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A lifesaving procedure for a Haitian priest

Yale Medicine Magazine, 2011 - Spring


With help from Yale-New Haven Hospital and Yale Medical Group, a Yale neurosurgeon treats a potentially dangerous aneurysm.

Ketan R. Bulsara, M.D., associate professor of neurosurgery, was born in a village in Gujarat, India, on the same day his father was to begin a journey to Zambia, where he hoped to build a better life for his family. His family decided to rush him to the airport so his father could glimpse his newborn son before flying to Africa. The entire village chipped in to buy Ketan’s mother and uncle train tickets—the first time anyone from the village had traveled first class.

Norbert Tibeau was born in the Artibonite, the central plateau of Haiti. Ask him about his life and Tibeau will tell you not only the date of his birth, but the date of his baptism. The middle of seven children—he has three older sisters and three younger sisters—the 28-year-old seminary student comes from a religious family. His parents are farmers who raise beans, corn, bananas, sweet potatoes, and manioc. “When I was little, my father used to teach the catechism,” Tibeau said. From an early age Tibeau helped out in church, singing and reading during mass.

The two men’s paths crossed on Tuesday, April 26, in an operating room at Yale-New Haven Hospital (YNHH), when Bulsara, using state-of-the-art technology, threaded a catheter less than 1 centimeter in width from the femoral artery in Tibeau’s thigh into his brain aneurysm.The aneurysm had grown to a diameter of 2 centimeters and bordered on such critical structures as the optic nerve and pituitary gland. If left untreated chances were high that within five years it would eitherkill Tibeau or devastate him neurologically.

Bulsara, director of neuroendovascular and skull-base surgery, is one of a handful of neurosurgeons in the world who is trained in both skull-based cerebrovascular microsurgery and in endovascular neurosurgery. Along with YNHH, Yale Medical Group, and medical device manufacturers, he donated his services to treat Tibeau, who’s studying for the priesthood in Haiti.

Tibeau’s headaches began in 2001, when he was still in high school. In 2007, he had yet to see a doctor about them, but with the assistance of Partners in Health, the international medical organization, he saw a doctor for the first time in 2008. By then the headaches were lasting for up to a week. He was seeing flashes of light, his vision was impaired, and the pain was incapacitating. “I would have to lie down,” Tibeau said. “Sometimes I couldn’t eat.” In January of 2010 Partners in Health made arrangements for Tibeau to travel to the neighboring Dominican Republic for an MRI. The trip saved his life in more ways than one. While he was away, in January 2010, an earthquake struck Haiti. Among the victims were all nine of his seminary classmates. They were in an underground parking garage, leaving class for the day when the school crashed down on them. “The reason I was saved is because I was sick,” Tibeau said. He also learned what his MRI had revealed—the potentially deadly or crippling aneurysm.

Through one of its initiatives, the Right to Health Care Program, Partners In Health searched for physicians and hospitals willing to donate their services. Once Yale agreed to provide charity care for Tibeau, Partners in Health brought him to the United States for treatment. “It can be difficult to find a hospital that can fix this kind of problem, let alone agree to do the surgery for free. We are very grateful to Yale and Dr. Bulsara for offering to do this case,” said Sybill Hyppolite, a coordinator with the program, who accompanied Tibeau and served as his interpreter during his stay in New Haven.

Bulsara said he was glad to help Tibeau, and attributed Tibeau’s successful outcome to the state-of-the-art care he received at YNHH through collaborations among neurosurgery, anesthesia, neurointensive care, nursing care, and surgical/radiology technologists.

Bulsara’sroad to a career as a neurosurgeon began when he was a teenager and his family left Africa for the United States. They lived first in Texas, then in North Carolina. His father believed in education and Bursala went to nearby Davidson College, then to medical school and residency at Duke, where he focused on cerebrovascular and skull base microsurgery. He also trained at the University of Arkansas for Medical Sciences. Given the rapid changes and advances in technology, he returned to Duke for training in endovascular neurosurgery. In 2007, he came to Yale as director of neuroendovascular and skull base surgery.

“Using a techniquethat is less invasive than other options, platinum coils about as fine as human hair were placed inside the aneurysm to allow it to clot,” Bulsara said of the procedure he performed on Tibeau. Until recently, he added, the recommended treatment was opening the skull, clamping off the artery, and performing a bypass. “Without treatment the risk of this aneurysm bleeding within five years would be close to50 percent. If the aneurysm bled, the chances of him being severely incapacitated or dead would be 30 to 50 percent.”

Two days after the procedure Tibeau was sitting up in bed, joking with one of his nurses, and sitting for an interview. He was to leave the next day for a seminary in Bloomfield, Conn., where he would remain for a month and be available for follow-up visits. He said he was feeling better and that his headaches had not recurred. Bulsara said Tibeau was doing well, and that he expected he would make a full recovery.

Given the nature of the aneurysm, Tibeau will need surveillance imaging and may require further treatment if it recurs.Tibeau plans to return to Haiti, where he will complete his studies and wait for an assignment to a parish.

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