2021 May

After a 1-year hiatus due to COVID-19, four NSVI international doctors from 3 countries made plans to return to Northern Haiti May 6-9 for its 21st mission.After contributing generously to NSVI and even making travel arrangements, Robert Kulik could not make it. US authorities were still not allowing Europeans to travel via the USA to the Caribbean, and travel via the Dominican Republic was logistically challenging and risky for a lone traveler. So the “International Team” was the remaining three of us. Chris and Beata were not coming from Europe, but still impressive distances to donate their time and expertise.

We performed the vasectomies at 5 locations for 42 men who had had a total of 233 children (average 6 per man). With our Medical Director Maudelin Mesadieu, we continued the training of 3 doctors (Bright, Trevant, and Dely) …

… and urologist Dr. Jolius Thelusme (bio HERE) took the opportunity to train his 4 urology residents.

NSVI gratefully acknowledges the hosts at our service sites… and of course our hard-working team:Once again, none of this would be possible without the support of “the man in charge”.

Plans had been made to visit 5 locations, and our Domestic Team had hung banners and distributed brochures to notify the communities.

Thursday May 6:
We arrived in Cap Haitien on Spirit Airlines Flight 350 at 12:20 PM. Our Haitian staff had picked up our stored supplies (tables, Mayo stands, and some equipment) at the Cap Haitian Health Network (CHHN) office and set them up in our procedure room at Hopital Ft. St. Michel. We completed 4 vasectomies, then brought all supplies to Hotel Roi Christophe, where we organized them to support two teams. We dined with a large group of Haitian doctors (see Photos below).

Friday May 7:
Eleven vasectomies at Dr. Mesadieu’s ULS Clinic in Ft. Bourgeois followed by …5 vasectomies at New Hope Hospital in Plaine-du-Nord.

Saturday May 8:
Team 1: Four vasectomies at CDS / Complexe Medico-Social de LaFossette.Team 2: Nine vasectomies in Grande Rivière du Nord, Then the whole group came together again for 5 vasectomies at Le Flamboyant Clinique Communautaire (Dr. Bright’s clinic) in Limonade.

Sunday May 9:
Four vasectomies at HFSM in Cap-Haitien until 11:00 AM. While the other doctors worked, I paid the staff, 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 returned home to the USA on Spirit Flight 351 at 1:20 PM.

And now some photos:

Thursday May 6:

Breakfast at the Ft. Lauderdale airport after our 6 AM flight from Tampa.

I was so surprised by the number of Haitian doctors who met us at Hopital Ft. St. Michel, so eager to learn vasectomy. Teaching began immediately, first with how to prepare and use the MadaJet. They will use needles in their own practices, but MadaJets provide speed and reduce waste during missions.

It had been over a year since Dr. Thelusme had done any vasectomies, but with a minimum of guidance, he was back up to speed.

I explained to our guest vasectomists that each patient gets a “goody bag” with post-vasectomy instructions in Creole, Dr. Mesadieu’s phone number, a few condoms as a reminder to continue contraception for 2-3 months, a small sum to cover income replacement and transportation costs, 2 doses of an analgesic, and, of course, a lollipop.

Dr. Thelusme began to train his residents.

On the evening of our arrival, we all had dinner at our hotel. Dr. Thelusme with all 4 of his residents, Dr. Mesadieu and his wife Wilmide Felizor, Dr. Bright (closest to the camera) and special guests Dr. Fritz Lolagne and Dr. Jory Desir. Dr. Lolagne,, Dr. Ramon Suarez (the Founder of NSVI) and I had introduced Dr. Desir to NSV when he was a urology resident 10 years ago.

Friday May 7:

After a hearty breakfast and distribution of NSVI shirts at the hotel …

… we took the traditional group photo before heading out to our first location …

… Dr. Mesadieu’s ever-growing ULS Clinic in Ft. Bourgeois.

A front-end expansion provided a cool counseling area and 3 procedure rooms.

With 3 tables set up in one room, Mario can keep all 3 tables supplied with instrument trays, and respond quickly to requests for extras.

Maudelin, Thelusme, and I could train at one table each.

Working together here are (L to R) Drs. Johanne Trevant (OB-GYN), Jerry Dely (general surgery), Jolius Thelusme (urology), and Enioth Bright (general surgery) …

… while Beata Byczko observes from a distance …

… and I intervene periodically to refine techniques.

Maudelin was proud to show his birthing room …

… and lab.

We then packed up all NSVI supplies, including our folding procedure tables …

… crammed 9 adults into each vehicle (Beata looks a little unsure about this) …

… and arrived at New Hope Hospital, 2 weeks after Dr. Shu’s Make Men Smile hydrocele group had worked their magic for the local men.

The large main operating room was in use, so we had to take another room large enough for 2 tables and Mario’s supply table.

With low patient turnout, not every doctor got his or her own case, but the Haitian doctors “shared” patients at one table …

… while the international guest vasectomists took another.

NSVI had never had a mission in which so many Haitian doctors came to learn vasectomy all at once. Diplomacy and sharing were needed to try to make the experience fulfilling for everyone.

We distribute brochures explaining vasectomy in simple culture-sensitive language in hopes that local acceptance of vasectomy grows.

Medical Director Dr. Eugene Maklin has done a wonderful jobs growing New Hope Hospital into a major center …

…fully equipped …

… with comfortable quarters for medical teams visiting from abroad.

And a rooftop patio …

…provides excellent views of the Haitian countryside and Ft. Liberte on the distant mountaintops.

After a day on bumpy roads between hot clinics, a swim in the hotel pool before dinner is REALLY refreshing.

Saturday May 8:

We all went to the CMS clinic near the center of Cap-Haitien …

… on a busy market street.

Despite noise from the street below, the facility is great. It has a huge bright room with plenty of space for 3 procedure tables.

As one team stayed and got straight to work …

… another group (Beata, Fritz, and me) took the scenic ride to our most distant service site in Grande Riviere du Nord.

It was quiet on Saturday, but we found the room that we had used in 2019 before the pandemic and set to work with two fans cooling us.

With only 9 patients, it was a great opportunity to help Beata refine her technique …

… while Fritz hadn’t lost a beat despite a long hiatus since his last fast-paced vasectomy clinic.

Always ahead of the rest of us, Mario know what we need before we do!

Once final selfie before departure to …

… Dr. Bright’s clinic in Limonade.

The other team from CDS had already arrived with Judeland Jerome handling supplies.

Chris and Chief Resident Wisten refined each other’s techniques …

while Jolius let his first year resident …

… have a go at his first vasectomy.

Meanwhile, someone had closed the door to Covsky’s car in the locked mode while the car was still running. With more than a little ingenuity, Sony and Rosny devised a long hook with which to push the window button to lower the window and gain entry.

That put everyone in a good mood for congratulatory photos …

… and a fine dinner at the hotel.

We then went to visit Dr. Thelusme’s Urology Specialty Clinic not far from Justinien Hospital, the medical center of Cap-Haitien.

With a spacious reception area …

… a combined office and procedure room …

… and a well-equipped lab, he is ready to see vasectomy patients with full financial support of NSVI.

He is proud to display a feature article about his fellowship training in the USA in urodynamics and female pelvic medicine and reconstruction.

We then went to the private medical office of general surgeon Dr. Jerry Dely.

Though on the second floor …

… it has a well-ventilated room spacious enough for 3 tables.

Sunday May 9:

On our final day, we were back at Hopital Ft. St. Michel. While Clodine counseled patients, Mario set up the room …

,,, abd /chris and I reviewed what equipment would be left behind for the next mission and what would go back to the USA.

With just a few patients in line, I took the opportunity to work closely with Chris and at the same time …

… review the principles which are most important to me because they seem to resonate well with trainees.

We did a final division of equipment before Covsky and I slipped away from the group to handle financial matters.

THREE FEATURES of this mission made it quite different from prior missions:

  1. The large air-conditioned room at Hopital Ft. St. Michel (FSM), our location very near the airport, was not available to us. We start and end each mission at FSM because it is so close to the airport. We had to settle for an alternate room which was large enough for only 2 procedure tables crammed closely together. This was not a HUGE issue because we has so few patients, but we need to negotiate better with FSM to get our favored room next time.
  2. We had far fewer patients than we normally have. This could have been due to the pandemic, but most of our patients are educated by a group of community facilitators who also recruit patients for between-mission clinics at Dr. Mesadieu’s facility in Ft. Bourgeois. Dr. Mesadieu pays the facilitators 1000 gourdes for each patient who accepts vasectomy, whereas NSVI has traditionally paid only 800 gourdes per patient. So they admittedly were less inspired to recruit patients for the NSVI mission and decided to just direct their efforts toward getting men for Dr. Mesadieu’s clinics. For our next mission Sep 1-4, we will pay 1000 gourdes per patient, and we will ask our Haitian doctors to “bring their own patients” by providing community seminars to distribute brochures and educate men about vasectomy.
  3. Far more Haitian doctors arrived for vasectomy training than at any prior mission. It was great to see such a high level of interest, and the more relaxed pace of fewer patients provided more time for training. There were two down sides to this: (a) our international doctors, whose donations to NSVI cover our expenses, did not get quite the number of cases that they were hoping for to gain experience, and (b) when vasectomy is described to prospective patients as a quick procedure, they can feel like they have been misled after they have been laying on a procedure table for 45 minutes, thus tarnishing the reputation of vasectomy and the credibility of our community facilitators.

Despite these issues, the rewards of seeing so much enthusiasm to learn vasectomy, the cultural immersion for guest vasectomists who had never visited Haiti, and the camaraderie of like-minded travelers made the experience very fulfilling. I am already looking forward to our next mission Sep 1-4.