Presentation Authors: Angelo Gousse*, Miami, FL, Henri Lanctin, Watertown, SD
Introduction: The health care burden of urologic diseases is significant in resource poor countries (RPC). Urologic training, equipment, access, and facilities are rudimentary, undermining urologic care provided to the entire population. A systematic approach is most effective in making significant and durable improvements.
Methods: From 2012-2018, a group of international and Haitian urologists have collaborated to develop the Global Association for the Support of Haitian Urology (GASHU). We hereby present our systematic approach to the development of improved urologic care in RPC's. The approach entails 10 major components: 1- Decentralization of urologic care throughout the country. 2- Regular hands on urology workshops focused on training residents and young urologists. 3- Telemedicine-assisted conferences at international academic centers in various subspecialties. 4- Out of the country fellowship opportunities for young urologists. 5- collaboration and support from prominent urologic organizations: AUA, EAU, SIU, GPC etc. 6- Yearly multi-day conference held at the 3rd world country including local and international participants. 7- Partnership with industry to help obtain heavy urologic equipment and supply. 8- Involvement of local governmental and non-governmental agencies to facilitate delivery of supplies for the program. 9- A designated local urology nurse sponsored by the program. 10- Yearly evaluation of our progress.
Results: Using this approach we have objectively elevated the level of Urology in Haiti by introducing new technologies and surgical techniques including: 1) Trans-rectal ultrasound biopsy and GU sonography; 2) ESWL; 3) Urologic Laser; 4) Multichannel Urodynamics; 5) Urethral reconstruction, vesico-vaginal fistula repair and pediatric urology; 6) Video-assisted- Transurethral resection surgery in 3 major geographic cities; 7) Strategic subspecialty fellowship opportunities abroad to benefit young Haitian urologists who will return to train practicing urologists and residents; 8) Development of urologic centers of excellence in different geographic parts of the country. This level of training and infrastructure was non-existent prior to our intervention.
Conclusions: Using the proposed strategy, it is possible to rapidly and effectively improve urologic care in underdeveloped countries. Prior uncoordinated and isolated efforts, which were based on a philanthropic service model, were not effective or durable. We propose the aforementioned systematic educational approach to improve urologic care in RPC's.