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.