Brigham Otolaryngologist Takes His Expertise to Haiti

Dr. Prince performing a procedure in Haiti.The expertise of the physicians and surgeons at Brigham and Women’s Hospital benefits patients well beyond New England. Through Partners in Health, the Boston-based nonprofit health care organization, specialists from the Brigham travel to hospitals in developing countries around the globe, offering patient care as well as training for local doctors.

Over the past decade, Brigham otolaryngologist Anthony A. Prince, MD, has made a number of trips with his colleague, Robert Boucher, MD, MPH, to Hôpital Universitaire de Mirebalais (HUM), in Mirebalais, Haiti. At HUM, he works with local otolaryngologists and general surgeons in providing a range of surgical services to treat head and neck disorders. On their most recent trip in November 2018, Dr. Prince and Dr. Boucher treated children, adolescents and adults for problems including sinonasal masses, thyroid goiters and malignant salivary tumors.

HUM is a modern, 300-bed facility that delivers primary care services to about 185,000 people and sees as many as 700 patients every day in the outpatient setting. As a university hospital, it also provides training and education for the next generation of Haitian nurses, medical students and resident physicians. Many other members of the Brigham community spend time at HUM, offering training and patient-care services in internal medicine, general surgery, pediatrics, and obstetrics and gynecology.

“Haiti has a population about the size of New York City—more than 10 million people—but there are only about 20 fully trained otolaryngologists in the whole country,” Dr. Prince said. “Access to otolaryngology services is quite limited for a variety of reasons, including lack of providers, cost and geographic distance to clinics and hospitals. Due to these constraints, many patients end up presenting with advanced disease. This can make treatment challenging and surgeries complex.”

At HUM, Dr. Prince and his U.S.-based colleagues support and supplement the care provided by the university’s sole otolaryngologist, who is available at HUM only on a part-time basis. Their support of HUM’s otolaryngology services includes donating surgical equipment and supplies that allow the team to safely perform a broad spectrum of head and neck surgical procedures, some of which were not possible in this part of Haiti a few years ago.

“It’s very busy, but it’s rewarding at the same time, especially seeing patients after surgery and knowing that we’ve made a difference in their lives,” Dr. Prince said. “Many of these patients have waited a long time to have these surgeries.”

Due to the lack of otolaryngology specialists in Haiti, transfer of surgical skills is an additional and important goal of Dr. Prince’s visits. During each visit, he teaches, advises and assists general-surgery resident physicians as well as the local otolaryngologist in contemporary head and neck surgical techniques.

“There are cases where they feel uncomfortable doing these procedures, but I think it’s helpful that I’m able to provide that level of expertise for them, as well as to help with their surgical volumes,” Dr. Prince said. “As the number of general-surgery training programs in Haiti far outnumber the sole otolaryngology training program, it is important that we take opportunities to transfer current head and neck surgery techniques to the general surgery trainees.”

Dr. Prince and his colleagues hope to eventually work with trainees in the country’s sole otolaryngology residency and training program in Port-au-Prince, which is about a 90- minute trip via winding, mountainous roads. For now, however, they’re focused on working with the local otolaryngologist and general surgeons to develop surgical plans for the more complicated cases. Eventually, Dr. Prince would like to bring some of Haiti’s otolaryngologists to Boston so that they can receive further training at the Brigham.