Olmigue St. Fleur didn’t think twice about making the five hour drive from her city to Pignon, Haiti after learning that a group of American doctors was coming to perform free surgeries at a hospital there. For 17 years she suffered from severe pelvic organ prolapse — a condition that greatly impacted her life every day.


After years of seeing doctors, St. Fleur knew she needed surgery, but doctors in the country didn’t have the skills required to perform this complex procedure. Her prolapse was so severe that her bladder and uterus protruded from her vagina by five centimeters, which made most daily activities uncomfortable.


St. Fleur is one of many Haitian women who are suffering unnecessarily because they cannot access the care of a urogynecologist, a surgeon who specializes in the pelvic floor which provides support for a woman’s urological and reproductive organs. There are few urogynecologists in the U.S. and none in Haiti who can treat pelvic floor disorders that wreak havoc on a woman’s quality of life.


The Houston Methodist team of urogynecologists – Tristi Muir, M.D., Fiona Lindo, M.D., MPH, Danielle Antosh, M.D., and Shweta Pai, M.D. – spent four days in Pignon where they evaluated 13 patients, performed six surgeries and trained Haitian health care professionals.


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“One in five U.S. women undergo surgery for a pelvic floor disorder such as urinary or fecal incontinence and pelvic organ prolapse,” said Muir, chairwoman of the department of obstetrics and gynecology at Houston Methodist Hospital. “That number doesn’t represent the many women who ignore their symptoms, are too embarrassed to talk about them, or are treated non-surgically. And I believe pelvic floor disorders are even more common in a poor country like Haiti, so thousands of women there are suffering with conditions that can be easily treated.”


The Houston Methodist team worked at Hospital Bienfaisance de Pignon, a nine-building facility powered by a single generator that provides family planning resources, maternal care and labor/delivery services, cholera treatment, prosthetic limbs, an HIV/AIDS clinic, and emergency care to locals and other Haitians who travel to Pignon for care at one of the country’s most modern hospitals.


One of the team’s goals was to train local physicians on how to diagnose and treat pelvic floor disorders, so that Haitian women could receive care even after the team returned to Houston Methodist.


“The local physicians, nurses, and OR teams were so welcoming and eager to learn,” said Lindo, global health director of women’s services at Houston Methodist Hospital. “We taught them how to perform easy tests to help them reach the right diagnosis. They worked alongside us in the operating room to learn the surgical techniques, and we left behind specialized surgical instruments so that they would be equipped to use their new skills. Because we were able to work so closely with the local medical staff, I know that care for Haitian women with pelvic floor disorders will improve.”


While Haitian and American women face different barriers in accessing care, they share the isolation often brought on by pelvic floor disorders. The fear of leaking urine or stool in public or being unable to engage in sexual activities lead to limited social engagement, which often leads to depression.


“One of the reasons I became a urogynecologist is that it gives me an opportunity to help women who are in a very vulnerable state,” said Pai, a urogynecology fellow at Houston Methodist Hospital. “The Haitian women we treated conservatively left with big smiles because they finally knew what their condition was and how to fix it. The women we operated on were thanking us and giving us hugs the day after their surgeries because they knew their suffering was over. We want to bring that same relief to other Haitian women dealing with pelvic floor disorders by continuing to come back to Haiti each year.”


Muir, Lindo, and Antosh plan to go back to Pignon once a year to treat patients, continue the education of local physicians and bring much needed medical supplies and equipment. This trip was funded by Derek Potts, a Houston-based trial lawyer who served as one of the lead attorneys on transvaginal mesh litigation and learned about the complex urogynecological issues women face.


“I feel very lucky to have been a part of this medical mission trip to Haiti, and I’m looking forward to going again,” said Antosh, director of the female pelvic medicine & reconstructive surgery fellowship at Houston Methodist Hospital. “An important part of what we should do as physicians is giving back our time to less fortunate communities and countries. On this trip, we helped some women and we trained some physicians, but there are many more women to help and much more work to be done to create lasting improvements in the health of Haitian women.”


As for St. Fleur, she was one of the six patients the team operated on while in Pignon. The morning after her surgery, she was walking around the hospital and noticed that she was no longer bothered by the prolapsed organs. Through a translator, she said she was happy to have relief after so many years and that she was very appreciative for the doctors who helped her.


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