Endourology Society – World Endo Initiative in Haiti

I traveled to Port-au-Prince, Haiti from March 4 – 11, 2017 as part of a small group of urologists doing humanitarian surgery associated with Project Haiti and teaching in the city of Port-au-Prince. We worked at the Hopital Saint-Francois de Sales in the center of the city. The hospital was rebuilt following the earthquake in 2010 and just reopened 2 years ago.

The urologist leading the mission was Dr. Henri Lanctin who trained in urology in Ottawa, Canada and has spent most of his working career in community urology practice in Minnesota and now South Dakota. He has been to Haiti on numerous occasions over the last 5 years

We did have a video teleconference with the local urologists approximately 2 weeks before the trip to Haiti. That provided me the opportunity to project a handful of instructional slides, walking through the various aspects of a PCNL case including positioning, gaining access and conducting the stone removal. Cook Canada supplied me with approximately $12,000 of new disposable equipment such as guidewires, balloon dilators, stone baskets and so forth which I packed up in large suitcases and took with me to Haiti. This equipment lasted to about mid week and then after soaking in Cidex I began to re-use this equipment on the subsequent cases.

During the week I did 16 endourology procedures including 12 PCNL’s and 4 ureteroscopies with Holmium laser lithotripsy. There was core group of 4 to 5 local urologists who scrubbed in and participated in most of the cases with the intention that they would begin to embark on these surgeries after I had left. Remarkably enough, the PCNL I did on day one was the first ever percutaneous stone removal done in the country of Haiti. At the present time open surgery remains the standard of care for urolithiasis in Haiti and there is no ESWL or flexible ureteroscopy currently available in the entire country.

There were many interesting challenges to conducting the cases. When I assessed the support services at the hospital the day we arrived, I found out there was no blood bank, no angiography and embolization in the entire country and the hospital had no step-up or ICU type of facilities to stabilize the septic or otherwise unstable patient. The preoperative assessment of the patients was limited to KUB x-rays for the most part and CT assessment was not available due to costs. The hospital did have a reasonably new C-arm but no one available or familiar with operating it. Project Haiti had purchased a used ultrasound lithotripsy unit which we had planned to use unfortunately this arrived with all components except the probes and therefore was not useable. We made due with a pneumatic device that , with some improvisation, was able to fragment renal stones. During the week there were occasional power outages that took down the entire operating room including the Anesthesia monitoring equipment and ventilator plus the C-arm and light sources. We would just wait things out and then proceed again when the power came back on. The nursing staff were excellent and enthusiastic and quickly picked up on the nuances and flow of endourologic cases. All of the cases were performed successfully without complication and all patients went home within a day or two which represents a significant advance to the typical care path.

Since I was in Haiti I have had several communications from the local urologists who I trained. They were triumphant in describing that they placed the first stents with fluoroscopic control ever done in the country as far as they knew. They have also performed their first successful semi-rigid ureteroscopy and laser lithotripsy. Aside from the technical aspects of the surgery that I was able to teach them, it appears this model also promotes camaraderie and team building amongst the local physicians.

For me this was a very satisfying and rewarding experience. I would certainly do it again if the opportunity arose. Both Dr. Lanctin and the local urologists in Haiti are deeply grateful to the Endourology Society for the support that was provided to offset my expenses to travel to Haiti and participate in this activity. I believe that the Endourology Society can have an immense impact worldwide with these types of initiatives. We have great people in our Society and I am sure many others would like to have the privilege that I have had on this recent trip to Haiti.

Respectfully submitted
Dr. John Denstedt, MD, FRCSC
Professor of Urology
Western University
London Canada

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