TRIP REPORT: Dr. DAN ROSENSTEIN:URETHRAL RECONSTRUCTION WORKSHOP – CAP HAITIEN, HAITI


Mar. 29- Apr. 6, 2019

This is a summary of my recent exhausting but gratifying surgical mission to Hopital Justinien of Cap Haitien from March 29-April 6th, 2019.
The American group that was tentatively going to join me ultimately canceled their trip due to justifiable personal safety concerns.  I decided to continue on the mission trip on my own.
The visit began on Saturday, and I was met by my host throughout the trip, Dr Jory Desir.  Dr Desir is one of the senior urologists at the hospital, and he introduced me to all the interns and residents that I interacted with throughout the week. These included Drs Josna Samson, Wisten Accelus, Richardson Paillant and Thelusme Jolius.
On the first evening the interns gave their month end urology presentations which were followed by a traditional Haitian supper prepared by the interns. After dinner everyone put their dancing shoes on for a few hours of dancing.   Things have changed since my internship!
On the following day I met the patients that Dr Desir had proposed to undergo surgery with our group in the following week.  Because this was primarily a urethral reconstruction workshop, the patients were all men with different types of urethral strictures awaiting urethroplasty.  The underlying causes of urethral strictures in most cases was trauma due to motor vehicle accidents (far too common in Haiti), or severe and untreated STDs.  The residents were very keen to participate in this unusual type of surgery.
Throughout the week, we completed 10 cases of complex urethroplasty, with each of the residents and Dr Desir performing most of the important surgical steps in each operation.  In at least two cases we were required to use buccal mucosal (cheek) grafts to reconstruct the damaged urethra.  These were also harvested with great skill by the Haitian surgical team.

 

Although supplies and sutures were in short supply, we were able to successfully complete these surgeries in a timely fashion.  In fact, the cases took exactly the same surgical time to complete as similar cases performed at my center in California.  This attests to the fact that my Haitian colleagues are remarkably skilled and were able to learn these complex surgical techniques with impressive fluidity.  All the patients recovered uneventfully with no obvious complications postoperatively.
I didn’t have much free time to explore Cap Haitien, but it appears to be a lovely seaside town with many historic landmarks relating to its significance Haitian war for independence in 1803.  I will look forward to returning next year to continue to work closely with my Haitian friends and colleagues. I am grateful that Project Haiti supported this mission.
Best – Dan

Project Haiti 2019 URETHRAL RECONSTRUCTION WORKSHOP

 

 

Flexible Ureteroscopy (F-URS) Course

Flexible Ureteroscopy (F-URS) Course

Hospital St. Francois de Sales,

Port-au-Prince, Haiti

March 24-27, 2019

Project Haiti Report:

Despite the planned GASHU meeting cancellation which was necessary due to sociopolitical unrest in Haiti, close contact with our Haitian colleagues cleared the way for a “mini” F-URS stone workshop at our urology teaching center at Hospital St. Francois de Sales (HSFDS) in the center of Port-au-Prince.

Project Haiti Faculty:

Dr. Henri Lanctin

Primary Haitian Urologist Attendees:

Dr. Bernard Brutus

Dr. Youry Dreux

Dr. Reginald Valme

Dr. Christian Valme

Dr. Mitelot Clervil

A number of other urologists and residents attended the lecture and observed cases.

Conference room at HSFDS

Course Sponsor:

Project Haiti

Special thanks to David Weigel (Prairie Lakes Healthcare System), Phil Ritter (Olympus), Mark Smieja (Boston Scientific), Dr. Bernard Brutus and Food for the Poor, and Mike Stickler (Fortec Medical)

Course Summary:

HSFDS staff anesthesia and nurses provided professional and competent assistance with rapid room turnover. In particular, Global Philanthropic Committee funded urology nurse, Japhare Joseph, was an invaluable leader.

Well stocked urology store room at HSFDS

 

Upon arrival on March 23, we spent the afternoon at HSFDS assembling equipment and organizing supplies. These had been shipped last fall. We then reviewed patients and x-rays and set our OR schedule.

Monday the workshop started with a lecture and discussion of the management of upper tract stones as well as indications for F-URS. We considered how F-URS would fit into the other treatment options offered in the stone center at HSFDS (semi-rigid ureteroscopy, ESWL and open surgery). The procedure was reviewed in detail and the ancillary equipment such as safety and working guide wires, access sheaths, baskets and stents were discussed. Complications and management of them were covered.

F-URS in Haiti has been made possible with the recent development of disposable technology. Reusable scopes are prohibitively expensive and delicate with expensive repair costs. Disposable scopes which are discarded after a single use in the US can be processed and deliver several more cases. With several centers saving the scopes it is felt that we can keep the stone center at HSFDS supplied with adequate numbers.

Drs. Brutus and Dreux performing first flexible ureteroscpic stone removal in Haiti

The remainder of Monday through Wednesday morning was spent doing cases including the first known F-URS case in the country.  Given the instructional nature of the cases and the complexity (big, hard stones!) we managed 6 cases, including a patient with bilateral stones. With their previous experience in semi-rigid ureteroscopy, the Haitian urologists were quick to learn and performed exceptionally well.

Image of kidney stone with Boston Scientific Lithovue monitor

My opinion upon leaving was that Drs. Brutus, Dreux, Valme and Clervil had a solid understanding of the technique, potential pitfalls and better handle on patient selection. They also had a better appreciation of the importance of preoperative imaging, including CT scanning. With current internet connectivity and ability to share radiological images and live surgery, they have ongoing support from members of GASHU. They are a solid core of individuals who work well together, share the vision of improved urological care in Haiti and are committed to teaching residents and the other urologists.

Future Planning:

The trip concluded with discussions and planning for the support of the 2 urologists in Gonaives where a new Canadian-funded hospital has been built. They have no cystoscopic equipment and also need training as they have recently completed the urology residency program in Port-au-Prince.  Dr. Clervil and the other urologists at the Partners in Health hospital in Mirebalais also are in need of cystoscopic instruments. We determined that shipping a set of ACMI instruments that has been donated by Dr. Ed Miedema, Colorado, to Dr. Clervil would be the best course of action and he will start training the young urologists in Gonaives. Once we acquire another set of instruments for Gonaives we can deliver and perform an endoscopic / TURP workshop.

We also initiated plans for the next trip in June 2019 for a workshop at HSFDS on percutaneous nephrolithotomy (PCNL) with Drs. Bob Marcovich, Keegan Maxwell and Henri Lanctin as well as site visits to Gonaives and Mirebalais.

On a personal note, I need to thank my Haitian friends and colleagues for their great concern and care during my 24 hour illness!

Henri P. Lanctin, MD, FACS

 

Dr. Lanctin Presenting a Pediatric Resectoscope

Dr. Lanctin presenting a pediatric resectoscope to Dr. Dreux. This is a gift from Dr. Ed. Miedema, a retired urologist from Colorado. This is an instrument that has been needed for a long time, to deal with a congenital malformation in males that can lead to kidney failure, posterior urethral valves. 

 

 

 

 

 

 

 

 

 

Minimally Invasive Surgery Course – Pignon, Haiti

Project Haiti Team Report

March 2 – 13, 2019

Minimally Invasive Surgery Course

Hopital de Bienfaisance

Pignon, Haiti

Faculty:

Paul Severson, MD, FACS, Founder of Project Haiti and MIMIS

Andrew Van Osdol, MD, FACS, Spearfish Regional Medical Center

Aaron Sachs, MD, Fellow MIMIS

Garald Jean-Louis, MD, GynEndo Haiti

Valerio Vital-Herne, MD, GynEndo Haiti

Sylvio Augustin, MD, HUEH

Ron Vitales, Inanimate Skills Lab Director

Project Haiti Team:

Dan McGuire, Medical student, Team Coordinator, Skills Lab Assistant

Christine Van Osdol, RN

Elizabeth Van Osdol, Team Assistant

Attendees:

4 hospitals, 16 Surgeons, including 3 staff surgeons and 13 residents. 

Nine were General Surgeons and seven were OB/Gyn physicians

Hopital L’Université D’Etat D’Haiti (HUEH) had 2 general surgery residents and 2 OB/Gyn residents

Hopital L’Universitaire de La Paix had 1 staff general surgeon, 2 general surgery residents, and 2 OB/Gyn residents

Hopital Justinien (Cap Haitien) had 2 OB/Gyn residents and 2 general surgery residents

Hopital Bienfaisance de Pignon had 1 staff general surgeon, 1 staff OB/Gyn, and 1 general surgeon to be (Adele’s son)

Course sponsor: Project Haiti, Inc.  We acknowledge this course is made possible through the generous donations of Cuyuna Regional Medical Center, Crosby, MN and Riverwood Healthcare Center, Aitkin, MN.

The Laparoscopy Course included lectures, inanimate skills laboratory, and live surgery over 4 days: Monday, March 4 through Thursday, March 7

Lecture content included the history of surgical innovation and teaching at Hopital  Bienfaisance, history of laparoscopic surgery globally, safe and effective use of laparoscopic instrumentation, a variety of general and gynecological surgical procedure lectures utilizing minimally invasive techniques delivered by all members of the Haitian and American faculty, and 2 SAGES lectures on the Fundamentals Use of Surgical Energy (FUSE), given in both French and English.  Flash drives containing all lecture materials were provided to each student.

New iPad-based trainers were utilized successfully in the Inanimate Skills Laboratory.  The SAGES Fundamentals of Laparoscopic Surgery (FLS) program was utilized as the basis for the lab.  The annual Endo Olympics competition was held with spirited camaraderie among the participants.

Surgeries included 6 laparoscopic cholecystectomies, a laparoscopic hiatal herniorrhaphy and Toupet fundoplication in a patient with severe GERD, a laparoscopic Heller myotomy and Dor fundoplication in a patient with severe achalasia, 2 diagnostic laparoscopies with surgical intervention for infertility, 2 open procedures for myomectomy, and a laparoscopic jejunostomy with esophageal dilation in a critically ill and malnourished man following a battery acid ingestion.  Two of the lap choles were conducted with 100% Haitian staff, including Dr. Sylvio Augustin as the lead surgeon, 2 residents assisting, along with anesthesia and a surgical tech.  Of particular note was the excellent anesthesia service provided (all performed by our Pignon staff!), which enabled the team to accomplish a first-time achievement: completion of 4 lap choles ina single day in the main OR, despite being performed in the slower paced instructional mode.  This was due to the excellent clinical care and efficient room turnover between cases.

At the end of the week a rooftop graduation celebration was held at the Minnesota Dorm with a traditional Haitian feast and recognition for all participants and the esteemed Endo Olympic medal winners.  Dr. Guy Theodore was in attendance and provided closing remarks at the celebration.

Hopital L’Universitaire La Paix – March 11-13, 2019

Dr. Paul Severson, Dr.Andrew Van Osdol, Dr. Aaron Sachs, and Ron Vitales followed up on last year’s initial visit by installing a donated Stryker laparoscopic tower, delivering lectures to residents and faculty, donating Laparoscopic Skills Training equipment and supplies, and conducting the first laparoscopic surgeries at the university.  Dr. Nesly Vastey, Chief ofSurgery, and Dr. Maurice, Assistant Chief of Surgery, hosted our team and provided excellent support, communication, and hospitality.  Lectures were attended by all of the residents and the surgery suite was crowded as the first laparoscopic procedure was performed.  Recently graduated Chief Resident and Endo Olympics Gold Medal Winner, Dr. Celisca Fornabial, and General Surgery Resident Dr. “Nash” Dorsainvil were mentored in 2 laparoscopic cholecystectomies and 2 laparoscopic appendectomies.  Dr. Celisca was the lead surgeon on the final laparoscopic cholecystectomy and performed very well.  It was a solid start to implementing a laparoscopic program, and robust discussions were held to communicate on-going training and development.  We will plan to make follow up visits to La Paix to continue to assist with their training. Dr. Andrew Van Osdol and Dr. Paul Severson plan to return to La Paix in the fall to continue the mentoring process.

Port-au-Prince – March 11, 2019

After our day of surgery at Hopial L’Universitaire La Paix, we traveled to HUEH to meet with Dr. Frank Telemaque, Chief of Surgery.  Upon arrival we were pleasantly surprised to find select surgery staff along with the entire surgery residency program in attendance to welcome and thank us.  Dr. Telemaque then made a formal presentation and recognition for Dr. Severson’s 30 years of investment with the Haitian people.  A “Wall of Friends,” containing photographs of 7 instrumental health care leaders was revealed, and Dr. Telemaque took great pleasure to note that Dr. Severson is #1 on the wall.  A champagne toast was held and fresh pastries were enjoyed by all in attendance.

We then traveled to Petionville to attend the Port-au-Prince Chapter Rotary meeting at the request of Dr. Vastey.  We arrived at the Kinam II hotel and were graciously welcomed by the leadership of the Rotary Club.  After a delicious buffet dinner, a formal recognition was made to Dr. Severson for his years of service to the country.  Dr. Severson thanked the chapter and emphasized the numerous successful projects that occurred because they were joint ventures with Rotary.

Lodging Comments

We found the Minnesota Dorm clean and well maintained, other than lacking hot water on this trip. The internet was functional. The food prepared by our wonderful cooks was exceptional and enjoyed by all. The staff at HBP also provided amazing support for the entire team and visiting surgeons. Thank you!!

We also enjoyed the accomodations and cuisine at the Cormier Plage near Cap Haitien at the end of our work week, before parting with half of our team, who flew back to the US through Cap Haitien on American Airlines. Sunrise Airlines was operational, and our Port-au-Prince team flew from Cap to Port without incident and were greeted and graciously welcomed by a large delegation of surgeons at the airport.

Our team of four stayed at the Ideal Villa Hotel, which is approximately 15 minutes from the La Paix Hospital.  The hotel has been very well maintained, is secure with an armed guard and gate, and we found the food for both the hot breakfast and dinner to be quite delicious.  The room rate of $90 per double, which includes breakfast, and is very economical.  On future visits to La Paix, we would recommend utilizing this hotel located in Delmas and not far from the airport, as an excellent choice and an economical alternative to the Matthew 25 house. It was easily booked online by credit card, and for the same price as Matthew 25, it has a restaurant, bar, internet services and a swimming pool. However, Matthew 25 has the advantage of the free and reliable airport shuttle.

Dr. Christian Valme Returns to Haiti

Dr. Christian Valme recently returned to Haiti after spending 6 months in Nadiad, India learning percutaneous kidney stone removal from Dr. Desai (pictured with him).


Upon returning home he met his son, Raphael, who was almost 3 months old. The India opportunity was made possible by Dr. John Denstedt and the Endourological Society as well as Project Haiti. We look forward to working with Christian and helping him to be a skilled endourologist so he can help his fellow Haitians with minimally invasive kidney stone removal.

 

Shipment of Supplies Heading to Port-au-Prince

“David Weigel, director of Materials Management at Prairie Lakes Healthcare System with shipment of supplies for upcoming flexible ureteroscopy workshop at Hopital St. Francois de Sales in Haiti. David was instrumental in preparing the supplies for shipment and utilizing his contacts with Old Dominion to secure charity rates for trucking the pallet to Food For The Poor in Florida. The shipment will arrive in Port-au-Prince in time for the training session.
Thank you David!,
Henri Lanctin, MD”

Dr. Christian Valme – India

“Dr. Christian Valme working in the “Wet Lab” and nearing the end of his 6 month fellowship in India, learning the highly specialized minimally invasive technique of “Percutaneous Nephrolithotomy”. Many Haitian patients will benefit from this procedure when Christian returns and is fully trained and equipped.”

REPORT: Haiti Trip Report, April 2018

Haiti Trip Report, April 2018

I arrived at Cap Haitien, in North Haiti, on Saturday, April 21 with Drs. Joe Costa, Joe Babiarz and their team (they will submit their team report). I was accompanied by Dr. Phil Abbosh from Philadelphia. He was on his first trip to Haiti and wanted to become involved with teaching urology in resource-challenged countries.

We were greeted by Dr. Jean-Geto Dube (urologist and Executive Director, Hopital Universitaire Justinien) and urologist, Dr. Jory Desir.

  The afternoon was spent preparing OR’s, and organizing equipment and supplies. Among the abundant OR supplies brought by the team, Project Haiti also donated a desperately needed electrocautery machine (from Prairie Lakes Healthcare System in Watertown, SD), a Stryker camera box with camera (from Stryker, Inc.) and a flexible cystoscope.

An enjoyable dinner that evening with our Haitian colleagues was followed on Sunday by a day of patient evaluation and teaching to the Haitian residents.  They were instructed in the proper retrograde urethrogram and voiding cystourethrogram techniques for evaluation of male urethral strictures. Drs. Costa and Babiarz scheduled their cases for the week.

On Monday morning Dr. Abbosh and I flew by charter with Missionary Aviation Fellowship to Les Cayes on the south peninsula. There we were greeted by Dr. Gaby Nelson and after a quick stop at our hotel, we were taken to Hopital Immaculee Conception (the public hospital) in Les Cayes. Our objective was to proctor Dr. Nelson in the technique of transurethral prostate resection (TURP) over the next 3 ½ days. On my last trip to this hospital in the summer of 2016 I delivered the generous Karl Storz donation of urological instruments and a camera / monitor system. At the time we did TURP cases with Dr. Nelson which he continued under the tutelage of Dr. Aubourg, a senior urologist who works mainly in the Leogane area. They did a number of procedures together, however, Hurricane Matthew hit in October 2016 and the OR’s were devastated. Fortunately, the donated equipment was not affected as it was safely stored in the hospital administrator’s second floor office.

With the limited resources in Haiti it has taken until now for the OR’s in Les Cayes to be rebuilt. One of the new OR’s will be specifically designed for urology. Although the new OR’s are not expected to be completed for another 6 months, the administrator allowed us unlimited access to one of 2 functioning OR’s from Monday afternoon through Thursday. During this time we did complete 12 TURPs with Dr. Nelson doing the majority or entire resection in 10 and Dr. Joseph, a young and recently-trained urologist, doing some of the resection in 2. We were joined by Drs. Bernard Brutus, Youry Dreux and Global Philanthropic Committee-funded nurse Japhare Joseph on Monday evening. Dr. Aubourg was also present for most of the cases.

  The cases went well. Dr. Nelson demonstrated very significant improvement despite very intense (often conflicting!) teaching of those present. It was felt after the last 2 cases (which he completed without help) that he was almost ready to start doing small prostate resections without proctors. Dr. Aubourg has committed to 2 days in May 2018, and Drs. Dreux and Brutus have also made a commitment to return.

A devastating occurrence was the sudden passing of one of the patients the morning after his surgery when he got up to wash in the bathroom. He had an uncomplicated procedure, had been very stable overnight with clear urine, stable vitals and normal temperature. The team assumed pulmonary embolus was the cause of death, and there was discussion about the lack of sequential compression devices and the need for them in Haiti where they are not available. We do utilize subcutaneous low dose heparin after most of our lengthy reconstructive procedures, however, we feel that with the risk of bleeding and significantly shorter resection times, this would not be appropriate following TURPs.

  The highlight of our stay in Les Cayes was an evening at Drs. Sahmonde and Leno Myril’s home for a terrific Haitian meal followed by Haitian folk songs accompanied by Leno’s guitar. They are a wonderful couple who cherish their family, friends and Haitian heritage.

On Thursday afternoon we drove to Port-au-Prince with Drs. Brutus, Dreux and Japhare. We made a stop at Hopital Lumiere in the village of Bonne Finn. It is a 120 bed primary care hospital located high in the mountains of southern Haiti and has been supported by Apostolic Christian HarvestCall.  A recent urology graduate from Port-au-Prince, Dr. Garçonville gave us a tour of the facility. He has attended a number of Project Haiti workshops in Pignon and has been working there several days per week. The hospital is very well-equipped and managed. After a meeting with several representatives from administration, we agreed to see what could be done to organize future workshops there. Specifically, TURP and urethral reconstruction were discussed as needs.

  On Friday morning Dr. Abbosh and I helped Dr. Dreux with a radical prostatectomy at Hopital St. Francois de Sales. All went well and it was a pleasure to show Dr. Abbosh the great teaching facility that we are in the process of developing there. Japhare Joseph continues to grow and impress in her role. She was well-received by the nurses in Les Cayes and has a natural ability to teach and be adored by her peers, physicians, and other health team members. Her organizational skills and pride in accomplishment are evident in the functioning of the urology service at HSFDS.

Once again, I was humbled by the commitment of our Haitian colleagues with Drs. Bernard Brutus and Youry Dreux unhesitatingly taking time away from their families and practices to accompany us to Les Cayes. Their comradery and assistance was a reminder of how little we would have accomplished in Haiti without this valuable partnership. We also continue to foster good relationships with the administration of the hospitals visited and this is essential for our ongoing success.

We have made new friends and colleagues as Dr. Bill Cleary and his organization, Citizens of the World Foundation, provided professional and competent anesthesia support for the team in Cap Haitien. Their mission aligns perfectly with Project Haiti as they are committed to teaching and supporting anesthetic care in Haiti. They have worked in the north for many years forging close friendships. We look forward to a long and productive relationship with them.

The trip proved to be beneficial for Dr. Abbosh who after this diverse visit to Haiti has expressed an interest in getting involved and sharing his talents with Haitian urologists. Several options for him are in discussion. He has clearly demonstrated that he is a team player with a great sense of humor. He has a wonderful gift of effective teaching and most importantly, understands our mission of improving urologic care in Haiti by teaching and supporting our less fortunate Haitian colleagues.

Respectfully submitted,

Henri Lanctin, MD, FACS