Dr. Roth Goes to Cuba to "Make Things a Little Better"

For Dr. David Roth, July 4th was anything but an ordinary holiday saluting our country's independence. Instead of fireworks above the Houston skyline, he was in a jetliner watching runway lights at Havana, Cuba's, international airport, Aeropuerto José Marti.

Dr. Roth, staff urologist at Texas Children's Hospital, was on a medical mission to the island nation, one of three American pediatric urologists to ever visit Cuba.

Prior to surgery, Dr. Matt Clark (standing to the right behind the young patient) and Linda Lambert, certified nurse anesthesiologist, seated just to the right of patient. The other four are Cuban nurses.

"I'd wanted to go on a medical mission for a very long time," says Dr. Roth. "When the opportunity came, I didn't hesitate."

Dr. Roth's colleague Dr. Catherine DeVries, a pediatric urologist in Augusta, Ga., and a member of International Volunteer Urologists (a group of physicians which makes periodic medical missions to Third World countries) alerted him to the Cuba trip earlier this year.

"We flew from Houston to Cancun, then on to Havana," says Dr. Roth, explaining that the chartered flights from Miami, which are allowed by the U. S. government for humanitarian reasons, occur only about twice a week. "There are flights from Cancun to Havana twice a day, so that made it pretty convenient."

The following day, a Monday, Dr. Roth, Dr. DeVries, Dr. Matt Clark, a pediatric anesthesiologist from Salt Lake City, and Linda Lambert, a certified registered nurse anesthesiologist, also from Salt Lake City, saw 30 patients and their families and scheduled the surgeries that would take place over the next four days. The patients - all boys - ranged in age from 6 months to early adolescence. Dr. Roth would perform complicated hypospadias, reconstructive surgeries to correct congenital anomalies of the penis.

"We were warmly welcomed by physicians and hospital staff, and by the government. The sub-minister of health spent time with us, and he was very interested in what we were doing, very supportive and thankful," says Dr. Roth. "They recognize the limitations they have, so they were very pleased to have us visit.

"They are about 20 years behind us. Equipment is antiquated, and medications are very limited. The access to medical care is slow."

All of the surgeries - Dr. Roth did four surgeries each day, each lasting about three hours - were follow-ups. The previous surgeries performed in Havana had had complications, and the expertise for the July operations was simply not there. "We brought with us micro-surgical instruments and optical magnification equipment," he says. "They do not have these, of course. In fact, they have very little. It's difficult to even compare their surgical suites with what you would find in the Texas Medical Center."

Performing surgery, Dr. Catherine DeVries (left) and Dr. Itsel Caravia, a Cuban resident physician. Far right, a Cuban nurse.

As a farewell gift, Dr. Roth and his colleagues gave their hosts a set of micro-surgical instruments.

The operations which the Americans performed, hypospadias, are corrective procedures bringing the tip of the urethra to the tip of the penis. In the congenital anomaly, the urethra ends midway along the shaft of the penis or even closer to the scrotum. Voiding while standing is impossible, as is maintaining an erection. About 7 in 1,000 males worldwide are born with the anomaly.

"We thought we'd brought enough fine suture material, but we ran out pretty quickly, so we used what they had available," says Dr. Roth. "You use what you have there."

Dr. Roth will follow-up on the cases via e-mail. He hopes to return for follow-up visits and more surgeries in six months or a year.

Drs. Roth, DeVries and Clark all conducted teaching sessions with their Cuban colleagues. Dr. Roth lectured to the Cuban Urological Society on each of his four days in Havana. He found that many Central American and South American physicians are trained in Havana.

As Dr. Roth sorts through the dozens of photographs he took during his week in Cuba, he reflects on the health care available to the Cubans. "There are virtually no antibiotics. They re-use gloves, catheters, whatever they have to work with," he says. "I met with doctors who say they will see what medications are available that particular day at the pharmacies before they begin writing their prescriptions.

"Clearly, our embargo has severely hurt the Cuban people. It's had the desired effect.

"I was pleased to go there. It's a place that really needed our help - the patients needed our help. You make things a little better if you can."

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©2006 Texas Medical Center

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