My son, Chris, and I arrived in Port-au-Prince on Sunday, Jul. 10 after overnighting in Miami where we received the instruments to be delivered to Les Cayes from Drs. Gousse and Brutus.
Monday morning I did my first case at Hopital St.Francois de Sales, with Dr. Youry Dreux, on a patient with prostate cancer. The OR and nursing staff exceeded my expectations and I believe that next week, once the agreement between HSFS and Societie Haitian Urologie (SHU) has been signed, the Karl Storz donated instruments for Port-au-Prince can be delivered. The urology service should become very busy, especially with the ongoing General Hospital strike. The GPC funded nurse, Japhare Joseph, was well received at the hospital and will work cohesively with their nursing staff. There is ample space for storage of the urology equipment, and the OR is well organized and spotless.
On Tuesday morning we flew to Les Cayes with Missionary Aviation Fellowship as it was felt to be unwise to do the long drive due to current political unrest in the country. The team included Dr. Pierre-Alix Nazon , Dr. Youry Dreux, and Japhare. Upon arrival we connected with the local urologists, Dr. Sahmonde Myril and Dr. Gaby Nelson.
We were taken to Hopital Immaculee Conception des Cayes, a large general hospital that serves the lower peninsula of the country. The hospital had in excess of 60,000 patient-visits last year. The situation was unchanged from my visit 2 ½ years ago with non-existent cystoscopic equipment. Patients who required cystoscopy were forced to travel the 3 1/3 hour road trip to Port-au-Prince. Dr. Myril, who attended the SIU training center in Trinidad on a SIU scholarship, and Dr. Nelson who has participated in multiple of our Project Haiti-IVUmed workshops in Pignon, were anxious to receive our precious cargo and to get to work! We were taken to meet with Medical Director, Dr. Joseph Yves Domercant in his office where the official presentation was made. There were reporters from the local and a Port-au-Prince television station present to record the event and conduct interviews. Although, I did not personally see it, I was told that the event was aired on at least the Les Cayes station.
We then proceeded to a conference room where we inspected and familiarized the receiving urologists with the equipment along with proper handling and set up. The monitor-camera box- light source unit was particularly studied and highly appreciated. It was communicated to the local urologists that it only be utilized with a proper surge protector unit due to the highly unstable power from the hospital generators. I conducted a teaching session on BPH, basic cystoscopy, indications and proper selection of patients for TURP along with technique, complications (especially TUR syndrome) and post op care. During this time, Japhare was working with the OR head nurse, teaching proper instrument care and cleaning protocol.
We then had time for 1 case, a TURP, which was performed by Dr. Nelson with the assistance of Dr. Nazon. The equipment performed well and the OR staff were attentive and competent.
Wednesday, with an early start we were able to accomplish 3 TURPs, a bladder neck contracture (post-open prostatectomy) and a cystoscopy. All cases were performed by the local urologists with alternating assistance from the 3 visiting urologists. The cystoscopy patient was found to have a prostate which we felt to be too large for TUR and will undergo an open prostatectomy in the near future. One other patient had uncontrolled hypertension and after a reasonable waiting period with no improvement, we elected to not proceed with intervention until he was better controlled. All patients had been in urinary retention with catheter drainage, suprapubic or urethral.
The procedures were all performed in the obstetric OR as the main OR’s were undergoing renovation. Although there is no proposed completion date, we were assured by the medical director that there will be a designated urology OR.
For a Haitian general hospital, we were impressed by the high level of dedication of the nursing staff. They worked well with Japhare who is proving to be an effective teacher and a wise choice by HSU.
Wednesday evening we were treated to a delicious Haitian meal at Dr. Myril’s house where we were entertained with some wonderful Haitian folk music by her and her husband, Dr.George who is an internist and an accomplished guitar player.
We left on Thursday morning feeling comfortable that the urologists have a good grasp of proper equipment use and clear understanding of personal responsibility for the care of it. They are not yet competent to perform TURPs, however, Dr. Nazon has committed to working out a support schedule with HSU to have urologists visit Les Cayes and work with them. In the meantime they can work on their cystoscopy skills. Both are considered to be responsible and knowledgeable of their limitations. They were asked to track all cases and report to the joint urology conference in Petion-Ville in October, which they enthusiastically agreed to do.
It is my belief that this donation by Karl Storz, supported by the Global Philanthropic Committee, will provide a huge service to the patients of the lower peninsula of Haiti for many years. It will also help bridge the working relationship between the urologists in Port-au-Prince and the 2 local urologists who are somewhat isolated and early in their careers. I felt a huge sense of personal gratification mixed with a deep sense of responsibility during the mission to deliver this very generous donation from Karl Storz to Les Cayes, Haiti.
Henri Lanctin, MD
July 15, 2016
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