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IVUmed Traveling Resident Scholar Report

Nitya Abraham, MD 
New York University 
 Kampala, Uganda – June 15-24, 2012 
Mentor: Dr. Susan Kalota 
Sponsored by: SUFU 

urology surgery

Through the generous sponsorship provided by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), Dr. Nitya Abraham traveled to Kampala, Uganda with mentor Dr. Susan Kalota to collaborate with the Urology Department at Mulago Hospital. While participating in cases and delivering lectures on female urology, Dr. Abraham was able to develop an understanding of the discrepancies in healthcare due to limited resources. As she now begins a female urology fellowship at Cleveland Clinic, her experiences in Uganda have helped shaped her career goals.

Reporting on her experience, Dr. Abraham stated:

resident scholar mentor

“I saw the photographs, I read the books, I watched the documentaries. I knew the need for medical assistance was great in places like Africa. Now finally I would be going to Kampala, Uganda for a female urology workshop through IVUmed. I embarked on the trip with excited eagerness, cheerful enthusiasm, and grandiose hopes to transform lives. But my high expectations were replaced with unanticipated disappointment. I left with a heavy heart, feeling powerless. Our trip seemed to me a ‘drop’ of help when an ‘ocean’ was needed. My idealistic naïveté was humbled by the unexpected challenges I encountered.

“My disappointment and remorse at the end of my IVUmed trip to Kampala stemmed from my inability to provide world class care to the patients there. Why should there be such disparity in the treatment of my patient in Cleveland and my patient in Kampala? What always seemed to be an abstract aspiration has now become a concrete goal after the IVUmed trip: I want to bring world class care to places like Mulago Hospital in Kampala, Uganda. This endeavor will be expensive, require a lot of time and effort, and will be difficult to accomplish, but I do believe it is possible.

  “I am grateful to IVUmed and SUFU for providing me this invaluable experience. It has opened my eyes and has changed how I envision my future career. One trip is just not enough. I strive to include international health care as a long-term commitment and integral part of my career because ‘every life deserves world class care.’”

For more information about IVUmed’s resident scholar program, including the current application and deadlines, please visit our website

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Jonathon Wu, MD
Stanford University
Hue, Vietnam – February 17 – March 4, 2012
Mentor: Dr. Walter Beh, MD
Sponsored by: The Western Section of the AUA

Through the generous sponsorship provided by the Western Section of the AUA, Dr. Jonathon Wu traveled to Hue, Vietnam with mentor Dr. Walter Beh. Dr. Wu and his mentor collaborated with Dr. Hung and his colleagues of the urology department, focusing on 19 patients with difficult cases. Dr. Wu was able to perform his first open pyelolithotomy under the supervision of a Vietnamese colleague, Dr. Tuan.
Reporting on his experience, Dr. Wu stated:

“In our two weeks of working mainly with Dr. Hung, I was very impressed by his surgical technique. Open surgery involved tediously dissecting out important structures and controlling all bleeding quickly with cautery or ligatures. He moved very quickly in the OR but was very purposeful with his movements. No suture was wasted as instrument tying was performed whenever possible. Bigger cases would often involve 2 attending surgeons intertwined in a well-rehearsed ballet.“What was even more impressive was the efficiency and resourcefulness of the hospital.
We mostly worked with Dr. Hung who has been on the urology staff for 6 years. He is quite motivated and very enthusiastic.
“This disparity was made much more obvious to us when we observed a kidney transplant on our last day.… During the course of our 2 weeks, we were able to see the kinds of needs our Vietnamese colleagues had.”
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Resident Scholar Reflections

Dr.John Mancini – Uganda 2012

As I stepped off the plane and onto the tarmac in Entebbe, a short distance from Kampala, I quickly realized I was no longer in my familiar world. The air was hot and dry, and though it was the middle of the night, I could see a think dust lingering in the air. I was greeted in the airport by Joseph Musaba, a very bright-eyed and energetic Ugandan in the final year of his fellowship training at Mulago Hospital. Right from the very start, he was so kind and gracious that I felt right at home, even in such an unfamiliar place. The trip from Entebbe to the apartment in Kampala took about one hour. Kampala was busy, bustling with traffic, motorbikes which outnumbers cars three to one, and many people walking along the side of the road, despite it being after midnight. I was immediately struck by the notion that this place is full of life!



We arrived to the apartment, which was adjacent to the property of Dr. Watya, the senior urological consultant at Mulago Hospital. He greeted us
outside the apartment, and together we entered the building. The power in our section of the city had been out for several hours. I would later come to realize that power outages were very common and unpredictable. Dr. Watya had brought a portable florescent light, which ran out of juice after thirty seconds. We toured the apartment by the light of our cell phones. I was very pleased with the apartment as it had most modern amenities and, by the dim of my cell phone, appeared to be nicely decorated.

My first full day in Kampala consisted of recovering from jetlag and making a trip to the local shopping center with another urology fellow, Dan. In the daylight, Kampala was certainly a very interesting place – a mix of tall modern glass buildings and slums, where people lived in little more than cardboard boxes. The roads turned from pavement to dirt without any notice, and large potholes were more common than smooth pavement. The sidewalks were mostly dirt, and a thick haze of dust covered the entire city. The traffic was intense, where motocycles (called boda-bodas) darted in and out from between cars and trucks, not seeming to pay much attention to traffic laws, other vehicles or pedestrians. Despite the chaos, I was impressed with Dan’s cheeriness. He alaways had a smile on his face, and when he got cut-off by a boda-boda, he just laughed. I found this to be a common theme among Ugandans; they were able to find joy outside of less-than-ideal circumstances.


The next day we went to Mulago hospital – a very large and impressive structure that appeared to have been last renovated in the 1970s. Most of the hospital was open to the air. It was very busy with people, mostly patients and their families, everywhere. In most corners and in open hallways, patients and their families were camped out, women breastfeeding babies, men holding small children. The urology ward consisted of two large
open bays, one for men and one for women. The men’s bay had approximately 40 cots, and they were all full. Huddled around each patient were their family members, at times numbering six to eight individuals per patient. The family members were primarily responsible for the non-
medical care of the patients. They provided food and helped keep the patients comfortable, doing a lot of what is done by nurses in the United States. During rounds, I was struck by how thankful and appreciative everyone was for the care they were receiving. Some patients had been on the ward for weeks, waiting to get their change to go the operating room. The operating room time was precious, only having two dedicated days per week. Surgeries for many patients with non-acute issues were delayed week after week as more urgent cases needed to be done. Then, after the weeks of waiting, when the patient was finally able to undergo surgery, there was much gratitude and appreciation, without plaint of their delay.

The operating room in Kampala is adequate for most surgical procedures, and I was certainly impressed with the skill of the Ugandan surgeons I worked with. I was most impressed with how they are able to accomplish so much with so little. Poor lighting, old operating tables, limited
instruments and scarce disposables, that would have made frantic most any attending from home, were well-tolerated and accepted by the Ugandan surgeons. By Necessity, they have had to become very creative in the operating room to accomplish the surgeries that vitally need to be performed.

We did several endoscopic cases during my time at the hospital. They have a very nice tower and camera, but otherwise are quite lacking of endoscopic equipment. I became frustrated on a couple occasions because simple endoscopic procedures that typically take less than 30 minutes at my home institution took over two hours at Mulago. The excess time was spent looking for pieces of equipment that would adequately finish the job, or struggling through the procedure using something that was barely sufficient. In one ureteral stone case, in particular, we found a large stone in the distal ureter with a semi-rigid ureteroscope. It was easily grasped with a stone basket, but could not be removed because of its large size. Eventually, a stent was placed, and the patient will have to come back and have an open procedure for stone removal. It was difficult for me to grasp being so close to being able to make the patient stone-free, but ultimately being
unsuccessful. If we would have only had a laser or even a handheld penumatic device like the Stonebreaker, we could have easily treated the stone.

I was also fortunate to have the opportunity to travel to the small town of Bundabugio on the western border of Uganda to experience what life is like in this very remote region of the country. The region is extremely isolated, about a three to four hour drive over very rough terrain from the nearest “city”. There is a small medical clinic in the town. Small clinics like this across the country are run by medical officers, who have the training equivalence of an intern in the U.S. They are responsible for whomever walks through their doors and are expected to perform surgery if required. It is not uncommon for these medical officers to perform C-section and appendectomies on a regular basis. They must take care of every situation they can as there is not a good system of referral and transport to larger
hospitals.

As I reflect on my trip, what I a most impressed with is how Ugandan urologists do so much with so little. They treat a very wide range of diseases, similar to what urologists treat in the US, but with fewer tools at their disposal. I take for granted training at a large hospital where we have essentially everything at our fingertips. Ugandan surgeons use creativity and excellent open surgical skill to bridge the gap. They are truly remarkable surgeons and people, and I have been blessed to learn from their skill, creativity, positive attitude and friendship.

I found my time at Mulago to be beneficial to the urology fellows, in that I was able to share my experiences, provide needed equipment and supplies through generous donations from both IVUmed and Duke University, and teach several endoscopic procedures they rarely perform. I highly recommend IVUmed continuing to assist the Ugandan people by sending more resident and attending urologists, as fellows would be able to travel to the United States. I would be willing to assist in having Duke University be a potential place where international students could come and learn.

Thank you very much for this incredible experience.


For more information on getting involved with our Resident Scholar Program, please visit our website at www.ivumed.org.
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Resident Scholar Reflections

Dr. Marc Bjurlin, DO – Bhopal, India

Through the generous sponsorship provided by the North Central Section of the AUA, Dr. Marc Bjurlin traveled to Bhopal, India with mentor Dr. Gopal Badlani. Dr. Bjurlin and his mentor participated in a free urology camp organized by the local Indian organization Jeev Sewa Sansthan (“Service to the Living”). During the camp, over 140 patients received much-needed urological care.

Reporting on his experience, Dr. Bjurlin stated:

“The urology camp patients of Bhopal came from miles away to receive their care. Graciously they would await their turn, one at a time, slowly moving up in the line, until it was time for surgery. There was no complaining of the long wait, no one complained that they wanted to be operated on first. There were no irritable patients being hungry from not eating prior to surgery. Everyone sat patiently with a face that expressed their gratefulness even though I knew no Hindi to communicate.

“The hours of surgery were long but the time passed at the blink of an eye. The pathology, scope and variety of urologic cases was remarkable. Equally remarkable was the efficiency of evaluating patients preoperatively based almost entirely on symptoms, urine analysis and a select intravenous pyelogram.

“Over the course of the urology camp, I learned much about the urologic diseases of India, their ailments, and surgical treatments. I expanded my knowledge of urology in a culturally sensitive manner. Yet, as my knowledge of urology grew through interaction with patients, my understanding of the human spirit matured. Instead of simply operating on patients who had urologic diseases, we provided respect, dignity, and compassionate urologic care to a community that taught me an indispensable lesson.”

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Resident Scholar Reflections

Dr. Jessica Casey, MD – Mahuva, India

Through the generous sponsorship provided by the Resident Scholar Alumni, Dr. Jessica Casey traveled to Mahuva, India with mentor Dr. Sakti Das to participate in a free urology camp organized by the local Indian organization Jeev Sewa Sansthan (“Service to the Living”). During the camp, over 130 patients received much-needed urological care.

Reporting on her experience, Dr. Casey stated:

“During my six days in Mahuva at Sadbhavna Trust Hospital, I operated like crazy – running back and forth between the 6 operating beds that filled 2 operating rooms. As I was finishing one case, a patient behind me was getting their spinal anesthesia injected and being prepped by assistants for me to operate on in a few minutes. During those short six days, I participated in 34 operations which ranged from delicate hypospadias work to minimally invasive percutaneous nephrolithotomy to a reconstructive extrophy repair; and this was only a fraction of the work being done while I was there.

“In Mahuva they did not have all of the fancy equipment we have in the states; there was no fancy LigaSure, no argon beam, no laser lithotripsy. They had a scalpel, cautery, suction, a light and a patient who needed surgery. If something is bleeding, quickly put an “artry” (i.e. hemostat) on it and move on. If the suction isn’t turned on, use one of your two laps to stop the bleeding and move on. If they don’t have the needle driver you want, make do with another.

“If I was struggling with a maneuver and blaming everything around me (the lighting, the instruments, the angle, etc), Dr. Das would calmly remind me to focus on my own skills and not blame my surroundings. Dr. Das’s influence made me reflect at my own actions. Often at Northwestern, surgeons complain about not having the right gloves, the right assistant, the best light, etc. in order to make excuses for their own skills. It’s best to just focus at the task at hand, not make excuses, and just get the work done.”

Jessica Casey, MD

Northwestern University

Mahuva, India – November 4-28, 2011

Mentor: Dr. Sakti Das

Sponsored by: The Resident Scholar Alumni

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Resident Scholar Reflections

Emma Ester Bendaña, MD
University of Rochester
Deschapelles, Haiti – November 12-19, 2011
Mentor: Dr. Robert Edelstein

Dr. Bendaña’s service in Haiti was made possible by a generous grant from the Northeastern Section of the AUA. Dr. Emma Ester Bendaña traveled to Deschapelles, Haiti with mentor Dr. Robert Edelstein to collaborate with Haitian hosts in the provision of urological care to patients in need. Dr. Bendaña evaluated over 100 patients and participated in 14 cases during the workshop.

About her experience, Dr. Bendaña stated:

“My trip to Haiti in November of 2011 opened my eyes to another world of urology. Even though I had some experience in traveling abroad to developed and developing nations – it was my first medical trip as a trained urologist. After four years of residency experience in Rochester, New York – I had the ability to analyze and problem solve urological issues and situations. I left as a new person and urologist. Haiti provided me with a setting to develop my skills further as a surgeon and challenge myself to solve problems.

“In Haiti, we had limited equipment and instrument accessories. It became a challenge to provide high level care with a limited set of instruments. As a result, my skills were pushed to their limits and enhanced. There was no room for indiscretion. Accurate histories were needed to appropriately plan for procedures based on our limited equipment and intra-operatively an accurate diagnosis was needed so that only the equipment that was needed was opened. Our goal was to use our limited one-time use instruments to their maximum without waste.

“It was an honor to work with the residents and other attendings in Haiti – and understand their own struggles and challenges as they do their best to provide outstanding care for their patients. In residency it is easy to get lost in the paperwork and mundane nature of the business. I needed an awakening and this trip gave me several opportunities to open my eyes.”
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