No Scalpel Vasectomy Mission To Haiti: No Reservations!

Many of my patients are probably not aware that I am both a firm believer in and a supporter of vasectomy. I have participated in several international missions to provide vasectomy in the countries of the Philippines, Haiti, and Kenya.

This article describes my 2015 mission to Haiti to provide vasectomy. We have done many missions since this mission but in 2020 the Covid pandemic and subsequent political unrest in Haiti has put a stop to these vasectomy missions.

We have temporarily stopped going to Haiti for reasons of personal safety. I believe and support vasectomy but I am certainly not going to get killed or kidnapped because of vasectomy. Vasectomy is important to me but it is not that important!

Once things go back to ‘normal’ I am sure we will return to Haiti to continue providing vasectomy.

It is too important a service to not do so.

Anthony Bourdain, Pope Francis and vasectomy

You may ask what does Anthony Bourdain have to do with vasectomy. The answer is nothing. Pope Francis has more to do with vasectomy than does Anthony Bourdain.

Anthony Bourdain. 

I have always been a fan of Anthony Bourdain and his travel/food/philosophy show Anthony Bourdain: No Reservations.

I have enjoyed observing the food he has eaten, the unique places he has traveled, and his witty, oftentimes hilariously sarcastic, view on life. As a result of my self-adopted kinship with Mr. Bourdain and his twisted philosophy on life, I thought I would model my blog documenting one of my previous Haiti vasectomy missions after Anothony Bourdain’s approach to travel, food, and life.

My blog will be similar but will be focused on the subjects of travel, food, and the intricacies of human reproduction and the control of, oftentimes, rampant human fertility.

Don’t rely on my description of the state of human fertility in the world.

Pope Francis.Pope Francis once commented, “We”…he actually said Catholics..but Catholics are not unique when it comes to fertility and “we” substitutes just fine “…should practice ‘responsible parenthood’ and don’t have to breed ‘like rabbits’.”

Even a Catholic Pope agrees we lose control of our desires and reproduce like rabbits…even the Pope believes in responsible parenting…I really like Pope Francis and would pick him for my fantasy Pope team any day.

Vasectomy In Haiti: No Reservations

No Scalpel Vasectomy International (NSVI) is a non-profit organization dedicated to providing the most advanced vasectomy techniques to the developing world, the areas of the world that most desperately need to control human fertility. The team is comprised of vasectomy specialists from across the world. NSVI has annual vasectomy missions to Kenya and the Philippines.

Vasectomy has long been known to be the most effective and most affordable way for a couple to pursue long-term contraception. No Needle, no scalpel vasectomy is a modern minimally invasive vasectomy, which is safer and more effective than other variations of vasectomy, and the procedure typically takes about 10-15 minutes.

Minimally invasive no scalpel vasectomy can easily be performed in an office setting under local anesthesia.

Vasectomy: Excellent Procedure For The Developing World

The fact vasectomy can be performed in a doctor’s office (on any table or barren patch of ground) and with local anesthesia (anesthetic that can easily be administered and does not require refrigeration or special handling) and with very few complications (very low risk of infection or life threatening complications) makes vasectomy ideal for any situation and any world: developed or developing.

Unfortunately most public health programs in the developed world have totally overlooked vasectomy as an effective strategy to provide safe, permanent birth control because of inaccurate perceptions about how vasectomy is perceived by men and because controlling the reproduction of women is a more ‘efficient’ strategy to control fertility and population growth.

No Scalpel Vasectomy International has made it their mission to spread the virtues of vasectomy around the world and have provided a special emphasis in areas of the globe that have the largest population growth problems.

The 2015 Haiti Vasectomy Mission is sponsored by No Scalpel Vasectomy International and the mission team is comprised of doctors from Haiti, Florida, Minnesota, and North Carolina.

The 2015 Haiti Vasectomy Mission Team is composed of five doctors, one nurse, and one patient educator. The mission goal will be to travel to Northern Haiti and perform vasectomy procedures at three different sites on as many men who are willing to have the procedure.

Vasectomy is almost non-existent in Haiti so introducing these procedures and expecting utilization is a huge task.

Vasectomy Haiti July Team 2015

Pastor Amos Myrtil is a native of Haiti. He left Haiti after the political turmoil of the Duvalier era and relocated to southern Florida where he worked with the HIV positive community. Pastor Amos returns periodically to Haiti and to his hometown of Plaisance. He serves as the Director of Missions in Haiti. He is fluent in Creole and is knowledgable about Haitian culture. He has been instrumental in recruiting patients and educating them about the benefits of vasectomy.

Dr. Maudelin Mesadieu is also a native of Haiti. He completed his medical school training in Haiti and works as a general practitioner. He learned how to perform vasectomy on a prior vasectomy mission and has become a very skilled provider of vasectomy procedures. He operates his own clinic in the town of Ft. Bourgeois. He gives tirelessly of himself providing general medical care to the people of his town. His patients pay him if they are able and he provides a great service to his patients.

Elisabeth Kaplan LPNwas born in Haiti and later moved to Florida. She is a pediatric nurse and she frequently returns to Haiti to provide medical care and solar power to the citizens of Haiti. She serves as a Counselor and Coordinator for vasectomy missions. She is fluent in Creole and is instrumental to the success of individual missions. Elisabeth is a co-founder of the Cap Haitian Health Network which is a non-profit health organization dedicated to improving the health of the Haitian People.

Dr. Ramon Suarez was a founding father of No-scalpel Vasectomy International (NSVI). He first began performing vasectomy missions in the Philippines and under his leadership the organization expanded to provide the highest quality vasectomy procedures in four countries: Philippines, USA, Kenya, and Haiti. The mission of NSVI is to promote and provide free No-Scalpel Vasectomy services worldwide, but especially in developing countries whose infrastructure and environmental resources are challenged by rapid population growth unchecked by established and/or effective family planning programs.

Dr. Charles Monteith (me) is a microsurgical tubal reversal specialist and the Medical Director of His Choice in Raleigh North Carolina. He also performs vasectomy and vasectomy reversal. Dr. Monteith has participated in past vasectomy missions to both the Philippines and Kenya.

Dr. Steven Shu is a office based surgery specialist in Edina, Minnesota. He offers No needle No Scalpel vasectomy in addition to vasectomy reversal. He previously participated in a Philippine vasectomy mission. Dr. Shu maintains a dedicated vasectomy website EZ Vasectomy.

Dr. Doug Stein is a vasectomy expert. He is a urologist who gave up his general urology practice to exclusively dedicate his practice to providing vasectomy in Florida. He joined NSVI and is the Development Director. Dr. Stein is an ardent supporter of vasectomy and vasectomy promotion. He maintains a dedicated vasectomy website Vas Web and if you have ever driven around Florida and seen signs about vasectomy then you have seen Dr. Stein in action.

As you fly over the Caribbean Sea towards Haiti, you can’t but help notice the beauty of the ocean beneath you.

The scenery suggested I was going to an all-inclusive luxury resort as we cruised over green islands ringed by white sand and deep blue.

Haiti from the air: Idyllic island surrounded by blue beauty

Even as you approach Haiti you notice a large, beautiful island with towering mountain ranges whose cliffs cascade abruptly into an azure colored ocean. Occasionally, you see smoke rising from a single mountain home. As you get closer, you see little clusters of home sites situated mostly near the coast. From the air Haiti serves the viewer an idyllic sense of tropical beauty.

The people on my plane all appear to be Haitian expats returning from the United States to their native homeland. They appear healthy, happy and beautiful. They have large bags stuffed with items they have purchased to bring back home. They are a beautiful people with deep, black skin. Skin so deep in color and smooth in tone it resembles the deepest parts of the Caribbean Sea. Their eyes and teeth provide a beautiful contrast against the deep, dark color of their skin. The contrast makes their teeth seem whiter than humanly possible. They all beam with pride to be returning home.

“The stark contrast from what I expected from a far distance to what I saw as we got closer reminded me of my college experiences in dark bars. Distance, poor light, and the judgment impairing effects of alcohol can make anything look good.”

– Haiti Vasectomy: No Reservations

Haiti: A proud country with a unique place in history

It is a well-known fact Haiti has the distinct reputation of being the only slave colony to have had a successful revolt against their French masters and become a free and independent country. No other slave colony can brag of this level of independence. In 1804, Haiti gained independence from France. Napoleon was too entrenched in his western war and he let the small Caribbean island go. Perhaps he foresaw the little island’s future?

Interestingly, the revolt against France started in the very part of Northern Haiti where our vasectomy mission would take place. Haitians have deep historical roots to nurture their sense of pride.

 

The descent: Haiti reveals her ugly identity

As you descend, Haiti slowly unrobes herself. No longer do you see the beauty of what the Caribbean has to offer… you begin to lose the sense of approaching an idyllic getaway. You begin to see her for what she really is…an old beauty queen who has long outshone her past. A previous pageant winner whose beauty has long disappeared beneath her sunken cheek bones and ragged, wrinkly, sunburned skin.

The stark contrast from what I expected from a far distance to what I saw as we got closer reminded me of my college experiences in dark bars. Distance, poor light, and the judgment impairing effects of alcohol can make anything look good.

A brown, beautiful, but featureless landscape reveals the absence of trees. There are few trees because most have been harvested for charcoal and lumber. The smoke rising from what I thought were cute little mountain houses was instead made by small groups of Haitians who could only find trees to burn for charcoal at the very tops of the mountains.

The soil is brown and rocky because most of it has been washed away as a result of deforestation. The land has been stripped of trees to create lumber and charcoal. The houses that looked so cute from the air reveal themselves to be ugly huts, many of them made of mud and cinder block and covered by decades old metal rusty roofs. They don’t look so quaint and cute when you are close up on them. None of the roads are paved but instead muddy, rocky, and full of trash…plastic bottles and plastic bags. Only God knows what else has been thrown away because no regular sanitation happens here.

As we prepare to land, my thoughts of a cushy all-inclusive luxury resort quickly fade and I realize I am in the real Haiti…the Haiti we have all seen on the news…the earthquake Haiti. The apocalyptic Haiti.

I am now seeing Haiti for what it is…an over-populated island stripped bare of scarce resources and people stacked upon each other in some places like rats on a ship in trouble.

“As you descend, Haiti slowly unrobes herself. No longer do you see the beauty of what the Caribbean has to offer… you begin to lose the sense of approaching an idyllic getaway. You begin to see her for what she really is…a previous beauty queen who has long outshone her past.” – Haiti Vasectomy: No Reservations

As the plane began its descent the passengers began clapping and singing in Creole expressing their happiness in returning home. When the wheels hit the runway the entire plane erupted in song and praise and clapping…thankful to be home and thankful to have landed safely.

I found myself thinking how ironic it was these Haitian people could be so desperate to leave their country to make a better living in the United States but also so happy to return to the same place of desolation. I guess home is home… no matter what condition home is in… or what conditions home has placed upon you.

No Fantasy Island on Haiti

As we exited the plane, the Caribbean heat and humidity hit me. The breeze revealed the slight tinge of an odor I would come to learn was the odor created from burning plastic.

We walked down an old-school aircraft ramp ladder…the kind I remember seeing as a kid in the 1970’s. The kind where you can get rained on or take a really nasty fall if you were not careful.

For some reason I thought of the TV show Fantasy Island as I walked down this ladder… only this was not the Fantasy Island I remembered. There was no raspy little Tattoo to great me….no suave Mr. Roarke to give me a lei, a drink and tell me this is the island where my fantasies will come true.

Instead, we passed underneath a brilliant colored Haitian flag against a deep blue, cloudless sky and underneath was an Caribbean band as we entered into Customs. Although pitiful, it was an appreciated attempt at a welcome to a historically important but currently undervalued island of the Caribbean Sea.

Customs was ‘modest’ at best. It was the easiest customs check-in I have ever had…let’s face it. People don’t try to sneak into Haiti…they only try to sneak out of  Haiti.

The customs check-in adequately reflects this understanding. Pay your $10 bucks and you are in.

Getting out of the Haiti airport and customs

There are two simple rules to get through customs and out of the airport:

Rule #1 Every person for themselves

Rule #2 Anything goes

Surviving the baggage terminal was my first lesson about Haiti.

It was an extremely narrow, rectangular space with one entrance to get in and one entrance to get out. It was filled with Haitians trying to get their bags. They were all yelling and shouting in Creole. Perhaps they were just talking loudly.

It always seems when people are talking in a language you don’t understand they always seem like they are yelling.

We waited for about 45 minutes as our bags were taken off the plane. This was a small time operation, a few guys, lots of people screaming, and, seemingly, no one in charge. The airport in Cap Haitian can’t possibly get more than 3 flights a day…most likely only one. I soon remembered we were among the first to make our connector flight in Miami, which means our bags were the first to get on the plane…and consequently the last to exit.

After the vasectomy team had gathered our bags, we headed straight out the door of the baggage ‘room’. I say room because it really was a room and not a terminal.

Immediately across the street were a line of Haitian men standing like an army at attention. It was a well-ordered formation and the fact they were on the opposite side of the street and not bum rushing us was likely because of some preconditioned police training. I was impressed no one was trying to sell me anything.

Luckily our driver was waiting for us in a Toyota land cruiser..the cool kind you see people driving when they are on a safari. With the driver was Dr. Mesadieu, the local Haitian physician who would be joining us to perform vasectomy procedures, and Elisabeth Kaplan, our team nurse and patient facilitator.

Mission goal: Scout primary vasectomy site

After escaping the chaos of the Cap Haitian baggage terminal, we moved on to our next objective. The goals for the remainder of the day were to scout our first clinic location, secure a new air conditioner for the vasectomy procedure room, change money to conduct the remainder of the mission, and check into the Roi De Christophe hotel. It was around 4pm. Electricity is undependable in Haiti.

There are no street lights and few homes have lights. When the sun goes down it gets dark in Haiti…real dark. Most Americans do not know what real dark looks like.

We drove from the airport headed for <strong>Fort St. Michel Health Center</strong>, which would be our base of operation to perform vasectomies in Cap Haitien.

Our drive from the hospital was my first real introduction to Haiti. I saw a society in disarray compared to what I was accustomed to seeing in the United States.

People were everywhere; walking in all directions. About every third person was just sitting and staring off into the horizon. Trash was on the street, in the center of town, and on both the sides of river. The trash in the river was so thick you could walk on it; floating trash riverwalk. Plastic bottles and bags were everywhere. I felt as if I were traveling through the town dump rather than the center of the city where Haitian independence was born.

The two images that stand out the most to me was the prolific amount of garbage lying around and the large numbers of people just sitting and doing nothing.

Eventually I came to realize the garbage is just what you get when you go to a poor country with little infra-structure and the people are sitting outside because it’s so hot. There is no AC inside most structures. There may not be much to do without TV or internet other than sit outside and stare at the horizon.

Mission goal: Secure air-conditioning for vasectomy room

Upon arrival at Fort St. Michel Health Clinic, we scouted out the procedure area and spoke with the hospital administrator about plans for the remainder of the mission. The primary objective was to discuss the broken air conditioner in the procedure room. We were given advanced notice about this and the first goal was to get it working.

“It’s hard to perform vasectomies with sweat running down your back and through the crack of your butt… it is a little distracting.”

– Haiti Vasectomy: No Reservations

I am not trying to come across as a privileged American who needs his air conditioner to keep his fat butt happy…but it is oppressively hot and humid in Haiti. The heat is magnified when you are inside a structure with limited ventilation.

You would think the island would be bathed by the ‘cool soothing winds of the Carribean Sea’ but such is not the case in July. In fact there was almost no wind at all. Moreover any place that is someplace worth being in Haiti has a 12 foot protective wall around it, which is great for security but sucks for encouraging airflow. Add to this we would have five doctors, two nurses, and three patients all within a 10 foot by 10 foot room with a single door, a single window, and no cross ventilation and conditions can get oppressive.

Not to mention again,  it’s hard to perform vasectomies with sweat running down your back and through the crack of your butt….it is a little distracting, but I eventually got good at it during this vasectomy mission.

AC or “No vasectomy for you!”

Dr. Suarez and Dr. Stein met with the hospital administrator and No-Scalpel Vasectomy International and offered to purchase a new replacement air conditioner for the hospital but it had to be installed within 24 hours or we would not be able to perform vasectomies at the hospital. The deal was made. The terms were clear. Money changed hands and no receipts were given.

In Haiti it pays to be as clear and precise as possible or the deal then becomes fuzzy and opens you up to being manipulated. The hospital was given money to purchase a new wall unit AC for the vasectomy procedure room where we would be working. We then left to exchange US dollars into Haitian Gourdes and this would prove to be a ‘unique’ experience.

Exchanging money in Haiti was an experience. We drove towards the center of downtown and stopped in front of the main bank. I was expecting we were going to exit the car, walk into the bank, and exchange money. It did not work that way.

Changing money in Haiti…interesting experience!

Instead a well dressed man standing across the street notices the car filled with mostly non-Haitians (i.e. white people) and walks towards us. He was wearing a nice shirt, a good pair of designer jeans, and wore a gold chain around his neck. He was dressed very differently than the other people walking on the street. On his wrist he wore a flashy gold watch and in his hand he was holding a cell phone. Being an American, my first thought was this seems like a drug deal.

I did not sign up for a drug deal. My intention was to go to Haiti, do some vasectomies, come home, and feel good about myself…it was not to buy drugs and get high…I could go to Colorado for that experience.

It was then Elisabeth chimed in, as if she could sense what I was thinking, and told us this was a guy you could trust. This guy was the ‘official’ money exchanger for the bank. I thought why did we not just go inside the bank? Why must we handle wads of cash on a busy street in an impoverished country? I was in the back seat so I just kept my mouth shut.

The money changer guy reaches into his pocket and pulls out a wad of Haitian Gourdes. This role of cash must have been at least 5 inches thick. Some of these bills had the feel, consistency, and appearance of used toilet paper. The entire transaction took place in Creole. We handed him a wad of crisp, clean US money. He calculates the exchange on his cell phone calculator and handed us a wad of not-so-clean and far from crisp Haitian Gourdes.

“It has been my life’s experience that women are often the creators and the motivators. Men like to think they are but they really are not.”

– Haiti Vasectomy: No Reservations

Women: Motivators and creators

Elisabeth was one of the few women on the vasectomy team and, as fate would have it, she would be the most instrumental and most meaningful member of our team. Elisabeth would be the ‘do-er’. She was the one who you could count on to get it done and make things happen.

It has been my life’s experience women are often the creators and the motivators. Men like to think they are but they really are not. In Africa and in Haiti, it seems the men do the hard manual labor, the drinking, and participate in the ‘mens decision making club’; however, these same men go home only to be told what to do by the women.

Although the same happens in the US, we are more reluctant to acknowledge it. The women make the decisions and often motivate us to do the labor to make it happen.

This would be the role Elisabeth would serve for us.

Haiti: A safe country to live and travel

As the money deal was taking place, Elisabeth taught me my most memorable lesson about Haitian culture. She informed me Haiti is a very safe country to live and travel. I was dumbfounded because that was not the impression I had when coming to the country.

Violent crime is minimal; assault, murder, mugging, and armed robbery were almost non-existent. Petty theft was more common but physical harm was not usually not a part of the crime equation. Elisabeth informed us the worst insult you could give a Haitian was to call them a thief. The average Haitian is very prideful and does not like to be thought of as being so depraved they would steal from others.

For the remainder of my trip, I felt more at ease about my stay in Haiti, but being an observant physician, I could not but help to notice the high walls with sharp objects around most of the buildings.

Our money deal was done and off we drove towards the Hotel Du Roi Christophe, which would serve as vasectomy mission headquarters.

After changing money, we had to check into our hotel.

As we drove towards the hotel, we passed a short stretch of road that paralleled the coast. There was ‘development’ going on. A row of houses immediately adjacent to the beach were deemed illegal and were demolished. This opened up the beach to future development and the entire stretch of coast was visible.

The water was not inviting. The crystal clear water of the Caribbean was nowhere to be found. Instead the water was dark…about the color of mud for as far as the eye could see. You did not want to swim in this stuff.

We passed a group of kids who were naked in the water…no one seems to have bathing suits here. I could not tell if the kids were swimming or bathing. Next to them was a rusted out hull of a shipwrecked fishing vessel. Men were gathered around it and appeared to be using a welder to dismantle the rusted frame. The beach was rocky and there was no sand to be found.

You would never find this beach on the cover of any Caribbean vacation magazine.

Vasectomy Mission Central Hotel Du Roi Christophe

As we approached the hotel I had the strange sense I had been here before…a sense of familiarity with the surroundings. As we entered the hotel compound I could see the beautiful French architecture and then realized I was familiar with what I was seeing because I went to college in New Orleans.

I was remembering the French quarter and the beautiful French architecture. It then made sense to me Haiti was similar because of Haiti’s history as a previous French colony.

We checked into the Hotel Du Roi Christophe. I was later informed this was the vacation house of the first Haitian King, Henri Christophe. Christophe was an interesting character. He was a slave, who gained his freedom through hard work, and eventually helped the slaves revolt and gain their independence from France. Haiti was the only slave colony to gain independence from European rulers. Christophe, in the name of doing good, eventually became oppressive towards his own people. At the age of 53, he ultimately committed suicide to avoid assassination. It is ironic how the ‘savior’ can sometimes become the ‘oppressor’.

Understanding the life of the first Haitian King can help you more easily understand how deep the roots of animosity are between Dominicans and Haitians.

The Hotel Du Roi Christophe was surrounded by a ten foot wall. It was about the size of a city block. The hotel itself was open, airy, and elegant. There was a checkered floor of black and white tiles, large open doorways, and beautifully shuttered windows. I could not tell if I was in France or Cuba but the hotel was a nice establishment. It had internet and air-conditioning… so I was good.

We checked into our rooms. The rooms were nice. The furniture was antique-ish. The floors were made of clean, cool tile, and the walls were made of old brick interlaced with mortar made of beach sand and coral. The room had a loft-like feel to it. We did have several mosquitos in the room. I found myself wondering which one had the <strong>Chikungunya virus</strong> and was going to mess me up for life. The others likely had malaria in their guts but malaria is a treatable condition, but only after you suffer for several days. There was a window air-conditioning unit…so I was good again.

I shared a room with Dr. Shu. I cannot remember the last time I ever shared a room with someone. It had been quite a long time…I was not really looking forward to sharing a room, but I was a guest of the NSVI vasectomy mission team and I thought it best to be cordial and not say anything. Ultimately, it would not matter because at the end of each vasectomy day I would be so tired I could have slept anywhere.

Dr. Shu later told me I was a snorer so it sounds like he got the rawer end of the deal. Sorry Dr. Shu but that’s what you get when they bunk you with the fat guy.

Internet connectivity is oxygen

After a liberal application of mosquito repellant, I had to do what any American has to do after a long day of traveling. I ran around the hotel lobby trying to find the strongest Wi-Fi signal I could find! I had to catch up on all of the day’s unanswered e-mails. Getting a strong signal with good connectivity was like breathing in fresh mountain air after a day of not being digitally connected.

I soon learned electricity in Haiti is undependable. I had only gotten through about half my emails when the electricity went out and it became pitch black! The lights flickered on and off initially and then went entirely out for three minutes. A guy walked over and started the hotel generator and the lights came back on and we were back in business. Any place in Haiti of good quality has its own back-up power supply. Hydrocarbon generators are popular but solar panels and batteries are growing in popularity thanks to more affordable Chinese solar panels. Solar is more dependable in Haiti than hydrocarbon.

The rest of my emails would have to wait because it was time for ‘Happy Hour’!

“The first thing we all ordered was beer. We are doctors but we were guys first. We do have our priorities right.”

– Haiti Vasectomy: No Reservations

Priorities: Beer first, food second, work third

I joined the team for dinner in the open-air restaurant. I felt like Humphrey Bogart except I did not look as cool as Humphrey. I was in shorts, t-shirt and Birkenstocks. I was only missing the Fedora and cigarette dangling haphazardly from my mouth. I was not used to this type of atmosphere…but it was hip. It all felt quite regal to me.

The first thing we ordered was beer. We are doctors but we were guys first. We do have our priorities right.

Two Haitian dudes at the table next to us recommended a local beer called Prestige, but the waiter recommended Kinanm, which is also a local beer. We couldn’t decide so we ordered a round of each!

We discussed the next days mission but mostly we drank beer. We ordered grilled fish and grilled lobster only to find out the restaurant was out of lobster. Running out of food items seems to be a frequent occurrence in Haitian hotels, but that is usually a good thing because it means the food is fresh and locally sourced. We don’t run out of things in the United States because we have plenty and we freeze the oversupply. Also you can make an argument, we don’t run out of things because we are better able to manage limited resources and reproduction better than the developing world.

“We don’t run out of things in the United States because we have plenty… we don’t run out of things because we are better able to manage our limited resources and reproduction better than the developing world.”

– Haiti Vasectomy: No Reservations

The table next to us..the two Haitian dudes…were actually a father and son pair who were from the US and vacationing in Haiti. The father migrated to Haiti during the Duvallier era and the son was born in the United States. The son was treating his father to a nice trip and brought him to Northern Haiti to stay at the hotel and see the less familiar sites of the northern coast. The pair made a cute father and son team. I soon realized the number one tourist group to Haiti was composed of individuals who had migrated to the US to live and who then returned to see family and vacation.

After about three beers and talking to these guys, I realized Haiti is a cool, off the beaten path kind of place to take a vacation for the adventure oriented individual. There are nice, historical things to see, a few nicer places to stay, and despite what you hear..there is food available to eat. Its not all starvation and dehydration in Haiti.

I finished my grilled fish, rice, and beans and returned to the room to call it a day. I had been up since 4 AM. I turned in and had a restless night sleep. I continued the circle of life by allowing mosquitos to feast the night on my blood…there were only a few in the room. I tried to kill them before I went to bed but they were too fast and good at hiding in the dark spaces. The light in the room was not good enough for me to track them down. Bug spray would have been a great idea but they don’t sell it in Haiti and TSA won’t let you take it on a plane. I soon realized if you let the few that you can’t kill feast on you then they get fat and leave you alone for a few days.

In the middle of the night I placed my hand underneath the headboard and something bit the crap out of me. I had shivers running down my arm the remainder of the night and a discreet bump on my hand for the next several days. I figured it was a spider. Spiders don’t carry the Chikungunya virus … so again I was good with this piece of knowledge.

We awoke to our first full day in Haiti with the plan to drive two hours to the mountain village of Plaisance to perform vasectomy procedures. We assembled in the hotel restaurant, checked our email, and had petite dejeuner (breakfast) of fruit, omelets and coffee.

Allow me to share insight on coffee and travel. It is an interesting conundrum that the places in the world known for producing the best coffee usually serve the worst tasting coffee in their restaurants! It takes like crap. I believe they only serve instant coffee. Why is this?

Perhaps Starbucks buys all the good stuff. These countries, understandably, would rather sell it to other countries at a premium rather than serve it at home. I am constantly disappointed by the horrible coffee served in areas known to grow the best coffee in the world!

After petite dejeuner, we gathered in the parking lot of the hotel to pack up our car. As we were packing several Haitian women approached us to sell whatever commodity they had to sell on that particular day. Haitian women are amazing. They are fit, strong, determined, and indelible. They can carry large amounts of weight and they do so by carrying it precariously balanced on their head. Human neck muscles are some of the strongest muscles in the body.

One woman was selling cashews. Another was selling young coconuts. I left to take a bathroom break and when I returned every one was drinking out of coconuts with the tops chopped off. This woman was chopping the tops of the coconuts with a sharp machete, allowing them to drink the juice, and then splitting the coconuts so the they could eat the fresh coconut meat. It seemed like a comical site…an older woman uttering some language we could not understand, wielding a sharp machete, and busting these coconuts open for a few coins.

I passed on the coconut juice because I was never fond of coconut juice. You always expect it to taste like pina colada but it never does. Coconut meat is just okay. If I was on the show “Naked and Afraid” I would eat coconuts all day long but I was neither naked nor afraid but I was full from breakfast. I just watched the vasectomy team have fun with the coconuts. There is a vasectomy joke in this story somewhere.

Vasectomy Team departs for Plaisance

Our seven-person team loaded into a Toyota diesel SUV for what I though would be an easy drive to the vasectomy site.

We passed the airport as we ascended into the mountains. The entire airport was enclosed by a 14 foot wall. On the top of the wall were empty poles. We were informed several hundred solar panels and batteries had been installed to provide electricity to the airport. Soon after they were installed they were stolen. Someone just climbed up the poles, removed the panels, and that was that. Again violent crime is minimal in Haiti but petty theft…especially in the dark of night is very common.

“I am a doctor and vomiting does not phase me…as long as I don’t have to look at it. Vomit, pee, blood, coughing, gagging, defecation, and farting…these are all naturally processes to me. No sympathy emanates from me… just don’t get it on me and we’re good.””

– Haiti Vasectomy: No Reservations

Not an easy drive to Plaisance

The drive was anything but easy. Sections of the road were paved but with numerous potholes. Most of the road was unpaved with deep gravel lined puddles. It was less of a drive and more of a tortuous snake route. Dr. Shu, poor guy, threw up. He blamed it on too much oil in his omelet mixed with the coconut milk he had recently consumed. I think it was because he did not get enough sleep because of my snoring.

Thankfully for Dr. Shu, Dr. Stein had a vomit bag. When Dr. Shu started gagging, Dr. Stein reaches into his bag and pulls out one of those old-school airplane vomit bags and gives it to Dr. Shu just in the nick of time. Meanwhile some poor lady is throwing up on Delta somewhere 20,000 feet above Oklahoma and can’t find the vomit bag that is supposed to be in the seat pocket in front of her seat.

Vomit and Dr. Stein’s magical fanny pack!

Dr. Stein is a pretty amazing guy. He always wears this little fanny pack even though he knows it is a bit dated. He has everything in that little fanny pack. He is like a magician…”Watch me pull “X” out of my fanny pack!”

Over the last several mission trips these are all the items I have seen him pull out of the little pack: a vomit bag, scissors, tape of several different varieties, surgical eye loupes, wrenches for the vasectomy air injectors, needles, pens, markers, a pharmacy of lidocaine, various other medications which urologist prescribe often but I shall not name, chondroitin, ibuprofen, Tylenol, he has many more as yet unidentified pills and comes close to rivaling Walgreens, honey (several packs), pens, paper, cell phone, camera, food coloring, vasectomy brochures, silk suture, and the list goes on. If you need it then just ask Doug Stein and chances are he has it tucked inside his fanny pack.

As Dr. Shu continued to vomit coconut milk and oily eggs without stopping, I looked at the life we passed as we climbed up the hill. I am a doctor and vomiting does not phase me…as long as I don’t have to look at it. Vomit, pee, blood, coughing, gagging, defecation, and farting…these are all naturally processes to me. No sympathy emanates from me… just don’t get it on me and we’re good. I can look at everything except I prefer not to look at vomit. These are all natural processes that you just have to get through and you will be all right in the end.

Daily Haitian routine: Survival!

I saw countless numbers of people going about their daily lives. Many of them were just sitting and looking into the distance. I guess this is what you do when you don’t have TV or electricity and it is too hot to sit inside.

I saw topless women in the doorways…real National Geographic type stuff. Men asleep on the bare ground. I saw shoeless kids kicking cans as excuses for balls. Women seemed to be doing most of the work..they were all carrying things on their head and I mean heavy things. They were working and cooking on charcoal fires by the side of the road. Everywhere a stream crossed the road there were woman and children washing clothes. The women seemed to be the only ones working.

Haiti is a dirty country…even the water is dirty. Amazingly many Haitians have the cleanest clothes I have every seen. I found myself wondering how can you wash a white shirt in a dirty, muddy, stream and manage to keep it looking white and pure. The Haitians sure knew how to do it.

Dr. Shu eventually stopped throwing his guts up and we pressed forward weaving side-to-side on the mountain road. Up into the hills we went and after about two hours of extremely rough driving we arrived at our ‘vasectomy office’ to begin a long day’s work.

Our vasectomy office was actually a two-story elementary school treacherously poised on the side of a steep mountain. We were given a small basement room to serve as our vasectomy procedure room. As we entered the room we were pleasantly surprised to find there were a large group of men anxiously waiting for their vasectomy procedures.

Many of the men had heard about the benefits of vasectomy. The word about the ease and effectiveness of vasectomy as a great method of permanent birth control had gotten around the town.

We quickly went to work organizing our supplies and setting up our exam tables. All instruments were laid out and accounted for. Our exam tables, which were actually massage tables, were carefully positioned in the small room. Three doctors were prepared to perform non-stop no needle no scalpel vasectomy procedures in a room the size of an average American bathroom.

My first vasectomy procedure: Toughest of entire trip!

I had the first patient of the day and as ‘luck’ would have it he was not an easy case..in fact he was one of the two most difficult vasectomy procedures of the entire mission trip.

He had the largest scrotum I had ever seen! It literally hung to his knee caps. His massively enlarged scrotum was the result of a chronic hydrocele (fluid collection around the testicles), which caused enlargement of his scrotum. He did have a surgical repair and this left him with redundant scrotal skin and significant scarring inside the scrotum.

To make matters worse his vas deferens were extremely thin and difficult to feel. I was able to recruit the assistance of our team leader, Dr. Stein, and the vasectomy procedure was performed without difficulty but took us four times as long as our average vasectomy procedure.

“Nothing can make you a better vasectomy provider than having to provide numerous vasectomy procedures in oppressive conditions while being eaten alive by biting insects. Nothing…”

– Haiti Vasectomy: No Reservations

Providing vasectomy in rhythm: It’s a mental thing!

I have this mental thing when it comes to vasectomy. Perhaps I am becoming superstitious but I feel the first procedure sets the tone for the remainder of the day. I was determined to get off to a good start and not ruin my trip. By requesting assistance, I was able to make the first case ‘easy peazy’. It takes a real man to ask for help.

Each member of the team pressed on performing vasectomy after vasectomy. The work was hard because there was no electricity or working air conditioner in the room where we were performing these vasectomies. Sweat pored down our backs during these procedures and the humidity combined with lack of airflow made the working conditions very difficult. Mosquitos were our assistants.

We took five minutes for a lunch of Spam sandwiches with cheese. All washed down with some sort of amazing tropical fruit juice. After a quick lunch, we continued working for the remainder of the day. As the sun rose overhead, the air became more hot and humid and the breeze ceased. Vasectomies became more difficult.

It seemed as soon as I got to a critical portion of the vasectomy procedure a mosquito would land on my arm and bite the hell out of me. It was impossible to stop in the middle of the procedure and swat them away. It was almost as if these little guys knew the best time to bite during a vasectomy and could take ready advantage of it. They knew the part where they could suck my blood and I was not in a position to swat them. It is kind of hard to stop a surgical procedure at a critical moment and kill a mosquito while wearing sterile gloves and still maintain surgical sterility. It became torture towards the last several cases.

Nothing can make you a better vasectomy provider than having to provide numerous vasectomy procedures in oppressive conditions while being eaten alive by biting insects. Nothing…

35 vasectomies in 4 hours!

By the end of the day, three working vasectomist completed 35 vasectomy procedures in about 4 hours. Some were quite difficult due to large scrotal hydroceles (some testicles were the size of softballs). The men had a combined total of 190 children, which averaged 5.8 children per man. We felt we had done good work for the day.

Our village sponsor, Pastor Amos, treated us to a Haitian dinner of chicken, rice, beans and fried plantains. It was home cooked and amazing! This meal was very welcomed after a long day of hard day of performing vasectomies. It was the best meal of the day. Most of the team drank beer. I have no problem with drinking beer but prefer to avoid alcohol after being in a state of dehydration. Instead I drank a tropical fruit punch soda. It was a Haitian soda called Tropical Champagne. It was the best stuff I put in my mouth the entire trip.

We packed equipment back into our SUV as the night began to fall and storm clouds began to gather. Just as we had finished it poured the proverbial cats and dogs and it started just as we tied the last suitcase to the roof of the SUV. We all loaded back into our transportation…I think it was a total of nine of us in a car meant to hold just a few less. We completed the return 2 hours jarring drive back to our hotel in Cap Haitian. As we came down the mountain all I could think of was my air-conditioned hotel room.

On the team’s second full day in Haiti, we planned to provide vasectomies at the medical clinic in Fort Bourgeois. We again had our petite dejuner (that’s French for breakfast) but the team skipped the vomit inducing coconuts this time.

We then drove to the clinic of Dr. Mesadieu, who is the leader of the Haitian domestic vasectomy team. The medical clinic was Uls Sante Clinic in Fort Bourgeois, Haiti and was high in the hills overlooking the city of Cap Haitien. The cooling breeze was better at this altitude.

Dr. Mesadieu: A true physician

Dr. Mesadieu works in a three room clinic nestled into the hillside between a church and several small houses. He works tirelessly to care for his patients.

Many cannot pay for their medical care. Those who can pay him pay him whatever they can afford. He was educated in Haiti and unlike other Haitian physicians he chose to stay and help the Haitian people. He is trying to expand his clinic and has purchased a small plot next to his existing clinic. He plans to build a larger heath clinic on this plot.

He proudly showed us the plot of land which was located on a steep hill. There were two huts and several goats on his new plot. He informed us these people would have to move when construction of the new building got underway.

Property in Haiti: You can stay as long as no one says go!

It seems property boundaries are not always well defined in Haiti. Essentially, you can build a hut wherever there is no other structure. You are welcome to stay as long as no one tells you to go.

I would imagine at first you build a new structure and hang out. If no one runs you off then you build a more substantial structure over time. The poorest huts seems to be made with mud and sticks. A step up from this is a house built with stones taken from the hillsides. The Haitian are very good at recycling stones for building…they truly do not leave any stone unturned. When you are able to build a structure with cinder blocks then you are doing very well on the social hierarchy scale in Haiti.

The number of partially built homes around Haiti amazed me. There were many places that had foundations only. Some places had walls but no roofs. Others had walls and roofs but no internal fixtures or inhabitants. I was informed people build their homes as they have time and resources to build. Building permits are not required. The speed of building depends on the available resources of time, money, and materials. When any of these resources run out then construction would stop. On some structures construction seemed to have stopped permanently.

Vasectomies and the man with the missing testicle

We began the day with a large number of vasectomy patients. We crammed ourselves into a small room; five doctors, two nurses, and three patients at a time. All in a room the size of an average American bathroom. Needless to say it was hot inside that room. Great for the half naked vasectomy patient but not so great for us.

One guy laid down in front of me for a vasectomy. His left testicle was there but his right testicle was missing. He only spoke Creole and I only spoke English. The leading diagnoses was the right testicle was removed for some reason or it never descended at birth. It is really not possible to be born with only one testicle…very very rare…kind of like only being born with one eye.

I inspected him carefully and he did not have any surgical incisions to indicate his testicle was surgically removed. I examined his inguinal canal and his abdominal wall. No testicle there.

I was able to summon a translator and the patient indicated he fell off his bike when he was a kid and ‘it just went away.’ I thought he was screwing with me and this story was the product of some local folklore Haitian mom’s tell their sons so they would be careful riding their bikes. I was then informed by a more senior member of the team severe trauma to the testicle can insult the blood supply and the testicle can just shrivel up, die, and disappear.

We just don’t see this stuff in the US. God it had to have hurt!

I cringed just thinking about this man’s childhood experience. I mean I have cracked my stuff on my bike handle bar as a kid and I have zipped my stuff up in a zipper and those events were fairly painful..need I say…excruciatingly painful experiences but nothing ever shriveled up, died, and disappeared!

This guy must have really smashed that thing hard! All I could think about was one Haitian kid curled up inside a mud hut for several days. This was one tough guy but thankfully his one sided vasectomy went great and was extra fast.

As luck would have it we had many more interesting and unique cases during the remainder of the vasectomy mission.

I would now like to discuss the case of the man with the scrotal hydrocele.

What is a hydrocele?

A hydrocele is a non-cancerous accumulation of fluid around the testicles. It can be a very common condition and can involve either one or both sides.

Hydroceles within the first year of life usually resolve without treatment. Those that do not resolve may remain stable but can grow overtime. Hydroceles are often small but can be as large as softballs or even as large as a basketball.

If hydroceles are uncomfortable or grow then they need to be surgically removed.

A man and his hydrocele

One of our last patients laid down on the vasectomy table for his vasectomy. When he pulled his pants down we were shocked at what we saw!

His right testicle was about the size of an orange and his left testicle the size of a cantaloupe! It does not take much of an imagination to understand this man had very unique challenges in his life and having a vasectomy would be one of them.

A large hydrocele can significantly distort the scrotal anatomy making the vas deferens more difficult to identify. It can also cause enlargement of the blood supply and increase the risk of a bleeding complication during a vasectomy.

In the United States it is not common to see hydroceles as large as the ones we saw in Haiti. In the US, most of these patients would have been referred to a urologist to have a simultaneous vasectomy and hydrocele repair in the operating room under general anesthesia. In Haiti, we did not have these resources available to us to complete this guy’s hydrocele repair; however, the vasectomy team would not be so easily discouraged.

Drain hydrocele and have a successful vasectomy

We came up with an improvised plan. We would drain the hydrocele on the table. Removing a large amount of fluid would decrease the volume and tension within the scrotal sac allowing us to safely perform the vasectomy.

This would require the teamwork of two doctors. We were able to locate a large needle; however, we only had a small syringe to withdraw the hydrocele fluid.

Under local anesthesia, we inserted the needle. One doctor held the needle in place while another doctor attached the syringe, removed 10 cc of fluid, and emptied the fluid into an empty water bottle.

This was repeated over and over until the scrotal tension decreased enough to allow completion of the vasectomy. After removal of 500 to 800 ml of hydrocele fluid, we were able to reduce the size of the hydrocele enough to complete the vasectomy.

Another difficult but successful vasectomy accomplished by the No-scalpel Vasectomy International team.

After completing the hydrocele vasectomy, we were ready to move locations. We had performed 18 vasectomy procedures during our morning session.

It was then God graced us with the presence of Pastor Joel.

Pastor Joel: A True Missionary of God

As we were packing up a portly white man walked into the room. We immediately noticed his presence. He was introduced to us as Pastor Joel and he wanted to stop by, see what we were doing, and say “Bonjour!”.

In Haiti, white people are fairly rare and when you see one they tend to stand out. I would imagine it is the same as seeing a black person in Idaho.”

– Haiti Vasectomy: No Reservations

I only spent a handshake and several minutes with Pastor Joel but I immediately sensed a goodness about him. He came to Haiti and felt God’s calling and he decided to stay. That was 40 years ago and he has never left!

Pastor Joel’s main focus is spreading the word of God to the people of Haiti but he also helps improve social services in the country. He maintains a cable television channel and has been a leading advocate for Haiti to people from other countries. He offered to film a segment about our vasectomy mission to spread the word about vasectomy to the people of Haiti.

I thought this would be a great opportunity to spread the word about vasectomy in Haiti.

Dr. Stein vs Pastor Joel: Immovable object and the irresistible force

As the team was about to leave, I literally drug Pastor Joel to Dr. Stein and informed him Pastor Joel would be interested in filming the vasectomy team on a future mission. Dr. Stein thought that was a marvelous idea…only he did not want to wait for the future. He wanted him to film us TODAY.

Pastor Joel was amicably reluctant because he had prior commitments for the day but little did he know Dr. Stein is rather tenacious when he gets something in his head. I knew what was coming so I just stepped back and enjoyed the show! It was like watching a good boxing match.

Dr. Stein would jab with a suggestion of when or how to video us TODAY and Pastor Joel would duck and weave with an excuse of what other obligations he had to do TODAY.

When Dr. Stein gets something in his head he won’t let it go and he will prevail. If Pastor Joel had told Dr. Stein we were expecting an earthquake that evening then Dr. Stein would have responded by saying, “No problem..we will do the vasectomy in the street so we will be safe from falling objects there and these iPhone 4’s have great image stabilization…wont be shaky at all!”.

Pastor Joel did not realize he was dealing with a master negotiator and before you knew it Pastor Joel was agreeing to video us later in the day. I love watching Dr. Stein work!

Only my close friends know this about me: I am not fond of Disney World. There I said it!

I have been hesitant to ‘come out’ about my feelings for Disney World because many view expressing a dislike for Disney as the equivalent of being a card-carrying member of the Nazi party or president of the KKK.

My disdain for Disney is derived from my personal experiences. While others are fond of the Disney ‘experience’, I have found Disney to be expensive and over-crowded with humanity. When I go there, I feel like a refugee in a foreign country trying to obtain asylum. I don’t know the area, I am constantly trying to gain entrance, and I am fighting for what seems like scarce resources.

I have spent more time profusely sweating and anxiously waiting in line for rides while at Disney than any other place. Standing in line for rides and food stresses me out. The stress of having to plan my day (several months in advance) to ride a few rides vastly outweighs any joy I receive from being there. I am certainly a glass is ‘half-empty’ kind of guy when it comes to Disney.

My Disney Experience

When I went to Disney with my three kids they were always in one of three states: crying because they were tired, crying because they wanted $15 popsicles, or passed out.

The photo on the left shows my kids in their most pleasant state (passed out) but it was only after we had spent 12 hours in the park and intentionally stayed late for the fireworks show. The  intent was for them to be awake for the fireworks show.

Our plan did not work out. Instead after the fireworks show they woke up and cried from fatigue all the way back to the hotel.

People are fond of saying Disney is a magical experience.

The only magic I have experienced at Disney is the magical transformation of innocent families underneath the heat of the high noon sun into not so nice people.

My last memory of Disney was of a mother crying and a pissed off father three heart beats from a heart attack as they stood in the Disney square trying to console their unconsolable crying child. Their overburdened stroller had flipped on its back from too much weight on the handles. The child was wailing, kicking his feet, and screaming into the sun like an\ hysterical astronaut ready for take off. The wheels of the stroller were spinning, apple juice was leaking from underneath the stroller, and Cheerios were rolling around on the pavement marking the scene of the accident.

This was my last memory of Disney: an innocent family trying to have a good vacation but decomposing under the stress of the experience. Yes this was truly magical. I felt for the poor parents who were trying to give their child a great vacation.

Disney: Long-timers and short-timers

There are two types of people when it comes to Disney: those who love Disney (long-timers) and those who don’t love Disney (short-timers).

People who love Disney buy yearly passes, have Disney credit cards, go several times a year, get all the character signatures, know the location of all the hidden ‘Mickeys” and are forever planning return trips. Those who don’t love Disney are kind of like me….’been there, done that, got the t-shirt, and lets move it along folks.’

I made similar observations about the Christian Missionaries I saw in Haiti.

One of Haiti’s main industries: Christian Missionaries

Haiti certainly seemed like it was Disney World for Christian missionaries. I saw more missionaries in Haiti than I have ever seen anyplace I have traveled.

The ones I met were mostly concentrated in the airport as they were entering and leaving. During the weekend, the Haitian airport was like the river where the migrating missionaries bottle-necked like wildebeest as they were entering and leaving Haiti on the weekends. As a first time visitor to Haiti, I was impressed by the concentration of missionaries.

In much the same way as I categorized fans of Disney, I also categorized the missionaries I met in Haiti. I met short-timers and long-timers….some were not so dedicated and some were very dedicated.

“Short-timers”: Getting their missionary merit badge!

I met some missionaries who were spending the obligatory week in Haiti…just like a trip to Disney. Their week was carefully planned with a planning organization during the summer months when it was less disruptive to their home life. Their travel, lodging, and meals were carefully planned by their respective organizations. They had fast passes to all the orphanages and aid stations. At the end of their mission, they were given an obligatory going away party and photo memory scrap books.

Many were high-school and college aged. Some were parents who brought their children so they could experience doing God’s work over the course of seven days. After a week they were done. Some were even returning to go to Disney (the real Disney in Orlando).

Most of the “short-timer” missionaries leaving Haiti were happy and excited while others seemed depressed by their experience (just like those leaving Disney). Although I may be coming off as condescending of these short-time missionaries, I can say in their defense at least they spent 7 days, while I only spent 3 ½ days!

“Long-timers”: Truly dedicated missionaries

I met one missionary who was truly dedicated: Pastor Joel. I am certain there were many more like him.

Pastor Joel left the United States and dedicated his life to Haiti. He has been there for 40 years and seems to have made a great contribution to the country of Haiti.

He is affectionately known as Frere Joel, or Brother Joel. This guy is the real deal.

Pastor Joel goes into great detail in his website about his calling to live in Haiti. Below is his story in brief.

I am not making this up because you cant just make stuff like this up.

Joel was a troubled teenager who was homeless and abandoned by his parents. He was running from the law and tripped out on LSD and was found naked and psychotic on a dark, rainy night on a lonely mountain road by a Christian couple. They picked him up and told him, “God loves you…”. In his weakened physical state and while under a LSD psychosis he experienced a transformation. He accepted God into his life, joined a church, and traveled to Haiti to fix a church motorcycle. He has never left Haiti.

This is the stuff of comic books and you just can’t make this stuff up.

I only met Pastor Joel for several minutes but I immediately liked him. He had genuineness about him and I am a better person for having crossed his path. After I returned home I Googled him, as he had suggested, and learned more about what he does in Haiti.

I encourage others to read more about Frere Joel: Pastor Joel’s Personal Testimony

Pastor Joel is the real deal…not a week-long Christian warrior who is checking something off his bucket list. He has a true love for Haiti and he is a truly dedicated Christian.

We could all learn by his example but we should all realize we all give of ourselves in different ways.

I wanted to take a quick diversion from my Haiti Vasectomy blog to share my feelings, or more appropriately my ‘pet peeves’, about doctors who claim they offer sterilization reversal because they see it as God’s mission.

Is the exclusive provision of sterilization reversal as your main practice really carrying out God’s mission?

History of vasectomy: Is vasectomy reversal God’s mission?

Vasectomy procedures were not performed in biblical times.

Castration was prevalent, but castration and vasectomy are way different procedures! Although the ancient Egyptians were fairly advanced for their time and even performed cataract removal procedures, they did not perform vasectomy or tubal ligation.

According to Wikipedia, the history of vasectomy is such that the first recorded vasectomy procedure was not performed until 1823 and this vasectomy procedure was performed on a dog. The first human vasectomy was performed soon after and the first vasectomy performed in the United States was in 1897.

It stands to reason if vasectomy procedures were not performed in biblical times it is more difficult to make the argument vasectomy reversal is God’s mission. Poverty, hunger, and sickness continue to exist and transcend the passage of time.

God’s misson: Curing the sick, helping the poor, feeding the hungry

I am not a biblical scholar but God’s missions seem to revolve around spreading the word of God, love for one’s neighbor, and helping those who are less fortunate than ourselves. God did heal the sick and help barren women become pregnant but these actions were done to support God’s omnipotence and as a symbolic act to help provide others with faith in the love for his children.

I find it very interesting when a doctor says they provide vasectomy reversal or tubal ligation reversal because they see it as God’s mission. I find it especially interesting when they exclusively limit their practice to sterilization reversal and claim they are doing God’s work. I am not trying to knock anyone for their beliefs, but they certainly have chosen a rather easy area of medicine in which to practice God’s mission; a financially lucrative (all cash and no insurance) area of medicine that is easier on one’s lifestyle (scheduled visits and few night or weekend emergencies) compared to other areas of medicine.

For me this is no different than a guy saying I sell Mercedes Benz and Lexus because it is God’s mission to help the poor with transportation…or I am a corporate takeover attorney because I want to help poor workers…or I am a real estate investor to help the homeless.

Don’t most people who perform God’s work do it for free?

Why do I perform vasectomy reversal?

I perform vasectomy reversal for two reasons: (1) to promote vasectomy (2) to further use my skills as a surgeon.

Although it may seem strange to say I provide vasectomy reversal surgery to help promote vasectomy it really is not strange at all.

Although most men acknowledge vasectomy is permanent, the smart ones are not afraid to ask if it can be reversed. Who wants to jump out of a plane without a parachute? Who would ride a roller coaster knowing there is no safety mechanism in cases an unpredictable problem were to occur?

I have always believed a true physician/surgeon uses their skills to help others. In particular, I like using my skills to help others in ways others doctors are unable or unwilling to help them, i.e. tubal reversal, vasectomy reversal, and single visit no-needle no-scalpel vasectomy procedures.

“Dammit Jim…I’m a doctor not a bricklayer!”

Often times when I hear a physician say I do “X,Y, or Z” because it is God’s mission, I experience a little inward cringe.

I am not trying to knock anyone who believes they are doing God’s work…but I am trying to poke fun and use a little irony to reveal the humor I see in their interpretation of their work.

Often when I hear a doctor say I am doing God’s work I often think of Dr. McCoy on Star Trek. Captain Kirk would often piss him off by asking Dr. McCoy to do something outside of his job description and he would always respond with the formulated statement,

“Dammit Jim, I am a doctor not a (insert whatever fanciful imagery which describes what he was being asked to do outside of the job description of doctor)!”

It is my personal belief that doctors should doctor and preachers should preach….now I will continue with Haiti Vasectomy 2015 Mission travel blog.

After finishing the morning vasectomy clinic in Fort Bourgeois and completing 18 vasectomy procedures, we departed for an afternoon vasectomy clinic at Fort St Micheal.

Functioning air conditioner equals a happy team

We arrived in Fort St Micheal around lunch time. The team was ecstatic because the recently purchased air conditioner was installed and working. This was no small feat in a country like Haiti.

In the United States if your window air conditioner is out then you run down to HHGreg or Best Buy, whip out your credit card, purchase it and then arrange a delivery time. Unless some disastrous situation arises you can pretty much count on your newly purchased item arriving, being installed, and perfectly functioning. Not so in Haiti.

In Haiti there are no department stores. There does seem to be one or two appliance stores in Cap Haitian but their inventory is questionable. Looking into these stores reminded me of the bar scene in Star Wars when Han Solo shoots the bad guy, the music stops briefly, and then everyone continues on their merry way. It as quite chaotic.

Even buying underwear is a challenge in Haiti. One of the members of our team left his underwear at his home. He had a difficult time finding underwear to buy because there were no clothing stores and most people stopped selling items when the sun went down. Needless to say he went ‘commando’ for the remainder of the mission. Poor guy.

3 doctors 3 hours: 30 vasectomy procedures

We had a busy evening of vasectomies in the hospital. We completed 30 vasectomy procedures in three hours. At the end of the day we were beat and ready to return to the hotel.

Pastor Joel arrives to film vasectomy

Amazingly Pastor Joel showed up to film a segment despite being given brief notice. Dr. Stein can be very convincing. We had actually finished the evenings vasectomies but Pastor Joel’s driver wanted to have a vasectomy and so the team obliged. Pastor Joel filmed the entire visit; the counseling, the vasectomy procedure, and the after care instructions. He said he would try to put the show on the airway to increase awareness of the benefits and importance of vasectomy in Haiti.

The team returned to the Roi De Christophe and it was about 630pm when we arrived back at the hotel. It had been a long, hot sweaty day. We had performed vasectomy procedures at two sites and also filmed a segment to increase vasectomy awareness in Haiti. We wanted some cold beers and a dip in the pool so we quickly changed into our trunks and headed straight for the pool. After a couple of beers on empty stomachs we swam as best we could. We must have been an interesting site to the other hotel guests.

Returning to the hotel: Swim, happy hour, eat, work!

After swimming we showered, changed, and met at the hotel restaurant. We were late getting there. The restaurant closes at 930pm. I was worried because if the restaurant shut down you were not going to eat that night. No room service late at night. No Dominoes pizza delivery. No fast food. There was nothing outside the hotel. It was perhaps the only place I had gone in the world and had never seen a McDonalds.

We order and we had grilled fish, rice and beans and beer. You can forget the beer. The hit of the night was mango juice. Some members of the team ordered it and it took 45 minutes to arrive. While we were waiting Dr Suarez shared his maxim of rules of eating in the developing world, ” If you can’t peel it or boil it then forget it!”

We were not sure why it took so long to bring the mango drinks until they brought them out to us. You could immediately tell they were freshly pressed. I had images of the kitchen staff running out late at night to climb up some mango tree because some Americans were ordering mango juice at night. They were absolutely delicious and probably the hit of the entire trip.

We finished up the remainder of the night in the hotel open air lobby swatting mosquitos and entering statistics about vasectomy patients into our database: patient age, number of children, number of partners, etc. Most vasectomy patients were in their 40s and had an average of 5 children and 2 partners. One man had 12 children with 6 partners… Papa was a rolling stone.

The trickery that can be Haiti

We awoke at 6am to complete our last day of vasectomy procedures in Haiti.

We packed our bags and ate breakfast. We were not sure if we were going to have any patients because we were returning to the same place the day before and we were not sure what the demand would be. We then got the call that 13 guys were waiting for their vasectomy procedures!

We loaded up the Toyota Cruiser, checked out of the hotel and headed back to the clinic. Today was my last day in Haiti and I would learn my most important lesson about how Haiti functions.

I would learn the Haitian way of coercing more donations from international aid groups. I call it the Haitian mind trick!

Haitian mind trick? A carefully orchestrated plan

When we got to the hospital we set up the room to start seeing the 13 patients who were waiting. The Haitian mind trick began.

We started performing vasectomy procedures in the well air-conditioned room until all the power suddenly went out.

We soon learned the newly purchased, newly installed, and absolutely brand new air conditioner was not working. It was stifling hot in the room. We asked why it was not working and we were told the hospital was on battery back up because of an electricity outage. The air conditioners were not on battery back up line because they require too much electricity and are not a necessity during an emergency or random power outage.

We asked the hospital administrator if they would run their diesel generator so we could have AC and continue with our vasectomy procedures. The hospital administrator then informed us the generator could not run because it was out of gas!

Of course we were told if we purchased gas for the generator then we could get it running again. To provide additional insight, our vasectomy mission group had already purchased a $600 air conditioner and the vasectomy mission team was paying the hospital a facility fee for each vasectomy performed. Now they wanted gas for their generator.

How the Haitian mind trick works

This is how the Haitian mind trick works: attract any aid group into the country, get from them what you can get, and then figure out a way to make them feel extra sorry for you and squeeze, even coerce, a little bit more from them. Often very sophisticated plans are used for the squeeze.

I was told a story that clearly illustrates the Haitian mind trick in operation. Keep in mind international aid is one of the top three industries in Haiti.

One important Haitian domestic organization purposefully keeps the main bathroom broken in an area where donors come to visit the organization. When donors visit the organization and ask to use the bathroom…they are directed to use broken bathroom.

The bathroom, I was told, is utterly disgusting and the toilet is filled to the rim with what toilets are typically filled with. When the donors leave the local organization they often donate extra money because of the deplorable conditions they witnessed. This is great example of the Haitian Mind Trick and how it works.

I found myself thinking if I lived in a developing country and people were constantly coming to help and donate…and then leaving me in desolation in my home country while they turned to a more comfortable lifestyle then I might do the same thing.

Breaking the mind trick and finishing vasectomy procedures

Drs. Suarez and Stein pitched a fit. They told the administrator the group was not going to pay for gas for the generator and we were leaving without performing the vasectomy procedures for the day.

We had a plane to catch in 3 hours and we did not have time for games. The hospital stood to lose out on the facility fees for procedures performed so they did have something to lose. We packed up our equipment and were ready to go to the airport. This was the doctor equivalent of a 2 year old temper tantrum.

Apparently some phone calls were made and the generator magically turned on. It seems as though the generator was not out of gas as we were informed. The generator turned on and we hammered out the remaining vasectomy procedures. We finished the vasectomies in under three hours and then we packed up as fast as we could and headed off for the airport.

We were cutting it close and we thought we were going to miss our flight. Thankfully the airport was only ten minutes away.

We were greeted by a throng of men at the airport who were wearing red shirts. They looked like employees but they were <em><strong>insisting</strong></em> on carrying my bags inside. They grabbed my bags despite my objections. I did not have much luggage to carry and I would have preferred I carry my own bags.

As soon as we were at the front counter they were anxious for tips. I refused because they gave me no choice in the decision. They had snatched my one and only small bag and carried it literally 20 steps to the front check in desk. I was not going to tip them for forced service.

Not many people go to Haiti and, as a result, not many leave… so the check-in line was a short. I was the first person at the desk. I got my ticket and cleared customs within 10 minutes. Our plane was late so we sat down in the airport restaurant, ordered sodas and meat pies, and entered the remaining data on our vasectomy procedures into our mission database. Eventually the plane arrived, we loaded , and took off for Miami.

Our Haiti vasectomy mission trip had been a very quick trip. We were only in Haiti Wednesday through Saturday but it seemed like a month. As a first time visitor, I was fairly traumatized by seeing the quality of living conditions and the amount of ecological devastation which existed. Our trip was so packed with events, there was so much to do, and so little time to think about it all.

I was looking forward to a long flight so I could close my eyes, lay back, and contemplate the totality of what had occurred over the previous three days.

My misfortune: Sitting next to a very talkative passenger

Unfortunately I had the extreme misfortune of being seated immediately next to a very chatty woman… extremely chatty. There was not a spare seat for me to move to anywhere on the plane. There would be no time for introverted contemplation.

Most of my vasectomy work days are spent helping people get through anxiety provoking surgical procedures. Most of my day is spent making small talk and helping them to get through stressful and difficult situations (vasectomy). When I go home, I am usually not a very talkative person. I am even less talkative in public. Unfortunately this woman would not have any of this.

When she sat next to me I could immediately tell she was a ‘talker’. I told myself, “Don’t make eye contact, don’t ask her anything, and don’t look her way.” I kept to my plan but she eventually had her way with me. She asked me some innocent question just before the plane took off and then I was trapped.

Our resultant conversation did not stop until the plane landed and we cleared US customs and it was not because I was eager to keep the conversation going.

Most visitors to Haiti’s have little understanding of the depth of the island’s problems

She was a ‘Weeker’: a missionary who gave up her life for one week to help the poor little orphans of Haiti. Previously I explained how donations and missionary work are Haiti’s leading sources of income. I also explained how Haiti was Disney World for Christian Missionaries. Missionaries sorted themselves out into one of two groups: those who made it their life’s work and those who made it their week long vacation, did the mission, and got the t-shirt types. Hence this woman revealed herself to be a ‘Weeker.’

This Weeker was a stay at home mom who left her husband and older children at home to travel (for a week) to Haiti with her two daughters to show them how fortunate they were. Through her church, she arranged to work at an orphanage for one week. Her first statement about her experience was how ‘blessed’ she was to be able to stay at the orphanage. Every other sentence contained the word ‘blessed’.

It seems all she did was stay at the orphanage and entertain the children for one week. Otherwise I really could not understand what she and her two daughters did during their week’s stay. She told me about all the children who did not have parents, how cute they were, and how ‘blessed’ these orphans were compared to other Haitian kids. She told me all the pertinent stories she could remember. She even whipped out the latest I-phone phone model and showed me videos she took of the orphans doing some National Geographic tribal-like dance for her and explained to me how ‘blessed’ she was to have taken this video.

She went on to explain to me how she was not rich, her husband was a minister, and she was just ‘blessed’. She then told me she home schooled her children and then I understood a lot more about her.

People who home school are just a little bit…different. I put them in the same category as people with AOL email accounts. They are just different!

Homeschoolers are a little like Preppers…those people who prepare for the end of civilization as we know it because of some disaster they predict will end the civilized world. Homeschoolers are just a little less ‘rednecky’ than Preppers.

I asked her what she was going to do when she returned home. She then explained again how ‘blessed’ she was but that she was immediately going to the French embassy in San Francisco to apply for a six month visa because she and her two daughters were going to France to live for six months to learn French. She told me she had done the same when she was younger, she felt blessed because of this experience, and she wanted her daughters to have the same blessed experience.

The condescending ass in me thought, why don’t you just stay in Haiti for six additional months, continue to help the orphans, and you could homeschool your children there? They do speak French in Haiti, at least a version of it, so you could learn French and also continue to help the orphans.

You could get more blessed points, and perhaps, even level up in your blessedness. I guess that was not a ‘blessed’ enough plan…or at least not as fun as France would be.

I was not really in the mood to be having this conversation but she insisted on continuing with our meaningless chit-chat. We have all been cursed at some point in our lives having to sit next to a very talkative person for a very long time.

All I wanted to do was sit there and have introspective thoughts about my experience in Haiti. I was not in the mood to hear about how ‘blessed’ someone thought they were.

I think I can put it in perfect perspective. Imagine you have just witnessed a horrific accident. You have seen a family die in front of your eyes in a car crash. The mother and father were thrown through the front window and the children were decapitated. Now imagine you gave your report to the police and are returning home on the public bus. Now imagine someone wants to sit next to you and tell you about their life and how blessed everything is about their life. Now you can better understand what I was going through at that moment in time.

Why don’t they have garbage service in Haiti? If you don’t know the answer…

At one point during our two hour non-stop conversation, I had a glimmer of hope because it seemed like we were having a meaningful discussion about Haiti. We discussed, among other things, the garbage that was ever present and lying all over the place.

Towards the end of our conversation she asked me, “Why don’t they have like a garbage service or something in Haiti?”

It was at this point I realized despair…this woman’s entire week was a waste of time. Her trip was only to check the missionary blessing box and to then move on to the next item in her long bucket list of activities. Did she not take anything away from what we both saw in Haiti?

Although a seemingly innocent question, her question reflected how little she understood about Haiti and the developing world in general.

To have a garbage service you need a few things: a functioning government, resources to pick up, transport, and process garbage, and citizens with money to pay for these services. Haiti had none of this…and where do you even start?

A simple question has a simple answer but a complex pathway in a country as devastated as is Haiti.

I really could not respond to her and thankfully the stewardess announced, “All tray tables should be in the upright position. We are cleared for landing in Miami.” I was relieved I did not have to continue our meaningless conversation.

Welcome back to the United States!

We landed in Miami and it was a great relief to be back in the United States.

Customs was a zoo…but a more controlled zoo than what I had been through in Haiti.

As I passed the last customs control gate a uniformed Customs Officer plainly looked at me and told me as I walked passed him, “Welcome back to the United States of America, sir.”

I wanted to drop to me knees and cry. These were the most precious words I had heard in a very long time. It was good to be back home.