Involvement in Haiti

In December 2009, an article published in Florida Medical Business (See the article here and forward to page 8) caught the eye of Ted Kaplan, MD, a pediatrician in Orlando with a special interest in Haiti. He thought that my efforts at preventing unintended pregnancy through vasectomy in Florida, India, and the Philippines would be very valuable in Haiti. His wife's cousin, Fritz Lolagne, MD, (click for his fascinating bio) is a Haitian doctor who performs tubal ligations and traditional vasectomies at multiple sites throughout Haiti. When Ted read about the no-needle no-scalpel method, he felt that it would be of great interest to Dr. Lolagne in his mission to make vasectomy more acceptable to Haitian men. Ted attended my vasectomy clinic in Kissimmee on January 7, 2010, his eagerness for me to provide vasectomy training in Haiti grew, and arrangements were made for Dr. Lolagne to visit my Tampa office during his next trip to the US in April to visit his family in Orlando.

Five days later, a 7.0 magnitude earthquake rocked much of the most densely populated areas of Haiti and Dr. Lolagne's home in Petit Goave, just west of Port-au-Prince, was destroyed while he was away providing tubals and vasectomies in northern Haiti. Undaunted, Dr. Lolagne continued with his work and came to the US as planned in early April.

Dr. Lolagne and I shared ideas when he came to my office on April 1. He was very impressed with the simplicity and speed of the no-needle no-scalpel technique and began to make plans for me to come to Haiti to help him determine which health care sites would be the most acceptable for providing vasectomy services. Much of Dr. Lolagne's work is funded by MSH, a nonprofit international health organization composed of more than 2,000 people from 73 nations whose mission is to save lives and improve the health of the world's poorest and most vulnerable people by closing the gap between knowledge and action in public health. But Dr. Lolagne provides most of his tubal and vasectomy services for no compensation at all.

Haiti's population of about 10,000,000 occupies a largely mountainous area the size of the State of Maryland, so it is one of the most densely populated countries on Earth. Even before the earthquake of January 12, 2010, Haiti was a country of extreme poverty and deprivation. Many of its natural resources, including its once-rich forests, have been depleted. Government corruption, crime, illiteracy, and disease are all too prevalent. It lies in the path of devastating hurricanes with the potential to turn its treeless hillsides into torrents of mud. Yet, while the infrastructure remains frail, the population continues to explode because of inadequate access to safe family planning.

Tubal ligations are most safely performed in formal operating room settings. While general anesthesia is too expensive, local anesthesia is used, but the procedures are still quite painful even when performed by the most experienced surgeons, and there are not enough tubal surgeons to meet the needs of the population. Vasectomies can be quickly done in simpler settings, and they are almost always painless when properly performed. So Dr. Lolagne wants to train doctors to perform vasectomies as well as tubals. And he wants me to help him because he feels that Haitian doctors will respond very positively to an American surgeon.

In late April, I visited Haiti for the first time, to determine, with Dr. Lolagne, which locations might be best for providing vasectomy services. Our decisions would be based upon the local facilities and the interest and support of local health care providers. We visited six potential sites.

Tuesday, April 27: First we visited with important health care officials in Port-au-Prince. Dr. Gadner Michaud (left in photo) is the Executive Director of Profamil (the international arm of Planned Parenthood) in Haiti. Dr. Andre Paul Carrenard, MD, MPH (right in photo) is the Executive Director of the Haitien Institute of Community Health (INHSAC; Institut Haitien de Sante Communautaire) and the former Director of Profamil.

Toward evening, we drove north along the coast toward Saint Marc and stopped at Club Indigo where we attended a meeting of MSH (Management Sciences for Health)health care representatives from the 10 departments.

I had the privilege of meeting Florence Guillaume, MD, MPH, a Family Physician and the second highest-ranking official of MSH in Haiti ...	... and Dr. Lucito Jeannis, an obstetrician/gynecologist who is the Country Director for JHPIEGO (Johns Hopkins Program for International Education in Gynecology & Obstetrics).
Dr. Lolagne and I returned to the week-long meeting a few days later and were given the opportunity to show a video of the NNNSV (No-Needle No-Scalpel Vasectomy). Dr. Jean Bernard Fevrier (seated at left), an OB/GYN who has recently transferred from JHPIEGO to MSH, works in PAP as a trainer of postpartum care and travels throughout Haiti with Dr. Lolagne to perform tubal ligations. Dr. Georges Dubuche (OB/GYN), in the light blue shirt, is in charge of matching funds for MSH.
Wednesday, April 28: We wakened early to drive to Fermathe where Dr. Lolagne was scheduled to perform tubal ligations at Baptist Hospital of Fermathe. But before leaving, I had an opportunity to meet Dr. Calerbe St. Louis, an OB/GYN who is the Departmental Technical Advisor for Les Nippes (one of the 10 departments).
On arrival in Fermathe, we enjoyed a nice lunch overlooking the Haitian hills with our driver Jean Robert Charles and Dr. Obelson Revolus, a second-year resident in OB/GYN at University Hospital in Port-au-Prince.
At Hopital Baptiste Fermathe, the patients were waiting. It was a successful day for tubals, but no interest in vasectomy.
General Surgeon Dr. Claude Bernard is the Director of Baptist Hospital Fermathe who, along with Administrator Jean Angus, graciously offered their facility as a vasectomy center in Haiti.

Thursday, April 29: We left Fermathe very early in order to pick up Lisette (Dr. Lolagne's invaluable assistant) in PAP and get to Cap Haitien on the northern coast of Haiti before nightfall. We would have to go most of the way on Route 3, the main connecting road between the two biggest cities in Haiti (PAP and Cap Haitien) and most of Route 3 is not paved.

About 1/3 of the way to Cap Haitien, at the town Cange within the central highlands of Haiti is Zanmi Lasante, one of the finest medical facilities in Haiti thanks to the vision and tireless efforts of Bishop Fritz Lafontant and Dr. Paul Farmer, the founder of Partners in Health.

Here are Dr. Lolagne and myself with Joanel Joasil, MD, Medical Director of Zanmi Lasante, Marie Flores Chipps, Coordinator of Activities at Zanmi Lasante, and Bishop Fritz Lafontant, Director General of Zanmi Lasante.

Further north in the remote city of Pignon, we were hosted by Dr. Guy Theodore, a Fellow of the American College of Surgeons, District Governor, and Director of the Hopital Bienfaisance de Pignon.

In Cap Haitien, we explained our goals to Dr. Ernst Robert Jasmin, Medical Director of the Northern Department ...

... and met with Dr. Guy Dugue, a General Practitioner with excellent surgical skills and owner of the Dugue Clinic of Medicine and Surgery (Clinic Medico Chirurgicale Dugue) just outside Cap Haitien on National Road #1. Dr. Dugue graciously offered his clinic as a site for vasectomy services and training. Pictured are Dr. Lolagne, his assistant Lisette, Dr. Dugue, and Dr. Dugue's wife.

After a hearty dinner in Cap Haitien, we made a nighttime journey all the way back to Club Indigo where we met again with the doctors of MSH and JHPIEGO on Friday April 30. We then went on to Petit Goave, where Dr. Lolagne's home was destroyed by the earthquake while he was fortunately performing tubal ligations in the far north out of harm's way. Then we went to Jacmel on the south coast to check a potential vasectomy site there. On Saturday May 1, I returned to the USA while Dr. Lolagne remained to carry on his mission and make arrangements for my second trip to Haiti to begin the process of training Haitian doctors to perform NSV at the sites most conducive to this new service.

On August 30, 2010, Dr. Ramon Suarez, urologist, NSV specialist, and President of No-Scalpel Vasectomy International (NSVI), joined me for my second trip to Haiti, this time to (1) perform vasectomies in Cange (Zanmi Lasante), Ouanamithe, Cap Haitien, and Fermathe, and (2) train doctors at these locations to perform NSV themselves and thereby offer the service year-round to men who wish to play a stronger role in family planning.

Use the links below to go to any page about Haiti:
First trip to Haiti: April 2010	Preliminary trip to Haiti: April, 2010
Second trip to Haiti: August/September 2010	Monday Aug 30: Arrival and MSH Tuesday Aug 31: Cange Wednesday Sep 1: Ouanamithe Thursday Sep 2: Cap Haitien Friday Sep 3: Fermathe
Third trip to Haiti: May/June 2011	Fermathe and Plaisance