A 6-year-old boy enters the ENT clinic at the State University Hospital of Haiti (Hôpital de l’Université d’Etat d’Haïti – HUEH) with a mandibular mass, a golf ball-sized benign tumor that pushes his teeth inwards and makes it impossible for him to fully close his mouth. Traveling from their home in southern Haiti, his mother has been seeking care for her son’s condition since he was 2. The record of his first visit to HUEH, located in the capital Port Au Prince, was lost like so many others in the 2010 earthquake. For his second, he and his mother hope for a better outcome.
The ENT residency training program at HUEH, Haiti’s primary public hospital and cornerstone of its public healthcare system, is the only such program in the country and is tasked with producing the next generation of modern-trained ENT surgeons. As there are currently only 14 ENT surgeons practicing in Haiti today, a nation of over ten million, this task is both challenging and critical. Through a long-term relationship with University of Strasbourg, the ENT Department at HUEH separated from Ophthalmology and began the small, 3-year residency program that now produces 3 ENT surgeons per year. Dr. Patrick Marc Jean-Gilles, the current ENT HOD and Residency Director, was one of the first residents to graduate the program before receiving additional training in France. Treating fibrous displaysia and other benign mandibular masses, which all too often go untreated in early stages in Haiti, was once seen as beyond the comfort level and capacity of local Haitian surgeons. Dr. Patrick Marc Jean-Gilles and his colleagues are challenging that perception and hoping to bring access to modern ENT surgical interventions to the Haitian people.
In June 2016, the Office of Global Surgery and Health (OGSH) at Massachusetts Eye and Ear (MEE) embarked on a new partnership with the HUEH ENT and Ophthalmology Departments. The first faculty visit served as both academic module and orientation, providing MEE faculty an intimate look at the state of ENT in Haiti and the young residents who are poised to become its future. Dr. Ramon Franco and Dr. Inna Husain, who recently completed her Laryngology fellowship, led a laryngology-focused module that introduced the use of the flexible laryngoscope in clinical examinations. During the course of the week, residents were tested on the introduced skillset and became accustomed to its regular use as a diagnostic tool in clinic. Fiber-optic laryngoscopy not only allows clinicians to more accurately diagnose (and treat) patients but also is revelatory as a means of teaching, allowing residents to get an immediate appreciation of both anatomy and technique. Under Dr. Franco’s direction, Dr. Farah Louis, one of the 3rd-year residents, performed the first laryngoscope-guided subepithelial epinephrine injection know to take place in Haiti by a Haitian surgeon.
The HUEH ENT faculty and residents face many challenges in both developing their capacity in terms of capability and resources and making that enhanced capacity accessible to their patient population. With the exception of Hôpital Universitaire de Mirebalais (HUM), currently subsidized by Partners-in-Health coordinated external funding, public hospitals require patients seeking surgical treatment to pay for materials. For many families, this becomes a choice pitting futures against each other: that of a child against his or her siblings, a grandparent against the next generation.
The future of the boy with the mandibular mass is not yet set, but the continued growth of ENT as a subspecialty in Haiti holds the best chance ensuring that future is a good one.
Our thanks to Drs. Patrick Marc Jean-Gilles, Myriam Leandre-Joseph, and the rest of the ENT residents and faculty at HUEH as well as to Dr. Robert Boucher (VA) and Dr. Pierre Bailley (University of Strasbourg).