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IVUmed – Helping Children Around the World

IVUmed Rwanda

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/

IVUmed patient in Vietnam

IVUmed in Vietnam

 

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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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Our Purpose for Service

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In just a few short weeks, an IVUmed volunteer team will be heading to Kampala, Uganda to conduct a female urology workshop. IVUmed workshops give our volunteer urologists the opportunity to change the lives of their host colleagues and their patients. The local doctors will gain essential surgical skills through training and educational models developed by IVUmed and its volunteers, who maintain professional contact throughout the year to continue the learning process.  Our international partners can then use their new capacity to help patients in their community, even after the volunteers have left.

This is a monumental event for our partner physicians, as well as patients like Veronica Nandego, shown above. Veronica Nandego mentions, “I have urinated on myself for 50 years.” Not only has she suffered countless years of public humiliation but has lost three children, lost ability to bear children and no longer presents proper urinary function. Veronica’s story is very common across Africa due to lack of capable physicians to perform the proper surgeries to deter maternal issues from becoming this severe.

IVUmed was contacted by local medical professionals in Uganda in hopes of coordinating for the upcoming workshop. We have had the opportunity to arrange travel arrangements for Veronica to reach Mulago Hospital, where the workshop will be hosted, approximately 45 kilometers away from her one-room hut in Bugembe.

Working with IVUmed’s volunteer physicians will better equip the local doctors with the skills they need to help many African women like Veronica return to society and  live a normal life.

IVUmed’s motto, Teach One, Reach Many, guides our continuing successes in improving the quality of life for individuals worldwide through building the confidence and skill sets of local medical professionals.

To read more about Veronica’s story and personal life, continue to this article.


Map of Uganda from Jinja district, where Veronica lives, to Mulago Hospital in Uganda.

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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 Feature

Yasmin Bootwala, MD
Emory University
Kampala, Uganda: February 5-14, 2010
Mentor: Dr. Stephen Watya
Dr. Yasmin Bootwala traveled to Kampala, Uganda to collaborate with mentor Dr. Stephen Watya and other Ugandan hosts in the provision of urological care to patients in need. Dr. Bootwala participated in 20 cases during her visit.
Dr. Bootwala’s service in Uganda was made possible by a generous grant from the Southeastern Section of the AUA.
About her experience, Dr. Bootwala stated:
IVUmed gave me the priceless opportunity to reconnect with some of my fundamental goals including using medicine as a means towards effecting social change.  I have had the good fortune to go on a number of international trips but nothing can compare to this trip.
“I met Ngozi who travelled to Kampala for her care and had been febrile with severe flank pain for multiple days.  I was present the day she was admitted and continued to follow her.  There was a lack of operating theatre space and therefore after she received a blood transfusion for anemia, had a negative HIV test, and was persistently hypotensive and ill on a large crowded open air ward, intervention became urgent.  She was taken to a small procedure room where she received local anesthesia and had a dorsal lumbotomy to evacuate an infected retroperitoneal hematoma.  She walked back from the procedure room to the ward, flooring me with her strength and lack of complaints.  Her definitive diagnosis was never known although it was highly suspicious for advanced renal cancer and she sadly passed away a week after her procedure.  She is one of the many patients who presented in an extremely advanced state of disease.  Her humility, grace and strength are imprinted in my mind.
“During a selfish time of intense training tempered by chronic fatigue, IVUmed offered me a reprieve, a chance to rekindle some of my passion for medicine.  I made lasting friendships and adopted mentors at home and abroad.  This trip is an unforgettable, exciting step in my journey to work with underserved populations and global health efforts focusing on sustainability.  I am privileged to have had this opportunity and hope to continue my involvement with IVUmed as I finish residency.”
  
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IVUmed is committed to making quality urological care available to people worldwide.