Neurosurgery training in Haiti
Project Medishare is a University of Miami medical partnership in Haiti founded in 1993 to establish a primary care network in the rural countryside and develop primary care training. Medishare evolved to include specialty surgery programs, including a program targeted towards the treatment of hydrocephalus in 2003. Over the years, the hydrocephalus program has treated over 1000 children with the help of neurosurgeons from many US and Canadian centers.
Medishare has gradually expanded the scope of neurosurgical diseases treated through partnerships with local surgeons. However, it became clear that Haiti required its own formally trained neurosurgeons and that would require a structured training program. Under the direction of Dr. Ariel Henry, Haiti’s senior formally trained neurosurgeon, Haiti’s first neurosurgical training program was established in 2015. This was made possible by the support of the FIENS neurosurgical curriculum and with Dr Henry’s stewardship with the National Medical School and the Ministry of Health. The neurosurgical curriculum developed by FIENS and adapted for use in limited resource centers worldwide, was instrumental in obtaining approval of their proposed neurosurgery program by the Haitian government.
The first trainee, Dr. Yudy La Fortune is a fully trained general surgeon from Cap Haitien, the country’s second largest city on Haiti’s northern coast. Dr La Fortune’s training is centered at L’Hospital Bernard Mevs (HBM) in Port au Prince, a private hospital owned by a public foundation.
The HBM is recognized as Haiti’s primary trauma and neurotrauma center, in addition to having a neonatal and pediatric ICU. It is also home to one of the few pediatric training programs in Haiti. The newly renovated neurosurgical OR opened in the fall of 2018, with a recently donated NC4 Zeiss microscope, but is still in need of instruments and equipment. In addition to Dr. Henry’s tutelage, mentorship for Dr. La Fortune is provided by rotating US and Canadian neurosurgeons, which continues to be nearly entirely pediatric focused. Now entering his third year of training, Dr. La Fortune is highly regarded by the medical and nursing staff at the hospital because of his clinical skill. He participates in the University of Miami resident academic conferences and working with one of the senior neurosurgery residents has contributed to two manuscripts on hydrocephalus treatment in Haiti.
What is missing in Dr La Fortune’s training is an expanded general neurosurgery operative experience. Although he assists Dr. Henry with his adult patients, there is the opportunity for visiting neurosurgeons interested in general cranial or spinal pathology to see clinic patients with Yudy at HBM and teach in surgery. Project Medishare and HBM have on site guest rooms for volunteers or the Port Au Prince Marriott is a short car rides from the hospital. Those interested may contact Jim Johnson, the FIENS volunteer coordinator or John Ragheb (jragheb@med.miami.edu).
The Science of Practice in Cerebrovascular Surgery: A Future Directed by Patient Need
FIENS Chairman Dr. Robert J. Dempsey, presented at AANS Schneider Lecture
At the annual AANS meeting plenary session, Dr. Dempsey was called upon to deliver the named lecture for the American Association of Neurological Surgeons meeting. He chose his experience in global neurosurgery and the needs of the developing world to demonstrate the responsibility of neurosurgeons to improve the care for all by using all their talents. He chose this theme, cerebrovascular surgery, because of data showing that it will become the number one cause of death and disability in the developing world in the next decade, surpassing infection, as demographics and patient need changes.
Dr. Dempsey next went through the history of medicine and how dedicated physician scientists had used the science of their time to improve the care for patients. Most importantly this made the most sense when the project was directed toward where patient need was greatest, rather than simply where physician interest was greatest or because of fascination with a procedure or disease.
Because of the increasing demand for care of cerebrovascular disease, Dr. Dempsey pointed out that several important things would become clear. We must treat both ischemic and hemorrhagic stroke and we must emphasize the tremendous burden stroke causes in premature loss of cognition, judgement, creativity and cognitive decline. He explained how research links atherosclerosis and its modifiable risk factors to ischemic stroke and cognition. This is true throughout both the developed and the developing world. He used the examples of physician scientists throughout our history working collaboratively to solve such immense problems just as we must work throughout the developing world through collaboration with administration, civilians, governmental groups and science to improve care and deliver it for an entire health system. In this way, we use the example of a devastating disease like stroke as a call to action for neurosurgeons to realize their talents and collaborative science in prevention, acute treatment and eventually repair of the injured brain after an event like a stroke. The message was one of optimism, as well as substantial challenges we need to work together to solve.
Updates from the FIENS Office
If are interested in one of our volunteer sites please contact our FIENS Volunteers Office :
Dr. James Johnston -James.Johnston@childrensal.org
Ms. Tracy Pohlman -Tracey.Pohlman@childrensal.org
Treasurer Office Contact:
If you are interested and appreciate our mission please consider donating today, be a member of FIENS.
Dr. Azam Ahmed- azam.ahmed@neurosurgery.wisc.edu
Mrs. Linda VanBrocklin- vanbrocklin@neurosurgery.wisc.edu
For more information and to make your contribution today please visit us at http://www.fiens.org
