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Dr. Maggie Lovin Shares Her Experience in Mongolia

 

Thanks to the generous support of the Southeastern Section of the American Urological Association, Dr. Maggie Lovin had an outstanding experience in Ulaanbaatar, Mongolia, where she worked with local urologists and patients at the National Center for Maternal and Child Health from October 20-28, 2018.

 

Dr. Lovin shares her experience:

“Our team was composed of two pediatric urologists, Dr. Carlos Angel and Dr. Angela Arlen and two pediatric anesthesiologists, Dr. Scott Stenquist and Dr. Laurie Steward, and myself. Our group bonded immediately, making working together effortless and enjoyable.

“We were hosted by the Pediatric Urology Department at National Center for Maternal and Child Health under the direction of Dr. Kurelbaatar Lkhagvademberrel. The 1500 bed hospital in the capital city is the main government referral hospital in Mongolia and provides free medical services to its patients through the national government insurance plan. There are six pediatric urologists serving approximately 1.2 million children in the country.

“After our flights, we got to work immediately the day we arrived to Ulaanbaatar. We conducted a busy 40 patient clinic that Sunday afternoon, booking 28 cases for the following week’s operating room schedule. We encountered a great variety of disease pathology including proximal hypospadias, ureteropelvic junction obstruction (UPJO), vesicoureteral reflux (VUR), urethral stricture, nephrolithiasis, epispadias-exstrophy complex, posterior urethral valves and disorders of sexual differentiation. We concluded our clinic Monday around mid-day, seeing 81 children in total.

“Monday afternoon, we began our surgical cases. We operated simultaneously with two surgical teams in separate operating rooms. This allowed ample time to teach the Mongolian surgeons the intricacies of several pediatric urologic procedures. The pediatric urologists were very eager to learn, and their enthusiasm for the workshop and their patients alike was contagious. In addition, this trip would not have been possible without our incredibly hard working operating room team, including the anesthesiologists, nurses and surgical scrub technicians. Together, we were able to treat several children with proximal hypospadias, ureteropelvic junction obstruction, vesicoureteral reflux and posterior urethral valves.

“On the last day of the workshop, we made rounds handing out soccer balls and toys to our patients to thank them for allowing us to be a part of their journey. The Mongolian parents presented us with Mongolian cashmere scarves and a traditional Mongolian game to thank us for helping their children. It was very touching to see people with so little to give, give so much.

“The Mongolian pediatric urologists made a conscious effort to make us feel at home in Ulaanbaatar. We worked hard all week, but took the afternoon of the last day off to have some fun. The Mongolian urologists took us sightseeing in the countryside. We rode camels, held eagles, and visited the Genghis Khan equestrian statue. The day ended with a Mongolian barbeque with our entire team.

“While this was my first global health mission, it certainly will not be my last. The people I met and the experiences I had in Mongolia have made an everlasting impact on my life. While there is great need for further pediatric urologic care in Mongolia and worldwide, organizations such as IVUmed are helping to bridge that gap. I would like to thank IVUmed and my physician mentors for this opportunity and I hope to use this experience as a stepping-stone to a lifelong commitment to international service.”

 

 

 

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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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Resident Report: Dr. Geolani Dy in Ghana

IVUmed Traveling Resident Scholar Report

Geolani Dy, MD
University of Washington
Kumasi, Ghana
February 27 – March 6, 2016
Mentor: Venkata Rama Jayanthi, MD
Sponsored by:  Allergan Foundation

 

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Allergan Foundation’s generous support made possible Dr. Geolani Dy’s recent IVUmed Traveling Resident Scholar experience in Kumasi, Ghana.  During the pediatric urology workshop there, Dr. Dy helped serve over 50 children.  IVUmed is grateful to Dr. Rama Jananthi from Nationwide Children’s Hospital for acting as Dr. Dy’s mentor.

Dr. Dy reported, “We evaluated over 50 boys and girls with a variety of congenital, traumatic and iatrogenic genitourinary conditions rarely seen by most urologists in the US.  We discussed surgical plans with families via our local physician counterparts, knowing that there were more than we could possibly manage surgically in a week. The remaining patients would wait until next year or until KATH urologists felt comfortable treating them independently.

“Frustrations led to great improvisation, mutual learning opportunities, and the realization that details we sweat in our home ORs may not warrant such angst.  Ultimately, the most difficult part was realizing that even if we had an extra few days to operate on all the patients, what we could provide in that time was not necessarily what they needed. It was the understanding that just because we can, does not mean we should. While this applies in all of medicine, a resource-limited setting makes this all the more obvious. The surgical knowledge our team possessed could not always be applied to our Ghanaian patients as it could to patients in Seattle, Washington or Columbus, Ohio, who have different access to follow-up care and supplies after surgery, who may have different cultural interpretations or expectations of their conditions, and who live daily existences with different functional demands.

“This IVUmed trip gave me insight that I had previously lacked after past medical trips as a student. It has never been clearer to me that providing the highest quality care requires a deep understanding of a patient’s sociocultural context, and as an important corollary, communication and medical decision-making that are truly patient-centered. It requires understanding the capacity of local providers, and doing what is within their means to manage and build upon once we have flown back across the globe. It requires a great deal of thought and effort beyond the operating room, which I look forward to cultivating over the course of my urologic career.”

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IVUmed Resident Scholar Nathan Hale, MD — Deschapelles, Haiti

The generous support of the Latin American Perpetual Education Fund made possible Dr. Nathan Hale’s IVUmed scholarship experience in Deschapelles, Haiti. During his time with mentor Robert Edelstein, MD, Dr. Hale participated in a surgical workshop focusing on general urology, serving over 200 patients.

Nathan Hale, MD

Nathan Hale, MD

After returning from the workshop, Dr. Hale reported, “I am so thankful that I was able to participate in this mission to Haiti. My opportunity to do this was only made possible by the generous donors who fund IVUmed. I thank you and want you to know of the change you are making in the lives of the patients treated, their families, and the members of each IVUmed team. Through IVUmed, we all become beacons of hope.

He continued, “I would like to share some of one patient’s words: ‘There really are no better words to say than thank you. A deeper concern invaded us and even plunged us into despair (we totally lost hope). The tears kept flowing from our eyes until the day of surgery. While I was in the recovery room, my wife asked you this question, ‘Do you think he will be Ok?’ You said he should. From that word, our worries started flying away and we took force. I can only say, ‘Thank you and all of your team.’ After the operation, I came from death to life.’ In the email were pictures of his road to recovery, and he looked like a new man. As I read the email, my heart swelled with joy to know the difference we made in this man’s life and in the lives of his family. I also realized that we had become this man’s beacon of hope.”

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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.

Recruitment Flyer_residents 2015

urology resident scholarship opportunity

 

 

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Notes from the Field: Hue, Vietnam – Part 2

Lawrence Jenkins, II, M.D. , an IVUmed resident scholar, volunteered with our general urology workshop in Hue, Vietnam on March 10-22, 2014. This is the second half of selections from his field notes:

Notes from the Field:  Hue, Vietnam

 

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Day 5

There was a ceremony with the university directors and urology senior staff where Dr. Hampton was given the title of Visiting Professor. It was nice yet very formal and Dr. Petrossian and I received small wooden plaques with the university and hospital name on it to commemorate our trip. Drs. Hampton and Petrossian left to go back to the US.

Day 5-7 – I took a bus to Hoi An, which was 4 hours south of Hue. I arrived in town at night and went into town to see a lantern festival where they turn off the lights and businesses only use candlelight and lanterns, and people place paper lanterns in the river. The next day, I took a tour to My Son Holy land, a sanctuary dating from the 4th to 13th centuries. We stopped at island on the way back to see sculptures and carvings being made. Later, I walked around the old town for a bit, then found a cooking class and made some delicious meals. In the morning before leaving I took an 8.7 mile / 14 km bike ride into the countryside and saw life outside of the tourist area.

 

Day 8

I met Dr. Kahan, from New Hampshire, who was the faculty mentor for the second week. This was his fifth or sixth trip to Hue. There were several open stone surgeries that day, one renal and two ureteral. The technique that the Vietnamese doctors had was superb and they were able to efficiently remove the stones without unnecessary manipulation. The afternoon surgeries were performed in the same room and at the same time as a general surgery case, which is unheard of in the US at the present time with infection concerns.

 

Day 9

We performed another nephrectomy, this was for a kidney with chronic infections. That evening the urology staff took us out for dinner and drinks. It was fun and we were able to socialize not only about urology but about life in Vietnam vs life in the US.

 

Day 10

We did 2 percutaneous nephrolithotomies with new renal access gained with the assistance of fluoroscopy. Both were for lower pole stones. The only method they have available for lithotripsy is laser; however, in the US we have pneumatic and ultrasonic lithotripsy as well. They were having difficulty gaining access and I was able to show a different method that I learned during residency. It felt good to be able to show them something new since they were showing me so much about open stone surgery.

 

Day 11

I did my third presentation for their morning conference. Most people seemed interested and had some good questions. We then went to see some surgeries and in the afternoon I spent some time in the clinic with one of the attendings. The clinic was one room amongst a group of many clinic rooms that likely rotated specialty. In the evening, we had a closing dinner on the river with the department. It was very nice to see everybody again and enjoy the authentic Vietnamese cuisine.

 

Day 12 – 13

Dr. Kahan left to go back to the US. I rented a scooter and rode around the countryside with one of the Vietnamese doctors, Dr Fu. We went to see several Buddhist temples and a lookout point with a great view over the Perfume River. That evening, I left for my extremely long trip back home.

Overall, it was an amazing experience that changed my perception of not only urology but the general delivery of healthcare. Seeing what they were able to do with much less equipment makes me appreciate what we have so much more. In Hue, medicine is pure, not overwhelmed by the need to order extra tests in fear of malpractice lawsuits. The Vietnamese doctors were very welcoming and I hope to go back one day.

 

 

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Vietnam: An Enduring Partnership

 

A team, including IVUmed board member, Steven E. Kahan, MD, JD., is wrapping up our latest workshop today – a general urology workshop at Hue Central Hospital, in Hue, Vietnam. IVUmed has a long, successful history of partnership in Vietnam.  Our volunteers began working with Vietnamese pediatric surgeons in 1994, predating our official incorporation in 1995.

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Vietnam has a population of approximately 95.5 million people, but have access to only  1.224 doctors per 1000 people. In 1994, fewer than 100 pediatric urology patients were treated annually there.  After many years of successful training, our partner surgeons now run their own training programs independently and treat over 1000 patients annually.

 

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IVUmed specialty workshops in Vietnam have included general urology, pediatric urology, and endourology. Dr. Kahan shared this photo taken at the classroom lecture portion of the workshop at Hue Central Hospital:

 

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Resident Scholar Applications are Open

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A Unique Opportunity

Since 1999, IVUmed has provided over 150 urology residents with
the opportunity to gain unique surgical experience in resource-limited

settings throughout the world. Residents in PGY-3 and above obtain
significant hands-on experience in urology under the supervision of
board-certified mentors.
Program Highlights

  • 1-2 week international trip, coordinated by IVUmed staff
  • Scholarships available to cover most trip expenses
  • Diverse surgical experience, with exposure to cases not often seen in the US
  • Service abroad to underserved populations
  • Share and interact with residents from other countries
  • Collaborate with mentors from other programs
  • Gain a greater insight of the international medical community

Application Information
The 2013-2014 application deadline is February 1, 2013. Applications
can be found on our website at How You Can Help.
Please contact Amy Steele for more information at 801-524-0201 or amy.steele@ivumed.org.

Tell your friends by sharing this link: http://www.ivumed.org/2012/12/resident-scholar-applications-are-open/

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Mary Frances James, MD
Eastern Virginia Medical School
Nairobi, Kenya – March 3 – 13, 2012
Mentor: Dr. Kurt McCammon
Sponsored by: The Mid Atlantic Section of the AUA
Through the generous sponsorship provided by the Mid Atlantic Section of the AUA, Dr. Mary Frances James traveled to Nairobi, Kenya with mentor Dr. Kurt McCammon.  Dr. James had the opportunity to experience grassroots surgery and its value in a developing nation.

 Reporting on her experience, Dr. James stated: 

“At the time of our arrival there was a nursing strike going on throughout the city including Nazareth Hospital.  This situation was very stressful for the sisters and added strain to the daily hospital management as the patient census continued to increase each day. …Despite this ongoing struggle within the hospital we were graciously welcomed by the FIHM sisters on our arrival.”

“The operating room staff was very hospitable and allowed us to use one of the two main operating rooms.”

“The first couple of days consisted of several second stage urethroplasties…. This was a wonderful experience as it was the first time I had seen this operation.”

“Overall my IVU trip was a wonderful experience. Traveling to Africa and working within the constraints of limited resources was an eye-opening and humbling experience.  In a field such as urology that has transformed with development of robotics and minimally invasive care I think it is important to remember how different healthcare is throughout the world.  I am extremely grateful for having had this opportunity and look forward to a lifelong commitment to urologic mission work.”

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Resident Scholar Reflections

Judith Hagedorn, MD
Stanford University
Hebron, West Bank – March 15 – March 24, 2012
Mentor: Dr. Scott Eggener
Sponsored by: Verathon

Through the generous sponsorship provided by Verathon, Dr. Judith Hagedorn traveled to Hebron, West Bank with mentor Dr. Scott Eggener to learn and assist surgeries at Hebron Hospital. Although in a politically turmoiled area, Dr. Hagedorn was able to develop an understanding of the diversities in healthcare due to limited resources.

Reporting on her experience, Dr. Hagedorn stated:

“Every morning we got picked up with the Ambulance of the Hebron Hospital. Our Palestinian driver made a daily pit stop, either to get some strong Arabic coffee or freshly fried falafels. 

“The hospital was quite simple, but clean. The staff was very friendly and showed

their appreciation for our visit. In addition, the patients were overly thankful and there was never a day we didn’t leave the hospital without a small present from one of the patients’ families.

“The clinical decision-making was also quite interesting and different from what I had learned in the Western World…. I had a wonderful, eye-opening, and rewarding experience, which definitely strengthened my passion to contribute to global health, and I am already looking forward to my next international medical/surgical trip.”

Interested in learning more about our resident scholar program?

Find more information at our website, www.ivumed.org.
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IVUmed is committed to making quality urological care available to people worldwide.