Recently, on our weekly Presidential Line conference call, we had the opportunity to speak with 10 AAOS fellows who had recently returned from humanitarian missions in Haiti. They represent the approximately 300 fellows who have been deployed to Haiti in the past month, since the earthquake on Jan. 12?a remarkable accomplishment, and an extraordinary showing by the orthopaedic community.

Part of our discussion focused on determining AAOS? role with future relief efforts concerning Haiti. Among the ideas proposed were reaching out to other medical associations; educating and credentialing volunteers; continuing to coordinate efforts and communications among relief organizations, volunteers, industry, the U.S. military and government, and international organizations; and engaging with the Haitian people to rebuild their medical system and train orthopaedic surgeons.

These are excellent ideas and we will be investigating them as we develop long-range plans for supporting the relief and rebuilding efforts in Haiti. Volunteers who have served in Haiti and others interested in these efforts will have multiple opportunities during the 2010 AAOS Annual Meeting to share their experiences and ideas.

New Resources

This week, the AAOS has added two new resources to our dedicated Haiti Web site, which we hope will help facilitate relief and rebuilding efforts. The first is a report from the US Public Health and Medical Services Planning and Response Program. This report, which is being managed by graduate students from Tulane and Yale Universities, shows population movement after the earthquake; provides an index and locations of medical facilities; reviews the health clusters, hospitals, clinics, and public health issues; covers logistics, including medical logistics and distribution points; and safety issues. It will be updated daily and should be of invaluable assistance to those on the ground or planning to depart.

In addition, the AAOS has made arrangements with the American College of Surgeons (ACS) enabling AAOS fellows who are not members of the ACS to use its online case log system. This will allow surgeons in the field and those who have recently returned from the relief effort to track and report on their cases. The system currently works with Palm and PocketPC phones. Support for iPhone and Blackberry devices will be available soon.

Voices from the field

We know that no one can make a better case for long-term involvement in Haiti than our own members who have been there and seen what remains to be accomplished. We share their voices with you?

James W. Price, MD: We went into several of the tent cities and were still finding untreated and undertreated fractures and wounds. Many of the people have not gone to any hospital for their injuries and have no way of knowing where treatment is available or of getting there if they do know. We coordinated our forays into the tent cities with the local Haitian police, who were very helpful. I would advise taking mosquito netting if you go, and a yoga mat, as we slept on the floor.

David S. Feldman, MD: I will start with what I saw and learned?First, one must place his or her own ego aside in doing a mission like this. It is not about doing the ?greatest? case or being recognized for saving a limb or a life. There are no surgical heroes in these situations and this is neither a movie nor a CNN special?.No matter how senior, we all changed dressings, looked at surgical wounds, placed IVs, and transported patients.

Second, one must know their skill set. If there are others to help you, then use that help and assist them. ?There is no credentialing committee in crises and one must know their own skills and defer to others to achieve the best result?.If you have experience with and are comfortable treating orthopaedic trauma, then you can certainly be of immediate help in these situations. Residents should be accompanied by attendings and not attempt to do this alone. If you do not feel comfortable with trauma, there is still help that you can render.

Stephen D. Katz, MD: Most injuries were crush injuries; we were dealing with initially 2-week-old injuries, and then by the end, 3-week-old injuries?.There will be lots of revision, infection, and nonunions to deal with in the future. I see a great need for prosthetics in Haiti, but at least in Les Cayes, there is no one who can make them. I am sure throughout Haiti there will be a huge need for both upper and lower extremity prostheses. But they will need to be made with local materials and need to be able to be repaired with local material.

Joshua E. Hyman, MD: On a personal level, this experience has been profound. Witnessing the personal, physical, and societal devastation will have a lasting effect upon me. On the other hand, seeing the tremendous outpouring of support from my orthopaedic colleagues has reinforced my belief in our profession.

You are so right, Dr. Hyman. We, too, are heartened and humbled by the response of AAOS fellows. You can read more stories on the AAOS Haiti blog (member login required), and see what the media has been saying about orthopaedic surgeons. If you have stories to share, please e-mail them to Haiti@aaos.org

Joseph D. Zuckerman John J. Callaghan Daniel J. Berry

AAOS President First Vice President Second Vice President