I got about a dozen to fifteen emails today letting me know that my Tuesday notes had not been received. I want to apologize to those folks and all of you and let you know that I did not actually write anything last night as it was a very long day. Most of us finally got to bed after our long days somewhere between 12:30 and 1AM; a long day but a good one! In contrast, tonight we returned to Hotel Rey at 7PM and this was a tremendous and much welcomed improvement!! I was noodling on the past couple of days and how to approach things regarding my comments for today and I landed on rolling both days activities into one posting. Like I said, it is my blog and I make the rules. I love this cuz I can do what I want. Incidentally, I called home just before beginning to write this; I wanted to tell Susan this is what I had decided to do. I was NOT soliciting her input or advice no matter what you might think, but she did tell me she was good with the plan!
Tuesday was a busy day and though I want to put the autoclave update in later, I think it deserves discussion now. Peter McNamara, Hugh Potter, and Peter Dowell have literally been laying underneath the dang thing for the ENTIRE trip. Every once in a while they actually even try and work on the problem. (kidding here). Between them and Allorio (the Dominican Mr. Fixit guy) they have more gadgets, gauges, wire testers, tools, and gizmos than I have ever seen in my life. They test things, run new wires, re-wire, reroute and work through multitudes of challenges. They are on the phone with tech support all the time and have developed their own language around working on this thing. I originally reported to you that this was a heating element issue and we believed it to be just that. However, we have gone MILES beyond that. As it stand now after 6 full days of diagnosing and bird-dogging the only thing we are absolutely certain of is that it isn’t working. My heart goes out to Peter M who has put his heart and soul into the autoclave for 6 days and has to leave to go home tomorrow without having seen it work yet. He leaves tomorrow morning at 910AM and our best case scenario at this point is that it could be a fully operational (Star Wars reference) autoclave on Friday, the day after we finish up. While it would have been nice (and a lot less time consuming) if it were working for our week, it would be ok now if we could just see it work one time, even if that was on Friday after we finish up! It is a terrible shame to have the challenges we have been experienceing with a fix so close at hand. I am just hopeful now that the normal employees of Juan Bosh are able to use the autoclave to help improve the quality of the care they are delivering. Sterilization and instrumentation issues continue to slow us down. It would be great to fix this once and for all. I did have a discussion with Dr. Taveres today about potentially looking into some type of mobile autoclave similar to what the military might use in a mobile hospital. All options are being considered. Shannon Coupens and I would probably give away almost anything at this point to open a pan that a) has a turned indicator, b) has all of the instruments in it that are supposed to be there, and having an autoclave that is capable of turning over large quantities of instrumentation in a fairly quick timeframe. It does not feel like this is too much to ask for when doing such good work for people who are really benefitting from it.
As an aside, as I sit here and type this out somewhere in my room there is a frog that is croaking, a bullfrog of some sort that is doing that deep huimmmm huimmmm croak. I am not that unhappy about this though as the croaking is a bit less annoying than the disco right underneath my room at Hotel Rey. The sub-woofer pumping out the bass that in turn is vibrating and walking my bed across the floor is no match for the frog, at least the frog is a natural sound even though I am not sure I can get to sleep without knowing where the critter is so I can throw up some anti-frog protection essential oil or something…
Tuesday was a big OR day with 10 knees and 5 hips on the books, followed by 9 knees, 4 primary hips, and 2 hip revisions today. This gives us 45 cases for the week which is amazing! We have 14 on the books for tomorrow which will put us at 59 joints in 4 days in conditions that this type of volume is a challenge. But when you stop and think about nearly 60 joints, 60 people who are in dire need of these operations, the trickle-down effect is logarithmic and quality of life improves in ways we cannot imagine. The logistics involved in getting all of the needed supplies down here to do this is simply amazing! I counted today just for fun (and cuz I am sort of slightly OCD and more than a little weird) and excluding the actual instruments there were 36 different boxes of supplies that had to be picked and 76 different types of sterile supplies on the field. Incredible really. What is even more amazing is the (short) story of one of our hip patients.
This picture is of one of our patients who was ok with his picture but not his name being posted. What he said was “I have waited 33 years for this operation, it is a miracle”. I would like to point out that he said this SHORTLY AFTER his surgery to our Physical Therapist Natalie Reed, LPT. In general patients take a while to get over the effects of anesthesia, they aren’t comfortable, have some pain etc. I think it is easy to see that this gentlemen is not in pain (he is smiling) and that he feels like the ‘miracle’ of having a hip replacement is something he has needed for a really long time just happened to him and his family cuz of us and you Walkers! Hats off to all of you good folks and our team down here and at home! Job well done!
The aforementioned Dr. Taveres let me in on some plantanos lore today. I have described to you before the plantain dish called Mangoo which is basically mashed up plantains with olive oil and vinegar. The funny part is that the name Mangoo actually comes from the fact that the first American to try the dish tasted it and said “man, this is good” and with the language barrier issue(s) it was repeated as Mangoo. I was curious about this so I researched it this afternoon. What I found was that the first American person actually to try it spit it out and had MY reaction to the awful little green slimy buggers but that the plantanos lobbyists lobbied really hard against the name Mancrap! Speaking of food, today’s lunch offered by Ramona was some steamed Mangoo with a garden salad. So let me get this straight. My lunch option after hours and hours of running as fast as I can and sweating myself to near death due to dehydration was some goo and salad washed in sketchy water? Pass. While this may seem like a step up from the Mangoo and chicken skin soup we got last year, just the thought of eating a salad here sends me running for the powder room. Having an “I ate the freshly washed vegetables GI challenge is definitely a huge mistake and you’re asking for trouble ! Thankfully Wednesday is always peanut M&M day and this year I brought down 11 pounds of peanut M&M’s split into ¼ cup baggies by my Uncle who is visiting us. For those with inquiring minds, a ¼ cup of your standard size peanut M&M is about 19-23 M’s depending on M size. These little guys go a long way to cheering up everyone on Wednesday when energy levels seem to decline and though they take up precious weight in the luggage headed down, they have a near magical effect on our volunteers here. I must admit I ate two baggies…
We begin the process of packing up tomorrow while still trying to get our 14 cases done. Like always our team will begin to head off to the beach or back home (wherever that is). But there is a lot of work to be done. Thank you all again for what you do for us, it is truly inspiring. As always, thank you for the emails, my apologies for not answering them, maybe I will next week. I truly appreciate the kind works and the encouragement from all of you.
It is now almost 2AM with a 6AM wake up call. After 4 hours of sleep the last 2 nights I, like most of us, am getting pooped (and that isn’t even a plantain pun)! Before I go, I want to say thanks to all of you who have someone you love and miss over here. Their (and your) sacrifice awes me. Their (and your) service inspires me. Thank you to them and thank you to you!
It’s off to bed for me, but first, gotta go find that dang frog…
This Years Operation Walk Freedom to Move team
The team gathered for a quick shot in front of the Juan Bosch Hospital. We will be preforming 50+ cases over the week. They range from hip to knee replacements. And an unusual hip revision will provide a learning opportunity where Dr. Duwelius will teach the residents (Doctors in training) a new Technic they will be able to preform long after we leave.
The Autoclave Saga Continues
After replacing parts, rewiring electrical, and working with the rep in New York Peter M was still unable to get the autoclave fully functional. Peter returns to Portland today but will continue to work the problem out and come up with a solution remotely. It is really close to functioning now and we believe its down to a matter of rewiring so we will keep you posted.
Enjoy some pictures from yesterday
Well hello Walkers! I hope you are all having as great a day as we did! Today was a fantastic day, one that none of us here will soon forget.
Our bus rolled away from Hotel Rey today at 630am, right on time. Felipe who is notoriously late but is so nice and such a great guy that no one even says anything to him was even on time. Felipe is Chilean, a med student at Harvard, and a mainstay on our team. He is one of our interpreters; a loveable guy who has the thickest hair of anyone I have ever met. So imagine if you will because Felipe is notoriously late, that I have seen the most amazing bedhead hair-dos in the world when down in the DR! This morning Felipe’s hair resembled a 1947 Studebaker Wagonaire Station Wagon pulling into a station to get some fuel. The thing is, that nowadays people pay a lot of money to make their hair look like they just woke up but Felipe just comes by this naturally. He must save a ton of money! Actually I am very jealous that he can do this, as most of you know there isn’t an awful lot up there for me to work with.
And speaking of 1947, our WWII era autoclaves ruled the day today, or perhaps more aptly put would be to say they made our lives miserable today. We began well with everyone getting first cases underway and things looking good. After successfully going through our first cases, we were getting things set up for our second cases. When we began popping open the instrument trays, one after the other after the other after the other etc. ad nauseam showed indicators that had not turned meaning that we could not be sure the instruments were sterile. For us what this means is that they simply cannot be used and we must start all over again. If we were at home in the US it would be a fairly simple solution of going to get new supplies and keeping our days moving. Here in the DR with our limited supplies and resources it means that we have to take the set that just had a bad run and re-wrap and re-sterilize it and hope for the best, which is about a 60 minute delay. Add on top of that, that EVERY room had the same problem and we were in an impossible situation. After our first re-run also failedwe got our best minds together and came up with a way to solve the problem. We changed the wrappers on our trays, made some weight modifications, and did some other mumbo jumbo. This solved the problem so that we are fairly confident that we won’t have bad runs but it also adds an extra 45-75 minutes of turnover/sterilization time to EACH and EVERY surgery. Needless to say, about 2/3 of the team left the hospital after 730PM tonight and 1/3 of us left at about 930PM so we have had pretty long days.
So why, you may be asking, did I start out this note to you all by saying today was a fantastic day that we will not soon forget? Well, cuz we did 15 joint replacements on people who really needed them, that’s why! We did 11 knee replacements, 3 primary hips and 1 hip revision. I was in a great position to see all of these patients today and they were all beaming and smiling, eager to have their surgery, even powering through our unfortunate delays. These folks know that because of you Walkers and because of our OWFTM team (those of you at home and those of us here now) they are getting a chance to thrive once again, a chance to re-enter a life that has somehow passed them by and left them lonely on the side of the road. They see others they want to keep up with, jobs they want to do, kids they want to play with, spouses they want to do life with and yet it is just somehow always a pinch out of reach, just beyond their fingertips…
Take Senora Flora for example. She has given me permission to tell you a little bit about her and to show you her picture. This is her in the recovery room:
Today Senora Flora was one of our very last patients to be done. She had been in Juan Bosh hospital since yesterday evening, waiting. Waiting and not eating. Most of you have been NPO before where you cannot eat or drink before some type of procedure. Well, there we were being delayed time and again by our crummy autoclaves. And there was this wonderful woman who wanted to get back to doing what she does which is much the same as any of us would want. She just wanted to re-engage with her family, she has been slowed dramatically by a horrible painful arthritic knee. Since we were running far behind, many of our residents were gone for the day and instead of a resident doing it, I was holding Senora Flora while Dr. Broad administered her spinal anesthesia for the surgery. But instead of me holding her, Senora Flora kept hugging me, tighter and tighter and telling me how happy she was that we were doing her surgery so that she could get back to her life. Later, after a successful surgery I saw her again and through one of our interpreters she asked me thank everyone who was responsible for her being able to get back to life, to catch up to some grandkids, to finally get back to things that are meaningful to her.
What is amazing is that that hug was given to me at about 630PM. I had been there for almost 12 hours, I had literally been running from one task to the next, I had not eaten breakfast or lunch (Ramona was not happy with me at all) I was hot and thirsty and had been problem solving non-stop for what felt like was a week! That one hug reminded me why I was there, why you all support what we do and enable us to continue to keep doing it, and it filled me with enough energy to make it through the day and write you a note at what is now closing in on 1AM here in the DR! Her gratitude and thankfulness were sincerely heartfelt and her appreciation for all of you and what you do is, well, she just wanted me to say thank you to each and every one of you…
Cadillac Autoclave update #2
Peter M as described before is an amazing man! He spent the ENTIRE day today working on the autoclave. This is a highly complex machine and like the proverbial onion has many layers. Each problem that is fixed causes something else downstream of it to malfunction once it is tasked to work again after many years of collecting dust. Peter is very confident that he (along with Hugh, Peter Dowell, and Allorio one of our host’s engineers) is almost finished with the chore of getting it up and running. When we do, days like today will be distant memories and bad autoclave runs will be a thing of the past, and the only run we will get is from those pesky plantains!
Plantain Health Facts:
Ok, this is directly from a reputable, scientific, peer-reviewed, food research organization. And they say it “seems” to be safe when taken by mouth by “most”adults. Um, what? Does this make any sense to anyone? “Seems” is not very reassuring or definite. “Most” is also sorta ambiguous, right? And seriously? It can cause diarrhea AND constipation in addition to high AND low blood pressure? Does that mean the same person is conflicted all in the same gastrointestinal distress period? I could get diarrhea and be constipated all at the same time? This is the most ridiculous thing I have ever read and I haven’t even gotten to the part where the disgusting bananawannabe can affect my blood pressure up or down seemingly also at the same time. And if it unsafe to apply to my skin, what about my insides? With all of this in mind, I have a much better idea: why not just eat a banana instead? Or even a Styrofoam container? Even that has more flavor than a plantain…
DR 2019 Sunday January 13
Dear Friends of Operation Walk Freedom to Move (OWFTM),
Hello dear people, so good to write to you all again! The beginning of our trip has been spectacular; no flights were delayed, all of our implants made it, and we have had none of the early trouble that plagued us last year! After last years’ challenging start to our mission, those of us on our governing Board made a decision to have our volunteers only fly through southern and warm weather cities. This decision was very wise as there were some weather related travel challenges in the US this past weekend but not for our team! We all made it just fine!
I have decided to call all the Friends of Operation Walk Freedom to Move, ‘Walkers’ cuz it’s way faster for me to type ‘Walkers’ than Friends of Operation Walk Freedom to Move. And since this is my blog, I get to make the rules! This is particularly exciting to me since I am a normal married guy and there is very little in life that I get to make the rules about! By the way, honey if you think this is not a good idea, just let me know and I can change it back…
We have had a very busy few days getting prepped for our week of surgery. I traveled down here with one of my favoritist people in the entire world, Danielle Simmons. Danielle is my niece and has just started going to college and has dreams of becoming an orthopedic surgeon! We arrived at the ILAC Mission at about 4:30AM Friday and our clinic began at 8AM. So after a couple hours of sleep and some awesome Dominican coffee we were beginning our time here of helping all of the people that you Walkers so wonderfully support!
Friday was our ILAC clinic day and we saw nearly double our normal amount of patients and practically filled our schedule! I think the word of our presence in January is spreading! Saturday was our clinic day at our hospital Juan Bosch and we we had a fully booked OR schedule by 10AM and began adding patients to our standby list!
While our docs were seeing patients other things were occurring:
Danielle, Shannon, Natalie and I were in the Mission warehouse beginning our task of pulling together all of the stuff we had left over from last year, searching out numerous Pat Williams hidey holes where each year I stash our most treasured items, and also locating and beginning to catalogue all of the supplies we ordered and shipped for the trip this year. This is an all-day affair, one that is dirty, sweaty, smelly, tiring, taxing, and can be quite back-breaking. Excellent news about Danielle being here to lift all the heavy boxes!
Meanwhile, Peter McNamara, Peter Dowell, and Hugh Potter were over at Juan Bosch working on that Cadillac autoclave that you Walkers so generously donated money for repairs for. I am not sure of all of the Dominican swear words yet after having been here for 10 years in a row, but I did hear a few new ‘blue words’ that I had never heard before. Believe it or not, most Dominican swear words use some derivative of plantanos which is Dominican for plantains. Hmm, NEVER woulda guessed that! A whole new language of swear words many of which involve the contemptable plantain somehow? It’s sorta like someone pitched me a softball. So easy to hit out of the park! Plantains aside (for now) my autoclave update for today is this. Peter McNamara is the engineer that volunteered to come down here and repair the autoclave. The repair will save us NUMEROUS bad runs in the World War II era machines we currently use (which we have to rerun costing us hours and hours). Bad runs mean delayed surgeries, frazzled nerves, and large portions of our volunteer staff ending their day at 9PM or later, even as late as midnight on one or two occasions. So the plantanos words weren’t good news as you might imagine. One repair lead to another problem, another repair, another problem and so on. Peter is a magician and even spent time filing down the edge of some nuts to make the tools that he had access to, work. Can you imagine? Getting a file and filing metal away to make your socket wrench work? I would just try and hit it with a big hammer and if that didn’t work I’d go get a bigger hammer and keep repeating that process until I broke forever the thing I was trying to fix! (See why I don’t get to make many decisions around home?) As we sit right this very second, the autoclave is partially working. There are two circuit boards that need to function; one is, one isn’t. Peter M feels very confident that we will be using the caddy autoclave before long, please keep your fingers crossed. This would be a HUGE improvement for us, a complete game changer for so many reasons!!! I will provide an update to you when I can. For now we have electricity flowing through the autoclave and we are getting steam pressure into it. That hasn’t happened for over 8 years! Progress!!!!!
So many old friends here! I am excited to see many of our team that I have not seen for 51 weeks! Life changes and our paths diverge where once they were parallel. But for this week each year the divergence takes yet another turn and here we are yet again taking care of these good people together, here in the DR! As always our docs, OR teams, and of our volunteers are set and staged to change lives of patients and their families forever! Thanks to all of you Walkers and your generosity that continues year after year we get to keep doing this! Drs. Paul Duwelius and Mike Vessely are joined this year on our Portland team by Dr. Carlos Lavernia from Miami. Dr. Lavernia is a Cuban national who has at least one Fellow who lives and practices here in the DR. We are very excited to have him this year and with our 5th room (2 being filled with our St. Louis docs, Drs. Tessier and Powell) we are shooting for our normal 50-60 joint replacements. We have some really challenging cases this year which I will fill in more for you as we go. As an aside, we saw a 15 year-old girl yesterday who has sickle cell anemia and has a horrible hip! She is WAY too young for this operation and though we want to help her we just cannot. Please pray for her to have some level of pain relief as she goes through life. We did agree to see her each year and may do her in time to come but she is looking at a decade or more of challenge before she is anywhere close to being a candidate for a total hip, but I digress. My old friends returning are:
Paul Duwelius, MD Mike Vessely, MD Shannon Coupens
Madeline Vessely Laia Alonso Felipe Flores
Alisa Labatto Tim Kirby Annette Gorreman-Kirby
Peter Dowell Andrea Weber Juan Rangel
Debbie Larson Natalie Reed Carolyn Swanson
Hugh Potter Connor Schwab Vafa Talebi
Brent Graham, MD
We have many new faces this year as well! I am personally very happy for Dr. Duwelius who has the distinct pleasure this year of having his daughter Maggie as part of our group. Each year at our Sunday night dinner we each stand up and say a couple words about ourselves. When Maggie’s turn came around she mentioned that obviously she has “lived around her dad a long time but he has never had a chance seen him in a professional setting”. So nice that she is going to be able to see dad changing lives here, making a difference. On the other hand, several of our group joked that though we have WORKED with Dr. Duwelius a long time we haven’t ever seen him acting professionally either! Just kidding Pablo, we love you dude!
We have other new faces as well:
Josh Valdez, ST Maggie Duwelius Donnie McMahon
Sharon Carver, RN Carlos Lavernia, MD Danielle Simmons
Maria Kirby Elaine Broad, MD
Today was spent at the hospital in preparation of our big day tomorrow. We have 4 hips and 11 knees on the schedule! It is a great way to start. I feel very confident this year. Thanks to the effort of a ton of folks I feel like our OR is more prepared than ever, more organized than ever, and we are set to do more good than ever.
And speaking of great ways to start, we all got to see Ramona again yesterday as well. She hasn’t changed at all, she is so nice, so motherly to all of us! She is still here cooking and smiling, and doing her best to take care of us while we are here! I have a new secret weapon when it comes to me not eating the gelatinous tasteless goo that some call mangoo (mashed plantain with olive oil) and some call wallpaper paste (mashed plantain with olive oil). The new secret weapon is Danielle. My day one plan was to use Danielle on Ramona showing her what a brilliant and lovable person Danielle is. Worked like a charm! Ramona decided to take Danielle under her wing and ‘put some meat on her’ while she is here in the DR. Ramona took my cold, soaked with condensation, nasty, soggy, unnaturally heavy, stinky, just above room temperature, Styrofoam container of goo and give it Danielle. I got a delicious piece of char-grilled sea bass in a truffle saffron chimet sauce for lunch, Danielle got wallpaper paste! This is gonna be great!