TRIP REPORT: Dr. DAN ROSENSTEIN:URETHRAL RECONSTRUCTION WORKSHOP – CAP HAITIEN, HAITI


Mar. 29- Apr. 6, 2019

This is a summary of my recent exhausting but gratifying surgical mission to Hopital Justinien of Cap Haitien from March 29-April 6th, 2019.
The American group that was tentatively going to join me ultimately canceled their trip due to justifiable personal safety concerns.  I decided to continue on the mission trip on my own.
The visit began on Saturday, and I was met by my host throughout the trip, Dr Jory Desir.  Dr Desir is one of the senior urologists at the hospital, and he introduced me to all the interns and residents that I interacted with throughout the week. These included Drs Josna Samson, Wisten Accelus, Richardson Paillant and Thelusme Jolius.
On the first evening the interns gave their month end urology presentations which were followed by a traditional Haitian supper prepared by the interns. After dinner everyone put their dancing shoes on for a few hours of dancing.   Things have changed since my internship!
On the following day I met the patients that Dr Desir had proposed to undergo surgery with our group in the following week.  Because this was primarily a urethral reconstruction workshop, the patients were all men with different types of urethral strictures awaiting urethroplasty.  The underlying causes of urethral strictures in most cases was trauma due to motor vehicle accidents (far too common in Haiti), or severe and untreated STDs.  The residents were very keen to participate in this unusual type of surgery.
Throughout the week, we completed 10 cases of complex urethroplasty, with each of the residents and Dr Desir performing most of the important surgical steps in each operation.  In at least two cases we were required to use buccal mucosal (cheek) grafts to reconstruct the damaged urethra.  These were also harvested with great skill by the Haitian surgical team.

 

Although supplies and sutures were in short supply, we were able to successfully complete these surgeries in a timely fashion.  In fact, the cases took exactly the same surgical time to complete as similar cases performed at my center in California.  This attests to the fact that my Haitian colleagues are remarkably skilled and were able to learn these complex surgical techniques with impressive fluidity.  All the patients recovered uneventfully with no obvious complications postoperatively.
I didn’t have much free time to explore Cap Haitien, but it appears to be a lovely seaside town with many historic landmarks relating to its significance Haitian war for independence in 1803.  I will look forward to returning next year to continue to work closely with my Haitian friends and colleagues. I am grateful that Project Haiti supported this mission.
Best – Dan

Project Haiti 2019 URETHRAL RECONSTRUCTION WORKSHOP

 

 

Minimally Invasive Surgery Course – Pignon, Haiti

Project Haiti Team Report

March 2 – 13, 2019

Minimally Invasive Surgery Course

Hopital de Bienfaisance

Pignon, Haiti

Faculty:

Paul Severson, MD, FACS, Founder of Project Haiti and MIMIS

Andrew Van Osdol, MD, FACS, Spearfish Regional Medical Center

Aaron Sachs, MD, Fellow MIMIS

Garald Jean-Louis, MD, GynEndo Haiti

Valerio Vital-Herne, MD, GynEndo Haiti

Sylvio Augustin, MD, HUEH

Ron Vitales, Inanimate Skills Lab Director

Project Haiti Team:

Dan McGuire, Medical student, Team Coordinator, Skills Lab Assistant

Christine Van Osdol, RN

Elizabeth Van Osdol, Team Assistant

Attendees:

4 hospitals, 16 Surgeons, including 3 staff surgeons and 13 residents. 

Nine were General Surgeons and seven were OB/Gyn physicians

Hopital L’Université D’Etat D’Haiti (HUEH) had 2 general surgery residents and 2 OB/Gyn residents

Hopital L’Universitaire de La Paix had 1 staff general surgeon, 2 general surgery residents, and 2 OB/Gyn residents

Hopital Justinien (Cap Haitien) had 2 OB/Gyn residents and 2 general surgery residents

Hopital Bienfaisance de Pignon had 1 staff general surgeon, 1 staff OB/Gyn, and 1 general surgeon to be (Adele’s son)

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 4 through Thursday, March 7

Lecture content included the history of surgical innovation and teaching at Hopital  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 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 utilized successfully in the Inanimate Skills Laboratory.  The SAGES Fundamentals of Laparoscopic Surgery (FLS) program was utilized as the basis for the lab.  The annual Endo Olympics competition was held with spirited camaraderie among the participants.

Surgeries included 6 laparoscopic cholecystectomies, a laparoscopic hiatal herniorrhaphy and Toupet fundoplication in a patient with severe GERD, a laparoscopic Heller myotomy and Dor fundoplication in a patient with severe achalasia, 2 diagnostic laparoscopies with surgical intervention for infertility, 2 open procedures for myomectomy, and a laparoscopic jejunostomy with esophageal dilation in a critically ill and malnourished man following a battery acid ingestion.  Two of the 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.  Of particular note was the excellent anesthesia service provided (all performed by our Pignon staff!), which enabled the team to accomplish a first-time achievement: completion of 4 lap choles ina single day in the main OR, despite being performed in the slower paced instructional mode.  This was due to the excellent clinical care and efficient room turnover between cases.

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 L’Universitaire La Paix – March 11-13, 2019

Dr. Paul Severson, Dr.Andrew Van Osdol, Dr. Aaron Sachs, and Ron Vitales followed up on last year’s initial visit by installing a donated Stryker laparoscopic tower, delivering lectures to residents and faculty, donating Laparoscopic Skills Training equipment and supplies, and conducting the first laparoscopic surgeries at the university.  Dr. Nesly Vastey, Chief ofSurgery, and Dr. Maurice, Assistant Chief of Surgery, hosted our team and provided excellent support, communication, and hospitality.  Lectures were attended by all of the residents and the surgery suite was crowded as the first laparoscopic procedure was performed.  Recently graduated Chief Resident and Endo Olympics Gold Medal Winner, Dr. Celisca Fornabial, and General Surgery Resident Dr. “Nash” Dorsainvil were mentored in 2 laparoscopic cholecystectomies and 2 laparoscopic appendectomies.  Dr. Celisca was the lead surgeon on the final laparoscopic cholecystectomy and performed very well.  It was a solid start to implementing a laparoscopic program, and robust discussions were held to communicate on-going training and development.  We will plan to make follow up visits to La Paix to continue to assist with their training. Dr. Andrew Van Osdol and Dr. Paul Severson plan to return to La Paix in the fall to continue the mentoring process.

Port-au-Prince – March 11, 2019

After our day of surgery at Hopial L’Universitaire La Paix, we traveled to HUEH to meet with Dr. Frank Telemaque, Chief of Surgery.  Upon arrival we were pleasantly surprised to find select surgery staff along with the entire surgery residency program in attendance to welcome and thank us.  Dr. Telemaque then made a formal presentation and recognition for Dr. Severson’s 30 years of investment with the Haitian people.  A “Wall of Friends,” containing photographs of 7 instrumental health care leaders was revealed, and Dr. Telemaque took great pleasure to note that Dr. Severson is #1 on the wall.  A champagne toast was held and fresh pastries were enjoyed by all in attendance.

We then traveled to Petionville to attend the Port-au-Prince Chapter Rotary meeting at the request of Dr. Vastey.  We arrived at the Kinam II hotel and were graciously welcomed by the leadership of the Rotary Club.  After a delicious buffet dinner, a formal recognition was made to Dr. Severson for his years of service to the country.  Dr. Severson thanked the chapter and emphasized the numerous successful projects that occurred because they were joint ventures with Rotary.

Lodging Comments

We found the Minnesota Dorm clean and well maintained, other than lacking hot water on this trip. The internet was functional. The food prepared by our wonderful cooks was exceptional and enjoyed by all. The staff at HBP also provided amazing support for the entire team and visiting surgeons. Thank you!!

We also enjoyed the accomodations and cuisine at the Cormier Plage near Cap Haitien at the end of our work week, before parting with half of our team, who flew back to the US through Cap Haitien on American Airlines. Sunrise Airlines was operational, and our Port-au-Prince team flew from Cap to Port without incident and were greeted and graciously welcomed by a large delegation of surgeons at the airport.

Our team of four stayed at the Ideal Villa Hotel, which is approximately 15 minutes from the La Paix Hospital.  The hotel has been very well maintained, is secure with an armed guard and gate, and we found the food for both the hot breakfast and dinner to be quite delicious.  The room rate of $90 per double, which includes breakfast, and is very economical.  On future visits to La Paix, we would recommend utilizing this hotel located in Delmas and not far from the airport, as an excellent choice and an economical alternative to the Matthew 25 house. It was easily booked online by credit card, and for the same price as Matthew 25, it has a restaurant, bar, internet services and a swimming pool. However, Matthew 25 has the advantage of the free and reliable airport shuttle.

Dr. Christian Valme – India

“Dr. Christian Valme working in the “Wet Lab” and nearing the end of his 6 month fellowship in India, learning the highly specialized minimally invasive technique of “Percutaneous Nephrolithotomy”. Many Haitian patients will benefit from this procedure when Christian returns and is fully trained and equipped.”

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.

   

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”

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

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