Emory Endosurgery Fellow Takes MIS Training to Surgeons in Haiti

Ben Martin (in scrubs) and Joe Sharma (2nd from the back) working with the Haitian trainees.

Ben Martin (in scrubs) and Joe Sharma (2nd from the back) working with the Haitian trainees.

May 2016

During his first Emory Medishare surgical trip to Haiti, Benjamin Martin, MD, then an Emory general surgery resident, began formulating a new project. On a break between cases, he had been talking to several of the Haitian physicians that staffed L'Hôpital Sainte-Thérèse de Hinche, the hospital in Haiti's Central Plateau that Medishare's teams had been visiting every summer since 2008 to offer free surgical care. The doctors queried him about minimally invasive surgery, and he was impressed by their curiosity and desire for delivering new technology to their patients.

"There is an extreme need for what Emory Medishare and various other organizations do in Haiti, and the motivations are pure and admirable," Dr. Martin says, who is now an endosurgery fellow of the Emory Department of Surgery. "But the truth is, we're only there for a month. After we leave, the people in the region have to get along as best they can in a resource-challenged environment that is beyond most Americans' imagination. One of the long-term keys to changing that situation is for Haitian surgeons to be able to do what we can do."

Shortly after returning home, Dr. Martin applied for a Global Surgery Research Fellowship Award, a grant the Association for Academic Surgery uses to fund mentored projects helmed by residents or fellows that have such goals as advancing surgical education in impoverished areas. He received the $10,000 award in 2015, and with the assistance of his Emory general surgery faculty mentors Jahnavi Srinivasan, MD, and Joe Sharma, MD, both of whom are Emory Medishare veterans, he began to develop a training program for Haitian surgeons in basic laparoscopic skills.

After over a year of planning and preparation, Drs. Martin, Sharma, and Srinivasan initiated the first phase of the project by traveling to Justinian University Hospital in Cap-Haitien, Haiti, for three days — May 8 through May 10 — to deliver simulation tools and didactic and hands-on training to surgeons and trainees at the facility. The government-sponsored hospital is like most others in Haiti, lacking such seeming necessities as reliable electricity and running water, but it does feature several residency programs. Upon their arrival, the Emory trio worked with 11 general surgery, OB/GYN, and urology residents and five attending physicians.

"I wasn't absolutely certain how the trainees would react," says Dr. Martin. "As it turns out, they were very enthusiastic and engaged. Their work ethic and commitment gave me the confidence to begin really pushing for additional support and donations to grow this effort. As we get deeper into this, I suspect that we will accrue enough data documenting their dedication to learning these skills that other people and organizations will want to contribute."

In a room that became permanently designated as the hospital's simulation lab, the Emory team set up several box trainers (devices that facilitate development of the psychomotor skills and dexterity required to perform laparoscopic surgery) and laptops running simulation software, and a large monitor for displaying the particular training scenario. Upon completion of didactic sessions and a skills test to set the pre-training benchmark, the trainees worked through a series of exercises compiled and, in some instances, designed by Dr. Martin.

"We focused on the essentials, the things you need to know before you can even begin thinking about doing actual surgeries," he says. "I came up with a few exercises, like running a 150cm length of rope to simulate inspecting small bowel during a diagnostic laparoscopy. We also did adapted versions of peg transfer, needle control, pattern cutting, suturing, and knot tying."

Before leaving, Dr. Martin advised the Haitian physicians to practice these introductory exercises as part of their daily routine, and emphasized that he would be returning to Justinian Hospital in June to test their progress.

Dr. Martin has accepted that this first trip is just the beginning of what could easily become a decade-or longer process. "You have to be realistic with an undertaking like this, particularly since there are so many forces in a country like Haiti that can trip up the timeline, from severe weather to political instability. The best way to look at it is as a series of little steps that will gradually build to some type of milestone, then going through the cycle again. We plan to apply for other grants, solicit additional involvement and support, maybe try to set-up a tele-mentoring system, and investigate bringing Haitian residents or surgeons to Emory for training sessions. And, of course, lots of visits to Haiti."

In July, Dr. Martin will complete the Emory Endosurgery Fellowship and relocate to the University of Minnesota for a colorectal surgery fellowship. However, he doesn't foresee the increased distance between him and his Emory collaborators and from Haiti itself making any difference in his devotion to the effort. The next major item on the agenda is to continue working with Drs. Sharma and Srinivasan to complete a comprehensive laparoscopic surgery training plan to submit to the Haitian government.

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