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

Urethral Reconstruction and Percutaneous Nephrolithotomy Workshop – March, 2017

Project Haiti Urology:
Urethral Reconstruction and Percutaneous Nephrolithotomy Workshop,
Hopital St. Francois de Sales, Port-au-Prince, Haiti
March 4-11, 2017

Team members:
Henri Lanctin, MD (Watertown, SD)
Frank Burks, MD (Royal Oaks, MI)
Dan Rosenstein, MD (San Francisco, CA)
John Denstedt, MD (London, Ont, Canada)
Bob Marcovich, MD (Miami, FL)
Keegan Maxwell, MD (St. Cloud, MN)
Maxx Gallegos, MD (Reconstructive fellow, Detroit, MI)
Desmond Adamu, MD (Urology resident, Miami, FL)
Will Sikes, CRNA (Plainwell, MI)
Megan Cleland, BN (San Francisco, CA)

The team arrived by air on Mar.4 and checked in to Le Plaza Hotel, near Hopital St. Francois de Sales (HSFDS) in downtown Port-au-Prince. A team dinner/meeting with Haitian urology colleagues was held that evening.

The next day we visited HSFDS, toured the facility and OR’s. Time was spent organizing equipment, meeting staff and seeing pre-op patients.

Drs. Burks and Rosenstein, working with Dr. Santucci’s fellow Dr. Maxx Gallegos performed, taught and proctored a total of 7 urethral reconstruction procedures. 2 were repeat procedures. There were 4 excision and primary anastomosis cases, 1 buccal mucosal graft, and 2 pelvic fracture urethral injuries. Two of the patients were pediatric (7 and 11 years). Application procedure for Peyronies disease was also completed. There were no complications encountered at the time of team departure from Haiti. Average estimated blood loss was 160 cc. With these cases, this team has now taught and performed 69 urethral stricture cases in Haiti. Haitian urologists, particularly Dr. Youry Dreux, continue to improve in their ability to do cases independently. Accordingly, workshops tend to have a higher number of either repeat procedures or a greater level of difficulty.

Concurrent with the reconstruction workshop, in a second room, a total of 16 stone procedures were performed on 11 patients. This was led by Dr. John Denstedt, who on this trip performed the first percutaneous nephrolithotomy (PCNL) in Haiti. The team also included endourologists Dr. Bob Marcovich and Dr. Keegan Maxwell as well as general urologist, Dr. Henri Lanctin. A total of 13 PCNL’s, 3 semi-rigid ureteroscopic procedures and a percutaneous removal of bladder calculus were performed.

Despite significant pre-planning, technical difficulties were encountered, including the absence of ultrasonic lithotripsy probes, mechanical problems with the backup pneumatic lithotripsy device and an underpowered laser unit which frequently overheated and required cooling and rebooting. These technical issues were compounded by lack of adequate pre-op imaging (CT scans or IVP) and a high level of complexity (large, multiple, dense stones with complex anatomy). There was only 1 case that a solitary stone could be removed without fragmentation.

Because of the above factors, 5 “second look” procedures were performed: 1 large staghorn due to mechanical problems with the pneumatic lithotripter, 2 due to complex intrarenal anatomy (1 with scarring from previous surgery, 1 with blown out calyx and scarred infundibulum), and 2 large, dense midureteral calculi which were embedded in the urothelium.

Despite the above issues and complexities, no complications were encountered by the time of team departure and all cases were either completely stone free by fluoroscopy or the offending calculus was removed. In all cases there was a Haitian urologist scrubbed and assisting.

Both the reconstructive and stone workshops were facilitated by pre-workshop teleconferences with team physicians and Haitian colleagues which included didactic lectures, Q&A sessions and presentation of proposed surgical patients by the Haitian team. This proved to be extremely effective and improved pre-workshop planning and scheduling of cases.

A great deal of time was spent planning next steps for the successful development of the stone treatment center at HSFDS and it is the hope that a young urologist or senior resident will be able to successfully apply for an Endourological Society fellowship for hands on training at a high volume center, such as currently exists in India. Dr. Christian Valme (4th year resident) was invited by Dr. Denstedt to apply to the financial committee of the ES.

The technical and equipment issues were discussed and plans devised to hopefully deal with them. It is anticipated that a second PCNL / URS workshop may be held as soon as late fall 2017, perhaps to coincide with GASHU annual meeting.

Funding for the PCNL / ureteroscopic workshop as well as procurement of equipment and supplies for the stone center was provided by the Endourological Society, a grant from Cook (Canada), Storz Urology, Project Haiti and Project Haiti team members, their hospitals, and various other equipment representatives.

Mr. Chris Gleason from NextMed, LLC who has partnered with Dornier to donate a Dornier ESWL unit joined us to tour HSFDS, meet with team members and hospital administration and develop a time line for implementation of the project. He also outlined the stone treatment decision engine that has been developed and our requirement to participate in outcome tracking and analysis. It was decided and arrangements were made to ship the unit now. Discussions occurred regarding who to send for training in Tucson, AZ with the GPC funded nurse and this was deferred to Haitian urology leadership for final decision. The 2 urologists who will be trained on the ESWL unit will be Drs. Bernard Brutus and Reginald Valme and they will be trained at a NextMed site in West Palm Beach. The dates for the first cases have tentatively been set for May19-21, 2017.

Preliminary discussions were held with an international radiology group, Rad-Aid regarding CT scanning and support at HSFDS as well as radiology resident and technician training. Contacts and introductions were made with further follow up planned.

It is the hope of the team that over time, when word spreads that minimally invasive treatment options are being competently performed at HSFDS, Haitian patients with symptomatic stone disease will present earlier. This will mean smaller, less dense stones which can be more easily treated and, more importantly, lead to less suffering. With our efforts Haitians from all socioeconomic backgrounds will have equal access to these treatment options.

Henri P. Lanctin MD, FACS
March 16, 2017

SHU and St. Francios de Salles Memorandum of Understanding

The Societe Haitienne D’Urologie (SHU) and the Global Association for the Support of Haitian Urology (GASHU) are proud to announce the official signature of a Memorandum of Understanding between the SHU and St. Francois de Salles on Friday, August 26, 2016 in Port-au-Prince on the premises of the newly built Hospital.

Background Information:

For more than 20 years, foreign urologists have independently provided direct patient care in Haiti or conducted educational seminars to share their expertise with fellow Haitian colleagues. In general, these activities have operated independently without cross-coordination and thus have failed to achieve their full potential.

Creation of Global Association for the Support of Haitian Urology (GASHU)

To overcome these shortcomings, several Haitian, American, and International Urologists have dedicated great efforts and resources for the past 5 years towards numerous seminars, workshops, AUA supported Ultrasound Workshops and two-day conferences in Port-au-Prince (2013, 2014). This has helped the organization overall to evolve into a better organized and coordinated Urology Association. The newly named Global Association for the Support of Haitian Urology (GASHU) will be able to streamline these efforts in order to maximize the positive impact to urology training, practice and patient care in Haiti. GASHU has recently identified the newly built Hospital St Francois de Salles (Port-au-Prince, Haiti) as one of the premiere hospitals in Haiti which offers great potential for the training of Residents and the development of surgical workshops. The geographic location and infrastructure of Hospital St Francois de Salles (SFDS) are superb. The Haitian Clergy and Leadership at SFDS are very welcoming and eager to help the Haitian Community at large.

This significant effort which holds great promise to change the landscape of urologic care in Haiti is supported by several influential foreign global Urology organizations and international leaders in the field of Urology.

The members of these efforts include the American Urologic Association ( AUA ) the Global Philanthropic Committee ( GPC ) , Societe Internationale D’Urologie - SIU, International Volunteers in Urology (current name Ivied ) Association des Medecins Haitiens a l’Etranger (AMHE) , Societe Haitienne D'Urologie (SHU) , Genito-Urinary Reconstructive Surgeons- GURS, Project Haiti, Notre Dame Filariasis Project, and Konbit Sante to name a few.

 

A Clear Mission:

The Mission of the Organization is to improve academic urologic training in Haiti by working with the residents and to better coordinate the efforts of non-Haitian urologists contributing to urologic care in Haiti. This will also improve access and quality of urological care in Haiti. Another focus point of our mission is to increase educational awareness towards the Haitian public on the importance of urologic disorders. This mission will be completed through various media outlets and activities.

 

What we Have Accomplished

By working with our partners through the GPC and through a major donation of Karl Storz and others we have secured the following equipment;

1- Endoscopic Equipments worth more than $ 350,000.00 donated by Karl Storz through GPC and delivered to St Francois de Salles, Catholic Charity Hospital (Port-au-Prince) on August 26, 2016, and previously to Les Cayes (State Hospital) July, 2016, and State Hospital Justinien (Cap Haitian), August 22, 2016. These instruments will allow for adult and pediatric endoscopic treatment of prostate and bladder diseases.

2- Three ultrasound and endoscopic units donated to the HUEH ( Hospital de L’Universite D’Haiti ) by Drs Lanctin ( Project Haiti ) , Gousse ( AUA liaison to Haiti ) , De Vries ( President of IVUMed ) and Badlani ( former Secretary General of the AUA ) . The ultrasound equipment will allow for prostate examination and biopsy, as well as imaging of the upper (kidneys) and lower (bladder) urinary tract. Prostate cancer is very prevalent in Haiti and these technologically-advanced units will significantly help with earlier detection of prostate disease.

3- A dedicated Urology Nurse who will oversee the care of the instruments and help with medical staff training and coordination of the Workshops.

4- Numerous previous Workshops, Training of Haitian Urology residents in the United States at Fundamentals of Urology ( AUA ) Didactics Course , Fellowship Training of Young Haitian Urologists ( SIU –GPC ) , and AUA sponsored Hands-On Ultrasound Course in Haiti

 

Future Equipments to Arrive:
1- Holmium Laser Technology
2- Extracorporeal Shock Wave Lithotripsy
These machines are state of the art for the management of kidney, ureteral, and bladder stones.

Future Academic Activities:
Future GASHU Conference at Karibe Hotel (October 29-30, 2016) where many International and Haitian Urologists and residents will be presenting their clinical and academic experience in Urology during the two day conference.

Future Workshops for the year
1- Vesico-Vaginal Fistula
2- Endoscopic Stone Surgery
3- Laser management of urologic disorders

Trip Report November, 2016

Urology Workshop Report – Hopital St. Francois de Sales, Port-au-Prince, Oct.31-Nov.2, 2016

US Urologists: Drs. Joe Babiarz, Joe Costa and Henri Lanctin
Haitian Urologists: Drs. Bernard Brutus, Pierre-Alix Nazon, Youry Dreux, Reginald Valme, Jean-Marie Aubourg, Jory Desir, Mitelot Clerivil
Haitian Residents: 3rd and 4th year

Following the Global Association of the Support of Haitian Urology (GASHU) meeting at the Hotel Karibe in Petion-Ville, a workshop was conducted at Hopital St. Francois de Sales. A recent agreement was signed between the Haitian Society of Urology and the hospital administration to establish a Urology Center of Excellence. This agreement includes provisions for the safety and maintenance of donated equipment and supplies, the ability of the GPC funded urology nurse and residents from the state university urology residency program to function in the hospital, and access to the hospital by the public patients HUEH and throughout the country.

The objectives for this session were a VVF workshop in one OR room and a ureteroscopic workshop in the other. The latter would include lectures on laser safety with “laser certification” of the Japhare Joseph (GPC funded nurse) as the laser tech and 2 urologists as the initial laser endoscopic urologists.

The number of cases was hampered by a number of factors: the hospital is new and unprepared for large number of cases, including nursing and anesthesia personnel (which we were relying on for this session), the recent resolution of the strike at HUEH which essentially shut down the residency program for over 6 months, Hurricane Matthew which was another devastating blow to the country, and the fact that Nov. 1st and 2nd are religious holidays in Haiti.

Despite this, 3 VVF cases were performed, 1 case which was a repeat from a large obstetric fistula which was primarily operated on by the Haitian physicians. Two of the 3 were challenging cases however, no significant early post op complications were encountered.

On the endourological side, we did 3 large distal ureteral calculi, ranging in size from 12 to 20mm. One stone unfortunately migrated to the renal pelvis and accordingly a stent was placed for later intervention. The laser functioned well and the urologists demonstrated good skills and knowledge of the laser function and settings.

On the last day we performed a dismembered pyeloplasty and resection of a large bladder tumor with the Haitian urologists. Pyeloplasties for UPJ obstruction are uncommonly performed in Haiti.

Observations and Conclusions:

1. HSFDS promises to be an ideal site for the establishment of a urological center of excellence in Haiti. A lot of the obstacles that were encountered on this trip were identified by the Haitian urologists who resolved to have further discussions with administration. The OR nursing staff are engaged and want to learn. They will need education and encouragement with issues like the establishment of case cards, post op urology care, care of the equipment, etc.
2. Japhare Joseph is perfect for her role, however, needs more training re. instrument care, laser safety and as we don’t have a dedicated x-ray tech, radiation safety.
3. Including a US Urology OR nurse and anesthesia provider to future teams would be advantageous, however, not a requirement.

 

Submitted by Henri Lanctin, MD

Les Cayes Trip Report – July, 2016

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.

Hopital St Francios d Sales

Operating Room at Hopital St Francios de Sales

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.

Dr. Nazon, Dr. Domercant, Dr. Lanctin, and presentation of donated equipment.

Dr. Nazon, Dr. Domercant, Dr. Lanctin, and presentation of donated equipment.

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.TURP

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.

Team Pic

The Team: Chris Lanctin, Dr. Lanctin, Dr. Nelson, Dr. Myril, Dr. Domercant, Dr. Dreux, Japhare Joseph, and Dr. Nazon

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

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.