whenthe last time this patient ate...

What I'm trying to get at, is that we come here to supplement the local staff already here. None of us comes in, starts changing things around to do it "our way"...we work hand in hand with the Haitian staff...not against them. They do things differently...many things differently; we adapt, make it work for the patient's benefit...because sometimes, you just have to roll with the punches. I'll let you know right now, I typed up the first 2/3 of this entry a few days ago...falling asleep at the laptop...the power goes out...patient is already in the room...gotta go to the bathroom...put on dry scrubs...power goes out (again)...remove a cast...pull some pins...beans and rice (again)...oh, was that the power that just went out, hmmm...bummer. It has been anything but easy, to sit down and update our little blog here...and we apologize.

So as you all read this blog, keep this in mind: we've been exhausted every single day; our bodies literally ache; we're tired, hungry, and thirsty...but it's not about us...it's about the people of Haiti who surround us...we're here to help...we do what we can. We enter this country, and we adapt...we greet each day with optimism...because, often times in life...you just need to roll with the punches...this is Haiti people...it's not an ideal scenario here. These men and women need our help, the children need our help...they need our smiles; so we adapt, we make it work, we do what we can...because when you need to make a smoothie without a blender...or do 20 cases in two days...you just have to roll with the punches.

Back in the saddle

One of the few good things about getting older (perhaps the only good thing) is that you need less sleep. As the old man of the group (Beth is 26, Adam is 28, Beer is 32, Paige is 34, Tom is 36, and JBice is 38), this guy (Pat) knocking at the doorstep of his 40's is up before 5 which gives me some time to catch up on some nerdy fantasy reading (last book in the Song of Ice and Fire series). After the youngsters all get up, it's morning meeting and off to our respective duties!

This morning, while Pat and Beth went to clinic, Amy "Uno" and I (Tom), went to the peds ward and distribute stuffed animals to the kids. As of right now, the peds unit is a free-standing cinder block structure...with now air-flow whatsoever.  There were 13 infants over there, none over the age of 18 months.  While I put on a puppet show for one little angelic girl, Amy did amazing cutsie-wootsie faces with another little girl across the room.  Conditions for these children will change, once they move the little ones in where the adminstration office currently are (hopefully in a couple of weeks).  Adam joined Amy and I shortly thereafter, as we all pitched in to help Amy Lindsay clean out the "storage room".  Now let me explain said room: a cinder block structure on the hospital grounds, with no light, no floor, jammed floor to ceiling with hospital supplies, some of which have been there since before the earthquake...and it's hot in there, like cook some bacon on my head hot.  As the thought of bacon entered my mind, I soon realized it was already ab out 1pm, which meant...time for beans and rice!!!

In the meantime, me (Pat), Beth, Matt, and Terry are wrapping up a busy morning clinic of about 50 patients jamming the hallway. People are pretty orderly and there's really no incidents to speak of. We start a little late because the xray guy doesn't show up till 9:30am, and there's one surgery to squeeze in before clinic anyway. But there's no complaining, no shoving matches, no "I've been waiting 6 hours for my appointment." Pretty remarkable considering they're seen on a first come first served basis so people start lining up at 7am, so a few people actually have been waiting 6 hours for their appointment. Makes me think of the last time we were here in November when Hurricane Tomas hit the channel between Haiti and Cuba. Clinic shut down early one day and the patients were told to come back the next morning, and a few people actually did stick around overnight to wait for their visit the next morning. The patience and resilience of these folks is formidable. What makes it even more remarkable is that since our last visit the hospital has now started to charge orthopaedic patients 50 goudes (a little over a buck) for their clinic visits - about half a day's wages for the average Haitian - and people still line up. The rationale is that there are a few well-to-do Haitians who can clearly afford private care but come here anyway; moreover, having a free source of orthopaedic care in the area (i.e., us) makes it difficult for the local guys to make a living. My personal opinion is that it's better to let a few rich folks get in for free than shut out a poor person who can't pay. But that's the system that's in place, and we're the guests here.

One guy's elbow is full of pus after a surgery a few weeks ago  - a poor guy with an ununited both bones forearm fracture from the January 12th 2010 quake (after awhile you start feeling silly asking people when they hurt themselves). Stuck in the needle, and bam, 35cc's of mustard colored pus in the syringe. Along with another woman with an infected toe who needs an amputation, and another gentleman in the hospital with an open tibia nonunion who needs another washout, we've got a few surgeries to do today after clinic. So I quickly follow Tom's lead and wolf down some rice, beans, and eggplant as well before heading to the OR.

Beans and rice for the crew, check.  With two more cases about to go, I (Tom), encourage Pat to finish quickly, as one of the two patients, is ready to take a "little nap", so we may rid her of her sore toe.  Heather mixes up a fine coctail for her, and Pat works his magic,  Paige tries to be funny as usual ... heavy on the "tries."  As a few others watch in awe, I decide I better go see how Dr. Dietrich is coming along with the VAC change next door.  That patient there is actually Spanish-speaking, so I chime right in, exclaiming how awesome his Talor Spatial Frame looks.  By his laughing, and smiling face, I figured Amy had been more than successful in her first spinal in four years.  With the surgical resident Matt (a third year surgical resident from Temple University) putting the final touches on ensuring the VAC seal stays intact, I meander back to see if Pat's managed to finish the amputation, and get the wound dressed.  After a completely full day of clinic, and four cases, not to mention working outside in the sauna ... we are all slightly more than tired and sweaty.

 

In the final analysis the sweaty wins out over tired, so after Heather finishes her Skype date with her son and husband back home in Blaine, we head back over to the Auberge du Quebec for some beer and food. One of the only veggie options on the menu is the Creole rice and beans, so guess what, it's rice and beans again for me (Pat). The walk there and back through a maze of twisty little alleyways is a little daunting and we have to backtrack more than a few times as we run into dead ends. Fortunately the locals are super helpful in guiding us the right way with a pointed finger, a smile, and a "Bonswa." Which is the parting word that we're going to leave you with tonight!

... and we're back!

Welcome back readers!

Well, after a six month hiatus, your favorite orthopaedic surgery team is back down in Haiti! If you're reading us for the first time, glad to have you following. We'll try and have something informative and maybe even mildly entertaining for you to read on a nightly basis this week! We just arrived yesterday at Hopital Adventiste d'Haiti in Carrefour, just west of Port-au-Prince. This time, we've got all the bases covered - Tom and I; Paige Saunders, Heather Ross Chalupnik, and Amy Beer for anesthesia; Jessica Bice OR nurse extraordinaire; Beth Bard MS4 and soon to be world traveler (she's doing medical stints in Uganda, India, and Sweden); and General Adam Schuda, surgical technologist, US Army Reserve. Now Tom being at a new job as tissue recovery coordinator for LifeSource, and Amy being from Methodist, we're no longer the Hennepin team, strictly speaking, but "Hennepin to Hait" sounded better than "Various Medical Professionals from the Twin Cities to Haiti".

Taking a cue from our previous three trips we had a fundraising party (Eighties for Haiti, check out the photos on our facebook pages) which raised $1167. Combined with everyone's individual fundraising efforts, including several thousand dollars raised by Tom, Amy, and Heather on GoFundMe.com, as well as $1000 from the Rotary Club of Duluth on behalf of Beth, we were able to recoup a large part of our costs on the trip. This helped a lot since each of us is paying for this ourselves and taking vacation time to come down here.

With snow flurries in the Twin Cities earlier this month, one might think that the heat would be a welcome respite, but that relieved feeling only lasted, oh, about 15 minutes. Which is about how long it took Tom to soak through the first of 12 bandanas he brought down. After haggling with a team of porters for our bags, we found our driver and made the trip to Adventiste. Along the way, we see the first signs of change here in Port-au-Prince: things actually seem cleaner! Now you certainly wouldn't eat off the streets (the 8-second rule is a zero-second rule) but the long stretches of road and sidewalk completely covered with trash are much shorter. The tent cities are still here in the capital however, and as we travel west to Carrefour, things are not quite as clean. The piles of trash are back, and in the middle of them picking out yummy tidbits you still see dogs with engorged teats and crooked limbs, pooping where they like and kicking back dirt with their hindpaws just like dogs everywhere.

Fortunately things seem to be going well at Adventiste. We unload our 8 hockey bags full of donated items ... OR supplies from Tom's job at Lifesource, masks and VAC (vacuum assisted closure) dressings donated from HCMC's ortho clinic, gloves from my neighbor Liz Sschuerer down the street, patient gowns from Jill Davidson, and tons and tons of kids' clothes, shoes, and toys rounded up by everyone on the team.

Our first night in we meet Dr. Terry Dietrich from Appleton, WI, who's out here for the year, and he fills us in on what's new down here. As we make our evening rounds the first thing we note is that the hallways are cleared out. Those of you who followed last trip's blog in July and November 2010, might recall the lack of space and lots of people having to recuperate from or wait for surgery in the hallways (including one poor soul with no family who balled up his poopy adult diapers and threw them down the hall). They've really made an effort to switch from crisis charity hospital mode to some compromise with their pre-earthquake fee-for-service mode. Along the way, they've built a system that ironically has provided a level of orthopaedic care that has never been seen before in Haiti ... a hospital with one full time and multiple part-time US-trained orthopaedic surgeons. A hospital where Drs. Dror Paley and John Herzenberg, two world-renowned experts in limb deformity correction, bring residents to learn. A hospital where a 11-year-old girl with Blount's disease and a botched prior correction (which her original local orthopaedist charged her family $16,000 for) can have her severely bowed legs straightened correctly this time - for free.

Although we didn't hit the ground running as hard as the prior two trips, we do notice one girl on rounds whose wound is looking fairly soupy so she needs a washout and dressing change in the OR the night of our arrival. Today, we have three cases in the morning - washout and bilateral long leg casts on a 16-month-old, washout and VAC change on a poor guy with an open (that's "compound" in plain English) tibia fracture, and removal of bilateral Taylor Spatial Frame external fixators on the 11-year-old girl above. Adam has the ubiquitous health care professional's fanny pack which at first glance looks amusingly like a stuffed Speedo worn over his scrub pants. After OR, we have some free time for a day trip to the beach near Jacmel, about 3 hours' drive away. The road does wind its way zigzag through the mountains, and we're all crammed into the back of two pickup trucks. With the thought of those mountains fresh in his mind, Tom - as we are all just standing waist-deep in the warm Caribbean waters - asks, "so, what elevation do you think we're at now?" There's a long pause as Amy and I look at each other, wondering is this a trick question, before I answer, "uh, zero?" and Tom, followed immediately by the rest of us, starts laughing is rear off.

Well, it promises to be a busy week like the last two trips, and we're all looking forward to the upcoming clinics and surgery days. We're also curious to see how we'll fit into the existing team down here and be busy and productive while at the same time respecting the people who've devoted a year to being here. Well, here's to a great week!