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!

Tom's reflections on the past 9 days

Monday, 8 November 2010

(These are Tom's final thoughts looking back on our return trip to Haiti - a snapshot in time as to how we feel right now ... the thoughts going through our minds as we return home from 9 days of travel, hurricane, sleepless nights, serving the Haitian people, and sharing time with our good Haitian friends. -Pat)

I caught myself this morning being bummed out we missed our flight by less than a couple of minutes...literally. I had to take a moment; I thought about how grateful I should be for having the luxury of riding in an airplane, to a country where I can be free...a place where I have air conditioning (and heat)...a home that has carpeting, drinkable water, and a refridgerator to keep food cold. In a land of flat screen tvs, name brand clothing, and food that makes us obese, life's necessities are lost in the glitz, the glamor, and the $5 footlong. We left behind an amazing culture, a land where people simply don't have the basic necessities to live...and some of those people die because of that. We have health insurance that may make us pay $10 or more for a visit to the doctor...so many of the people of Haiti don't have the $1 for an ER visit. It saddens me...it completely breaks my heart to be perfectly honest. I arrived home this morning, and had a great cup of coffee at good old MSP airport, and a turkey sandwich. Those two items would be a pretty hot commodity back in Haiti. I chugged down two cans of pop as Pat and I got caught up on the blog...I'm willing to bet those children at the orphanage have never even had pop in their lives. As we all stood amongst those 44 children the other day, I shed a tear that nobody saw (becaue I was sweating profusely). How these children make the absolute most out of nothing; in America we have everything, yet complain we have nothing. Five children played with one empty bottle of sprite in the middle of a sewage-ridden street...in America we'll fight tooth and nail to make sure our children have the latest and greatest video game. How ironic is that...
We amputated the leg of a gentleman who was so excited to have it removed, he was "bumpin' knucks and blowin' it up" post-op. A little girl smiled as the pin sites on her external fixator were cleaned. Pat and I witnessed a miracle in Andre, who back in July was paralyzed in a halo...and now walks around and does yoga. (Andre  has JRA, or juvenile rheumatoid arthritis, and was a partial quadriplegic due to cervical spine subluxation when we were last here back in July. In the previous 3 months he's made a complete recovery - Pat.) I'd also like to say he has no home. Andre has no parents, but has an uncle, so no orphanage will take him. It isn't a safe environment for him to be with his uncle, so he lives at the hospital. He loves to color, loves to read, and doesn't like to let go when you hug him. Andre's story is all too common in Haiti...it makes my soul cry. We don't share these stories with you because we're trying to make you feel bad. There's  nothing wrong with having some blessings. We share these stories, because it's important to let people know what really goes on in a country that's not our own. That having material goods and living in the comfort that we are accustomed to is a pipe dream that we should not take for granted and that most of the world would be dying to achieve. We saw people bathing in ditch water and kids playing soccer with an empty Sprite bottle. We saw homeless people taking a bath in the sink in orthopaedic clinic late at night. Earthquake aside, Haiti had a lot of problems begin with, but it's slowly making changes. You can only see these changes if you've been there...we want everyone to understand it's an ongoing effort, unknowing if the end is in sight...but you do what you can, and you leave it all out on the field.
We had a spectacular team this time around, and each and every person got worked to the bone, literally (our bones were aching). As we said before, it's not about how many cases we did, or about how much we could donate...it's about each minute of our time we gave to each patient, each Haitian hospital worker...each innocent child. I can't speak for everyone, but if an experience such as the one we just had doesn't make you pause, and thank the good Lord for the life each of us has, you might want to get your heart examined...because it might be missing. Every person has a breaking point, and we each hit ours on the same day...but we overcame, we conquered those 9 days we were there...we did what we hope was some really good stuff, at least for the few people we were able to touch. There is so much need, so many people we weren't able to touch, but at least we were able to touch a few. Each person in that hospital should get an award, because our supporting cast was unbelievable...bring-the-house-down awesome! In a situation like we were in, we always wanted to do more, give more money, donate more supplies, hand out more food, including our own, clothe one more child...but we're human...and you do what you can...and you leave it all out on the field. We did that every single day.
Looking back at this trip, I realized more it's the relationships you develop, it's the 5 minutes here, and the 15 minutes there you spend with the patients, with the children, with the workers who sleep on the countertops at the hospital. It's the smile you smile, the hand you shake, the hug you give, sometimes that's all the medicine someone needs. There is still much work to be done, and we left an awful lot of it for the incoming team, and they'll do the same for the one after that, and the one after that...
We'll go back again. We'll continue to fight for every inch, strive for every yard, and help as many Haitians as our bodies give us strength for. The six of us did just that...we did what we could...we left it all out on the field...and we'll go back for another season.

Our last Day: A day of Sadness and a Day of Joy

 Saturday, 6 Novemer 2010

So the morning began with a 7:30am church service.  All of a sudden, Nathan is called out immediately, and Paige follows suit.  We wouldn't find out until after church, that a new born baby had just arrived unresponsive from one of the tent cities.  An anesthetist from one of the tent cities an hour and fifteen minutes away went to check on this little soul, who was born at 36 weeks. The baby had no pulse,  and was not breathing.  Upon arrival, CPR was performed, and Paige intubated the child, as the local anesthetist was unsuccessful.  Unfortunately, the baby did not survive.  This death added to the weeks' toll...it is without question gut-wrenching, that I say there were four deaths at the hospital during our stay.  Sometimes, even when you do what you can, and you leave it all out on the field, you end up with heartache.  This is again one of those times.  On a more positive note, we've been following the poor lady with the pelvic and acetabular fracture (and did we mention she also has a left femur fracture that needs to be fixed) closely and day by day her hemoglobin is slowly inching upwards, she's making more urine (those beans are working again!), and her blood pressure is holding steady. She actually might pull through. Once Paige breaks the news about the poor newobrn to all of us, we look that much more forward to visiting all of the children at the orphanage that Frantz's parents run.  The six of us, as well as Sarah Carignan from Boston, and guided by Frantz, Claudy, and Roosevelt, the Adventiste translators who've become our friends, gather our backpacks and a few other donated goods we have, and head out into the sweltering heat.  Along the way, heaps of trash, piles of rubble, and homeless Haitians line the streets.  This is nothing new.  Ten months after the quake, little has changed.  We noticed more of the streets are getting

cleaned; we actually saw more than one garbage truck, and some people were sweeping the sidewalks.  Although a lot of aid groups are pulling out (for example, MSF Holland and the German Red Cross) because the disaster phase of the earthquake is over, other advancements have been made, like Wycleaf Jean's group clearing rubble, and money to the government for cleanup. So despite things still looking pretty desolate to the casual observer, there are some unglamorous but important changes being made. We are all looking forward to visiting the orphanage that Frantz's mother runs here in Carrefour. Upon arriving at the orphanage it hit me; the sight of 45 children, huddled together under a tarp.  In an area smlller than most apartments, these children eat, sleep, play, and live with remnants of sheet metal and tarps held up by tree branches.  Their carpet is dirt and rubble.  A faint, hauntingly familiar odor hovers in the air, in the background of your awareness, making you wonder where you've smelt that before, and then you realize it's stale urine. They had one toy that everyone shared...one toy.  It's difficult to write this, as my memory is instantly haunted.  They have so little; we already saw children with some of Cole (my 4-year-old son)'s flip-flops and clothes on... the same one's I'd brought when I came down with Pat back in July. You can see these flip-flops in the photo... Amidst all of this...they never stopped smiling.  We all spent time singing and playing games with them...looking into their sweet innocent eyes, and wishing we could take all of them back with us...but we know we can't (eve though Tom's bag could probably hide a few inside it - sorry, couldn't help adding that in - Pat.).  These kids range in age from 2 to 16. Among them is Jean Junior, or just Junior, whom everyone at Adventiste knows well and has been a constant source of joy to all at the hospital, with his charm, energy, and infectious smile. He's right there near the front, in red, his smile a mile wide as he dances and sings to all the songs that the kids sing at the orphanage. You'd never know his father had just passed away on a Wednesday morning in July, the last time we were here. (He passed away due to an AIDS-related opportunistic infection.) Among the games we play is Detective. It goes somehin like this ... one kid, the detective, leaves the room. The kids pick a leader who beats out a rhythm using his or her arms and/or legs ... as he or she changes the rhythm, everyone else follows suit. This can be hand clapping, fist pumping, or my favorite, the chest pounding. The detective comes back in and has to guess who the leader is. The whole time, the rhythm is punctuated by collective chants of "Changez movement!" to the beat ("Change movement!"). It's catchy, fun, and makes you forget you're surrounded by the smell of urine and the filth of the street. The kids, especially Junior, seem to love anything that involves them getting to jump around and sing, and frankly so do we. Beth, Sarah, Paige and Tom do a great job of whooping it up as leaders of Changez movement. Tom in particular brings down the house. Something about the sight of large bald bandana-covedred dome and his big blue eyes really captivate the kids. Looking at the roomful of adorable face makes you want to bring them all home with you ... Unfortunately, as big as Tom's bag is, I'm not sure how many of them we could sneak home in it! As it is, the odds are not good. Junior is the only one I know of of the whole lot of them who's been adopted. As it came time to leave, we became rejuvenated with some awesome Haitian hip-hop music. Frantz is kind of a mover and shaker and stops the tap-tap every so often to jump off at this kiosk or that to get another CD for Beth so that by the end of the trip she's amassed quite the collection of Haitian hip-hop, pop, and

boy-band stuff. This is what we needed, despite these conditions, we found joy in the day, just like these amazing people we're here to help.  You see, if you didn't know what had happened last January, and had never seen the filth, the tents,the unemployed, the homeless...you'd be awestruck at the outlook these people have.  A strong faith, and a big smile gets these Haitians through each day...take a minute, and it's easy to see. As Beth and Sarah groove with Francesca (Frantz's niece) in the back of the tap-tap, we head back to the hospital to gather our gear.  We need to decompess some, have a little bit of relaxation, reflect on what we've done, sweat a little more, and have a cold one...for Andrea this would mean an ice cold Mountain Dew.  We leave Pat at the hospital to do the hand off to the incoming orthopedic team, Andrea to complete the census, and the rest of us load the gear (why is my bag the heaviest?) and bring it to the hotel. ..

As Tom and the rest of the crew bring all of our stuff to the Auberge du Quebec (we've decided to take a break there for our last night before heading home tomorrow morning), Andrea and I go over the census with the new team from Dallas. Unfortunately, despite the week's worth of work (including three consecutive 20+ hour days), we've still left them with 7 patients in-house who still need surgery and at least that many who are out there in Carrefour with instructions to return to clinic to meet the new team on Monday who also need surgery. Fortunately, this group includes three orthopods, their own jet, and a lot of equipment. The funny thing is, no matter how hard you work, and how much you bring (and all six of us truly felt that we gave it our all and left it all out there on the field), there's always going to be that feeling of regret, that you could have done more, seen more patients, operated longer at night, stayed longer ... I suppose it's a natural feeling when you're in a country of 9 million million people, surrounded by so much need. One of the HCMC residents had asked me after our last trip, did I get the feeling that it was just spitting into a bucket and didn't I get the feeling that there's no way you could do enough? Well of course you can't do enough for everyone. Out of a country of 9 million people, did it really matter that we saw x many patients in clinic and did x many surgeries? The more appropos question to ask would be, for the people we did operate on, how much did it matter to them? And did helping them out make your trip, the preparations, your time, and the lack of sleep worthwhile? I think if you look at it that way, the answer is clearly yes. For the 44 kids at the orphanage who didn't get adopted, the weekly groups of doctors visiting them may not have made much of a difference. Junior is one kid whom if you asked him, I bet 100% he'd say yes as well.