Haiti: Orthopedic Surgical Program
Strengthening the CORE Project: March 1 – July 12, 2017
August 02, 2017
Dr. Patrick Dupont
Summary of Activities
Since our first involvement in Haiti after the devastating 2010 earthquake, Real Medicine Foundation (RMF) has focused our efforts on strengthening existing facilities that wish to offer quality services to less fortunate groups. First, we teamed up with CDTI Hospital in the post-earthquake emergency phase, and we later promoted the idea of public/private hospital consortium with a strong and organized social component. The hospital consortium project, linking 4 major private facilities, became the second healthcare project green lighted by the Interim Haiti Recovery Commission (IHRC) after the Mirebalais Hospital.
Since sufficient funding was never reached to implement the consortium, RMF chose to concentrate on establishing a flagship for this model, as we still believe that stronger involvement of the private sector, through a comprehensive and organized network of private facilities offering a socially conscious conduit for needy population groups, is essential to achieving significant improvement of Haiti’s global health care and providing greater access to secondary and tertiary care by leveraging core competencies and reinforcing the public system’s struggling structures.
Although we are not abandoning this larger vision, for the past 4 years, we have centered our activities around a specific need identified in the aftermath of the January 2010 disaster and throughout the first 2 years afterwards, where fractures and other limb trauma complications became a recurring issue. Real Medicine Foundation implemented an orthopedic surgical program to treat pediatric patients with such problems, and the program has evolved to include congenital and acquired limb deformities. We treat children and young adults from the metropolitan area of Port-au-Prince, but also from very remote provincial towns in the southern and northern departments of the country.
Thus far, in installments over a 4-year period, 60 children have received specialized elective surgery, including preoperative biological and imaging screening, as well as follow-up visits, radiographic evaluation, and wound dressings to treat their conditions. Their complete treatment from screening to final healing has been made possible at a mere fraction of what these procedures would cost, allowing these children to be rehabilitated in such a way that their own future and contribution to society can be greatly improved.
Now with the help of a dedicated surgical team; a responsible and socially conscious hospital, Centre Hospitalier Sainte Marie (CHSM), which we have recently partnered with; and the funding from LDS Charities, RMF has been able to implement a larger community outreach project, which we believe can greatly impact improved access to quality care and be a stepping stone towards a sustainable model of social involvement of the private healthcare sector for the benefit of all.
New Partner Facility
Although we believe that CDTI Hospital (our first partner facility in Haiti) should still be a major component of our envisioned hospital consortium, its involvement remains difficult due to the hospital’s current condition and funding. RMF has found and partnered with another privately-owned hospital with like-minded philosophy: Centre Hospitalier Sainte Marie (CHSM). CHSM is an already functioning hospital and a potential actor in our envisioned network. The implementation of the CORE project has started in late April 2017, with the launch of the 4th surgical program session and of the 1st educational program, while preparing for subvention of the family and emergency care components.
Planned Structure of CORE Project
Strengthening the Project
With primary funding pledged to RMF’s activities in Haiti after Hurricane Mathew’s destructive path through the southern portion of the country in 2016, we decided to capitalize on our goals as well as CHSM’s vision and care programs to implement a Community Outreach and Rehabilitation Effort (CORE) project, with 6 major components: providing long-term educational activities, improving surgical procedures, increasing access to emergency care, subsidizing treatment of at-risk/low income families, implementing fast and pre-organized disaster response, and improving regular outreach missions with mobile clinics.
The ADYS Program
The ADYS program (Ale Di Yo Sa, literally translated “Go Tell Them This”) is the result of a partnership established between RMF and the SPEC Institute, which aims to supplement the RMF-CHSM CORE project in Haiti with a community and preventive health component. During this first phase, the program will concentrate on the development of health education activities in 5 targeted communes: Carrefour, Gressier, Léogane, Petit-Goâve and Les Cayes. This component has been launched strategically at the beginning of the 2017 hurricane season to prepare for its potentially disastrous effects. This first educational program of the CORE project will be a 6-month mission in selected southern locations.
Selection of Patients
The 4th installment of the orthopedic surgical program has been launched in April 2017, and selection of the first
10 patients of the targeted 60 patients were finalized mid-June. 9 children and 1 adult are part of this first group
treated between June and July at the Centre Hospitalier Sainte Marie (CHSM). Screening of the next 10 patients is currently underway, and already 5 additional patients have been selected for surgery in August.
Medical Equipment Allocation for CHSM
Improving Care for Families
As previously mentioned in our concept note and October 2016 report, we allocated some of the funding pledged to RMF to two aspects of the emergency care component. The first has included acquisition of surgical equipment so that we will be able to adequately implement treatments that will be given to patients sponsored by Real Medicine Foundation. Specialized equipment provided includes external fixator sets and Stryker power tools to allow Centre Hospitalier Sainte Marie (CHSM) to later implement surgical treatment of the emergency and family care components of the CORE project and basic life support and acute cardiac life support equipment for CHSM’s first ambulance, to serve and benefit the subsidized families and individuals covered by RMF’s sponsorship.
In the aftermath of the January 12, 2010 earthquake, in addition to tackling some of the immediate relief needs, RMF moved forward with a comprehensive long-term strategy for sustainable health services development in Haiti to help rebuild its shattered public health system. Six years have passed since most of Haiti’s infrastructure was devastated, and while much progress has been made in rubble clearing and somewhat in rebuilding efforts, there is still much work to be done. Our new Surgical Support program is providing surgeries and follow-up treatment for children and adults in Port-au-Prince, Haiti.
- To provide free clinical services at Hôpital Lambert Santé Surgical Clinic in Pétion-Ville.
- To provide care for patients with severe conditions and deformities, while focusing on improving their overall health, functionality, and optimizing their chances to thrive as active members of their communities.
- To increase overall access to quality secondary and tertiary care for the entire Haitian population.
Click to enlarge
Diagnosis: Severe bow-legged deformity, left leg
Treatment: Surgical correction to realign lower extremity (osteotomy), long leg cast for 4 to 6 weeks following surgical procedure
Fletcher Saintil is a 9-year-old, very sweet boy. He is the third child of a family of four children and was born afflicted by a severe deformity of the lower extremities, more pronounced on his left side. Fletcher’s condition appears to be due to an illness called Blount’s disease. His parents are very modest in origin and means, and they initially sought treatment at an outpatient clinic devoted to such conditions in downtown Port-au-Prince.
St. Vincent Clinic, where Fletcher was being seen, is currently unable to provide any kind of surgical treatment for the children that they see regularly for outpatient services. Thus, Fletcher was sent home without any solution to his deformity. He was among the 20 children selected for the (2014–2015) orthopedic surgical program installment and scheduled in the second session of 10 surgeries, but he was prevented from being treated when the orthopedic surgical program ran out of funding at that time. Later in 2016, difficulties in contacting his parents prevented him once more from being selected when the second half of this program was finally completed.
This time around, thanks to funding provided by LDS Charities, Fletcher was able to be called back and screened once last time to finally find a solution to his long-standing deformity. He and his father could barely contain their joy when they got the call to come in for screening.
Now at 8 weeks post-surgery, Fletcher has regained full mobility of his knee and ankle and will start physical therapy shortly to begin using his newly corrected leg.
Medgine Olivier, 13 years old
Diagnosis: Severe bow-legged deformity from rickets, both legs
Treatment: Corrective osteotomy
Medgine is a 13-year-old girl who has been an orphan as long as she can remember. At age 2, she was lucky to be placed in an orphanage funded by a Dutch organization, where the owner of Coeurs pour Haiti (Hearts for Haiti) took her under his wing and began actively looking for funding to allow Medgine to have surgeries. When he learned about the orthopedic surgical program, he found in our services exactly what he was looking for to help this disenfranchised girl.
Medgine, who was then 12 years old, suffered from severe bow-legged deformity of both her lower limbs. The deviation, affecting the thigh and shinbones, was diagnosed as caused by rickets, a vitamin D deficiency, very easy to prevent with daily supplements, but much too often observed in rural Haiti, mostly for lack of proper health education. Her femurs and tibias are curved as a result and need to be corrected surgically to offer normal alignment and ambulation.
After the first surgery on her right side in 2016, Medgine showed very satisfactory results in realignment of her lower extremity and started physical therapy to strengthen her right thigh and leg muscles and prepare for surgery on the left side. We were able to perform this second procedure in June 2017, again with a very suitable outcome. With follow-up x-rays showing early signs of bone healing, Medgine was referred to start physical therapy to prepare for walking on her newly corrected legs.
Diagnosis: Unilateral bow-legged deformity caused by Blount’s disease
Treatment: Surgical correction to realign lower extremity (osteotomy), long leg cast following surgical procedure
Nekelida is a 9-year-old girl, the third child in a family of four children. She was born afflicted by the same type of severe lower extremity deformity as Fletcher, but only on her right side. Her parents also sought out care initially at St. Vincent Clinic in downtown Port-au-Prince, before being referred to RMF’s orthopedic surgical program when staff at St. Vincent Clinic informed the family that surgical resources were not available at the clinic.
Nekelida was among the last of the 10 children to be treated during this session, and a realignment osteotomy of her shinbone was performed with overcorrection of her deformity to prevent recurring deviation and loss of reduction and a long leg cast was applied to properly immobilize her lower extremity.
3 weeks after her surgery, Nekelida’s cast and sutures were removed, and a removable splint was applied to allow passive physical therapy until her next visit. Our young patient seemed very happy with the way her leg looks now.
Diagnosis: Recurring severe bow-legged deformity caused by Blount’s disease
Treatment: Surgical correction to realign lower extremity (osteotomy), long leg cast following surgical procedure
We met Berline back in 2012, after she was evaluated at St. Vincent Clinic following an initial surgery done at the University General Hospital in Port-au-Prince. She was afflicted by a bow-legged deformity of both lower limbs since birth and had received a corrective operation at the University General Hospital with apparently unsatisfactory results.
When we first saw Berline, who was then 8 years old, we were impressed by her resilience and her smile. She shared that her deformity was the cause of much teasing and sometimes harsh remarks from children she knew, and although sadness could be seen on her face as she was telling us about being teased, her smile was never far and came back so fast, it lit up the room.
We first tried a delayed result procedure on Berline’s legs by impairing growth on one side of her shinbone in 2013. She was supposed to be reevaluated in 2014, but despite our best efforts, when we tried to reach Berline’s mother 6 months after the surgery, we could not get in touch with her. We were finally able to reach her in 2015, 2 years after Berline’s surgery. She apologetically told us that she had been afraid of another surgery. Later, she did not come back for the follow-up visit we had scheduled with her.
We lost track of Berline again and could not reconnect with her parents before the end of 2016. It was not until June 2017 that Berline’s mother came back voluntarily to Dr. Beauvoir’s office with her now 12-year-old daughter. Berline’s left lower limb had been almost completely corrected, but the right leg showed a severely worsening condition, and as it is common with Blount’s disease, her growth cartilage had prematurely closed.
Very satisfactory results were obtained postoperatively, and Berline was discharged. She was the last of the first
10 patients treated so far through our orthopedic surgical program in 2017.