Port-au-Prince, Haiti, 2017

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.

University of Nebraska Surgery on Sunday: Omaha, NE, June 2016

UNMC Bellevue Charitable Hernia Mission 2016

The Surgery on Sunday model was used and after University of Nebraska Medical Center administrative approval and multiple organizational meetings a date was set, June 3.  Dr. Hans Dethlefs at the One World Clinic evaluated all patients pre-operatively and eventually we performed 11 hernia operations in one.  Dr. Sam Cemaj, Dr. Tiffany Tanner and Dr. Arika Hoffman performed the surgery.  Recovery was uncomplicated in the hospital and two weeks postoperatively the patients are doing well.

The facility is modern and very well kept and managed making patient comfort easily possible.

 

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The Anesthesia staff, Surgeons and medical students who participated.  Dr. Cemaj on the left is the team leader.

A nice article appeared in the World Herald about a grateful patient who had made a good addiction recovery before undergoing surgery.  Thanks to Rosanna Morris, the CEO of Nebraska Health Systems for her generous support of the initiative.

        

                            

                                  

 

Mao, Dominican Republic, November 2015

2015 HRFU Dominican Republic Mao Trip Summary

The trip was held in Mao at the Luis L. Bogaert Hospital for a second straight year. This repeat site for HRFU in the Dominican Republic trip once again was truly a tremendous success.  During 5 consecutive days in November we performed approximately 72 hernia operations on 66 individual patients of which 25 were pediatric hernias.

Aside from the operations that were performed numerous other patients were examined and benefited by being referred for additional medical, cardiac and even oncologic workups as a result of items identified pre­operatively and intraoperatively while we were at the site.

As always our team members were grateful for the experience. We had team members representing Jersey Shore University Hospital (Neptune, NJ) , Lankenau Medical Center ( Wynnewood, PA) , Centrastate ( Freehold, NJ) , Swedish (Seattle), CHOP (Philadelphia) Hospitals as well as an Italian team from Milan Istituto Clinico Sant’Ambrogio ­ Milan & Multimedica Hospital, University of Insubria­Varese.

Drs. Jarrod Kaufman, Giampiero Campanelli and Marta Cavalli were the adult surgeons and Dr. Robert L. Weinsheimer was our pediatric surgeon. Dr. Kaufman acted as team leader for the second year and brought many new first time physicians. Dr. Kari Palmer an Internal Medicine physician facilitated the pre­op and post op evaluations. Dr. Michelle Barnes joined to help provide high level anesthesia for the pediatric patients.

The anesthesia team consisted of Drs. Michelle Barnes (peds) and Dr. Anthony Fugaro.

The entire team of nurses, scrub technicians, sterile processing and translators performed well under more predictable, but less than perfect conditions. As this was our second time returning to the site we tried to help correct some of the needs and as a result we donated 2 new electrosurgical units and had 2 new sterilizers also donated which greatly facilitated the operative flow and instrument sterilization.

There is continued enthusiasm on the part of the team members and local hospital staff members to continue our work at this Mao based hospital. The Timmy Foundation, Banelino and the HRFU Local staff truly helped round out the team for our second successful mission at this location.

There were many good moments and below are but a few.

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Below two of our pre-operative patients are waiting for their procedures.

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Surgeon Training:  Two fully trained local surgeons were trained by Drs. Campanelli on the Lichtenstein repair.  Both surgeons did very well and were awarded 10 pieces of donated mesh for future Lichtenstein repairs on poor patients.  This was done after watching the trainer operating on one patient and then after completion of 5 other groin hernia operations performed by the doctors with Dr. Campanelli first assisting each of them for the remaining cases.  After each of the 5 operations a written rating form was used to assess surgical performance and has been standardized by HRFU.

Training has become an important part of the HRFU mission.  Many additional successful hernia repairs will need to be performed by these surgeon we have trained. We believe that this training will eventually lead to the training of these surgeons to become trainers for hernia repair in their local area.

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Dominican Republic, November 2015

HRFU ILAC 2015 Mission trip

The team functioned well in the outstanding ILAC facility.  New surgeons included Dr. Brian Jacobs, a Pediatric surgeon, Dr. John Murphy, Dr. Alex Schroeder from Hamburg Germany and Dr. Kal Nandipati.  Many team members returned and we performed 88 hernia operations.  One patient with a very large hydrocele was challenging but had no complications after the hydrocelectomy.

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The entire 2015 team

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Jim and Pat on the left in front of the Manion room

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At the Wednesday night fiesta

Ouanaminthe, Haiti, November 2015

2015 HRFU Haiti Ouanaminthe Trip Summary

Hernia Help’s trip to Haiti last November was full of the usual adventures and misadventures customarily encountered on such missions to desperately poor countries. Two of them are worth the retelling as they bracketed both the beginning and the end of our journey.

Can you imagine our surgical team checking 30 supply bags at Newark New Jersey airport to find that only 29 of them had arrived in Santiago in the Dominican Republic on our way to Haiti. Of course it would be the very one containing all of our suture material and mesh. Fortunately a prescient member of our team (Dr Kern) had packed a “little extra” in his personal luggage and all was well. I wish I could remember the name of the delightful United Airlines agent who managed to find our bag in New Jersey and have it delivered to us within 36 hours. Without the two of them we would have had a very unproductive week indeed.

The real highlight of the week however occurred on Friday afternoon as we were packing to leave and head home. Barging in the door at exactly 1 o’clock came 2 man carrying a 20-year-old pregnant woman unconscious having an eclamptic seizure. Had they arrived one hour later both mother and unborn child would have died. However I’m delighted to tell you that by 1:50 PM both mom and little baby girl “Jersey”, delivered by emergency cesarean section, were coming along nicely in our recovery room. The professionalism and teamwork of our volunteers and the Haitian staff was awesome during that vital three quarters of an hour.

In the meantime 50 procedures were done for hernias and hydroceles with which many of our patients had suffered a lifetime of misery, discomfort and indeed embarrassment. They were readied preoperatively, put to sleep, operated upon, woken up safely and efficiently dispatched home. This was a remarkable achievement considering the conditions my team worked under, and it left everybody including our patients deeply satisfied.

Great care is taken by Hernia Repair for the Underserved in its selection of volunteers and each of them are top class in their chosen fields.  Karen Batchelder and Kara Crawford, respectively circulating nurse and scrub tech, worked so well together with Dr. Bob Fitzgibbons, a world renowned surgeon and editor of the journal Hernia,  that it was hard to think of them separately.

Edith Marquez and Amy Campeau, both scrub techs, were wonderful. I hope the surgeons they work with Stateside realize that they are sharing the operating room with real gems.  Scott Muttel was the life and soul of the team. Only I realize how this trip was in large part due to his efforts in the enormous preparation required beforehand to make it a success. This man can fix anything with duct tape.

Rachel Dowd, pre and post-operative nurse while teaching, arranging discharge and follow-up was ever vigilant constantly on team recordkeeping, necessary administrative work to preserve the Preferential Option for the Poor; that is to maintain high quality of care.  .  Neena Philip, our preoperative nurse, worked with Rachel Dowd deep in the recesses of the hospital, without air-conditioning. Laboring always with a good-humored laugh, joy and a twinkle in her eye.

Dette Kutch, postoperative nurse, jumped right on board only days before the trip after an unexpected family emergency with one of our volunteers. John Dowd, whose quite gentle help and willingness to do anything made working with him a delight.  Austin Philip, was our youngest member at 17.  His enthusiasm, good humor and attention to detail bode very well for this young man’s future. He was also our official photographer and I can guarantee you he has the largest collection of hernia photographs of any teenager in the United States!

Drs Guy Salomon and Vadim Galkin, anesthesiologists, both first-timers to Haiti, neither seemed to break a sweat under daunting conditions that could be described at best as spartan.  Dr Steven Kern’s, a snowman of a gent from Minnesota, winning wit and wisdom entertained us all mightily, all this along with his remarkable surgical skills.  Dr Dwijen Misra, without missing a beat joined us mid-week to provide support when Dr. Fitzgibbons left for a teaching appointment in Argentinian. Dr. Misra’s infectious gregariousness impressed us all.

Such kindness, care, compassion and competence has left both myself and our 60 patients all the better for having known these outstanding professionals.

Kevin Buckley

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Pediatric patients ready for surgery

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Staff members at the CODEVI dining area

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The Post Op Area

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Surgery in Room 1

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A salutation from the Pediatric patients