Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.
May 26, 2012
Happy Birthday to me! I left New Orleans to travel to Miami, and then I’ll continue to Port-au-Prince the next morning. We have a layover in Miami as we always do. There, we typically meet our teammates, organize supplies and prepare to hit the ground, ready for our mission.
There are usually three to four of us that come in together, but this tour is much different for me. We have moved to our next phase of relief at Klinik Hanger. We no longer need teams of three to four now that the Hanger Clinic has evolved to a sustainable prosthetic, and now, orthotic clinic as well. I am not concerned going in alone since this is my fourth tour. My thoughts are filled with anticipation of seeing the progress of the clinic and all of my friends. The only way I can describe it is like having a child and having to leave them behind. You know you have to leave but will return and the excitement is overwhelming as you arrive back. Clinically my thoughts are to help further education, assess needs and assist.
On a lighter note, I decided to take myself out for my birthday. My plane arrived earlier than usual so I went to South Beach for a walk and dinner. The best part was when I grabbed a cab back to the airport hotel my cab driver was an older gentleman whose name was Joseph Jean St. Pierre. I recognized this name so I said “koman yea” (how are you). He looked back in surprise with an intrigued look. He says “pa pe mal” (not so bad). “Mwen rele Jay”, I say. He says “mwen rele Jean; Ha Ha ou pale creole?” We started speaking to each other about how I can speak Creole. Jean was very excited learning about our efforts in Haiti. I was able to bring him back home even if it was for a very short time. When we arrived at the airport hotel he wished me well and said the ride was on him, “Mesi zanmi mwen” (thank you my friend).
Monday, August 20, 2012
Monday, August 6, 2012
Job Satisfaction – Reflections from former lead prosthetist Anna Avakian
One of the things I’ve always loved about this field is that we get to make a tangible difference in peoples’ lives. Getting up, out of bed and into work can mean Ms. Smith gets to walk on her preparatory prosthesis for the first time or Mr. Jones will walk out of the office behind the wheelchair he arrived in. I love the joy that comes with making a difference.
Sometimes in life, we do not get to see first-hand the results of our efforts.
The first time I left Haiti at the end of August 2010, I knew the work started would continue. Vern Hostettler took over from me and I had the confidence that he would continue on in the training of the technicians and running of the clinic. But, a part of me was saddened that I wouldn’t get to see the results.
But, I did.
After Vern, followed Brandon Khoury, Chris Blades and Spencer Mion. Jay Tew also returned for a stint in early 2011. Last October I had the honor of returning to Klinik Hanger and seeing how far the efforts of so many had gone. The Haitian technicians: Alix, Tcho, Joel, and Cira were taking charge and almost running the clinic. When the patients arrived they would flock to the front, grab patient charts and escort the patients to the rooms to make a repair, take a new cast, or do a fitting. I watched in giddy satisfaction to see a clinic that needed very little of my help. Our education program has been a success – we not only have provided prosthetic care, but taught Haitians how to care for Haitians, creating a lasting impact. Those with limb loss in the Artibonite region of Haiti no longer have to take multiple tap-taps (a Haitian form of transportation) and struggle to get to Port-au-Prince to receive care. Mothers of children born in this area with a limb deficiency will no longer agonize over if their child will have a chance to walk, play, or kick a ball like other kids. And, in Deschapelles, amputees receive respect and excellent care to get them back to living. This care, for the most part, isn’t coming from a “blanc” but from another Haitian who speaks their language, knows their culture, and will be there for them for years to come.
Talk about job satisfaction!
For each and every person who contributed and continues to contribute to the Hanger Ivan R. Sabel Foundation in Haiti, thank you for the impact and difference you’ve made!
Sometimes in life, we do not get to see first-hand the results of our efforts.
The first time I left Haiti at the end of August 2010, I knew the work started would continue. Vern Hostettler took over from me and I had the confidence that he would continue on in the training of the technicians and running of the clinic. But, a part of me was saddened that I wouldn’t get to see the results.
But, I did.
After Vern, followed Brandon Khoury, Chris Blades and Spencer Mion. Jay Tew also returned for a stint in early 2011. Last October I had the honor of returning to Klinik Hanger and seeing how far the efforts of so many had gone. The Haitian technicians: Alix, Tcho, Joel, and Cira were taking charge and almost running the clinic. When the patients arrived they would flock to the front, grab patient charts and escort the patients to the rooms to make a repair, take a new cast, or do a fitting. I watched in giddy satisfaction to see a clinic that needed very little of my help. Our education program has been a success – we not only have provided prosthetic care, but taught Haitians how to care for Haitians, creating a lasting impact. Those with limb loss in the Artibonite region of Haiti no longer have to take multiple tap-taps (a Haitian form of transportation) and struggle to get to Port-au-Prince to receive care. Mothers of children born in this area with a limb deficiency will no longer agonize over if their child will have a chance to walk, play, or kick a ball like other kids. And, in Deschapelles, amputees receive respect and excellent care to get them back to living. This care, for the most part, isn’t coming from a “blanc” but from another Haitian who speaks their language, knows their culture, and will be there for them for years to come.
Talk about job satisfaction!
For each and every person who contributed and continues to contribute to the Hanger Ivan R. Sabel Foundation in Haiti, thank you for the impact and difference you’ve made!
Friday, July 27, 2012
An update from former Hanger Klinik lead prosthetist Anna Avakian
Leaving Haiti last October was kind of like saying goodbye to a dear friend when you’re moving far away.
You don’t know when you’ll see them next but there are constant reminders or flashes of experiences that bring you back, reminding you of their impact on your life, and how much you miss them.
For example, my friend Esther is forever linked to grocery store tomatoes. She’ll never let me forget a hilarious evening that started with me “squeezing tomatoes” to choose the ripe ones. This involved a mad rush back to the store since I had left the rental video near the pile of tomatoes because I just “had” to buy a couple more on the way out. In my defense they were perfectly ripe and an amazing price!
Reminders of Haiti are everywhere, too.
Summer has returned to the Atlanta area – hot and humid. So far, I’ve resisted turning on my AC at home and have an oscillating fan keeping the night air pulled in through the window to cool me off and lull me to sleep. It feels just like Haiti, and many nights my thoughts drift back there; the experiences and people that have changed my life.
A photo of some of those people, our amazing group of technicians and staff in Deschapelles, hangs on my wall at work. Their smiles forever ingrained in my memory. Above that hangs a colorful painting by a local Deschapelles artist reminding me of the vibrancy of life in a little town worlds away.
A book of Creole Proverbs sits on my shelf at home where, a couple of weeks ago, I even heard a rooster crowing in the middle of the night. I wonder if the time-confused rooster in Deschapelles is still around?
And, I will never be able to look at a hot dog the same way again. For the rest of my life, they will remind me of Haiti and the hot dogs and spaghetti meal that’s a common breakfast there.
I’m hopeful I’ll get to go back. A chance to spend time with a dear old friend. Time has changed us both. Situations are different. But, the love and connection I feel for Haiti and its people is unwavering.
You don’t know when you’ll see them next but there are constant reminders or flashes of experiences that bring you back, reminding you of their impact on your life, and how much you miss them.
For example, my friend Esther is forever linked to grocery store tomatoes. She’ll never let me forget a hilarious evening that started with me “squeezing tomatoes” to choose the ripe ones. This involved a mad rush back to the store since I had left the rental video near the pile of tomatoes because I just “had” to buy a couple more on the way out. In my defense they were perfectly ripe and an amazing price!
Reminders of Haiti are everywhere, too.
Summer has returned to the Atlanta area – hot and humid. So far, I’ve resisted turning on my AC at home and have an oscillating fan keeping the night air pulled in through the window to cool me off and lull me to sleep. It feels just like Haiti, and many nights my thoughts drift back there; the experiences and people that have changed my life.
A photo of some of those people, our amazing group of technicians and staff in Deschapelles, hangs on my wall at work. Their smiles forever ingrained in my memory. Above that hangs a colorful painting by a local Deschapelles artist reminding me of the vibrancy of life in a little town worlds away.
A book of Creole Proverbs sits on my shelf at home where, a couple of weeks ago, I even heard a rooster crowing in the middle of the night. I wonder if the time-confused rooster in Deschapelles is still around?
And, I will never be able to look at a hot dog the same way again. For the rest of my life, they will remind me of Haiti and the hot dogs and spaghetti meal that’s a common breakfast there.
I’m hopeful I’ll get to go back. A chance to spend time with a dear old friend. Time has changed us both. Situations are different. But, the love and connection I feel for Haiti and its people is unwavering.
Thursday, October 13, 2011
Change
Anna Avakian, CPO, a former lead prosthetist at the Hanger Clinic, has returned to serve another term as lead clinician. Following is her first blog post since her return to Deschapelles.
Change.
Sometimes it seems to be the only constant in life.
In the past year I've experienced a lot of change: a new position within Hanger, a move to a new city/state, a new home, and recently a new boss.
But now I am back in Haiti. Back to the heat, the 3 minute walk to work, and working with the same great Haitian guys that have been our technicians since the doors opened here in February of last year. Many things are familiar here and it's like returning home in some ways; although, it's more like returning to a childhood home as an adult. The same, but changed.
One wonderful change to see is the growth in both the knowledge and skill of the four Haitian technicians. They now take the lead and we come alongside to instruct or guide as needed. They are confident in casting and modifying basic below-knee amputee patients, can fabricate all types of prostheses, and cast above-knee amputee patients well, too. It is a pleasure to see this change here. So many people have joined together and volunteered their time to make this reality that I have the pleasure of seeing. It's a nice change :)
Change.
Sometimes it seems to be the only constant in life.
In the past year I've experienced a lot of change: a new position within Hanger, a move to a new city/state, a new home, and recently a new boss.
But now I am back in Haiti. Back to the heat, the 3 minute walk to work, and working with the same great Haitian guys that have been our technicians since the doors opened here in February of last year. Many things are familiar here and it's like returning home in some ways; although, it's more like returning to a childhood home as an adult. The same, but changed.
One wonderful change to see is the growth in both the knowledge and skill of the four Haitian technicians. They now take the lead and we come alongside to instruct or guide as needed. They are confident in casting and modifying basic below-knee amputee patients, can fabricate all types of prostheses, and cast above-knee amputee patients well, too. It is a pleasure to see this change here. So many people have joined together and volunteered their time to make this reality that I have the pleasure of seeing. It's a nice change :)
Saturday, July 2, 2011
A recap of weeks 4 & 5
I dropped off the last group of volunteers at the airport and waited for the new group to arrive. They weren’t too hard to pick out as they walked down the long walkway toward the parking lot. Jeff, Mark and Rolf all had that typical “deer in the headlights” look as they were being whisked along in a sea of people. We headed back to Deschapelles and, after a quick tour of the hospital grounds, got them settled into Kay Hanger. 
Since this is the rainy season, transportation becomes problematic for the patients traveling to HAS / Hanger Klinik. There is quite a bit of apprehensiveness for people to leave their homes for fear of not being able to return. Since our buses were not bringing patients in at the frequency of earlier rotations, we decided to make these next two weeks much about education. Joel, Cira, Alex, and Tcho have learned so much already and are more than capable of casting, fitting, aligning and delivering prostheses practically unassisted. The focus during this period of lighter patient loads will be to educate them further on some of the reasons why they make the adjustments they do and to associate a little anatomy and physiology with the cast modification techniques.
Joint teaching time with physical therapy students:
The physical therapy students were covering the psycho-social aspect of being an amputee in Haiti and we were able to join their classes. We had a great discussion group with both classes and our patients in the Klinik. There was a lot of sharing during this session and the technicians, therapists and patients gained knowledge from this opportunity. They were also able to learn about prevention of Cholera as this is the Cholera “season”.
Casting:
I also taught them a new way to cast above-knee amputees. We outlined a casting and modifying course while using Mark, one of our volunteers, as the patient model. The four technicians gathered around, taking notes and asking pertinent questions throughout the whole demonstration. We modified the cast together and they fabricated the standard AK prosthesis, which we would use later during the alignment portion of the course.
After day three of this rotation, we started to pick up again as the buses poured in from Port-au-Prince, Leogane, and Gonâve. While all four of us stayed very busy casting, fitting and delivering bilateral and unilateral above-knee and below-knee prostheses, we still had some time in the afternoons to integrate more education into our mission here.
Anatomy and Physiology:
We took some time to discuss some anatomy and physiology as it pertains to the above-knee amputee. We went over some very basic boney landmarks of the pelvis so they can see how they relate to the fit and alignment of the AK socket. We emphasized problematic areas such as the ramus and distal/lateral femur. This helped reinforce why certain cast modifications were made and why certain boney landmarks (such as the trochanter) are critical to proper AK alignment. Again, they all took several notes and were not afraid to ask questions. The questions they asked indicated that the information was making a lot of sense to them.
Alignment:
Later in week two of this rotation we went over AK alignment and some typical gait deviations they have seen over this past year. We put together a chart that shows the classic schematic man exhibiting the most common deviations such as, lateral trunk bending, circumducted gait, abducted gait, knee instability, and medial/lateral whips. The chart lists some basic causes and possible solutions. We used Mark and the prosthesis they made for him to put the lesson plan into practice. Starting with a perfectly aligned prosthesis we changed one variable at a time. They were to identify the deviation, the cause, and then practically apply the solution. This section of the course provided the most discussion and feedback. They all got a chance to problem solve and associate the reasons why they have been intuitively making these adjustments over the past year. While this group of technicians are extremely mechanical, it was good to show them why a gait deviation is not always associated with alignment but rather, the fit of the socket as well.
Last year, in the early weeks of this relief effort, the focus was to provide as many quality limbs as possible. However, with that said, I am grateful to be a part of the instructional efforts here. Providing 20 to 30 limbs over a two-week rotational span is nothing when compared to teaching four very highly motivated and talented Haitians to provide for their own people. This cliché is unfortunately overused but no words describe our efforts better than, “Give a man a fish and he eats for a day. Teach a man to fish and he will eat for a lifetime.”
Since this is the rainy season, transportation becomes problematic for the patients traveling to HAS / Hanger Klinik. There is quite a bit of apprehensiveness for people to leave their homes for fear of not being able to return. Since our buses were not bringing patients in at the frequency of earlier rotations, we decided to make these next two weeks much about education. Joel, Cira, Alex, and Tcho have learned so much already and are more than capable of casting, fitting, aligning and delivering prostheses practically unassisted. The focus during this period of lighter patient loads will be to educate them further on some of the reasons why they make the adjustments they do and to associate a little anatomy and physiology with the cast modification techniques.Joint teaching time with physical therapy students:
The physical therapy students were covering the psycho-social aspect of being an amputee in Haiti and we were able to join their classes. We had a great discussion group with both classes and our patients in the Klinik. There was a lot of sharing during this session and the technicians, therapists and patients gained knowledge from this opportunity. They were also able to learn about prevention of Cholera as this is the Cholera “season”.
Casting:
I also taught them a new way to cast above-knee amputees. We outlined a casting and modifying course while using Mark, one of our volunteers, as the patient model. The four technicians gathered around, taking notes and asking pertinent questions throughout the whole demonstration. We modified the cast together and they fabricated the standard AK prosthesis, which we would use later during the alignment portion of the course.
After day three of this rotation, we started to pick up again as the buses poured in from Port-au-Prince, Leogane, and Gonâve. While all four of us stayed very busy casting, fitting and delivering bilateral and unilateral above-knee and below-knee prostheses, we still had some time in the afternoons to integrate more education into our mission here.
Anatomy and Physiology:
We took some time to discuss some anatomy and physiology as it pertains to the above-knee amputee. We went over some very basic boney landmarks of the pelvis so they can see how they relate to the fit and alignment of the AK socket. We emphasized problematic areas such as the ramus and distal/lateral femur. This helped reinforce why certain cast modifications were made and why certain boney landmarks (such as the trochanter) are critical to proper AK alignment. Again, they all took several notes and were not afraid to ask questions. The questions they asked indicated that the information was making a lot of sense to them.
Alignment:
Later in week two of this rotation we went over AK alignment and some typical gait deviations they have seen over this past year. We put together a chart that shows the classic schematic man exhibiting the most common deviations such as, lateral trunk bending, circumducted gait, abducted gait, knee instability, and medial/lateral whips. The chart lists some basic causes and possible solutions. We used Mark and the prosthesis they made for him to put the lesson plan into practice. Starting with a perfectly aligned prosthesis we changed one variable at a time. They were to identify the deviation, the cause, and then practically apply the solution. This section of the course provided the most discussion and feedback. They all got a chance to problem solve and associate the reasons why they have been intuitively making these adjustments over the past year. While this group of technicians are extremely mechanical, it was good to show them why a gait deviation is not always associated with alignment but rather, the fit of the socket as well.
Last year, in the early weeks of this relief effort, the focus was to provide as many quality limbs as possible. However, with that said, I am grateful to be a part of the instructional efforts here. Providing 20 to 30 limbs over a two-week rotational span is nothing when compared to teaching four very highly motivated and talented Haitians to provide for their own people. This cliché is unfortunately overused but no words describe our efforts better than, “Give a man a fish and he eats for a day. Teach a man to fish and he will eat for a lifetime.”
Wednesday, June 29, 2011
A recap of weeks 2 & 3
After a great first week I was excited to really dig my heels in and get a lot of work done. The first task was to drop off the current volunteers and pick up my first group at the airport – Tom Sandy from Ohio and Carton Blasburg from Kolm, Germany. It was a good transition and we began our two-and-a-half hour journey back to Deschapelles. It is exciting to see new people come in to Haiti. I get to play tour guide for a while and show them the ropes. These guys really fit in well and have done a great job in the Klinik and made some new friends in the process.
Some other exciting news was the education and testing that Brandon and I started in my first week culminated in all of the technicians (Tcho, Cira, Alix, and Joel) passing an exam to become recognized for their hard work. They were presented with certificates for Technicians I. I was so honored to be a part of this experience. As I presented them with their certificates I could see how proud they all were. This is very important here as certificates are not given out on a regular basis. It is not just a symbol of recognition; it truly means a great deal more. These guys certainly deserve this honor. Thank you all who have been a part of the Haiti Klinik. The technicians have learned a lot from you.
In the upcoming weeks I will continue to increase their knowledge base in fabrication skills and introduce some more formal classes. We will begin teaching general terms, anatomy, and improving casting skills to allow them to improve their clinical skills. They will learn to become practitioners and be able to practice patient care.
Some other exciting news was the education and testing that Brandon and I started in my first week culminated in all of the technicians (Tcho, Cira, Alix, and Joel) passing an exam to become recognized for their hard work. They were presented with certificates for Technicians I. I was so honored to be a part of this experience. As I presented them with their certificates I could see how proud they all were. This is very important here as certificates are not given out on a regular basis. It is not just a symbol of recognition; it truly means a great deal more. These guys certainly deserve this honor. Thank you all who have been a part of the Haiti Klinik. The technicians have learned a lot from you.
In the upcoming weeks I will continue to increase their knowledge base in fabrication skills and introduce some more formal classes. We will begin teaching general terms, anatomy, and improving casting skills to allow them to improve their clinical skills. They will learn to become practitioners and be able to practice patient care.
Thursday, June 16, 2011
Returning "home"
Last year Hanger prosthetist Chris Blades from Portland, Maine volunteered at the Hanger Clinic in Haiti for two weeks, and is currently serving a two-month term a as lead prosthetist at the Clinic.
I have been very excited to return to Haiti and Deschapelles. I had been looking forward to seeing my friends here again, and wondering how well they would remember me from my first two week rotation one year ago.
It was a great feeling arriving at Kay Hanger after the long journey from Port-Au-Prince. As Brandon had stated on his arrival it felt like coming home. As I saw each of the staff I was always met with big hugs. “Bon Jou!!” “Sak Pase!!” (The customary greetings). I was thrilled they all remembered me and were just as excited to see me. It felt more like a family reunion.
It was a quick week of learning the lead practitioner role and responsibilities. Brandon has done a great job and already having been here I already knew the general flow of the Klinik.
On Monday, the van from Port-Au-Prince arrived and out came one of my patients from a year ago. Kennda is a young teenaged woman who had great difficulty wearing her below-knee prosthesis. She had a very sharp tibia and despite many attempts to relive her pain in the prosthesis she could not get comfortable. We discussed with the surgeons at HAS the possibility of a revision of her residual limb. This was done the very next day (two days before I returned back home). We saw each other one last time to say goodbye on our last night here. I had prayed for her hoping the surgery would make the difference. To my surprise, Kennda stepped out of the van, walking so well you would never know she had a prosthesis at all. When she saw me she ran up to me and gave me a big hug and thanked me again for what we had done for her. It was a great start to my return to Haiti.
The week continued and I saw a few more patients that had returned for adjustments that all remembered me. I love this place; I love these people. It is amazing what an impact we all have here. It is a wonderful thing or as the Haitians would say “ Bon Bagay!”
I have been very excited to return to Haiti and Deschapelles. I had been looking forward to seeing my friends here again, and wondering how well they would remember me from my first two week rotation one year ago.
It was a great feeling arriving at Kay Hanger after the long journey from Port-Au-Prince. As Brandon had stated on his arrival it felt like coming home. As I saw each of the staff I was always met with big hugs. “Bon Jou!!” “Sak Pase!!” (The customary greetings). I was thrilled they all remembered me and were just as excited to see me. It felt more like a family reunion.
It was a quick week of learning the lead practitioner role and responsibilities. Brandon has done a great job and already having been here I already knew the general flow of the Klinik.
On Monday, the van from Port-Au-Prince arrived and out came one of my patients from a year ago. Kennda is a young teenaged woman who had great difficulty wearing her below-knee prosthesis. She had a very sharp tibia and despite many attempts to relive her pain in the prosthesis she could not get comfortable. We discussed with the surgeons at HAS the possibility of a revision of her residual limb. This was done the very next day (two days before I returned back home). We saw each other one last time to say goodbye on our last night here. I had prayed for her hoping the surgery would make the difference. To my surprise, Kennda stepped out of the van, walking so well you would never know she had a prosthesis at all. When she saw me she ran up to me and gave me a big hug and thanked me again for what we had done for her. It was a great start to my return to Haiti.
The week continued and I saw a few more patients that had returned for adjustments that all remembered me. I love this place; I love these people. It is amazing what an impact we all have here. It is a wonderful thing or as the Haitians would say “ Bon Bagay!”
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