Stories From the Field:

HAITI

Developing an Anesthesiology Residency in Haiti

Daniel Saddawi-Konefka, MD Anesthesia Residency Program Director, received an MGH Global Health Travel Award to go to Haiti in an effort to determine opportunities for collaboration and development of the anesthesiology residency at and l’Hopital de l'Universite d'Ētat d'Haiti (HUEH).

The 2010 earthquake that hit Haiti was of magnitude 7.0. It caused major damage to the capital Port-au-Prince and other cities in the area. A global response at the time helped Haiti rebuild and provided substantial aide and healthcare to the population. That aide has slowly receded, and in its place the Haitian people have a need to become more self-sufficient. This includes robust training of anesthesiology residents who will provide care in Haiti. We went to Haiti to determine opportunities for collaboration and development of the anesthesiology residency at and l’Hopital de l'Universite d'Ētat d'Haiti (HUEH).

There are two residency programs in Haiti, and HUEH’s is the larger of the two. Training comprises three years for dedicated anesthesia training. (This occurs after high school, 6 years of medical school, and one year of general practice [similar to an intern year]). The HUEH hospital currently has a total 21 residents over three years of training. There are 8 operating rooms in their hospital (4 general OR, 2 labor and delivery, 1 ophthalmology, 1 ENT), which run elective cases from 8 am to 4 pm.

Our trip comprised one weekend in March, during which we met with Program Leadership and residents to discuss needs and opportunities for growing their program. We also toured a new hospital facility that is being constructed (as the result of a partnership between the United States, France and the Haitian government). In our conversations with them, we discovered several areas where we could work with them to improve their physician training.

The first was ultrasound-guided regional anesthesia. Pain control is a key component of the practice of anesthesia, and regional anesthesia has a significant role in analgesia for many surgical procedures, in particular for extremity operations that are common at HUEH. The Anesthesia department has expressed an interest in developing the capacity to perform ultrasound guided regional anesthesia. To that end, we plan a future collaboration where we will send faculty and residents down for a week-long regional training session with them (currently scheduled for October 2018).

A second area was training for critical care. The HUEH does not currently have an intensive or critical care unit (ICU), but the new hospital building (scheduled to open in 2019) will have an ICU and will need training physicians to care for patients there. Without the ability to handle complex and critically ill patients, the capacity of HUEH to deliver and teach advanced clinical care is, and will continue to be, severely limited. To help them with this, we toured a neighboring hospital that had a small ICU, and made recommendations to set up a rotating resident rotation that will provide them with relevant ICU training in situ.

Lastly, we are working with them on their didactic curriculum, and planning to set up remote video conference lectures that can be delivered interactively by members of our department.

Looking forward, we hope to cultivate a relationship between our two programs such that our future trainees will have the opportunity to learn more about global health and have opportunities to contribute firsthand.