REPORT: Cap Haitian April 2018

Cap Haitian April 20-27, 2018

Dr Jory Desir greeted a portion of our team at the airport in Cap Haitian. Our team included Dr Joe Costa MD, Dr Henri Lanctin MD, Dr Phil Abbosh MD, Dr Chip Carnes MD (HO4), Dr Sabine Nguyen MD (HO 4), Statia Smith RN and Dr Joe Babiarz MD.  After a short lunch we traveled to the University Hospital Justinian where Dr Dube, hospital director, greeted us as well.  After a tour of the facilities and Dr Lanctin delivered the anxiously anticipated new Bovie machine and the Olympus flex cystoscope and the Stryker camera and light source.   We began an evaluation of facility needs including space in the operating theater for urology equipment to assist with efficiency as physicians are currently having to transport all equipment across the campus to the operating room on the day of cases.

Dr. Lanctin and Dr. Desir test donated equipment on arrival.

Several patients were then evaluated including some with vesicovaginal fistula and some men with urethral stricture disease.  The day ended with a dinner hosted by Dr. Desir and Dr. Dube at the LaKay.

On Day 2 our team along with our Haitian colleagues evaluated additional patients with fistulae and urethral obstruction.  Both residents and staff physicians from the US and Haiti participated in this hands on interactive session.  Preparation in the operating room occurred as well for upcoming surgeries to begin in the morning.  Patients were then jointly reviewed and the physicians created a plan for the operations to be accomplished by Haitian surgeons assisted by US surgeons.  In addition, the remainder of our team arrived.  This included Dr. Bill Cleary, Lura Spears CRNA and Kelly Joe Gabel who will assist in teaching of the anesthesia providers from Haiti.  The focus of the trip is in expanding the knowledge and skills of our Haitian colleagues in both urology and anesthesia.

On Day 3 through 6 the team assisted the Haitian urologists and anesthetists in performing complex bladder fistula repairs and complex urethral repairs not only improving patients’ quality of life but developing local team operative skills so that these repairs are available locally through native surgeons and under the anesthetic care of local providers in the future.  US resident physicians Dr Cheeps Cairnes and Dr Sabine Nguyen and Statia Smith were critical to the success of the workshop working with local operating room staff including circulating nurses, surgical techs and recovery room staff to build efficient team work.   The skills of the local providers were excellant but their outcomes and future success will depend on continued infrastructure support including equipment, facilities and operations.  The equipment delivered by Dr Lanctin was used throughout the week including the Storz endourology equipment, the Stryker Camera, the bovie machine, suture and equipment provided by Project Haiti and the flexible cystoscope. An additional future needs assessment was carried out with the assistance of local urologists, anesthesiologists, residents and administrators. 

Left:  Dr. Tellusme Jolius, a Haitian urology resident, performs a urethral repair with his attending, Dr. Desir Jory and calm US urologist Dr. Joe Costa, as residents and medical students look on.  Right: Dr. Bill Cleary teaching Haitian anesthesia students and staff. 

  

Top: Dr. Joe Costa delivers state of the art lecture to staff, residents and medical students. Bottom: Culmination of trip when Haitian staff urologist Dr. Desir leads Haitian resident urologist through case with Haitian anesthesia students and staff providing anesthesia as Dr. Costa looks on. 

Left: Dr. Joe Babiarz directs Haitian Urologists while performing a complex vesicovaginal fistula repair. Medical College of Georgia (IVU Med sponsored resident) Chip Carnes in background assists with teaching surgical assist/tech skills.
Right: Dr. Joe Babiarz and Dr. Jory Desir after another successful case.

   

REPORT: Urethral Reconstruction Workshop

Project Haiti Urology:

Urethral Reconstruction Workshop,

Hopital St. Francois de Sales, Port-au-Prince, Haiti

April 1-7

 

Team members:

  • Frank Burks, MD (Royal Oaks, MI)
  • Jonathan “Nick” Warner, MD (Pasadena, CA)
  • Maxx Gallegos, MD (Albuquerque, NM)
  • Joe Pariser, MD (Minneapolis, MN)
  • Will Sikes, CRNA (Plainwell, MI)
  • Justin Lendhardt, CRNA (St. Cloud, MN)
  • Claudie Williams, NP (West Palm Beach, FL)

Preparation for our trip began many weeks before we arrived and included a Zoom video conference with Dr. Youry Dreux and other Haitian attending urologists and Haitian residents. The conference included a short didactic session reviewing the management of Pelvic Fracture Urethral Injuries (PFUD) and a presentation of 7 cases. The cases were presented by Dr. Youry Dreux and included relevant history, imaging and planned management. This conference and the presentation of cases with management plan represents a significant advance in the knowledge base of our Haitian colleagues and is a testament to the efforts of the IVUmed and Project Haiti teams that have built capacity within the country of Haiti.

The 6 members of the team arrived by air on March 30 and checked in to Le Plaza Hotel, near Hopital St. Francois de Sales (HSFDS) in downtown Port-au-Prince. Claudie Williams arrives on April 1st.  A team dinner/meeting was held that evening.

The next day we visited HSFDS, toured the facility and OR’s. Time was spent organizing equipment, meeting staff and verifying that all anesthesia equipment was operational and necessary anesthesia medication was available.

Drs. Burks, Gallegos and Warner working with Dr. Sean Elliot’s fellow Dr. Joseph Pariser performed, taught and proctored a total of 11 urethral reconstruction procedures. Three of the procedures were repeat procedures. Two excision and primary anastomosis procedures were performed for short mid-bulbar strictures. Four PFUD repairs were performed and 2 first stage Johansen urethroplasties were performed. Buccal mucosal graft (BMG) was harvested in 4 cases and this is a skill that Dr. Lemause and Dr. Kedex are developing. One of our more complex cases was a patient with intersex disorder who had a urethra cutaneous fistula from prior urethral surgery and was currently voiding from a scrotal urethrostomy with significant penile chordee. After reviewing the case and available imaging we performed a closure of his urethral fistula and first stage Johansen urethroplasty with BMG for advancement of his urethral out to the distal phallus as well as correction of his chordee. On our last day of the work shop a patient with a very complex pelvic fracture (significantly malpostioned pubic bone from non-operative management of his pelvic fracture) had an attempted PFUD repair that was aborted because of concern for failure to progress and an inability to identify the proximal prostatic urethra despite aggressive resection of the boney pelvis. There was also concern for a possible rectal injury if we proceeded to remove additional scar and bone. After much discussion Dr. Warner and I made the decision to abort the case out of concern for the patient.  There were no complications encountered at the time of team departure from Haiti. Average estimated blood loss was 200 cc. Detailed postoperative instructions were left with Dr. Dreux regarding catheter management and recovery.

With these cases, this team has now taught and performed 79 urethral stricture cases in Haiti. Haitian urologist in attendance were Drs. Youry Dreux, Joe Kedex (junior attending), Billy Lemause (senior resident) and Bernard Brutus. Each of our cases had a Haitian urologist scrubbed in and participating in key portions of the cases such as urethral dissection, excision of scar associated with PFUD injury, urethral anastomosis and harvest of buccal graft. Dr. Dreux’s operative skills and clinical judgement have progressed such that I would consider him at the level of a newly fellowship trained reconstructive urologist. He reports doing 2-3 urethral reconstructive cases a month at HSFDS and other hospitals in Port-au-Prince. He is also receiving referrals from other urologists throughout the country and makes every effort to include the referring urologist in the management plan and the eventual operation.

While at HSFDS our team verified that the fluoroscopy machine was in working order and that the ultrasonic lithotriptor was operational. Over all the facilities at HSFDS were adequate and safe for performing the complex and routine urethral reconstruction. Anesthesia staff and residents were available and helpful. The PACU staff could use some development in standardized postoperative recovery protocols.

One of the highlights of working at HSFDS is interacting with the Urology nurse Japhare Joseph. She has done an excellent job at organizing the urology equipment and supplies and has developed significant expertise in handling and maintaining the urology equipment. She is a true asset to the Urology Department at HSFDS.

In summary we had a very productive and educational trip. Verbal feedback from Drs. Dreux, Kedex and Lemause expressed appreciation of the didactic teaching and proctored surgical procedures. Members of our team have expressed to me that they found working at HSFDS enjoyable and interacting with our Haitian colleagues as a highlight of the trip. We hope that our efforts will continue yearly. We are looking forward to updates regarding the patients’ recovery and encouraged our Haitian colleagues to reach out to us by phone or email for any concerns.

Respectfully submitted,

Frank Burks, MD

April 20, 2018

 

Thank you e-mail to Drs. Joe Costa and Joe Babiarz

Thank you Joe and Joe,
I talked to Junelle and she is happy for the surgery.She is going to have her smile back as she was depressive after a disaster like this in her life. She has been admitted in a teaching hospital and stayed in for more than 20 hours in obstructive  labor and she lost the baby – she had nerve compression – Finally she has been referred to another hospital because there were no materials for her C section and  her Hysterectomy done because of uterine rupture.
Many thanks because what you did is priceless – May God continue to bless you all.
Looking forward to meeting you soon.
Best regards to you and your family Guys.
JEAN – JUMEAU Batsch,MD
Family Practice/Obstetrique – Gynecologie
Colposcopy – Laparoscopy – Cure de Fistules VV
Cell Phones : (509) :3632 – 4324 / Contact
Home Phone : (509) :3733 – 5178
Office in P-A-P : 86 Chemin des Dalles CTM

E-mail : jjbatsch09@yahoo.fr

<To Serve,you only need a Heart full of Grace,
a Soul generated by Love > “Martin L. King Jr”

First 2 Days for the Cap Haitian Week

Cap Haitian April 2018

Cap Haitien 2018

Dr Jory Desir greeted a portion of our team at the airport in Cap Haitian. Our team included Dr Joe Costa MD, Dr Henri Lanctin MD, Dr Phil Abbosh MD, Dr Chip Carnes MD (HO4), Dr Sabine Nguyen MD (HO 4), Statia Smith RN and Dr Joe Babiarz MD.  After a short lunch we traveled to the University Hospital Justinian where Dr Dube, hospital director, greeted us as well.  After a tour of the facilities and Dr Lanctin delivered the anxiously anticipated new Bovie machine and the Olympus flex cystoscope and the Stryker camera and light source.   We began an evaluation of facility needs including space in the operating theater for urology equipment to assist with efficiency as physicians are currently having to transport all equipment across the campus to the operating room on the day of cases. 

Several patients were then evaluated including some with vesicovaginal fistula and some men with urethral stricture disease.  The day ended with a dinner hosted by Dr Desir and Dr Dube at the LaKay.

On Day 2 our team along with our Haitian colleagues evaluated additional patients with fistulae and urethral obstruction.  Both residents and staff physicians from the US and Haiti participated in this hands on interactive session.  Preparation in the operating room occurred as well for upcoming surgeries to begin in the morning.  Patients were then jointly reviewed and the physicians created a plan for the operations to be accomplished by Haitian surgeons assisted by US surgeons.  In addition the remainder of our team arrived.  This included Dr Bill Cleary, Lura Spears CRNA and Kelly Joe (Buba) who will assist in teaching of the anesthesia providers from Haiti.  The focus of the trip is in expanding the knowledge and skills of our Haitian colleagues in both urology and anesthesia.

 

Hopital St. Francois de Sales Accepting Donations from Project Haiti

April 6, 2017

FROM: Project Haiti, Inc.

Dear Governing Board of Hopital Saint Francois de Sales (HSFDS),

Mgrs. Harris and Chadic

Fr. Roland

Drs. Alouidor, Eustache, and Brutus

Project Haiti is pleased to bestow donations to Hopital Saint Francois de Sales that now enable the hospital to begin laparoscopic surgery. The donations are detailed in the separate attached manifest document and the retail value of the donations, assuming that the hospital ordered this equipment, is $118,800 US. This equipment was successfully installed into Salle d’Operation #3 at HSFDS on Tuesday, April 4, 2017 by Stryker Endoscopy representative and Project Haiti volunteer Jake Boegel. On April 4th and 5th, many laparoscopic surgeries were successfully performed by Project Haiti surgeon Dr. Martin Perez and HUEH surgeon Dr. Sylvio Augustin, under the direction of Dr. Paul Severson and Ron Vitales.

In addition to the Stryker hardware donation, additional laparoscopic tools from Medtronic and surgical supplies from the Minnesota Institute for Minimally Invasive Surgery were donated through Project Haiti as well with an additional estimated value of $9400 US.

We want to thank Riverwood Healthcare Center for processing and shipping to Florida, Food for the Poor for transporting the donations from Florida to Haiti, and HSFDS authorities and Dr. Bernard Brutus for their assistance in acquiring the donations from Haiti Customs. The Project Haiti team appreciates the hospitality of all the wonderful people at HSFDS and the cooperation of all departments to make this initial laparoscopic education a success. We were able to help educate several surgery residents in the basics of laparoscopic surgery and would like to plan expanded courses in the future.

We look forward to a fruitful future relationship with HSFDS, and on behalf of the Board of Project Haiti, Inc., we congratulate you for your beautiful new hospital and appreciate the opportunity to become a small part of your bright future.

Respectfully submitted,

Project Haiti, Inc. Board of Directors

Paul Severson, MD, President

Henri Lanctin, MD, Vice-President

Pat Lanctin, Secretary

Jody Albers, Treasurer

Ron Vitales, Board Member-at-large

Mike Evans, Board Member-at-large

Returning to Hopital St. Francois de Sales

Dear Dr. Mondestin, Dr. Eustache, Msgrs. Chadic and Harris, Pere Roland,

Thank you for welcoming Dr. Andrew Loveitt and me back to Hopital Saint Francois de Sales, as we assisted Dr. Sylvio Augustin and your surgical team in performing laparoscopic surgery. Two patients from HUEH were able to receive the benefits of Minimally Invasive Surgery on Tuesday, March 27 in your beautiful hospital. We applaud your vision, compassion and persistence in continuing the push toward laparoscopic surgery for the population.
Dr. Mondestin, it was a pleasure to meet you and review the laparoscopy donation from Project Haiti with you yesterday. I am forwarding the summary email after our first laparoscopy was performed at Hopital Saint Francois de Sales last year. Please review the Haiti Manifest so that you can see exactly the laparoscopic equipment that you now possess for your future. This will bring you up to date with the laparoscopy project. I will also forward the email chain after the donation last year for your own edification.
I am also taking notes on the existing inventory to identify future needs for disposable items and additional equipment.
In addition to providing basic laparoscopy equipment in the OR, Mike Evans from Project Haiti (the expert in telecommunications and videoconferencing) has also consulted here and reviewed the plans with IT and bio-technical. After you have completed your initial installation, we would like to connect the laparoscopic Operating Room with the classroom for teaching larger audiences, as we have been doing for many years at the Laparoscopic Training Center in Pignon.
Naturally, in order for your HSFS staff to become proficient in laparoscopic surgery, and for you to become a center of excellence, we encourage you to foster a growing relationship with our young talented general surgeon, Dr. Sylvio Jr. Augustin, that we have trained to perform safe laparoscopic surgery. It would be great to see collaborative relationships with other teaching institutions develop over the next few years.
Please do not hesitate to email me regarding any requests or consultation.
Warm regards,
Paul Severson, MD, FACS, FASMBS
President, Project Haiti, Inc.
Co-Director, Minnesota Insititute for Minimally Invasive Surgery
Director, Minnesota Reflux and Heartburn Center
Program Director, MIMIS Fellowship in Advanced GI MIS, Bariatric Surgery and Flexible Endoscopy
Clinical Adjunct Professor, University of Minnesota Medical School

Pignon Surgery Report

Pignon Surgery Course

 

Team Report

March 16 – 28, 2018

Minimally Invasive Surgery Course

Hopital de Bienfaisance

Pignon, Haiti

Faculty:

Paul Severson, MD, FACS, Founder MIMIS

Andrew Loveitt, DO, Fellow MIMIS

Garald Jean-Louis, MD, GynEndo Haiti

Valerio Vital-Herne, MD, GynEndo Haiti

Sylvio Augustin, MD, HUEH

Mike Evans, Telecommunications Expert

Ron Vitales, Inanimate Skill Lab Director

Project Haiti Team:

Marlee Novak, Medical student, Team Coordinator, Skill Lab Assistant

Chad Riddle, Nurse Assistant

Joseph Vitales, Team Assistant

Attendees:

14 Surgeons, including 3 staff surgeons and 11 residents. 

Seven were General surgeons and seven were OB/Gyn physicians

HUEH had 3 general residents and 2 OB/Gyn residents

Le Paix had 1 staff general surgeon, 2 general residents, and 2 OB/Gyn residents

Chancerelle had 2 OB/Gyn residents

Pignon had 1 staff general surgeon and 1 staff OB/Gyn

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 19 through Thursday, March 22

Lecture content included the history of surgical innovation and teaching at Hopital de 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 new 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 implemented successfully in the Inanimate Skills Laboratory.  The SAGES Fundamentals of Laparoscopic Surgery (FLS) program was utilized as the basis for the lab.  An ultrasonic energy lab was also conducted, which provided hands-on experience for all students with this newer technology.  The annual Endo Olympics competition was held with spirited camaraderie among the participants.

Surgeries included 7 lap choles, 2 laparoscopic Toupet fundoplications, and 4 diagnostic laps with surgical intervention for infertility.  The last 2 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.  The last procedure was completed utilizing the ultrasonic energy device exclusively, marking a new first for the Haitian staff.

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 Saint Francois de Sales – March 26 and 27, 2018

Dr. Paul Severson and Dr. Andrew Loveitt joined Dr. Sylvio Jr. Augustin and performed 3 laparoscopic cholecystectomies, utilizing the laparoscopic equipment donated to the hospital by Project Haiti in 2017. The cases were performed skillfully by Dr. Sylvio Augustin as the primary surgeon and we found the equipment well cared for and in excellent working condition. We were greeted by urologists Drs. Bernard Brutus and Youry Dreux, who were performing surgery for stone patients in the next room.

Hopital L’Universitaire La Paix – March 28, 2018

Dr. Paul Severson and Dr. Andrew Loveitt were invited to meet the residents and faculty at La Paix, and were picked up the Le Plaza and escorted by the Chief of Surgery Dr. Nesly Vastey to Hopital L’Universitaire La Paix. All the residents and some of the faculty gathered to meet us and after bilateral speeches, we evaluated the existing laparoscopic equipment and then toured the facility, including the operating rooms. There may be 2 surgeon champions at that residency program, one general surgeon that attended our course in Pignon, and also a pediatric surgeon with some prior laparoscopic experience in his fellowship. We made plans to invite both faculty and residents at our next course, and will consider developing another laparoscopic site there in the future.

Urethral Reconstruction Workshop

From Dr. Youry Dreux to Dr. Frank Burks and team following the recent urethral reconstruction workshop at Hopital St. Francois de Sales in Port-au-Prince:
 
On behalf of the attendees, I would like to thank each of you for making yourself available to come down in Haiti to help us out with our patients suffering with urethral stricture.
I would like to let you know how grateful and joyful we are because we spent this whole week with you guys and, as usual ,the ambiance was very good ,you were teaching us with patience ,enthusiasm ,wisdom and humility .
We do hope you will make it  safely back home and may the Lord keep protecting your family and preserving you life .
Once again thank you so much ,guys ,please feel free to come back any time  you will be always  welcome.
.
SINCERELY  Youry

Surgery Week at the Hopital Bienfaisance de Pignon

Plastic surgeon, Dr. Fogarty has had a long relationship with Project Haiti and Hopital Bienfaisance de Pignon. He has returned after a several year hiatus. Here is a brief summary of his week:
Dr. Guy and All,Just to inform you that we (the hospital) received today a donation of US $ 10,000.- from Dr Fogarty / Interplast West Virginia for the surgery week at the Hopital Bienfaisance de Pignon.  Attached you will find a copy of the check.

They have seen patients in outpatient clinic on Saturday and during the week.  From Monday to Wednesday, the group performed 18 surgeries (plastic surgeries).

They have 8 cases scheduled for today.

Tomorrow afternoon (Friday 16, 2018) there will be teaching (lectures) for the medical staff. (see attached subjects list).

The group (Interplast West Virginia) willeave Pignon on Saturday (March 17, 2018) at 6:00AM .

They plan to come back to Pignon next year (March 08 – 16-, 2019).  They would like to see a lot of patients.  We will made appropriate arrangement in order to have more many patients for them next time as we know a year in advance.  Also we have been informed that some of the patients does not come because they do not have money to cover their travel fees (transportation, lodging, etc..) .

A million of thanks to the Interplast West Virginia team.
Lucy, the team coordinator, is copied in this email.

Noel Marie Adele

Administrator
Hopital Bienfaisance de Pignon

Summary Report for Dr. Osiris – Haitian urologist who received training

Summary Report.

Dr. OSIRIS Marc Aurele Joseph.

Fellowship in Endourology

Place: Hôpital General de Grand Yoff (HOGGY) , Dakar, Senegal

Dakar Partner: Institut de Formation et de Recherche Universitaire (IFRU) and GRAND YOFF HOSPITAL.

Haitian Partner:  Société Haïtienne d’Urologie (SHU) and Hôpital de  l’Université d’Etat d’Haïti (HUEH).

Financial Partners: International Society of Urology (SIU) and Project Haiti

Duration of Training: 3 Months

Started: July 6, 2017

Ended: September 26, 2017

Activities:

Outpatient Clinic _ international meeting and Workshop (URO-DAK) _ endosurgery_ open surgery.

 

THE TRAINING:

  • Monday : 

Morning: exploration department (cystoscopy_ urethral dilatation_ prostate biopsy_ JJ Stent training)

Afternoon: Outpatient clinic

  • Tuesday_Wednesday_Thursday_Friday: surgery/Operating Room.

 

SURGERY / WATCHING AND SCRUBBING

(1_ first surgeon, 2_first assistant, 3_second assistant, 0_watcher)

Endo- UROLOGY SURGERY

TOTAL  | SCRUBBING (0   1   2   3)

TURP 10 | 4 (2-2-2-2)

TURV 7  | 3 (2-2-2)

URS+ LASER 8  | 6 (2-2-2-2-2-2)

URS+ SW+LASER 2 | 2 (2-2)

PCNL 2 | 1 (3)

EIU 1 | 0

POST.Ur. VALVE RESEC. 2 | 1 (2)

ENDO PYELOPLASTY 1 | 0

   __________________________

TOTAL: 33 | 17 (scrubbing)

 

OPEN SURGERY

TOTAL | SCRUBBING (0   1   2   3)

ADENOMECTOMY 6 | 3 (3-1-2)

NEPHRECTOMY 3 | 0

TOTAL PROSTATEC. 6 | 3 (2-2-3)

HERNIA 7 | 5 (2-2-1-1-1)

URETROPLASTY 5 | 2 (2-2)

HYPOSPADIAS 1 | 1 (2)

URETERAL REIMPL. 1 | 1 (2)

VARICOCELE 1 | 1 (1)

TOT/SLING 1 | 0

CRYPTORCHIDIA 2 | 2 (1-1)

CYSTOLITHOTOMY 2 | 1 (1)

URETHROCELE 1 | 1 (2)

VULVOPLASTY 1 | 1 (2)

_______________________________

TOTAL: 37 | 18 Scrubbing

 

INTERNATIONAL FORUM and WORKSHOP / URO-DAK (July 11, 12, 13)

  • URODYNAMIC
  • VESICO-VAGINAL FISTULAE REPAIR
  • URETHROPLASTY
  • RECONSTRUCTIVE SURGERY OF VAGINA (EXCISION!!)

Mentor /Teacher: Dr. Mohamed JALLOH and the surgical STAFF.

CERTIFICATION: IFRU, HOGGY, Professor Serigne M. GUEYE.

PERSONAL THANKS:

I would like to think every personality and organization that contributed to the accomplishment of this program. This training had been very a successful experience, increasing my knowledge and my skill in the urology practice.

Endoscopic procedures are the future of the urology, and I am very determinate to help the Haitian Community by sharing my experience with the young residents.

I want to thank our partners in Dakar for all these human resources that they are providing for the International urology’s gold success.

Best Regards,

Dr. Marc Aurèle Jph. OSIRIS