Inauguration of ESWL at Hopital St.Francois de Sales (HSFDS)

Planning for this event began May 2016 in San Diego at the annual meeting of the American Urological Association. At that time I was offered the opportunity to participate in a project to bring ESWL, a non-invasive kidney stone treatment, to Haiti. Long term business associates and friends Chris Gleason (CEO, NextMed Inc,) and Todd Pierce (CEO, Translational Analytics and Statistics Inc.) were aware of our work in Haiti and had a desire to go international with their new decision engine for stone treatment. They felt that Haiti would be an interesting challenge for their first site. They approached Brock Faulkner (CEO Dornier MedTech, America) and they agreed to donate a refurbished ESWL unit. New units are valued at approximately $400,000. After my initial disbelief transitioned into doubts that it could be successfully accomplished, I discussed it with Dr. Pierre-Alix Nazon, a urologist from Haiti who was also attending the AUA in San Diego. At that time Dr.Nazon was the leading kidney stone urologist in Haiti. Todd and Chris met with him to explain the details of their offer and his enthusiasm and excitement following this meeting convinced me that we needed to make it happen. This launched the year-long project. Unfortunately, Dr. Nazon passed away prematurely in January 2017 before seeing it's completion.

The timing of the offer coincided with negotiations between our newly formed Global Association for the Support of Haitian Urology (GASHU) and the governing board of Hopital St. Francois de Sales (HSFDS) for a “Memorandum of Understanding” to develop a urology center of excellence in Port-au-Prince. Our goal was to establish a center which would function as a facility to teach Haitian urology residents and provide contemporary urological care to all patients in Haiti. A number of generous donations have facilitated this: the Global Philanthropic Committee (GPC) of the AUA and the Societie Internationale Urologie provided funding for a full time urology nurse, ForTec Medical Inc. donated a Holmium laser lithotripter, Karl Storz Urology inc. donated a complete set of new adult and pediatric urological endoscopy instruments, and Dr. John Denstedt, the Endourological Society and Cook Medical,Inc. lent expertise and funding to start a percutaneous nephrolithotomy (PCNL) program in Haiti (see report from March 2017 trip to HSFDS). ESWL would be the final piece in the formation of a stone treatment center.

Although the unfortunate loss of Dr. Nazon was untimely, other urologists from the Haitian Society of Urology stepped up to complete the project. This effort was led by Dr. Bernard Brutus, Dr. Youry Dreux and Dr. Reginald Valme. Resident participation by Dr. Christian Valme, in particular, was invaluable.

The Haiti ESWL project included crating and shipment of the equipment (totaling 2532 lbs.) to Coconut Creek , FL after complete refurbishment. This was organized and funded by Dornier who have proven to be dedicated partners. With the help of HSFDS and Dr. Bernard Brutus, arrangements were made to have the equipment shipped by sea from Florida to Haiti by Food For The Poor Inc. This process, which included clearing customs was accomplished smoothly.

Dr. Dreux and the GPC funded nurse, Japhare Joseph, were chosen to be the ESWL technicians and their training was meticulously planned, funded and undertaken by NextMed. They both completed an internet based training course before attending an intense specially designed simulation and live training course over a 2 week period in Tucson, AZ and Dallas, TX. Dr. Brutus and Dr. Reginald Valme also spent time observing at a NextMed ESWL center in Fort Lauderdale, Fl.

Following the 2017 annual meeting of the AUA in Boston Todd Pierce, Chris Gleason, Brock Faulkner, Mary Butler (Chief Technology Officer, Dornier MedTech International), my wife Pat and I flew to Port-au-Prince for the inauguration of the ESWL unit and treatment of the first cases.

Our arrival was preceded for several days by the arrival of Dornier engineer Patrick Dixon, whose task it was to install the unit and deal with the complexities of an unpredictable power supply. Being experienced with installations in multiple countries, as well as a great team member, he proved to be the perfect person for the task.

The day prior to our arrival, the lead trainer for NextMed, Paul Starr arrived to inspect the equipment to ensure a successful launch. He worked with Patrick, and the Haitian ESWL “techs” Dr. Dreux and Japhare to familiarize them the the nuances of the Compact Delta I. He also coached them on the complex computer based data reporting program that they had learned about in Tucson. Completion of this data entry to record patient outcomes data is the only expectation that was requested in return for the generous donation.

By the time we arrived all was set from the equipment perspective and the Haitian urologists had lined up a number of stone patients who eagerly awaited non-invasive treatment of their kidney stones.

On Thursday May, 18th, 1 year after the initial offer, a reception was held at HSFDS in conjunction with a press conference with the national Haitian media to celebrate the launch of the ESWL program at the stone treatment center. The enthusiasm and pride of the hospital staff and administration was palpable and we know from the number of patients who presented at the hospital the next day looking for treatment of their kidney stones that the word was disseminated by the news media.

After the ceremony, we successfully screened a large number of patients, reviewing each case with the local urologists and teaching appropriate work up, evaluation and patient selection. This process will be greatly aided by the Translation Analytics and Statistics decision engine.

Over the next 2 ½ days we did 15 successful ESWL treatments (14 patients with kidney stones and 1 with a distal ureteral calculus). Dr. Dreux and Japhare proved to be very capable and knowledgeable from their training and Paul was a seasoned, laid back teacher who allowed them to work through the complexities of operating the system. Patrick stayed back an extra day to support and work on power issues. Several items that need to be adapted were identified and will be addressed, demonstrating Dornier’s long term commitment to the program's success. The hospital electrician and Bio-Med technician were trained and familiarized with the system and with the help of “Zoom conferences” technical support will be accomplished remotely as much as possible.  Dr. Dreux and Japhare will participate in the data retrieval program and regular internet based bi-monthly conferences with US NextMed technicians for ongoing training and feedback on their outcomes.

Upon departure the consensus was that the stone center had a viable ESWL program to offer Haitian patients and the core urologists and technical support staff were well positioned to provide outcomes that would rival top US treatment centers. The dedication of Todd, Chris, Brock and Mary along with the staff of their companies, NextMed and Dornier was inspirational.
HSFDS is proving to be a very willing and enthusiastic partner in this project to form a urology center of excellence. From the opening reception we felt welcomed. We were served lunches daily which included very appetizing Haitian dishes and on the last day we were presented with gifts. The nursing staff in the OR, and on the wards were enthusiastic and willing to learn. On Saturday morning we were pleased to have Mgr. Serge Chadic, a hospital board member, come to observe one of our cases.

The only dark cloud that hung over this very satisfying 3 day experience was that Dr. Pierre-Alix Nazon was not present to bear witness to the outcome of his visionary thinking. We anticipate that many Haitians will benefit from the generosity of this donation from NextMed, Dornier, Translational Analytics and Statistics, and all those who helped to make this ambitious project a success.

Henri Lanctin MD, FACS

Posted in Uncategorized.