2019 December

NSVI conducted its 20th mission to Haiti from December 5-8. Torrential nighttime rains left some roads gullied or muddy, and the parking area of one of our main clinics flooded. But we provided vasectomies for 85 men who had had a total of 448 children, an average of 5.3 children per man.

Steven Shu is a veteran of multiple NSVI missions to Haiti and the Philippines and of his own NGO’s missions to Haiti. Jean-Philippe Bercier has been a vasectomist for nearly 5 years and joined NSVI for the first time.

We performed the vasectomies at 5 locations, this being our first trip to Grande Rivière (Gran Rivyè in Haitian Creole). With our Medical Director Maudelin Mesadieu, we continued the training of 3 doctors (Compere, Trevant, and Dugue) with whom we had worked during previous missions, and we completed the training of urologist Dr. Jolius Thelusme, who will now lead a second domestic team, providing vasectomies between NSVI missions.

Our hosts at 4 locations. I never met our host at the clinic in Grande Rivière.

Under the leadership of Administrative Director Covsky Aimable, we had a team of experienced personnel who need very little direction.

Once again, none of this would be possible without the support of “the man in charge”.

Schedule:

Thursday Dec 5:
Arrived in Cap Haitien on American Airlines #2732 at 4:00 PM. We did not have time to perform vasectomies today, but we stopped at Hopital FSM to hang banners and provide brochures for our return on Dec 7 & 8. Our Haitian staff had picked up our stored supplies (tables, Mayo stands, and some equipment) at the Cap Haitian Health Network (CHHN) office. We brought them to Hotel Roi Christophe, where we organized them to support two teams. We dined with Dr. Jolius Thelusme and began the NSV training process with videos and models.

Friday Dec 6:
Team 1 (Mesadieu, Bercier, and Trevant): 16 Vasectomies at Dr. Mesadieu’s ULS Clinic in Ft. Bourgeois.
Team 2 (Stein, Shu, Jolius, and Dugue): 15 Vasectomies at the Dugue Clinic in Plaine-du-Nord.
When finished, Team 2 went to the Complexe Medico-Social de LaFossette to explain vasectomy to the women waiting for their appointments at the prenatal clinic. Unfortunately, we arrived after the clinic was over, but we did meet our host Dr. Constant and made sure the procedure room was ready for the next day.

Saturday Dec 7:
The plan was for both teams to go to CDS/LaFossette in downtown Cap-Haitien, assess the number of patients, and then part of the group go on to Grande Rivière. But the driver of Team 2 bypassed the downtown area, and by the time his passengers (including Dr. Shu of Team 1) were aware, the traffic was too dense to go back. So Dr. Shu got a ride back, while Stein and Bercier went on to Grande Riviere. All of our trainees were with the other driver.
Team 1 (Mesadieu, Shu, and all trainees): 20 Vasectomies at CDS / Complexe Medico-Social de LaFossette.
Team 2 (Stein and Bercier): 22 Vasectomies  in Grande Rivière du Nord.

When finished, both teams went to the Hopital Ft. St. Michel (HFSM) for 5 vasectomies during a big rainstorm. When finished there, we simply locked the door so we could continue on Sunday morning without having to set up again. Dr. Shu went to the airport to return to the States. Due to a schedule change, the American Miami flight was too late for his connection to Minneapolis, and he had to leave a day early for a full office schedule on Monday.

While at CDS, Dr. Mesadieu had learned that a patient whose vasectomy had been performed the day before had developed a scrotal hematoma. So on Saturday evening, we took the patient to Justinien Hospital where Dr. Jolius, Dr. Stein, and Dr. Wisten Accilus (Dr. Jolius’s third year urology resident) drained the man’s hematoma under spinal anesthesia in the operating room.

Sunday Dec 8:
7 vasectomies at flooded HFSM in Cap-Haitien until 1 PM. While the other doctors worked, I paid the staff, equipped Dr. Jolius with all of the equipment he would need to run a second domestic team, and divided remaining supplies and equipment into (1) those that we donated to resupply Maudelin’s domestic team, (2) those that stayed in Cap-Haitien for the next NSVI mission, and (3) those that I brought home to the USA.

Dr. Bercier and I arrived at the airport by 2 PM, well ahead of our 5 PM flight time. But at 2:50, we received a message from American that our flight had been postponed until 10 AM on Monday. The plane’s departure from Miami was delayed by mechanical issues, and since the runway in Cap-Haitien has no landing lights, planes cannot land after dark. Covsky brought us back to the hotel, where I called my Monday reversal patient with the news that his procedure would be postponed until Wednesday. Faithfully, Covsky retrieved us in the morning for an 8 AM arrival at the airport.

Now some photos:

Urologist Dr. Jolius Thelusme joined us for dinner at our hotel on the evening of our arrival. He had consulted on a scrotal hematoma after the mission in June.

He had never performed NSV, so we began the training process …

… with videos …

 

… and models. A torrential rain occurred later that night.

The next morning, nice and sunny, our Haitian Team all came to the hotel for breakfast …

… to apply envelop labels …

… and to fill envelopes with acetaminophen …

… and a little money to help patients with transportation costs and lost income.

We all went to Dr. Mesadieu’s clinic in Ft. Bourgeois in the hills above Cap-Haitien. The steep side road leading to it was deeply gullied by rain erosion …

… and the new retaining wall on the downhill side had been washed away.

It was a disaster for Dr. Mesadieu, and he hopes that the contractor who made the wall will stand by his work and rebuild it to protect Maudelin’s clinic from washing down the mountain.

Nonetheless, Dr. Thelusme proceeded to counsel …

… the men who had faithfully arrived for their vasectomies before his departure to the Dugue Clinic.

At the Dugue Clinic, Dr. Thelusme learned how to prepare a MadaJet and …

… he and Dr. Dugue performed several vasectomies under close supervision, while Dr. Shu handled the bulk of the workload. Both trainees made great progress, and with one more day of training, I think Dr. Dugue will be ready to lead her own Domestic Team.

At CDS LaFossette, most of the patients at the prenatal clinic were gone, but Tenel left brochures with our lead facilitators to be sure that men in that area were aware of our return on Saturday. Our host Dr. Constant was also happy to meet Dr. Bercier, our French speaker from Canada.

Always eager for a good photo, Steven tried to capture the challenges of life in Haiti. Streets crowded with people …

… piles of refuse …

… and sometimes the building materials of construction workers.

After another nighttime terrential rain in Cap-Haitien, Stein and Bercier went south into the Haitian highlands to the town of Grande Rivière. A communication breach had left our trainees Thelusme, Trevant and Compere with Mesadieu at CDS LaFossette.

It was a wonderful break from the big city and the clinic was great.

We worked steadily to complete 22 vasectomies in about 3 hours.

Security officer Rosny kept us moving by escorting patients in and out.

One of the men whose vasectomy had been performed on Friday at Ft. Bourgeois had developed a hematoma (blood clot) in his scrotum. He was taken by his family to the urology department at Justinien Hospital. At the moment, there was no electricity inside and we had to examine the patient using headlights and cell phone flashlights.

We then walked to the operating room along outside walkways.

The sterilizer room at Justinien Hospital had old equipment, but it worked!

A central hallway led to two operating rooms, both seen in this panoramic view.

The OR was old but well equipped. The overhead operating light was not functioning, but a gooseneck lamp served as a substitute. Here the patient is sitting up for administration of spinal anesthesia. His procedure went very well. A drain was removed two days later and he was discharged much more comfortable than he would have been had we not drained the hematoma.

It poured again on Saturday night, leaving the parking lot at Hopital Ft. St. Michel flooded once again.

The lower walkway to the procedure room was flooded, but our waiting chairs were high and dry.

Now in his 4th day of training, Dr. Jolius had really mastered NSV technique.

Dr. Bercier needed to do little more than assist. The rain had deterred some patients, but with fewer patients, there is more time to train.

And we had time to restock Dr. Mesadieu with supplies, and provide Dr. Jolius with about six sets of instruments and enough disposables for his first 20 cases. He has an autoclave at the hospital, so he can transition to cloth drapes and sterilize his own sutures and thermal cautery pouches from bulk materials that NSVI also provided.

For a final photo, we were joined by 4th-year medical student Tattegrain Winpha. Our next star vasectomist in Northern Haiti?

Off to the airport early, but to no avail. Our flight was postponed to the next day – mechanical problems in Miami and an inability of aircraft to land in Cap-Haitien after dark due to the absence of runway lights.

The bright side of the delay was one more breakfast at our hotel with Covsky …

…and beautiful weather as we ascended out of Cap-Haitien.

Next mission? March 24-27, 2020.