Medical Mission Trip: Facilitating Clubfoot Care In Haiti

I recently made my eighth trip to Haiti for an ongoing clubfoot project. It was my 15th medical mission trip overall. I first started going in 2002 and have been hooked every since. I love it and wish I could do it full time. I often have colleagues and friends ask about my trips so I thought I would do a brief travel log of my most recent trip.

We are in the midst of trying to establish a clubfoot foot program for Haiti run by Haitians. “Parachute medicine,” in which one parachutes in a do a bunch of surgery, is of minimal value. I will discuss this in much more detail in my next blog. Indeed, the notion of “parachute medicine” is best summarized by Kaye Wilkins, MD, the leader of our group. “We want to leave skills, not scars.”

My role with the project is Director of Education and Training. We have been working on this project for about the past five years. It is a slow process but we can see the progress and children are being cured at a very high rate without surgery. Our mission statement is “To treat and cure every clubfoot in Haiti without surgery.” We have a long way to go but we are on the correct path.

3-15: We arrived in Port-au-Prince, Haiti. In addition to Dr. Wilkins, a pediatric orthopedist who serves as the team leader and administrator, our team includes Ken Thomas, MD, an orthopedist, Idgie Garnier, MD, a pediatric orthopedist and program director from Port-au-Prince, and Giancarlo Ledsma, who is the Country Coordinator for Dominican Republic and Haiti.

3-16: We depart to visit Partners in Health (PIH), which is run by Paul Farmer, MD, in Cange, Haiti. The road was awful and without question the worst road I have ever been on for any of my medical mission trips. We did a presentation to the staff at PIH on clubfoot and the Ponseti method of treatment.

After our lectures, we saw five clubfoot patients in the clinic and some additional orthopedic patients. One patient had an osteochondroma of the femur and another patient had an equinovarus deformity patient due to cerebral palsy. Both patients were scheduled for surgery. Dr. Thomas and I performed the surgery on the latter patient. The surgery consisted of a split anterior tibial tendon transfer and a posterior tibial tendon recession. Both cases went well and without complication.

We then traveled to Tomond to visit a clinic in the more upper region of the Central Plateau. We are trying to evaluate the best location to establish the next center for the clubfoot program. This is very difficult terrain so we are trying to pick a central location to serve the Central Plateau of Haiti. We then had a four-hour drive back to Port-au-Prince over the same brutal roads.

3-17: At St. Vincent’s Hospital for Handicapped Children, we saw 37 patients, applied 55 casts and did seven tenotomies during a very busy day. Out of the entire group of patients, only two feet needed surgery. The clinic is doing a fantastic job of documentation with the Pirani scoring system and data collection.

3-18: I visited a diabetic clinic in Port-au-Prince to discuss a diabetic foot program. They were very interested and this is another project I have been attempting to get off the ground. I have put together a formal proposal and have enough contact now. I am going to try to push it forward on this trip.

Then I went to the University Hospital, which is the teaching hospital in Haiti, and met with the general surgery department to discuss this program with them. They were also very excited about it but there is concern about the hospital being a government facility and the red tape that is involved.

We then went to the Iron Market in downtown Port-au-Prince to look for souvenirs. It was a very intense and chaotic experience, and not for the faint of heart.

We had dinner with the Minster of Health to discuss our program at a very interesting restaurant in Petionville. Joining us for dinner were the secretary to the Minister, an orthopedic surgeon and a representative from the World Health Organization. It was a very productive and enjoyable evening.

3-19: At the Healing Hands clinic in Port-au-Prince, we saw five patients. One patient had clubfoot, another had a diabetic foot ulcer, and we also saw some orthopedic conditions. We had other organizational meetings to move the clubfoot program forward. In the afternoon, we traveled to Jacmel, which was a two-hour drive over winding roads through the mountains.

3-20: At the Pazapa Center, we saw seven clubfoot patients and examined a total of 12 feet. We applied five castings and performed two tenotomies. The clinic is doing a very well with the treatment program and documentation.

We then returned to Port-au-Prince. The ride was rough and winding, certainly not recommended for those prone to motion sickness. We arrived smack in the middle of Saturday evening traffic in Port-au-Prince. One has to experience this phenomenon to appreciate it. It is an amazing mass of cars and people, and makes getting from point A to point B exhausting.

We had dinner in a small mom-and-pop place on the way to our hotel. We had a very nice evening reviewing our trip and making plans for the future of the clubfoot program.

3-21: We went through the trials and tribulations of getting through the airport chaos for a long day of travel back home to family after a long week away. Overall, the trip was very successful and despite the difficulties of Haiti, it is a country I love and a people I am honored to serve. As Albert Schweitzer said, “There is no reward for the work, except the privilege of doing it.”



Patrick DeHeer DPM FACFASsays: April 21, 2009 at 10:49 am

Website: hoosierfootandankle.com
Email: padeheer@sbcglobal.net
Twitter: http://twitter.com/padeheer

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markwmorrissays: May 5, 2009 at 11:09 am

I am part of a medical mission affiliated with the Parish Twinning program.
We recently returned from the island of La Gonave where we are establishing a permanent dispensary in a remote mountain area.
I have two patients needing on-going care: a 2 year old with congenital clubfoot and a 16 year old unable to walk because of a year old hip/pelvis fracture sustained in a soccer game.
Can you help me locate treatment (and in the case of the 16 year old xray diagnostic testing) for these two children ?
We absolutely agree with your philosophy: the heart of our project is sending two young women through nursing school to staff the clinic and one young man through university in hospital administration.
Thanks, Mark Morris MD, St Petersburg, Florida and Anse-à-Galets, La Gonave, Haiti

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Patrick DeHeer DPM FACFASsays: May 7, 2009 at 11:16 pm

Hi Mark,

First my email is below to contact me directly. I would suggest Dr. Idgie Garnier at St. Vincent's in PaP. She is the only pediatric orthopedic surgeon in Haiti and we work closely with her as she is the director of the Haiti Program. I may be returning to PaP later in May for a training session and may be able to see the patients with her. Please keep in touch.

Patrick A. DeHeer, DPM

Website: hoosierfootandankle.com
Email: padeheer@sbcglobal.net
Twitter: http://twitter.com/padeheer

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lylekarimsays: May 13, 2009 at 12:23 pm

Hello Mark and Patrick,
I enjoyed this article- thank you Patrick. Mark- if you are looking for a specialist to refer patients to please check Medical Mission Exchange (www.mmex.org). MMEX is a free, online database of short- and long-term medical missions and clinics in the Dominican Republic, Haiti, Guatemala, Honduras and Belize. Our goal is to facilitate referrals of underserved patients to appropriate medical specialists. MMEX is a non-profit organization, founded by a physician in 2003.

MMEX gives doctors on medical missions a way to communicate with other doctors with scheduled visits to the same area. They can use this information to compare notes, transfer supplies or, most importantly, refer patients to one another. The MMEX website allows team leaders to make and maintain entries themselves... or we can enter the information. The more people hear about MMEX, the more effective this service will be. To this end, I ask you for assistance in spreading the word. Please help by visiting MMEX and entering your upcoming trips! MMEX also provides extensive links to medical mission and health-related issues in Haiti (here: http://mmex.org/links.aspx?Cat=All).

Sincerely,
Lyle

Lyle Karim
Medical Mission Exchange
Website: www.mmex.org
Email: lylekarim@mmex.org

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Anonymoussays: November 23, 2009 at 4:05 pm

Patrick, I concur with the sentiments of your trip because we were there at the same time as you and Dr. Tim. Our experiences were the same exhaustive but well worth the trip. We presented at the FHADIMAC Clinic and provided diabetic shoes for people with diabetes, that was our second trip to Haiti and I know the kind of work that you are doing and my wife and I will save lives. Ann and Tim Jackson, Jr. Angel Star DME, Winston-Salem, North Carolina.

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