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Resident Scholar Report: Dr. Heckman in Vietnam

IVUmed Traveling Resident Scholar Report

Jennifer Heckman, MD
University of Wisconsin
Hue, Vietnam
March 11 – 19, 2016
Mentor: Steven Kahan, MD

Sponsored by:  North Central Section of the AUA

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Hue is a city in central Vietnam on the banks of the Perfume River, where I was fortunate to be able to spend a week working alongside local urologists.  While in Hue, I had the opportunity to observe and participate in the delivery of urologic care, from didactic instruction in conferences to teaching at the bedside and in the clinic to involvement in the operating room in a variety of surgical procedures.

Through my wide range of experiences, I was able to appreciate both the similarities and differences in urologic practice and training in comparing Vietnam and the United States.  Fundamentally, in both settings, the focus is on evaluating and managing medical and surgical diseases of the male and female urinary tract systems and male genital system.  Basic surgical principles and techniques, too, transcend geographic borders.

The burden of disease as well as the access to and delivery of health care, however, differ vastly between countries.  With regard to urologic disease burden, the diversity of cases I saw in Vietnam was very different from that which I have become accustomed to in the United States.  A large majority of the operative cases for stone disease, for example, were performed using open or percutaneous techniques (as opposed to endoscopic management), a testament to both the differences in presentation of disease as well as in the readily available technology and skills in Hue.

The striking difference in disease presentation was apparent not only in cases of benign urologic conditions, such as the finding of a four centimeter ureteral calculus, but also in cases of malignancy.  In making rounds with the local urologists on inpatients in Hue Central Hospital, I met a woman with advanced bladder cancer whose initial presentation was with gross hematuria, anemia, renal failure, and bilateral hydronephrosis.  She and her family had traveled quite a distance from a more rural area to seek care in Hue after the agriculture season (the family’s livelihood) was complete. IMG_6160

Such a presentation is not an uncommon one to encounter in Hue.  As one of the local urologists explained, in Hue, as well as in Vietnam in general, patients often present with later stages of disease, as limited resources, including time, money, and transportation, often contribute to delays in patients seeking necessary medical care.  Many people must often continue to work and defer medical care in order to support their families, sometimes at the expense of their own health.

The urologists in Hue are well-trained, and in a city of about 350,000 people, there are 12-15 urologists who practice in three hospitals and numerous clinics throughout the city.  Training is different from that in the United States, with medical school graduates paying to participate in residency programs.  Urology residency, like other specialties, is three years in duration, and in early post-residency careers, one sees young urologists practicing and operating alongside more senior urologists.

Urologists in Hue face unique challenges in working in a resource limited setting.  While in Hue, I had the opportunity to observe and/or participate in 11 cases, ranging from ureteroscopy to open ureterolithotomies to an open radical cystoprostatectomy with ileal neobladder.  There were notable differences in accessible equipment.  In the operating room, for example, there were limited instruments available, and fluoroscopy, too, was not always readily available or reliable.  In addition, certain disposable items were often sterilized and re-utilized out of necessity.  Different surgical skill sets were also apparent.  While open stone surgery was commonly performed, flexible ureteroscopy is far less often performed, and urologists cite lack of equipment and training as reasons for this disparity.

Despite the material, financial, training, and infrastructure challenges faced by urologists in Hue, the practice of urology is well-adapted to the environment.  The capacity for fundamental urologic interventions exists, and while technology is not as advanced as it may be elsewhere, the surgeons have excellent technical skills, and though resources are limited, the urologists are very resourceful.

It was a privilege to have the opportunity to work alongside the urologists in Hue and participate in the delivery of urologic care.  I was able to view urology through a new lens, and through this experience, I gained practical experience in a new environment.  To see another country and its people and to begin to understand not only a different healthcare system and its challenges, but also a different culture, has afforded me a unique perspective.   I have made new connections with colleagues that will hopefully prove to be long-standing relationships, as I incorporate global health practice into my urology career.

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Dr. Kovell Reports on Resident Scholarship Experiences in Vietnam and Mozambique

In December 2014 and May 2015, Dr. Caleb Kovell participated in IVUmed’s Resident Scholar program, traveling to Vietnam and Mozambique.  Dr. Kovell’s experience was made possible by the generous support of the Mid-Atlantic Section of the American Urological Association.   He was accompanied by Joel Gelman, MD in Vietnam, and Ryan Terlecki, MD in Mozambique. Kovell Vietnam 2

Reflecting on his experience, Dr. Kovell reported, “From these trips, I will take with me lasting friendships, mentors, and connections from here at home and across the globe.  Over the course of my IVUmed experiences, I had the chance to work with some incredible surgeons and innovators in the field of reconstructive urology.  (Joel Gelman, Johan Naude, Igor Vaz, John Lazarus, Sanjay Kulkarni, Aldo Marchesini, Pippi Salle).  These are names that I had always heard about and read about in the world of international reconstructive urology, but thanks to IVUmed, I have had the chance to meet them, learn from them, and count them as colleagues and friends.  During my two trips, I interacted with numerous urologists from Vietnam and specialists from around Africa.  We had the chance to share our teaching with them, and assuredly they taught us a great deal about their cultures, patients, and health care systems.   Most importantly, we formed lasting bonds with the patients who we cared for and their families that I will never forget.  Hopefully we have been able to change their lives for the better as well.”

Kovell - VietnamHe added, “Over the last year, I learned a great deal about urology and reconstructive medicine.  Thanks to IVUmed, I also was able to experience first-hand what it takes to successfully translate these skills to international locations.   These trips have confirmed for me that I will make international medicine a significant part of my urology career moving forward.  I hope that a large part of that will involve continued collaboration with an organization as wonderful as IVUmed.   I was truly humbled by the experiences.   Thank you again for everything.”

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IVUmed’s Work Helps Combat Global Poverty

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IVUmed experts provide hands-on training to build local capacity and increase access to quality healthcare.

According to the World Health Organization (WHO), 2 billion people lack access to basic surgical care. Access to specialized care like urology is even more restricted with critical shortages of trained personnel. The United Nations cites the unavailability of healthcare as one of the root causes of extreme poverty. Debilitating health conditions not only drain family resources, but also affect productivity and prevent many throughout the world from earning a living. A breadwinner unable to work due to illness, or family members obliged to stop working or attending school to care for a relative can lead to considerable loss of income and long-term poverty.

IVUmed works to make quality healthcare more accessible in resource-poor areas of the world. We build self-reliant surgical teaching programs capable of meeting the needs of their communities. By providing expert surgical training to physicians and nurses throughout the world, children and adults in need of care will not have to live for years with debilitating conditions that threaten their economic and overall well-being.

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The Year Was 1995…Look How Far We’ve Come!

Twenty years ago, IVUmed was incorporated by its award-winning founder, Catherine deVries, MD, to address the enormous need for patient care and professional training in urology in resource-poor areas of the world. From common congenital malformations to pelvic floor injuries, various cancers and other diseases, urology represents a vastly underserved area of global health.Vol. 1 Issue 1 Newsletter

Initially established to help meet the staggering need for pediatric urology in developing countries, IVUmed has grown to include virtually all areas of urology and incorporates education for nurses, anesthesiologists, radiologists, pathologists and other related areas of medical and surgical care. IVUmed’s services have been requested in over 30 countries in Africa, Asia, Central America and South America. With a proven model that has helped to successfully build surgical training programs in countries as diverse as Honduras, Vietnam, Senegal and Mongolia, IVUmed tailors its efforts to the needs of each of its many partner hospitals and communities.  Our partners in these sites have demonstrated strong long-term commitments to IVUmed’s work and mission and will ultimately serve as a bridge between today’s investment of resources and our shared vision for access to quality healthcare in the future.

Our success is based on uniting peers and strengthening relationships among medical providers with a common shared purpose of ensuring access to quality urological care.

* We connect physicians and nurses in low-resource settings with experienced colleagues for peer to peer interaction.
* We provide hands-on education through ongoing on-site surgical workshops.
* We build self-reliant surgical teaching programs capable of providing local and regional education.
* We are the chosen provider of care and education in partnership with multiple global urological organizations.
* We identify, support, and develop future generations of IVUmed volunteers and host colleagues.

We have refined our capacity-building model over two decades and have become the go-to organization for urology training in developing parts of the world. Our intensive, onsite hands-on workshops equip physicians and nurses throughout the world with the skills they need to serve their communities. Meanwhile, the greater objective of IVUmed training is to develop future generations of medical personnel by building lasting surgical teaching programs. Your support helps ensure that children and adults in resource-poor areas of the world will no longer have to suffer for years with treatable conditions that greatly affect their quality of life.

Our surgical workshops are complemented by distance consultation and other means of instruction and support to help ensure that our partners progress toward their training goals. We also utilize telehealth technology for distance education and are collaborating on educational modules comprised of surgical video, lectures, medical animation, and testing.

Please join us this 20th anniversary year, on Facebook, Twitter, Instagram and Pinterest.  Together, we will make a difference!

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IVUmed – Helping Children Around the World

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IVUmed in Rwanda

IVUmed’s Pediatric Urology Capacity Building Program makes quality surgical care available to children around the world – especially in low-resource areas. We accomplish this by building a global network of train-the-trainer centers of excellence. There are no pediatric urologists in sub-Saharan Africa, Haiti, and many places in India, leaving millions of children without access to care for debilitating urological conditions.

Pediatric urology diseases, malformations and injuries are among the most common conditions affecting children worldwide, and are up to 10 times more common than cleft lip and palate. In the US, when a baby boy is born with a condition such as hypospadias (a congenital condition in which the opening of the urethra is situated on the underside of the penis instead of at its tip), surgery can be performed before the child is even out of diapers, and there are few to no lasting effects. In countries where this type of surgery is not available however, shame, poor self-esteem and secrecy surround this condition, which often results in adult infertility if left unrepaired.

IVUmed’s teams of volunteer physicians, nurses, and anesthesiologists provide hands-on surgical workshops, lectures, online educational materials, telehealth consultation, and impact measures to equip doctors and nurses with the skills they need to care for children in their communities. In turn, these newly trained medical professionals build future capacity for care by passing along IVUmed training to their colleagues, fulfilling IVUmed’s motto, “Teach One, Reach Many”.

IVUmed’s focus on education stands out among global health organizations, as does our focus on urology. Another unique element to IVUmed is our collaborative model. While IVUmed is guided by a dedicated board and staff, leadership of our programs stems from the dynamic doctors and administrators at our many partner hospitals around the world. Their priorities lead our efforts, which are put into action by our volunteer doctors and nurses. Together, and with the generous donations of many benefactors, we are building a worldwide system of pediatric training programs, ensuring that children everywhere will have access to the care they need.

With the help of supporters like the Ronald McDonald House Charities, the Societe Internationale d’Urologie (SIU), the American Urological Association (AUA), the Pan-African Urological Surgeons Association (PAUSA), and regional surgical associations, IVUmed is building a strong global network. Teaching hospitals throughout the world, skilled medical volunteers, ministries of health, local community leaders, international medical societies, regional colleges of surgeons, and charitable foundations combine strengths to give children everywhere the opportunity to lead the healthy, productive lives they deserve.

You can be involved too, whether a physician, engineer, photographer, philanthropist, medical student, etc.  We invite you to explore our volunteer opportunities here.  http://www.ivumed.org/how-you-can-help/

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IVUmed in Vietnam

 

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Surgical Groups Like IVUmed Can Help Combat Ebola Outbreak

“While the fear of Ebola delays efforts to treat surgical patients in need”, according to General Surgery News, “African surgeons do their best in time of fear and lacking resources.” See full article here.  For the last 20 years, IVUmed has sent groups of talented, dedicated medical volunteers into low-resource areas in Africa and around the world to teach local physicians and nurses patient care and management for surgical conditions in non-emergency situations. This training can also be applied to successfully manage public health emergencies like the Ebola outbreak. With strong surgical infrastructure in place, medical providers who have been taught by IVUmed already have the knowledge they need to meet the challenges of a crisis situation.

Local physicians and nurses are taught skills for acute care, patient management, sterile technique, and other key areas of surgical and infectious disease management. Additionally, successful treatment of the crippling effects of many surgical conditions builds the confidence of communities in their healthcare providers and hospitals to allow for more rapid and effective response to disease outbreaks. Since surgical success is plainly visible, local patients gain trust in the capabilities of their hospitals and hospital staff.

Through our Teach One, Reach Many model, IVUmed helps improve the overall strength of our global partner institutions.   Get involved and support the life-changing work of IVUmed today.  www.IVUmed.org

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Urology Residents: Apply Now

Applications are now being accepted for our Traveling Resident Scholar program for the 2015-2016 academic year.  North American urology residents and fellows who will be PGY-3 or above during the next academic year are eligible to apply.  For applications, please visit http://www.ivumed.org/what-we-do/traveling-resident-scholars/ .  The deadline is February 1, 2015.  For more information, please contact our office at 801-524-0201.

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urology resident scholarship opportunity

 

 

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World Impact: IVUmed President in the News

IVUmed president and founder, Dr. Catherine de Vries, was honored as a feature in the July issue of Salt Lake Magazine.

 

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Here are some highlights from the article:

 

“Pediatric urologist Catherine deVries sees patients at Salt Lake City’s Primary Children’s Hospital, but as president and founder of IVUmed, she sends doctors and urology residents around the world to train local medical professionals in countries with few resources. “

“…In 1994 DeVries started her own nonprofit, IVUmed, in Honduras and Vietnam. Today, it provides medical care to kids in Asia, Latin America, Africa and the West Bank in the Palestinian territories.

“When we started in Vietnam, they had done less than 80 pediatric urological operations—total—in the year we started,” she says. “Now, 20 years later, they not only do a full range of surgery serving all of South and Central Vietnam, but also have a teaching program of their own—it’s exactly what we hoped for.”

“Beyond IVUmed, deVries’ supports global healthcare in other ways. She is the director of the University of Utah Center for Global Surgery, a member of the Global Alliance for Elimination of Filariasis, a parasitic disease spread by flies and mosquitoes that can lead to blindness, and she shares her experiences with students as a professor of surgery at the University of Utah.”

Read the full article here on the Salt Lake Magazine website.

Thank you to Salt Lake Magazine for this excellent article and interview with Dr. de Vries, for recognizing her personal commitment to global surgery and global health, and the efforts of the organization she founded and continues to lead today.

Follow us online for more updates on IVUmed workshops and events around the world:

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June 9-15 is Men’s Health Week!

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June is Men’s Health Week, and the month of June is Men’s Health Month, a time to “heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys.” 

 

Men’s Health Month is anchored by a Congressional health education program and celebrated across the country and internationally with screenings, health fairs, media appearances, and other health education and outreach activities.

 

IVUmed’s workshops provide quality care and build surgical capacity to serve men and their families  in low-resource regions all over the world. Our medical volunteers provide surgical training for both common and neglected urological conditions affecting men, women, and children. Click here to learn more about IVUmed’s workshops, serving men, women, and children on a local and global scale.

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Check out this link from www.menshealthmonth.org if you’d like to participate in Men’s Health Week events in your area!

 

Follow us online for more updates on IVUmed workshops and events around the world:

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