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Dr. Agochukwu Travels to Mongolia for Her Resident Scholar Experience

IVUmed sponsored, through its alumni fund, Dr. Nnenaya Agochukwu’s recent Traveling Resident Scholar experience in Ulaanbaatar, Mongolia with Dr. Jeremy Myers of the University of Utah acting as her mentor.

Dr. Agochukwu reported, “Upon embarking on this journey, I did not know what to expect.  From the initial application, I was filled with excitement.  RS_Mongolia 2015_Agochuwu2When I received news of my acceptance to the IVUmed resident scholars program, my excitement sky-rocketed.  Our first case was a redo urethroplasty.  I had only seen a few urethroplasties thus far in my training, so the opportunity to see a redo urethroplasty was quite exciting.  The operating room was clean, and well suited for the operation.  Our translator, Ogi, was key in everything we did.

Dr. Myers, Dr. Erka and I scrubbed for the case.  At the beginning of the case, Dr. Myers, the leader for our team, began by asking Dr. Erka if I could start the case.  Without hesitation, Dr. Erka agreed.  I thought that was incredible, the willingness to allow me, someone who Dr. Erka just met that morning and whom Dr. Myers just met the day before, begin such a critical operation.  I was excited, and in disbelief.  As we carried through the case, Dr. Erka and Dr. Myers worked together, with Dr. Myers leading the case and taking time to teach Dr. Erka key skills and techniques.  This was a live example of teach one, reach many as there were several other young urologist there watching and learning as well.

The second week, was fascinating.  Dr. Erka and I were now alone to do several of the cases that were on the schedule, those were similar to the cases from the first week.  I had a very unique opportunity in the sense that I could first hand witness the IVUmed mission statement.  As Dr. Erka and I worked together, I could see the surgical techniqueRS_Mongolia 2015_Agochukwu1 s and intraoperative decision making, that Dr. Myers had taught the previous week in action.  It was amazing.  I could see right then and there, firsthand that the investment Dr. Myers and the IVU med team had made was in banking terms, returned 100 fold.

I knew it would be a good experience, but what I did not know and what I was not prepared for was that it was an amazing, life changing experience.  The key that IVU med  and particularly my mentor, Dr. Myers, has opened my eyes to is that it is even more crucial to leave something behind, to allow for growth far beyond one’s departure.  The Mongolian urologists spoke endlessly about the impact of IVUmed on their practice in Mongolia.  To me, life is about giving back, that’s what brought me into medicine and I am glad that IVUmed has shown me the facilities to give back.  For that, I am truly grateful to IVUmed.”

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Dr. Lee Reports on his Resident Scholar Experience in Mongolia

The generous support of the New York Section of the AUA made possible Dr. Daniel Lee’s recent IVUmed Traveling Resident Scholar experience in Ulaanbaatar, Mongolia.   Dr. Joseph Smith from Vanderbilt graciously acted as Dr. Lee’s mentor during the workshop.RS_Mongolia 2015_Lee

Dr. Lee reported, “Access to quality urologic care and management is a large issue in Mongolia; there are only eleven trained urologists in a country of 3 million people, with all 11 urologists practicing in the capital city of Ulaanbaatar. The goals of this trip were to assess the patient needs in urologic oncology, educate the surgeons in evidence based management and treatment of oncologic diseases, and establish a system for tracking patient data and outcomes.

Dr. Smith from Vanderbilt served as the supervising surgeon for the urologic-oncology patients. The first day involved a review of approximately 30-35 patients with differing presentations, several incidentally found renal masses, advanced prostate cancer, non-muscle invasive and metastatic urothelial carcinomas, and invasive penile squamous cell carcinomas. After reviewing those initial cases, we prepared about 6-8 cases that the urologists requested Dr. Smith to perform because of their technical difficulty and in order to train the other urologists. It became evident in reviewing the cases that the urologists in Mongolia were very well-trained and were very well acquainted with the standards of care for renal masses and penile cancers. However, there were some inconsistencies noted in the management of prostate and urothelial carcinomas that reflected systems problems, unique to Mongolia, and general lack of access to more recent data and gold standards for treatment.

RS_Mongolia 2015_Lee2There were signs of extensive delay from initial diagnosis to definitive treatment; the two radical cystectomies we performed there had an average delay of a year from initial diagnosis to presentation for cystectomy (without any previous intravesical or chemotherapy).  When radical cystectomies are performed, patients only receive Mainz II (sigmoidorectal pouch) reconstructions with ureteral tunneling as the surgeons have only been trained in this reconstruction and are not familiar with ileal conduits, neobladder, or other continent diversions. This represents a large area of need that could be easily modified with proper training, as ileal conduits have significantly decreased rates of ureteral stenosis and other complications. There is also a need to develop a system that can update data in real time and can be queried and analyzed.

Urologists in Mongolia are very well trained and technically excellent, however there are certain systems and care management issues that can be easily modified with continued education and easy access to resources. Hopefully, this trip will represent the first step in continuing the IVUmed mission to: ‘Teach one, reach many’.”

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Dr. Hannick, IVUmed Resident Scholar, Travels to Senegal

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Dr. Hannick in Senegal

Dr. Jessica Hannick’s recent Traveling Resident Scholar experience in Dakar, Senegal was made possible by the generous support of the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).  Dr. Serigne Gueye graciously organized the Senegal workshop and acted as a mentor to Dr. Hannick.

Dr. Hannick reported, “This past August, I had the honor of traveling to Dakar, Senegal to operate with local Senegalese Urologists as an IVUmed Traveling Resident Scholar. Never having traveled to Africa before, this was an amazing opportunity not only to experience a new continent, but also to immerse myself in the medical community of another culture.  My assignment was at the Hôpital Général de Grand Yoff (HOGGY) located in Dakar. HOGGY is also IVUmed’s first center of excellence, having begun working with IVUmed in 2009 first in pediatric urology and now in reconstructive urology.  As part of this designation, HOGGY has advanced to the stage of providing service independent of IVUmed workshops, training residents within its institution, and offering training to providers from neighboring countries.

I spent the first day observing Dr. Niang in outpatient urology clinic and was amazed by the broad spectrum of patients we encountered, as well as the level of resources available to him and his patients. We saw an adolescent girl with enuresis who had recently experienced a lapse in her dry periods due to altered nighttime hydration during the recent month of Ramadan. The subsequent four days, we spent in the operating room operating, assisting, and interacting with the local African surgery residents, who had ventured to Dakar from Madagascar, Algeria, and Chad to work with Dr. Gueye and his colleagues.

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Dr. Hannick, Dr. Chrouser and team

During the rest of the week, as I participated in a nephrectomy and numerous obstetric fistula repairs, I witnessed the fantastic camaraderie amongst the attending urologists, surgical residents, nurses, and medical support staff. I was honored to be a member of the team for the week. I also had the unique opportunity to aid Dr. Gueye and his American and Senegalese team of fistula surgeons and interested colleagues in filming for an obstetric fistula trainer. Truly embodying IVUmed’s “Teach One, Reach Many” motto, the fistula trainer will enable surgeons from remote areas to gain the simulation training necessary in resource-poor areas to be able to provide thousands of African women plagued by obstetric fistulas with hope for a second chance in life. Leaving Dakar was not bittersweet, as I knew we were not parting ways for good, but rather toasting to the beginning of new, lifelong friendships.”

If you would like to support IVUmed’s continued work in Senegal, please make a contribution here:  www.IVUmed.org/give.

 

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Dr. Kaplan, IVUmed Resident Scholar, Travels to Senegal Workshop

The generous support of the Western Section of the AUA, made possible Dr. Alan Kaplan’s Traveling Resident Scholar experience where he recently participated in a locally organized workshop in Dakar, Senegal. IVUmed is grateful to Dr. Serigne Gueye for organizing the workshop and acting as a mentor.

Dr. Kaplan reported, “As a medical student in Tel Aviv, rotating on general surgery, I remember asking the chief resident – who had emigrated from Britain for surgical training – how he was able to communicate in the operating room when he first arrived. With a crooked smile he said: ‘Photo_Kaplan1We’re surgeons, we understand each other in the theatre; it’s like a dance.’

Seven years later, I found myself dancing a similar dance. I was scrubbed in across from a Senegalese Urologist performing a radical retropubic prostatectomy. He spoke French and Wolof (the local language) and my French is as bad as my Wolof. I had been fortunate enough to earn a scholarship to travel with IVUmed to Dakar, Senegal. Spending a week in the Department of Urology at Hopital General de Grand Yoff, I saw patients in clinic and scrubbed on open and endoscopic cases. The trip, supported by the AUA Western Section, exposed me to the difficulties of providing care in a resource-poor environment. I was particularly impressed with the agile skill with which the Urologists there adapted to and overcame obstacles that would seem insurmountable back home. Dr. Lamine, the Senegalese Urologist with whom I operated, exemplified that skill and agility.

The first thing I noticed about Dr. Lamine was his posture, erect and confident. He operated with definitive movements and a keen eye. We exchanged few words during the first part of the case, reacting and responding to each other’s moves almost by instinct. I listened attentively and registered a few of the foreign words for familiar surgical instruments. After the lymph node dissection was complete and the nerves were spared, he looked up and issued an almost salute-like nod expressing his satisfaction. It was the same approval I sought from my attendings back home and made me feel at ease.

The next thing I noticed was Dr. Lamine’s brow during a particularly difficult part of the dissection. Similar in height, his forehead came to within a few centimeters of mine while we operated. Just beneath his IVUmed scrub cap – a parting gift from prior grateful visitors – a few beads of earnest sweat showed up and lined the furrows that deepen during the tough part of an operation. I knew that sweat and had the very same lines. Once the prostate was out and the bleeding controlled, I motioned to ask how he liked to do the vesicourethral anastomosis. He deferred with a gentlemanly gesture and handed me a bent needle driver to proceed. After tying down the final knot I looked up at Dr. Lamine and declared in my best French accent, voila. He didn’t stop laughing until the skin was closed. We would operate together on several more occasions during the trip, each time delighting in our silent surgical dance. For in the OR, we truly did speak the same language.”

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