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.”