IVUmed-Project Haiti Reconstructive & General Urology Workshop #8

Pignon, Haiti
March 5-12, 2016

The team arrived on the grass airstrip in Pignon, March 5th on an afternoon flight from Port-au-Prince with Missionary Aviation Fellowship in their Cessna and Caravan planes. We also brought Japhare Joseph, the newly hired nurse who has been funded by Societie Internationale d'Urologie to work at  L'Hopital de l'Universite d'Etat D'Haiti (HUEH), the main hospital of the public university medical school in Haiti.

After settling in the dorm, "Minnesota House" and touring the hospital and community we had dinner and spent the evening on the roof of the dorm enjoying the cool breeze and getting to know each other.

Sunday morning was spent at the hospital unpacking the shipment of supplies, organizing our equipment and instruments and familiarizing ourselves with the anesthetic machines, etc.

An afternoon clinic was conducted to evaluate the patients referred for surgery. This was facilitated by attending Urologist, Youry Dreux and 2 residents from Port-au-Prince.

Monday morning we started operating and through Thursday afternoon the majority of big cases were done. Friday morning 2 minor cases were completed, the equipment was packed and the OR was tidied. After lunch with the Haitian OR staff and doctors, thank you cards with gifts were given to OR staff and certificates of attendance were presented to the attending urologists.

Because of the large number of urethral reconstructive cases that came from throughout the country, including Port-au-Prince (1/2), LesCayes and Cap Haitien fewer general urology cases from the local Pignon area were completed by Dr.Lanctin. Three TURPs were performed for urinary retention, 40, 80 and 75 gm prostates. The first 2 were uneventful and discharged on day 2, voiding well with clear urine. The third, a 59 year old, was taken back from PACU twice due to persistent bleeding. The first time was a repeat cysto, and the second time a cystotomy was performed. He did well and was discharged on POD#3 with arrangements for a voiding trial. One patient scheduled for a TURP was found to have a pinhole stricture just below the membranous urethra which was dilated, and another was found to have numerous bladder calculi which required cystotomy for removal. An incidental lesion which appeared to be a TCC was found and biopsied. Follow up was arranged with our colleagues in Cap Haitien.

Fourteen urethral reconstruction cases were performed by Drs. Burks, Costa and Gaines. There were 6 membranous, 6 bulbar and 2 pendulous strictures. The main etiologies was pelvic trauma and infectious disease. Average stricture length was 2 cm and average operating time was 154 minutes. Three of the pelvic fracture cases were repeat procedures, the primary repairs being performed by our Haitian colleagues. There were no immediate post operative complications. All patients were discharged from hospital upon our departure.

We worked with 3 Haitian attending urologists and 6 residents (4 from Port-au-Prince and 2 from Cap Haitien). At least 1Haitian physician scrubbed on all cases and residents started all TURPs. A highlight case was a urethral reconstruction (EPA) which was performed by an all-Haitian team. Lectures were given on urodynamics/ stress incontinence, hypogonadism/ testosterone replacement, urethral stricture disease and vesico-vaginal fistula. All residents were at the level of 4th year and it was readily apparent that their knowledge base and surgical skill level is far below where it should be.

Team chemistry was phenomenal and all OR activity was smooth with efficient room turnover, appropriate instrument and patient care.   Nurse teaching, especially to Japhare, was accomplished in all nursing areas, including PACU. With appropriate training she appears to be a valuable resource for HUEH urology program and future US Urology teams, if appropriately integrated into the team.

Our IVUmed - Project Haiti workshops have now trained 30 Haitian Urologists, Gynecologists and residents. Many have been present for multiple workshops.  After this week a total of 57 urethral reconstruction procedures have been done. We are encouraged by the improving surgical skills, and number of cases being performed by several of the repeat attendees, especially Dr. Youry Dreux. Learning of the English language and the development of basic surgical skills was encouraged.

Posted in 2016.