NEWS FROM TRINIDAD & TOBAGO (click here for pdf version)

TRINIDAD AND TOBAGO SPINAL DEFORMITY PROGRAM JOINS FOCOS TO FORM A NEW CHAPTER
By Vincent Arlet MD and David Toby MD: Trinidad and Tobago FOCOS Chapter Representatives

David Toby MD, and Vincent Arlet MD

Dr David Toby has been performing Spinal deformity Surgery in the Islands of Trinidad and Tobago for the last 25 years. As a Chief of Staff at the Princess Elizabeth Center for handicapped Children he has developed a Spinal deformity program where all children from the 2 islands are referred to. His referral pattern is from both islands of Trinidad and Tobago and comprises a population of 1.2 millions. Dr Toby is a Pediatric Orthopedic Surgeon and operates fifty scoliosis every year.

On January 19th 2008 for the third consecutive time a medical team from the University of Virginia went to the republic of Trinidad and Tobago to operate severe spinal deformities. The enthusiastic team consisted of Dr Pajewski NeuroAnesthesiologist, , Susie Crush Orthopedic OR nurse, Ericka Guy Neuroelectrophysiologist, James Brezina Spine fellow and myself. On Saturday evening after a twelve hours journey we were greeted by Dr Toby at Port of Spain Airport.

The next morning on Sunday we were all geared up to operate a Sixteen years old girl who had 160 degrees scoliosis.. Dr Toby had prepared her for surgery for the previous 2 weeks by applying skeletal traction. Such traction had reduced the curve to 100 degrees.. In this case surgery can be considered as a life saving procedure to prevent to prevent the lungs from being compressed by the spine. The surgery lasted a total of 6 hours and required the insertion of multiple implants as well the need to cut ribs on both sides and the insertion of 2 Titanium rods. The patient went then into the Intensive care unit for 2 days and then started to mobilize. Ten days after the surgery patient was 4 inches taller and could go home without a brace.

Before Surgery , curve is measured 160º	After Surgery ,her height has increased by 6 cm, the curve is down to 70 º

The next two days we operated two other spinal deformities , in the range of 80 degrees. The third day was spent at the clinic seeing patients that we would operate during our next FOCOS visit in June. By the fourth day each patient was in a stable condition in the hospital and Dr Toby could discharge them in excellent condition one week after our departure

The success of the mission was possible thanks to the excellent team Dr Toby had gathered over his life time dedication caring for children with spinal deformities,( OR nurses, physiotherapist, anesthesists …).

As the Trinidad FOCOS Chapter was started we could already get generous donations that help support Princess Elizabeth Centre for handicapped Children. Such generosity will no doubt help strengthen the Trinidad FOCOS chapter so children with spinal deformities do not have to accept such ailment as irremediable. We are also grateful for our sponsors Synthes and Impulse monitoring who helped with the logistics of this mission.

Dr Vincent Arlet, MD

Dr Toby, Dr Arlet and the Princess Elizabeth Clinic Team performing surgery on a 160 degrees scoliosis	Intraoperative view of rod placement after rib costotomies
Dr Toby surrounded by his team from left to right Angela murphy physiotherapist,Christine Tanker Occupational therapist, Dr David Toby. Janet Graham clinic nurse, Geeta pollard OR theater nurse	Documentation of the patients before and after surgery . Patients enjoy to check out their pictures.