A team from Sinai Hospital's Rubin Institute for Advanced Orthopedics arrived in the Dominican Republic (DR) on January 21, 2010, to work at the CURE International Hospital in Santo Domingo. Team members included Dr. Shawn Standard, a pediatric orthopedic surgeon, and Dr. Marie Gdalevitch, an orthopedic fellow. Dr. James Pepple, a pediatric anesthesiologist, joined the other Sinai doctors on January 23. Since 2008, Dr. Standard and Dr. Pepple have gone on medical mission trips to the CURE International Hospital in the Dominican Republic on an annual basis.
This year's medical mission was drastically changed when the massive earthquake occurred in Haiti one week before the scheduled mission trip. Dr. Scott Nelson, former Medical Director of CURE International Hospital, organized a local team and traveled to Haiti the day after the earthquake, setting up one of the first functional hospitals in Port-au-Prince. Dr. Nelson and CURE International asked Dr. Standard and the Sinai team to travel to Santo Domingo earlier than they initially planned to help during Dr. Nelson's absence. Many Dominican children with severe deformities at the CURE International Hospital had been waiting a year to receive treatment from the Sinai team. With the influx of Haitian patients and the previously scheduled Dominican children, a medical crisis was forming.
Dominican children (from left to right) awaiting surgery who have bilateral radial clubhand,
dislocation of the hip, a severe extension deformity of the knee, and a deformity
of the lower leg (tibial deformity).
On the day of Dr. Standard's and Dr. Gdalevitch's arrival, Haitian patients began to arrive on the doorstep of the CURE International Hospital. The patients were brought by family members evacuating Port-au-Prince or by international medical volunteers looking for any possible medical care. The first patient was a 22-year-old student named Benajine who was the lone survivor of a school that had 85 students. She survived by crawling out through a window after the building collapsed. She suffered traumatic amputations of her right hand and was developing a severe infection. She also had pelvic fractures and a severe fracture dislocation of her right foot. Benajine underwent several surgical procedures during the next week to treat her infection, which successfully saved her hand.
On the following day (January 22), three Haitians underwent surgical treatment for upper leg fractures (fractures of the femur) that occurred during the quake. With the Sinai team's assistance, the Haitian refugees underwent these urgent surgeries and the Dominican children also received surgical treatment for previously scheduled complex deformity correction. During the first three days of the mission, the Sinai team performed ten operations to help both Haitian refugees and Dominican children. Each operation lasted from one to three hours.
Dr. Standard with Dominican doctors treating a 14-year-old Haitian orphan's
upper leg fracture (left) and an X-ray of this patient's upper leg fracture (right).
Pictures before and after surgery of a Dominican child with an angular deformity of the
lower leg (pseudoarthrosis of the tibia). The Sinai team corrected the deformity
during a four-hour surgery.
Picture (left) and X-ray (right) of a young Dominican girl
after a six-hour surgical correction of a congenital hip dislocation.
On Sunday and Monday (January 24 and 25), the CURE International Hospital was closed because it was a national holiday. With the help of a local orthopedic surgeon, Dr. Standard found a public hospital in San Juan, DR, that was inundated with Haitian refugees. The Sinai team boarded a public bus with their operating room equipment at 5:30 AM on January 24 for the four-hour ride towards the Haitian border. Although the San Juan hospital appeared to be a good structure, it was very primitive and was overwhelmed by forty Haitian refugees. When the Sinai team visited the pediatric ward, they found appalling conditions. The bandages of multiple children with significant injuries had never been changed after the initial treatment. The Sinai team spent the first two hours with a local orthopedist examining all the patients to determine who was in need of the most urgent care and to set up an operating room schedule. Dr. Gdalevitch became the team translator with her French and Spanish linguistic abilities.
Dr. Standard, Dr. Pepple and Dr. Gdalevitch arrive at the San Juan, DR, public hospital (left). The Sinai
team rounds on the crowded wards to examine Haitian refugees (center). Dr. Standard examines
children in the pediatric ward to plan the operating room schedule (right).
The first case that needed to be on the operating room schedule became obvious when the team met Gustov and his mother. Gustov, a seven-year-old boy, sustained a severe soft tissue (e.g., muscle, skin) injury and the broken bone penetrated the skin of his lower leg. The initial treatment, performed a week earlier, was minimal at best, and the child was becoming very ill because of the deep infection in his lower leg.
After taking Gustov to the operating room with the intention of trying to save his lower leg, his condition deteriorated. After anesthesia was given, the soiled dressings were removed and a horrendous wound and infection were discovered. At that time, Dr. Standard and Dr. Pepple agreed that an immediate amputation was needed to save Gustov's life. Dr. Standard and Dr. Gdalevitch amputated the infected leg and spent 2 hours reconstructing the soft tissues so that Gustov could have a below-the-knee amputation instead of an amputation through the knee. An amputation through the knee would have made it more difficult for him to have a prosthetic limb in the future.
Seven-year-old Haitian boy named Gustov with severe infection
of the lower leg lies in the pediatric ward of the public hospital (left).
Dr. Pepple places regional block for surgical anesthesia (right).
Dr. Standard and Dr. Gdalevitch had to perform a lower leg
amputation to save Gustov's life.
After completing Gustov's surgery, the Sinai team performed three additional surgical procedures: they removed dead tissue and washed the wounds of two children and they performed a surgery to preserve the leg of a 19-year-old girl with severe fractures and crush syndrome of the lower leg.
The rest of the evening was spent visiting patients, changing dressings, giving the local staff advice on treatment, and arranging transfer for seven children back to Santo Domingo for additional treatment at the CURE International Hospital. However, attempting to move Haitian patients in the Dominican Republic became a political maelstrom with multiple calls to regional and national medical directors. Finally, ambulance transport was arranged for the first group of children, which included Gustov, for further care. In the morning, the political barriers appeared again and the transport of the patients was in jeopardy. Fortunately, a Haitian regional medical director arrived at the hospital to transport the Haitian patients back to functional and better equipped hospitals in Haiti.
The Sinai team returned to Santo Domingo, DR, on Monday evening (January 25) to plan for the week's surgical cases and to examine patients who were in the surgical ward. Several patients had been admitted for upcoming surgical correction, and the patients who had surgery the previous week were still recovering.
Dr. Standard and Dr. Ted Beemer (new Medical Director of the CURE International Hospital) examine
a patient before surgery (left). The pediatric ward begins to fill as the week progresses (middle).
Dr. Nelson (previous Medical Director of the CURE International Hospital) writes postoperative orders
after seeing patients in the pediatric ward (right).
During the next week at the CURE International Hospital, the Sinai team performed twenty complex reconstructive surgeries for both Dominican children and Haitian refugees.
Complex lower limb reconstruction surgery was performed to straighten
the leg of a young Dominican girl (left with new teddy bear).
Dr. Standard and Dr. Gdalevitch perform complex reconstruction and apply an external
fixation device to correct the severe leg deformity of a young Dominican boy. This deformity resulted
from a previous injury to the growth plate.
A thank you note (left) from a patient, Alianna, and mother to Dr. Standard after he
performed an operation to correct the congenital dislocation of Alianna's hip joint (X-ray on right).
Several months from now, the region will still need orthopedic surgeons who can treat bone infections, broken bones that failed to heal and broken bones that healed incorrectly. Drs. Standard and Herzenberg are planning return trips to both the Dominican Republic and Haiti this summer. The new director of the CURE International Hospital, Dr. Beemer, is depending on Drs. Standard and Herzenberg to provide ongoing support for pediatric limb deformity conditions.
This mission trip was funded in part by the Save-A-Limb Fund, a program of Sinai Hospital, a 501(c)(3) non-profit organization. The Save-A-Limb Fund fights to save limbs from amputation and to provide hip and knee replacements to patients in need both domestically and abroad.
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Sinai Hospital of Baltimore's orthopedic physicians choose to spend their free time going to foreign countries to treat people who would otherwise not have proper medical care. Haiti is only one of the places they travel to with their missions of help and hope.
Dr. James Pepple, Dr. Shawn Standard, and Dr. Scott Nelson (former Medical Director and Orthopedic Surgeon of CURE International Hospital) in 2008.
Dr. Marie Gdalevitch with a young Dominican girl in the pediatric ward of the CURE International Hospital in 2010.
X-ray of Benajine's hand with traumatic amputations of the fingers.
Dr. Gdalevitch and Dr. Standard stabilize a 19-year-old girl's fractured leg using the only power drill (Bosch hardware drill) available in the ill- equipped operating room.
Dr. Pepple, the Haitian Medical Director, and Dr. Standard arrange transport of the Haitian refugees.
Dr. Standard operates on a Dominican child at the CURE International Hospital.
Dr. Standard with a Haitian girl after she underwent surgery to clean and stabilize the foot injury she sustained during the earthquake.
Dr. Standard operates on a Haitian refugee at the CURE International Hospital.
A young Dominican boy gives Dr. Standard a thumbs-up in the clinic.
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