Head and Neck Surgeon Teaches Haitian Doctors Virtually Until He Can Resume Trips Post-COVID-19
Since 2015, Donald T. Weed, M.D., FACS, co-leader of the Head and Neck Site Disease Group at Sylvester Comprehensive Cancer Center and vice chair for academic affairs in the Department of Otolaryngology at the University of Miami Miller School of Medicine, has accompanied a group from Thomas Jefferson University to Haiti to help train head and neck surgeons and other providers there in complex head and neck surgical procedures.
The group of otolaryngologists, residents, fellows, nurses, and operating room techs travels one to three times annually for long weekends or sometimes longer trips. They have provided extensive training for Haitian otolaryngologist/head and neck surgeon Patrick Jean Gilles, M.D., who treats patients and runs the otolaryngology residency program at the Universite D’Etat D’Haiti.
Then came COVID-19, putting a temporary stop to the in-person training but not to the group’s desire to keep helping.
So Dr. Weed, who is also the W. Jarrard Goodwin Professor, once again joined one of his former Miller School fellows, Joseph Curry, M.D., who today is professor of otolaryngology at Thomas Jefferson, and Dr. Jean Gilles to organize the inaugural and virtual 2020 Joint Head and Neck Surgery Conference in November. This conference brought together faculty from Thomas Jefferson, the University of Miami, and the Universite D’Etat D’Haiti to continue training Haitian head and neck surgeons and residents.
Drs. Weed and Curry have been focused on training Dr. Jean Gilles as a microvascular surgeon, although he and his team perform a number of less complex head and neck procedures as well.
“Dr. Jean Gilles has a lot of patients with large benign tumors of the neck and face, specifically ameloblastomas of the upper and lower jaws. The benign tumors are well treated with surgery but not without appropriate reconstruction,” said Dr. Weed.
The reconstruction, called fibula osteo-cutaneous free flap, involves transplanting skin, bone, and blood vessels from the lower leg to the head and neck area. The 8- to 10-hour operation involves using bone from the fibula to rebuild portions of the lower jaw or upper jaw.
“The real focus is to get Dr. Jean Gilles up to speed with his ability to do these surgeries independently. His skills have progressed quite a bit but his infrastructure to support these surgeries successfully is still lacking,” Dr. Weed said.
Making the trips to Haiti has been the best option for everyone involved, according to Dr. Weed. Dr. Jean Gilles is unable to leave his practice and trainees in Haiti to do a fellowship in Miami or Philadelphia because patients around Port-au-Prince have limited access to otolaryngology/head and neck surgery care. His trainees also cannot afford to lose a valuable faculty member for an extended period. Therefore, it is far more feasible to train Dr. Jean Gilles and his residents in their own environment, with their resources.
As Dr. Jean Gilles’ skills have become more advanced, the team is now focused on training the support staff necessary for the successful conduct of these procedures and the after care of the patients. Local patients benefit, as well, when the U.S. team visits. The group is supported by the nonprofit group Complex Head and Neck Care and Education (CHANCE), founded by Jefferson physicians, and has performed more than 100 major head and neck surgeries on patients in Haiti.
On these trips, Dr. Weed is usually accompanied by one of the Miller School Otolaryngology Department’s residents or fellows, as well as an operating room nurse and tech from UHealth Tower, and they meet the Jefferson team in Port-au-Prince.
“All of it came to a halt with COVID-19 and forced us to find a way to continue our efforts amid this pandemic,” Dr. Weed said. “We tailored a five- to six-hour course with lectures to address what they are currently doing, what they are interested in, and provide more specific and relevant content to Dr. Jean Gilles, his colleagues, and trainees.”
The experience overall has been productive but also frustrating, according to Dr. Weed. “The surgeons in Haiti have incredibly difficult challenges to their ability to deliver care safely to their patients,” he said.
Among those challenges are natural disasters, such as earthquakes and frequent hurricanes, recurring periods of political unrest, and now the pandemic.
“We had to keep the momentum going,” he said.
Training Dr. Jean Gilles so he can train his residents is one solution. But treating patients successfully and safely also depends on operating room support and resources, as well as caring for patients in the critical days following surgery.
“We are hoping to help build a program in Haiti that is sustainable,” Dr. Weed said.