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Putting the ‘I’ in International

The IVU workshop in Wad Medani, Sudan continues a strong collaboration. We want to thank Drs. Desai, Vijayakumar, Patel, and Pandya for traveling from India to Sudan to teach PCNL.

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Reaching Many with Music

Anna Holley of The Young Artist Chamber Players (YACP) applied her musical talent to raise awareness and funds for IVUmed. Around 50 people attended Ms. Holley’s charity violin performance on May 28th at Dumke Recital Hall at the University of Utah. Proceeds from the event will help support IVUmed’s global surgical education programs.

The (YACP) was founded by Jack Ashton in 1985. Since then, excellent string players along the Wasatch Front in Utah have enjoyed participating in this quality chamber orchestra. Through the years, the YACP has performed as part of the Governor’s concert series, in the Lobbyfest at the Utah Symphony, side-by-side with the Utah Symphony and at benefit performances. YACP takes a yearly performance tour through the state of Utah.

We are grateful for Ms. Holley’s thoughtful support. Please contact Josh Wood if you are interested in organizing a similar event.

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Bonjour from Dakar

This week a team of IVUmed volunteers is in Dakar, Senegal focusing on teaching pediatric urology and urologic oncology.

Here are a few notes from IVUmed board member and volunteer nurse, Barbara Montagnino, RN:

Bonjour from Dakar!

Everyone arrived on time as did our luggage and supplies. On Sunday we received a warm welcome from the head of department, Professor Serigne Gueye.  Our team has both pediatric and uro-oncology volunteers.  On the first day, the uro-oncologist volunteers booked several patients for surgery who have complex urological tumors.  The team also saw 22 pre-selected kids in clinic and booked 13 for surgery.  With limited time and resources for the week, we unfortunately can’t operate on all.  There are some sad cases with many families traveling from surrounding countries who were not chosen for surgery.  Hopefully the local urologists will be able to help them with their improved skills after the team is gone.

This is a multi-national workshop. There are urologists from Senegal, Morocco, Ivory Coast, Burkina Faso, Niger, Cameroon, Mauritania all in attendance.  The impact of this training will be far reaching!  The colorful IVUmed hats are a hit and a coveted item.

There is good interaction between our team and our hosts who have been welcoming to us. There is sincere willingness to learn but language is a barrier. We are all learning a few French phrases and fortunately team member Dr. Toren speaks French.

We are getting used to seeing goats on the side of the streets all over the city as well as the local mode of transportation: brightly painted van packed to the max than two or three people stand in on bumper and hanging on while texting.

 

You can support the team and their efforts by donating online HERE.

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IVUmed Resident Scholar, Dr. Kabra, Helps Teach Laparoscopic Nephrectomy in Trinidad

Resident:  Kabra Aashish, MD (University of Texas Health Science Center) 

Location: San Fernando, Trinidad; March 18-25, 2017

Mentor:  George Martin, MD

Sponsors:  South Central Section of the AUA

 

Dr. Kabra reported, “This workshop was well organized. There was so much planning, so many details, that despite limited communication before, you can tell how much effort went into it. All their residents played an active process in organizing, getting to know us, and overall setting up for a successful week. We got to know almost each one individually which was a treat. Aside from urology itself, we were able to learn so much about the country, hospital, culture, individual stories, healthcare, and urologic issues. It was great to pick their brains to compare the differences to America.

“We focused the entire week on working towards having the urologists master the laparoscopic nephrectomy.  After Dr. Martin and I presented the basic techniques from setup to dissection and extraction in the first case, we quickly transitioned to coaching Dr. Ramsoobagh and his partner through the cases. Eventually, they were performing them on their own, and it was truly amazing to see it all happen within one week. After we left, they booked additional laparoscopic cases the following week when we were gone to keep their momentum going and hopefully maintain everything they had learned. It was a true pleasure once they emailed us a few days after we left with the good news of them having finished their first laparoscopic nephrectomy on their own. I think the impact of this type of training really makes these mission trips vital, even more so than simply doing a handful of cases in that time as well. The department of urology in San Fernando can now apply everything they’ve learned for years, even generations of training, to make an extremely large, immeasurable impact.

“Through IVUmed, I now have a clear goal in sight in the next few years after I establish my own practice…to become an IVUmed mentor myself one day and contribute to these wonderful opportunities. I sincerely thank my scholarship benefactors for allowing me to have this life changing experience.  I plan to be back, and will see you hopefully as an IVUmed mentor next time! Thank you!”

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Resident Scholars, Drs. Chouhan and Reddy travel to HCMC, Vietnam

Residents:  Jyoti Chouhan, MD (SUNY Downstate Medical Center) and Thanmaya Reddy, MD (University of Alabama at Birmingham School of Medicine)

Location: HCMC, Vietnam

Mentor:  Joel Gelman, MD

Sponsors:  Dr. Chouhan:  New York Section of the AUA; and  Dr. Thanmaya:  Southeastern Section of the AUA and University of Alabama at Birmingham.

Dr. Chouhan’s Report:

“My trip to Vietnam through IVUmed was a special trip for several reasons.  Participating in international medicine has been a professional goal for me since I was a pharmacist. However, this was difficult for me to accomplish in my prior career. When I found out about IVUmed, I jumped at the chance to apply for the traveling resident scholar program and crossed my fingers that I’d be chosen! This trip has allowed me the firsthand experience to see the benefits as well as challenges related to helping patient populations in a different geographical and cultural setting.

The focus of our trip was male reconstruction. Dr. Hung Do Lenh has been practicing male reconstruction in Ho Chi Minh City for the past few years and these trips help him hone his skills to help the many patients there with urethral stricture disease. As much of the country travels on motorbikes, the risk of motor vehicle accidents leading to pelvic fractures and associated urethral injuries is high. The IVUmed mission of “Teach One, Reach Many” was a strong theme during the trip. Taking into account the hospital and cultural differences, we were able to give patients there the best surgeries possible.

We were also able to observe and participate in general urology cases that were done by the staff urologists at the government hospital. One interesting observation was that they did not have flexible ureteroscopes. This meant they performed a high volume of laparoscopic and open stone surgery; this is a rare event in the US.

The hospital there serves a large volume of patients from Ho Chi Minh City and the surrounding areas. Interesting aspects of their health system included patients being able to pay more to have their surgery on the same day or on a Saturday. As many of these patients come from far distances, they are hesitant about leaving before they feel they are fully healed. Dr. Hung Do Lenh explained that all patients in their hospital can stay as long as they want until they are comfortable with discharge.

I cannot thank IVUmed and the New York Section enough for providing these opportunities for residents. They are valuable and life changing both for the physicians and patients in the countries that are served, but also to the US based residents, fellows, and physicians that participate in these trips. I can definitely say that my experience in Vietnam strengthened my resolve to participate in international medicine upon completion of my urologic training.”

Dr. Reddy’s Report:

Dr. Reddy reported, “I joined a team of three other Urologists from the United States on this trip: Dr. Jyothi Chouhan, an IVUmed resident scholar from SUNY Downstate; Dr. Kristi Hebert, a reconstructive Urology fellow from UC-Irvine; and Dr. Joel Gelman our mentor also from UC-Irvine.

Dr. Gelman travels to Ho Chi Minh City for two weeks every year to share his expertise and skill in urethral reconstruction with the physicians of Binh Dan Hospital. Every year, Dr. Gelman and our host physician, Dr. Hung Do Lenh organize two weeks of urethral reconstructive cases to advance the reconstructive surgical capabilities of the local Urology department to allow them to treat patients with complex urethral disease in Vietnam that would otherwise be managed with chronic catheters or live with a lifetime of voiding issues.

My week began by a welcome reception hosted by the hospital administration. I learned that they have been very supportive of Dr. Gelman’sefforts to establish Binh Dan Hospital as a leader in urethral reconstruction in this part of the world. Dr. Gelman took his time to review details of the cases, turning simple case presentations into an in-depth learning exercise in how to evaluate and decide on management of patients with complex urethral stricture disease. I learned from Dr. Hung Do Lenh that many patients in Vietnam whohave urethral stricture disease are mismanaged due to the lack of physicians with formal reconstructive training in rural areas. Many of the patients who end up at Binh Dan Hospital have undergone multiple prior failed endoscopic and open attempts at urethral reconstruction. Often presentations were also delayed due to financial and transportation reasons.

The remaining week was spent in the operating room, where Dr. Gelman guided Dr. Do Lenh and other physicians through fundamentals of urethral imaging, cystoscopy, and urethroplasty. Through this I could appreciate IVUmed’s message of “Teach One, Reach Many” as many of the procedures were not only directly observed by multiple other physicians but surgeries were also live broadcasted for remote audience members who were able ask questions real-time. During time spent in the operating room, I learned the unique limitations and challenges of working in a setting with restricted resources. After our scheduled urethral cases, I took time to observe and scrub in with local physicians. Due to lack of flexibleureteroscopy and minimal training in percutaneous techniques, many of these patients were managed with open or laparoscopic surgery for stone removal. Costs of procedures played a large role in determining operative approach as many patients were required to pay themselves.

This trip opened my eyes to the strengths and weaknesses of health care systems outside of the United States. It also furthered my appreciation for the amenities we often take for granted in America. I learned that through sharing experiences and knowledge, we as physicians can impact many patients worldwide. I hope to continue participating in global health endeavors in the future and will be forever grateful to IVUmed and the Southeastern Section of the AUA for giving me this opportunity and a foundation in global medicine to build upon.”

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Resident Scholars, Drs. Banapour and Bassett, Travel to Ajmer, India

Residents:  Pooya Banapour, MD (Los Angeles Medical Center) and Mitchell Bassett, MD (University of Utah)

Location: Ajmer, India

Mentor:  Gopal Badlani, MD

Sponsors:  Dr. Banapour:  Western Section of the American Urological Association; and  Dr. Bassett:  University of Utah

Banapour10Dr. Banapour’s Report:

“Crowds of patients filled the streets outside of the hospital with their family members and medical records clasped tightly to their bodies. As soon as they made eye contact with our team, their looks of despair became replaced with a namaskar, a traditional Indian greeting of admiration. As I peered at the week’s case list, I saw that we had a wide variety of operations ahead of us: DVIUs, TURPs, TURBTs, Ureteroscopies, PCNLs, retropubic slings, cystolithotomies, orchidopexies and more.

Banapour5One of the most impressive things for me during the urology camp was how fast the operating room turnaround time was. Within seconds, patients were taken off of the table and transported to post op while another patient was loaded onto the OR table. Within seconds, spinal anesthesia was established and the next case was started. Besides the rapidity of the cases, I was amazed at how so much could be done with such minimal material. Surgical instruments and drapes would be rewashed and reused in between cases. None of the material was wasted which allowed for rapid turnaround.

One of the most memorable cases that I was involved with was a TURP that was not going well. The resection was extremely bloody and we were not making any headway. All of a sudden, we converted the case to an open simple prostatectomy. The patient’s position was changed and we immediately made our suprapubic incision to get to the prostate. Within minutes, we delivered the bloody prostate and started obtaining hemostasis. It was amazing how with such rapidity, hemostasis was obtained. I was impressed that with such few resources, so much was accomplished at this camp.

I am beyond thankful to IVUmed for giving me the opportunity to make changes to the lives of so many people. It was a life-changing experience for me to be able to work with such esteemed urologists: Dr. Gopal Badlani, Dr. Rohit Ajmera, Dr. Sunil Gokhu and more. I am also thankful for the support of my mentors at Kaiser Los Angeles, including Drs. Gary Chien and Polina Reyblat. Without their support and leadership, I would have never been able to have such a remarkable experience providing care to patients in India.”

Dr. Bassett’s Report:

“A passing boat leaves no trace upon the waters” was one of many dictums that Dr. Gopal Badlani was taught by his mentor, Sant Hirdaram Sahib.  While visiting his memorial in Pushkar, Dr. Badlani explained the old adage was meant to teach humility; to learn not take yourself too seriously. The mental image of an ocean vessel creating a large wake and then completely disappearing after only a few seconds kept recurring in my head throughout my trip to India.  Something bothered me with this reasoning.  It is the antithesis to the “butterfly effect”—where even small changes can have long lasting effects.  Why did it bother me?  Because what I was seeing during my IVUmed experience in Ajmer was the exact opposite.

Dr. Badlani and his team had been coming to Ajmer and other cities for the past few decades conducting free urology camps for patients who could not afford surgery.  Complicated cases were saved for these camps so a team of physicians could brainstorm treatment plans.  Urologists from surrounding areas came to learn new techniques and help tackle the large volume of patients needing surgery.IMG_0035

I arrived at the hospital a day before Dr. Badlani and was shown a quick tour.  I noticed a small poster written in English advertising our free urology camp and wondered how many people would actually show up.  The following day my question was answered as we were greeted by dozens of patients and their families eagerly waiting to see the urology team.  Dr. Badlani arrived with style—flanked by local volunteers, politicians, spiritual leaders, administrators, and yes, a press corps.  Apparently, the tiny ripple he created years ago didn’t go unnoticed.  His volunteer spirit was contagious.  We had tremendous support from local business leaders, cooks, hotel staff, scrub techs, nurses, surgical residents, and anesthesia.

Over the next five days, we performed over a hundred surgeries including many TURPS, PCNLs, slings, and DVIUs.  Additional surgeries less often seen in the US included open simple prostatectomies, vesicovaginal fistula repairs, and open cystolithotomies.  One of the first things I noticed was the different equipment in the operating room.  It wasn’t just adjusting to Storz vs Olympus products; it was using technology and equipment that I had never seen and frankly never knew existed.  Everything was reusable and designed to be done as affordable as possible.

The turnover time between cases was record setting.  As soon as one patient was waking up, the next one was already walking in taking his place.  The team of orderlies and circulators was on point rapidly scrubbing down the room and prepping the next patient.  The sequence of cases was planned with laterality in mind to avoid having to move around beds, C-arms, and monitors.IMG_1264

Post-operative patients soon overran the small hospital taking up even the hallways for makeshift space.  Rooms were filled wall to wall with beds with only enough space for one person to walk between.  Catheter management and irrigation was taught to family members to assist the outnumbered floor nurses and residents.  Unlike in the United States, patients were not given narcotics following surgery.  Scheduled acetaminophen and ibuprofen were all the patients needed on the floor.  The opioid epidemic stemming from unused prescriptions has not affected India.

While some of the community urologists were learning from Dr. Badlani, others were there to teach us and the general surgery residents.  I was amazed at how facile they were with getting access on their PCNLs.  I asked how many they had done thinking it had to be at least a hundred.  I was shocked when he told me he had done over ten thousand.  In a country of over 1.3 billion people, surgical volume is not a problem.

Although our operative week was extremely productive, it was just a drop in the bucket compared to the millions of people world-wide that need urologic surgery.  “Teach one, reach many” is the mission statement of IVUmed.  While the wave Dr Badlani started in Ajmer years ago is still growing, there is another wave not as often spoken about.  He has taken dozens of residents with him to India through the years.  We have returned to our home institutions and disseminated our experience from sharing various surgical techniques to gushing about the joy of service.  While a boat may leave no trace upon the water, I discovered how much of an impact we as urologists can have on the most destitute and desperate people and the powerful and enduring impact they leave on us.”

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Celebrating Bold Leaders on International Women’s Day

This year’s theme for International Women’s Day is ‘Be Bold for Change.’ We celebrate the people who live these words and are grateful to those who make our Women’s Health Program possible.

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Check out our team in action in Senegal!

Surgery, lectures, and friendship. This week in Dakar, Senegal we have a team teaching and building capacity in reconstructive urology. Thanks to our partners at Aytu Bioscience!

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Resident Scholar Report: Dr. Chris Doiron in Mexico

IVUmed Traveling Resident Scholar Report

Christopher Doiron, MD

Queen’s Urology, Kingston, Ontario, CA

Valladolid, Mexico: November 5-12, 2016

Mentor:  Douglas Whittemore, MD

Sponsor:  Northeastern Section of the American Urological Association

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Dr. Doiron reported, “Through discussions with our hosts at San Lucas, I learned that Mexico has a two-tier medical system. A public system is supposedly available to all those who cannot afford to pay for care in the private system, while specialists often crossover and work in both systems. However, there is concern that while working in the public system, specialists funnel patients into their private practices, where they are remunerated better. Patients required to receive their care in the public system are reportedly left behind, often receiving sub-standard care, sometimes never receiving intervention for their illness.

Our day was booked full with a few transurethral cases. My staff mentor and I went to another storage area and collected our transurethral set. I was again impressed with the amount of equipment they had on hand and the immaculate records they kept. Some of it was perhaps a bit outdated, but we had little trouble finding a set we were happy with. We sterilized it and were ready to get to work.

Our cases went smoothly that day. I cannot say that there were not problems. But this is global surgery – challenges are an anticipated part of the experience and instead of getting frustrated with the problems that arose, we worked together as a group to find solutions. And at the end of the day, our patients received high quality care that was safe, effective, and I think will experience outcomes similar to those we provide our patients with in our high-income, resource-rich settings.

I cannot thank the Northeastern Section of the AUA enough for their generous financial support and congratulate them on endorsing a global surgical experience for urology residents. Global surgery remains an actively expanding field and enthusiasm for the opportunities to participate abound, particularly amongst our trainees. IVUmed should be congratulated on their continued commitment to providing valuable care to those who need it most, for including residents in their work and their mantra of ‘Teach One, Reach Many’ remains an important consideration as we forge ahead, seeking ways to collaborate with those less fortunate.”

 

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IVUmed is committed to making quality urological care available to people worldwide.