The Latest from Rwanda

As our IVUmed team wrapped up their week in Rwanda, Dr. Alli Greening reported,

“I’m now finishing up about 40 hours of air travel in a little over a week, am confused as to what time it is, and exhausted from a busy OR and teaching schedlue. I am also really excited to have identified some problems with the anesthesia education and hopefully our next steps in Rwanda. I am already figuring out how to improve anesthesia education there, and hopefully not only bring it up to a  level commiserate with their surgical capabilities,  but make it self sustaining by beginning to work with a core group of providers and develop a curriculum that they can then teach and disseminate to others, something both myself and Bob Nguyen feel is a key concept in this project.

Despite the jet lag and exhaustion, when Bob asked if any of us would like to return next year, every one of us immediately raised our hands. As I sat at the Hotel Des Mille Collines (former Hotel Rwanda) celebrating with a drink on the way to the airport with part of the team we remarked this was each of our favorite mission ever. The team dynamic had been phenomenal, we had seen really substantial progress in the two surgeons, and were talking about future direction with very appreciative and committed higher ups at both hospitals.

Cheers to Rwanda 2016!”

Reporting from Rwanda

Dr. Alli Greening reported the following regarding work by the IVUmed currently in Rwanda for a week-long pediatric workshop:

“Where to start… the first day in the theater at the military hospital in Kigali was today. Rather than a hospital for military personell this is more like a hospital run by the military for the people of Rwanda,  a place that attracts a number of high complexity cases from around the country. With this being the 4th of 5 trips we’re expecting the local team to be doing, well, most of the doing as we slowly step back.

We managed to meet our goal of getting 4 cases in each of our two rooms despite having an almost continuous string of roadblocks hurled at us.  As soon as I would start talking and drawing on a topic the Rwandans turned into rabid learners. At one point I could barely move, with two medical students,  two nurse anesthetists,  and a physician anesthesiologist all practically on top of me while I was talking about airway obstruction.  This is exactly why I love IVUmed so much, we’re not just swooping in, doing cases, and coming home, but are there primarily to teach and our Rwandan teammates are not going to let a morsel of knowledge get by them.”

– Dr. Alli Greening

Quotes from the Field: Kilgali, Rwanda

IVUmed service last month included five workshops, making March our busiest month to date! We’re highlighting this tremendous work with quotes from IVUmed volunteer medical providers on those trips and photographs from the regions served.

Today’s Highlight:  Kilgali, Rwanda

Our reconstructive urology workshop in Kilgali was a great success. Lead by Jeremy Myers, M.D., our IVUmed team  saw 30 patients and performed 25 surgeries. They also provided training for 12 doctors and nurses.

“This was very enlightening for me, allowing me to see and experience the challenges facing health care delivery in a developing country. It was a great opportunity to visit an area of the world previously unknown to me.”

– Stuart Anderson, MD

“It means a lot to expand knowledge in an area where there are talented surgeons and in Rwanda the trip felt impactful.” Jeremy Myers, MD

“Felt proud to be part of team that helped to pass on valuable skills to our Rwandan colleagues.” Olufenwa Famakinwa, MD

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Notes from the Field: Reconstruction in Rwanda

Jeremy Myers, MD, of the Department of Genitourinary Injury and Reconstructive Urology at University of Utah School of Medicine, recently returned from an IVUmed reconstructive urology workshop trip to Rwanda. Upon returning to the United States, Dr. Myers recorded his thoughts on working with IVUmed and his experience in Rwanda. He has kindly allowed us to share his thoughts here:

Jeremy Myers 3/17/2014 – University of Utah and IVUmed:

“I am just returning from a 2 week trip from Rwanda, Africa with IVUmed.  The focus of this group, headed by Catherine DeVries MD, is on increasing global urologic access through education of local surgeons.  The motto of the organization is “Teach One, Reach Many.”  This philosophy differs substantially from many relief organizations or mission trips.  Most often these trips seek to give aid and provide surgical care in resource poor countries.  While this is a noble sentiment, the impact of these trips may not be very great when they are viewed in the context of a country’s overall population and needs.  How much impact can a single trip have, with 20-40 operations performed in a country with a population of millions?

“This is why IVUmed’s mission and guiding principles are so important.  As opposed to impacting a few patients, surgeons can impact a population by identifying sites where surgeons are wanting to increase the level of care they provide and have the basic resources needed to create this change.

“In Rwanda, there are 2 urologists for a population of 12 million people!  They are talented surgeons that are concentrated on providing quality care and also upon training more urologists.  They are now training 2 other urologists and anticipate a residency in urology in the future.

“Our trip was the first adult reconstructive urology workshop in Rwanda.  We found that the surgeons there were very talented.  They had excellent fine dissection and made the most of the resources they had.  They perform about 50-60 urethroplasties a year.

We were able to demonstrate new techniques [that will enhance the local care of severe pelvic injuries].  The [local surgeons] should be able to incorporate [them] into their skill set with their already impressive urethroplasty experience.  These were challenging cases, but not something the Rwandan surgeons had had much exposure to.

“Our team consisted of 2 adult reconstructive urologists, a urology resident, a radiologist who was married to one of the reconstructive urologists, and an anesthesiologist.  We performed about 26 operations in 2 weeks.

“We were able to have the weekend in Kigali, which is the main city in Rwanda.  Our weekend was spent visiting the markets in the city and relaxing.  We also made a visit to the genocide museum.  While this was a difficult visit to make, we felt this was something important to do in order to understand how the genocide has affected all of Rwanda and shaped its current government and culture.

“This was a fantastic trip and our team felt we were able to educate and show the Rwandan surgeons some advanced techniques that they can incorporate very readily into their practice.  I am looking forward to returning and reinforcing these techniques and observing what progress the urologist have made in shaping their urology training programs.  They were inspiring surgeons and individuals and very gracious hosts for our trip.  While it takes a while to get to Rwanda, the experience was worth it.”

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Bringing ideas and countries together with telehealth

IVUmed is invited—and invited back—by host countries that see us as long-term partners. To make the most of the interval between each hands-on surgical training workshop, we have increased our use of telehealth technology.

In partnership with the University of Utah, we have conducted a series of lectures and consultations with our colleagues in Rwanda. This allowed IVUmed volunteers to provide some initial training before hitting the ground in Kigali for their first on-site workshop.

IVUmed is currently working to increase access to this valuable technology among its partner sites and is developing a digital training platform that will combine videoconferencing, distance consultation, and content libraries. This software, developed by IBM and Boston Children’s Hospital, will make an entire digital learning package available to doctors and nurses in low resource—and importantly—low bandwidth areas of the world.

IVUmed partners around the globe wish to participate in this learning format. In fact, 93% of those surveyed stated that they are very interested in telehealth training in their facilities.

Through videoconferencing, online learning libraries, and remote consultation, our volunteers’ efforts have an even greater impact. They provide further education on concepts covered during workshops to maintain continuity and to prepare for further hands-on instruction. The technology also allows our volunteers to provide remote training in multiple countries at the same time.

Urology workshops show promising future for urology advances in Kigali, Rwanda

As our first surgical workshop in Rwanda, the IVUmed team was encouraged by the opportunities for surgical education there. The team worked in two sites: Kigali and Gitwe. Our volunteers, led by Drs. Hiep Nguyen and Richard Santucci taught pediatric and reconstructive urology in Kigali, while in Gitwe, reconstructive urology was the primary focus.

Dr. Nguyen and the pediatric urology team were based at King Faisel Hospital and the University Teaching Hospital of Kigali where they had the opportunity to provide surgical education and conclude the workshop with a day-long educational symposium. IVUmed and our Rwandan partners plan to continue pediatric and reconstructive urology education in Kigali. The facility is well-suited for surgical training and includes a faculty that is eager and capable. Dr. Nguyen has already made plans for a follow-up visit in late spring.

“This trip provided me with more experiences than I ever could have expected. I was able to conduct research, help out with a mobile EMR system, assist in the OR, and generally get a much better feel for the needs in East Africa,” mentioned David Miller, MPH candidate and IVUmedvolunteer.

With minimal resources available in Gitwe, Dr. Santucci and fellow IVUmed volunteers were able to assess the need and discuss opportunities for the physicians in Gitwe for continued education.

DID YOU KNOW?
Surgical need on the international level has dramatically increased, only 3.5% of surgical procedures are performed in the poorest one-third of the world.

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