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Haiti Retinal Brief for Potential Visiting Retinal Surgeons

Shared by Dr. Daniel Alter who has been serving in Haiti, this brief was shared in February 2017 for anyone willing to help with training in Haiti.
Prior to 2014, vitrectomy surgery was non-existent in Haiti and only the few that could afford it would travel to the U.S. or Dominican Republic to have their surgery. We now have two locations in Haiti that are fully equipped for training local ophthalmologists in complex vitrectomy surgery and about 200 vitrectomies have been performed. The purpose of this experience is to continue training the two local physicians with the ultimate goal of them being able to handle complex vitrectomy surgery on their own. 
Both Dr. Taverne's clinic in Port au Prince (PaP) and Dr. Dupuy's at Vision Plus Clinique in Cap Haitien (Okap) are well-equipped with Alcon Accurus vitrectomy machine and Biom indirect viewing systems and good microscopes. Both sites also have direct and indirect laser with Iridex 532 on Zeiss SL-30s and cryomachines as well. Iridex 810 is available as backup and for cyclodestructive procedures. Both have fundus photography. Angiography is not done due to lack of emergency services. 
Travel is fairly easy with direct flights from the U.S. are both sites are within 10-30 minute drive from the airport depending on traffic. The doctors and their personal drivers will likely meet you at the airport and provide all needed transportation.
Cases will be somewhat prescreened by Dr. Taverne and Dr. Dupuy and you will see these patients and decide which cases to do. A fairly high percentage of the cases would be considered complex vitrectomy usually related to PDR with TRD and other RDs of all types including trauma. Usually 3-6 cases/day. Vein Occlusions are very common there with so much hypertension as is Sickle Cell Retinopathy. Polypoidal is surprisingly common. CMV retinitis and chorioretinitis from syphilis or TB and other strange case will present as will cases of optic neuropathy 
Anaesthesia is MAC with sedation at Dr. Taverne's in PaP and straight local with oral valium at Cap Haitien. General anaesthesia and heavy sedation are not available due to lack of emergency response infrastructure and the clinic setting. 
Haitian Creole is spoken by most Haitians and is based on French. Both doctors and a few of their staff can speak pretty good english, but translators can also be arranged. Those wishing to learn some basic Creole can find "Creole Made Easy" on Amazon or study a blog called "". To develop listening skills, one might try Voice of America in Haitian Creole for daily news, or listen to "La Bonne Nouvell" on Most of the younger residents at the University Hospital in Port au Prince speak some English. 
Neither site really requires you to bring a scrub nurse as they are already fairly proficient. Bringing a scribe/technician/friend/family member can be useful to increase the amount of baggage you can bring, but during surgery they might eventually get a little bored and go back to the hotel to relax for a couple hours. It is useful but not necessary to have a scribe of some sort to help keep organized with the paperwork and surgical log. 
American Airlines has a strict one bag/coach two bags business class with no exceptions unless you get approval from high up. Requesting exemptions be attached to your record locator can be done if you know someone at American like a pilot. They then can put a request into their chief pilot who can then forward it to management. Make sure you request both legs of the trip. Then if you get word that it is approved, I would still recommend calling customer service a few days later to check that their really is a note on the record locator. Have them read it to you and verify it is for the entire trip. Two max. sized bags may be the minimum to complete a 3-5 day mission since the vitrectomy kits take up so much room. Target has the maximum sized bags for $80-150 and you really need the biggest you can find. Business class is definitely recommended if you are going to bring some sensitive equipment in your carryon to donate. Delta, Jet Blue, and Spirit also serve Haiti. Delta may allow 3 bags for business. Always check before booking as their websites can often hide baggage restrictions to Haiti. 
Supplies are requested through Alcon Foundation by SEE. We have a spreadsheet with all the likely items and we hope this makes future trips easier. Visiting doctors can request additional supplies from their own contacts. Many suppliers/vendors/hospitals are more than happy to help if you ask. Expired supplies are generally not recommended. Customs usually goes without trouble, but some money can occasionally be requested from you. Especially, if you show up with more than the usual number of bags. Usually it isn't a problem. 
For clothing, scrubs can be worn all the time if desired. Otherwise you really only need light clothing like collared short shirts and Khaki pants or something like that for men and something along those lines for women. 
The food is very good and generally safe. Prophylactic use of Pepto-Bismol can be considered and many seasoned travelers swear by it. Neither site has a lot of mosquitos, but Zika virus may still be going around. Some take malaria prophlaxis. Some bring azithromycin for Cholera which is mostly in rural areas. Most of your hospitals would have a travel nurse that can make recommendations if not sure. 
For Port au Prince there are several good lodging choices. The new Marriot is about $150/night (look for AAA discount if member) and about a mile from Dr. Taverne's clinic and the University Hospital. The Royal Oasis and Karibe are a little farther away. The Oasis is almost as nice as the Marriot. Karibe is owned by one of Haitien ophthalmologists families and has pretty grounds and a real local feel. Lastly, Le Plaza is only one block from Dr. Taverne's and would probably best be described as adequate. 
For those going to Cap Haitien, Auberge du Picolet is the best and then Hotel Christophe is fine too. For those going to Port au Prince, they may want to spend some time with the residents at HUEH for training, lecture, or even bringing them some needed supplies like like lenses, indirects, cataract supplies or just about anything. From the retina standpoint, many Haitian residents did not learn indirect ophthalmoscopy skills. Maybe this was because most posterior segment problems weren't treatable. They are always in need at HUEH in PaP and it is best to contact the Chief Resident and Chief of Service to arrange a visit. SEE has those contacts. 
Drops are very important and many hospitals and surgicenters open a bottle for each patient. Ask you administrator to save them for Haiti. Look around your office and OR and just about anything you see is useful.
Why Mission Work? Because we're called to!!


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