Here is just a little sampling of few of the more memorable surgical cases we have encountered in Haiti. Change the channel if you’ve not got the stomach for the world of surgery.
GOITER
Goiters are endemic in Haiti due to general iodine deficiency. Most patients referred for surgery have massive goiters causing symptoms. The problem with surgery for goiter in Haiti, particularly with poor patients in rural areas, is that you must preserve enough of the thyroid to maintain normal thyroid function. It is unlikely that these patients would have access to thyroid replacement medication which would be necessary for their lifetime if the entire thyroid were removed. Careful judgement is required also because we don’t have access to pre-operative thyroid function tests – you have to rely on basic clinical assessments.
Intraoperative photo removing a large goiter from one thyroid lobe.
CLEFTS
Cleft lips and/or palates are not uncommon in Haiti. People with cleft lips or other visible deformities are often ostracized by society.
A large neglected cleft lip in 16 year old girl.
Here she is on post-op day 2.
A very pretty 6 year old with large cleft and difficult pre-maxillary protrusion.
Here she is all-dressed up on post-op day 2 ready for discharge home.
A youngster with a palatal fistula.
Same child with fistula closed on post-operative day 3.
KELOID
Keloids are very commonly seen. Unfortunately, large ones have a fairly high rate of recurrence because of the inability for close post-operative care and steroid therapy.
FIXIEN ST FLEUR
One of the team favorites. A handsome young boy with a large benign growth of the maxilla – ostracized from society because of the visible deformity of his mouth and not attending school.
Here he is at the time of his first evaluation in 1999. At that time a small biopsy was taken and brought back to the US for pathologic examination.
On our return trip the following year the young boy’s maxillary tumor was removed.
Here he is immediately post-operatively.
And here he is the next day with his discharge presents and the beginnings of a smile.
The trip was cancelled in 2001 due to 9/11, but on our return trip in 2002, the young man returned to say hello.
ITZAAK
Another memorable patient, Itzaak. A woman in her mid-50’s with a massive parotid tumor obstructing her airway as it crossed through the soft palate to the opposit side of her throat.
Her operation was one that team members will always remember. In all the trips taken thus far, she’s the only one who required blood transfusion. We had to purchase 2 units of whole blood from a blood bank in Port-au-Prince. The patients family travelled to retrieve the blood and brought it back to the hospital the next day in a cooler on ice.
Here is Itzaak one year later with Gary and Jean Marie. She had some mid- and upper-facial paresis prior to surgery which is more apparent post-operatively but she is happy to be alive and came by to say hello.
HERNIA
Here is Dr John Walz about to remove the largest hernia I have ever seen. But then I’m just an ear, nose, and throat doc.
ESOPHAGEAL FOREIGN BODY
Another memorable case from 2005. A 5 year old boy with a coin lodged in his esophagus for the past 5 months. A previous attempt to remove it by a gastroenterologist failed. Here are pics of successful removal with rigid endoscopy. The child was discharged home 2 days later eating normally.
BURNS
Unfortunately burns are also frequently seen during our visits. Here Dr Brown our plastic surgeon is doing a dressing change on a young boy with a severe upper-extremity burn.
PROSTATES AND HYDROCOELES
Year in year out, the highest volume surgeon is Dr Pope our urologist whose schedule is filled with massive hydrocoeles and prostate surgery. Here he is with a Haitian co-surgeon doing an open prostatectomy.
TRAUMA
While we are in Haiti, the emergency room of Hopital St. Croix will on occasion require assistance.
Here is a gentleman with a gun shot wound to his neck, about to undergo surgical exploration.
Here is a gentleman involved in a motorcycle accident with a maxillary fracture. As there was no plating system available, his fracture was repaired with dental wire.
Just a sampling of the many cases done over the years. In 2005 during a 4 1/2 day stay, there were 56 operative procedures performed by 4 surgeons.