Haiti Trip Report, April 2018
I arrived at Cap Haitien, in North Haiti, on Saturday, April 21 with Drs. Joe Costa, Joe Babiarz and their team (they will submit their team report). I was accompanied by Dr. Phil Abbosh from Philadelphia. He was on his first trip to Haiti and wanted to become involved with teaching urology in resource-challenged countries.
We were greeted by Dr. Jean-Geto Dube (urologist and Executive Director, Hopital Universitaire Justinien) and urologist, Dr. Jory Desir.
The afternoon was spent preparing OR’s, and organizing equipment and supplies. Among the abundant OR supplies brought by the team, Project Haiti also donated a desperately needed electrocautery machine (from Prairie Lakes Healthcare System in Watertown, SD), a Stryker camera box with camera (from Stryker, Inc.) and a flexible cystoscope.
An enjoyable dinner that evening with our Haitian colleagues was followed on Sunday by a day of patient evaluation and teaching to the Haitian residents. They were instructed in the proper retrograde urethrogram and voiding cystourethrogram techniques for evaluation of male urethral strictures. Drs. Costa and Babiarz scheduled their cases for the week.
On Monday morning Dr. Abbosh and I flew by charter with Missionary Aviation Fellowship to Les Cayes on the south peninsula. There we were greeted by Dr. Gaby Nelson and after a quick stop at our hotel, we were taken to Hopital Immaculee Conception (the public hospital) in Les Cayes. Our objective was to proctor Dr. Nelson in the technique of transurethral prostate resection (TURP) over the next 3 ½ days. On my last trip to this hospital in the summer of 2016 I delivered the generous Karl Storz donation of urological instruments and a camera / monitor system. At the time we did TURP cases with Dr. Nelson which he continued under the tutelage of Dr. Aubourg, a senior urologist who works mainly in the Leogane area. They did a number of procedures together, however, Hurricane Matthew hit in October 2016 and the OR’s were devastated. Fortunately, the donated equipment was not affected as it was safely stored in the hospital administrator’s second floor office.
With the limited resources in Haiti it has taken until now for the OR’s in Les Cayes to be rebuilt. One of the new OR’s will be specifically designed for urology. Although the new OR’s are not expected to be completed for another 6 months, the administrator allowed us unlimited access to one of 2 functioning OR’s from Monday afternoon through Thursday. During this time we did complete 12 TURPs with Dr. Nelson doing the majority or entire resection in 10 and Dr. Joseph, a young and recently-trained urologist, doing some of the resection in 2. We were joined by Drs. Bernard Brutus, Youry Dreux and Global Philanthropic Committee-funded nurse Japhare Joseph on Monday evening. Dr. Aubourg was also present for most of the cases.
The cases went well. Dr. Nelson demonstrated very significant improvement despite very intense (often conflicting!) teaching of those present. It was felt after the last 2 cases (which he completed without help) that he was almost ready to start doing small prostate resections without proctors. Dr. Aubourg has committed to 2 days in May 2018, and Drs. Dreux and Brutus have also made a commitment to return.
A devastating occurrence was the sudden passing of one of the patients the morning after his surgery when he got up to wash in the bathroom. He had an uncomplicated procedure, had been very stable overnight with clear urine, stable vitals and normal temperature. The team assumed pulmonary embolus was the cause of death, and there was discussion about the lack of sequential compression devices and the need for them in Haiti where they are not available. We do utilize subcutaneous low dose heparin after most of our lengthy reconstructive procedures, however, we feel that with the risk of bleeding and significantly shorter resection times, this would not be appropriate following TURPs.
The highlight of our stay in Les Cayes was an evening at Drs. Sahmonde and Leno Myril’s home for a terrific Haitian meal followed by Haitian folk songs accompanied by Leno’s guitar. They are a wonderful couple who cherish their family, friends and Haitian heritage.
On Thursday afternoon we drove to Port-au-Prince with Drs. Brutus, Dreux and Japhare. We made a stop at Hopital Lumiere in the village of Bonne Finn. It is a 120 bed primary care hospital located high in the mountains of southern Haiti and has been supported by Apostolic Christian HarvestCall. A recent urology graduate from Port-au-Prince, Dr. Garçonville gave us a tour of the facility. He has attended a number of Project Haiti workshops in Pignon and has been working there several days per week. The hospital is very well-equipped and managed. After a meeting with several representatives from administration, we agreed to see what could be done to organize future workshops there. Specifically, TURP and urethral reconstruction were discussed as needs.
On Friday morning Dr. Abbosh and I helped Dr. Dreux with a radical prostatectomy at Hopital St. Francois de Sales. All went well and it was a pleasure to show Dr. Abbosh the great teaching facility that we are in the process of developing there. Japhare Joseph continues to grow and impress in her role. She was well-received by the nurses in Les Cayes and has a natural ability to teach and be adored by her peers, physicians, and other health team members. Her organizational skills and pride in accomplishment are evident in the functioning of the urology service at HSFDS.
Once again, I was humbled by the commitment of our Haitian colleagues with Drs. Bernard Brutus and Youry Dreux unhesitatingly taking time away from their families and practices to accompany us to Les Cayes. Their comradery and assistance was a reminder of how little we would have accomplished in Haiti without this valuable partnership. We also continue to foster good relationships with the administration of the hospitals visited and this is essential for our ongoing success.
We have made new friends and colleagues as Dr. Bill Cleary and his organization, Citizens of the World Foundation, provided professional and competent anesthesia support for the team in Cap Haitien. Their mission aligns perfectly with Project Haiti as they are committed to teaching and supporting anesthetic care in Haiti. They have worked in the north for many years forging close friendships. We look forward to a long and productive relationship with them.
The trip proved to be beneficial for Dr. Abbosh who after this diverse visit to Haiti has expressed an interest in getting involved and sharing his talents with Haitian urologists. Several options for him are in discussion. He has clearly demonstrated that he is a team player with a great sense of humor. He has a wonderful gift of effective teaching and most importantly, understands our mission of improving urologic care in Haiti by teaching and supporting our less fortunate Haitian colleagues.
Henri Lanctin, MD, FACS
Project Haiti Urology:
Urethral Reconstruction Workshop,
Hopital St. Francois de Sales, Port-au-Prince, Haiti
- 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.
Frank Burks, MD
April 20, 2018
April 6, 2017
FROM: Project Haiti, Inc.
Dear Governing Board of Hopital Saint Francois de Sales (HSFDS),
Mgrs. Harris and Chadic
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.
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
Dear Dr. Mondestin, Dr. Eustache, Msgrs. Chadic and Harris, Pere Roland,