GI lab

Guest Discussion
1

Earthquake and pestilence- disasters lead to boom times in Haiti. NGOs are sprouting faster than furniture factories in Szechuan province.

St Damien’s is not immune to this. Aid levels are high, and missionaries, with neither stock portfolios nor big landholdings, do not recall the tech boom or the real estate boom. The subsequent crashes were of vague interest to them- nothing personal.

So edifice complexes are inevitable. But aid levels are already dropping, so to me, their plans seem too ambitious already. Nobody trusts the government, and there are tsunamis with fallout in Japan, tornadoes in Tuscaloosa, and Missouri’s drowning. Haiti is yesterday’s news.

So the challenge is to do something discrete, something sustainable, and cheap.

When your only tool is a hammer…let’s build a GI lab.

First, fill the hangar with stuff begged, borrowed and bought cheap:

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Then the plane:

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If you pack your passport on the bottom, skip over Exuma, and go straight to Port au Prince.

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The clouds are thicker over Haiti, it’s heating up.

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Unload, and keep the reagents on ice if you can- but it’s a long way from Miami.

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Resume tent life, and deploy Nancy K’s handsans. Ron Council sent DEET, and I used it like I liked it! Haitian mosquitos are innumerable.

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Meet the elegant Dr Maria Gambirasio, AIDs specialist from Bergamo,

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and look over the pleural effusion and cavitary TB in the AIDS guy.

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Work the cholera wards til we can negotiate space for the lab,

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Stumble across a portable sonography machine…I have got to get me one of these! Remarkable utility.

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Finagle a whole container, with Knollenberg quality arctic air.

Of course, Haiti is rich in containers, but the air! I was feeling the love.

Notice the near wall of the container makes the wall of the hospital ward.

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A little long and skinny- like me in 1975. Reminded me of my first real office, after a trial period in the old beauty shop, with its barber chair bolt holes in the floor- an opthalmologist’s eye chart exam room, 6X40 ft- what an echo chamber that was.

Fill it:

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And get busy.

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Discover awful gastric cancers we can’t do much with,

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And several ulcers and some colitis we can.

Return to the cholera wards where there are some really sick ones:

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And get back home through the magnificent Exumas,

managing to miss the entire Bahamas COPA crew:

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But not all the weather:

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It was a pretty productive run.

2

Richard,

I cannot say how much your service touches my and my family’s hearts!

Thank you so much!

3

Thank you (again) for posting this.

If I did 10% of what you did, I would burst with pride. Or cry my eyes out. I’m not sure which.

4

Wonderful trip and mission, but the obvious question is, “What the hell is your airplane doing in the middle of that mess?” Based on the scale of the Class B airspace on the screen it looks like there is only 5-7 miles between a hook tail of red and a cell filled with magenta. That doesn’t look like any place a small airplane or a 737 should be. Just because you are flying back from a mission of mercy does not protect you from dangerous weather. Please be careful so you can make more trips to Haiti.

5

Unless that weather is convective, moderate rain never hurt anyone. you cannot determine on the basis of an XM weather signature alone whether an area of precipitation is flyable safely or not. Other factors need to be taken into consideration. The good doctor is also an instructor and I am sure used his wisdom in the process of flying through this!

6

Richard,
None aviation related. But how do you like the portable sonography machine? We are using them at our forward operating bases in Afghanistan and Iraq. We are using them instead of portable x-ray machines. So far we are detecting; fractures, internal injures, etc… we love them… They are pretty durable, as we’ve brought several on the objective, that way we can use them at the point of injury if required.

7

Mike:

That’s a fair question- I was just checking to see if anybody was paying attention.

It was an ugly XM, but not convective. I poked my nose in at the Southern end of it, prepared to turn about, and it was rainy but smooth. And from the photo, I turned North then West for a smooth ride home.

8

I had a little experience with 2D ultrasound- the radiology reports contain static images, and the snapshot pictures are so open to interpretation that I just had to trust the radiologist.

But this little handheld lets you sweep the abdomen and pelvis, and the rolling picture immediately becomes 3D, and so much easier to interpret. We found gallstones, ovarian and cervical cancers, a couple pregnancies (Congratulations! You’re not just vomiting from cholera!), complete with corpus luteum cyst- you could tell which ovary produced the egg that’d been fertilized. We saw a nodular liver and ascites in a cirrhotic. And we could see the pancreas better than I ever could before. I could outline the spleen easily, and with a little instruction, I bet I could pick out a splenic rupture. In the gastric cancer patient, I could see celiac nodes. It can be scaled for a cardiac echo- I tried it, but for me, that’ll require more training.

I didn’t use it on bones. What do you look for?

I was really excited about it.

I think you’re on to something in a military use- so portable, rechargeable, and I think the sweep is so clear, it could be taught pretty quickly.

I really want to get one, if they aren’t too expensive. I’d carry it in a workbag, and scan bellies as a routine part of a GI physical exam.

9

Rich,

What make/model portable ?

Thanks

10

Richard,
Here is a link for you to read more about it.

While I like 3rd Group and will not steal their thunder, Drew Landers, mentioned in the Article deserves all the credit! When Drew was the Surgeon and I was the Chief Medical Operations Officer for Combined Joint Special Operations Task Force-Afghanistan we provided medical assistance to over 150,000 local nationals in 9 months. It was an amazing deployment for our team. We had just over 100 medical providers for the rotation. We evacuated several Afghan children to the US, Germany, England, Spain and Italy for definitive care. It was amazing what we seen over there… As I’m sure it is for you in Haiti…

Also, note that the $40K price tag includes training. But that was the governments price… so you could probably buy it off the self for about $4K :slight_smile:

11

Marty:

I amashamed I didn’t write it down, and I’m having a hard time focussing on the name as I enlarge the photos.

But the one I used is identical to the ones in John P’s article …sonolite…something

I’ll tell you Saturday.