Port-au-Prince, Haiti, 2017

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Mission Summary                                                                                                                                                   St. Francois de Sales – October 2017

Hernia Repair for the Underserved                                                                                                                                                                   Nick Carter

 

Introduction

From 10/1/2017 to 10/7/2017, The Centre-Hospitalo-Universitaire Saint Francois de Sales (CHUSFS) welcomed a group of 16 American medical providers for a training mission in hernia surgery.  The visitors included two surgeons, two surgical residents, a pediatric anesthesiologist, a critical care pulmonologist, CRNA, four OR nurses, and five PACU nurses.  The intent of the mission was to train Haitian surgeons in Lichtenstein hernia repair for adult patients, pediatric inguinal hernia repair, and laparoscopic inguinal hernia repair.  The mission also presented an opportunity to establish proof of concept for laparoscopy and complex ventral hernia repair at   the CHUSFS.

Summary of events

In total, 77 patients received operations including 25 children.  There were 15 ventral hernia repairs and 10 laparoscopic cases performed.  Haitian trainees included Dr. Jacklin Mertus, an attending surgeon from CHUSFS, and Dr. Rolph Richeme, chief of surgery at Hospital Raoul Pierre Louis in Carrefour.  Trainers included Dr. David Chen of UCLA, Dr. Robert Cusick of Children’s Hospital and Medical Center in Omaha, and Dr. Jean-Fritz Jacques of the Hospital of the State University of Haiti (HUEH).  Two surgeons from HUEH, Dr. Jacques and Dr. Silvio Augustin, underwent additional training in advanced laparoscopic techniques.

Fig 1. Dr. Richeme performing a Lichtenstein hernia repair with Dr. Jacques.

Anesthesia and nursing providers from the CHUSFS and HRFU collaborated to provide safe perioperative care for all patients.  Surgery and anesthesia residents from HUEH also participated in clinical care and training.  There were no reoperations or immediate complications.

Fig 2. Ms. Chantal Corrioland (CHUSFS Head OR Nurse), Dr. Cynthia Ferris (HRFU Pediatric Anesthesiologist), and Dr. Johanne Duchatellier (CHUSFS Anesthesiologist)

Discussion and Future Opportunities

This visit represented the first Hernia Repair for the Underserved (HRFU) clinical mission to the CHUSFS.  A brief discussion of opportunities for future collaboration:

Creating a Center of Excellence

The CHUSFS administrators expressed continued interest in hosting a permanent national referral center for patients with complex hernia disease.  The infrastructure at the CHUSFS supported a busy clinical week.  Overall, the laparoscopic equipment is in good condition and image projection is satisfactory for safe performance of operations (see Fig 1).  The biggest challenge was maintaining an adequate supply of CO2 for insufflation as well as compatible tanks, regulators, and hoses.  We found this problem to be surmountable through teamwork, communication, and reducing our CO2 consumption by using a hand-pump for insufflation as much as possible.

Fig 3. Dr. Jacques performing a laparoscopic inguinal hernia repair

Elevating the profile of the CHUSFS in Port-au-Prince and provinces

the CHUSFS leadership arranged for a visit from a television crew from Radio Tele Soleil, the television and radio station belonging to the Archdiocese of Port-au-Prince.  Msgr. Aris expressed an interest in planning increased media exposure and perhaps a formal press conference during future missions.

Fig 4. Drs. Eustache, Carter, Telemaque, and Chen prepare for a television interview with Radio Tele Soleil.

Skills Lab and Additional Collaboration

Dr. Jean Gary Doucet, president of the Haitian Association of Surgery, expressed interest in developing a skills lab that would allow Haitian surgeons from various institutions to develop laparoscopic and open surgical techniques.  Low-tech laparoscopic trainers could be sited at HSFS to simulate intracorporeal suturing, knot-tying, and other fundamental skills.  There may also be an opportunity for increased collaboration between HUEH and the CHUSFS surgeons to identify patients who are candidates for laparoscopic repair.  A weekly hernia clinic, historically held on Saturdays at HUEH, might be transitioned to the CHUSFS to develop laparoscopic experience for surgeons from both institutions.

Additional Items and Next Year

Haitian staff feedback will be obtained and future trips will be planned.  A Memorandum of Understanding between CHUSFS and HRFU is in discussion.