Country Spotlight: Vietnam

IVUmed collaborates with partners in more than 20 countries. Vietnam stands out as one of the very first countries IVUmed established relationships in.

The first IVUmed workshop in Vietnam was in Ho Chi Minh City, Vietnam in 1994. Since then, IVUmed volunteers have led 29 workshops in the country. While the first workshop in 1994 focused on pediatric urology, IVUmed now leads workshops focused on an array of different sub-fields, such as general urology, reconstructive urology, & endourology. Over the years, IVUmed expanded its partnerships in Vietnam and now collaborates with providers in Hue, San Pedro Sula, Nha Trang, & Danang, in addition to those in Ho Chi Minh City.

Jennifer Heckman, MD travelled to Hue, Vietnam in March of 2016. Dr. Heckman noted that “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.”

Given IVUmed’s long-standing partnerships in Vietnam, it isn’t surprising that IVUmed volunteers have served more than 700 patients in the country and provided more than $4 million in services. When IVUmed volunteers first began working with Vietnamese pediatric surgeons in 1994, there were fewer than 100 pediatric urology patients treated annually. Now, IVUmed’s partners run their own training programs and treat more than 1000 patients annually.

IVUmed volunteer Steven Kahan, MD has enjoyed multiple workshops in Vietnam. He comments that these workshops are “the purest form of medicine.” Dr. Kahan shared, “this is the reason I went to medical school. This was about working one on one with students, caring directly for patients and teaching other doctors new techniques so that they can in turn treat patients on their own when we leave.”

IVUmed volunteers in Vietnam consistently return home feeling fulfilled. This fulfillment stems not only from offering aid. IVUmed volunteers regularly gain new insights and even new surgical knowledge.

Tiffany Perkins, MD, who served as an IVUmed Resident Scholar, commented on the educational aspect of the experience. She remarked, “We had very interesting surgeries throughout the week including partial cystectomy for urachal mass, partial penectomy for penile cancer, radical orchiectomy for testicular mass, radical nephrectomy for renal mass, laparoscopic varicocelectomy, laparoscopic seminal vesicle mass excision, and multiple stone procedures including open pyelolithotomy as well as ureteroscopy. As a resident, I was grateful to participate in their surgeries and learn from the staff. I was very excited to perform my first open pyelolithotomy with Dr. Hung, as this case is not commonly done in the United States. I was very impressed with the resourcefulness and technical skills in the operating room. The urologists in Hue were very meticulous with their dissections maintaining very minimal blood loss and working through very small incisions.”

IVUmed workshops offer unique opportunities for growth, both for providers in low-resource countries and for IVUmed volunteers. The goal of every IVUmed workshop is to Teach One, Reach Many. However, this transmission of knowledge goes both ways. While our volunteers depart with the goal of teaching local providers how to perform specialized surgeries in urology, they return home with broadened cultural awareness, surgical capabilities, and, often, a greater sense of purpose.

Notes From Vietnam

Dr. Kyle Ericson, a urology resident at Cleveland Clinic, is enjoying an IVUmed workshop at Binh Dan Hospital in Ho Chi Minh City, Vietnam. Dr. Ericson is working under the guidance of Dr. Joel Gelman, who is a long-time IVUmed volunteer. They are joined by Drs. James Furr (Dr. Gelman’s reconstructive urology fellow), Alexander Doudt (IVUmed Resident Scholar), and Caitlin Shepherd (IVUmed Resident Scholar).

Dr. Ericson arrived in Vietnam on Saturday, March 23. You can peruse his photos and commentary below.

Dynamic Workshop in Kumasi, Ghana

Dr. Richard Yu, a pediatric urologist and long-time IVUmed volunteer, led a 9-person pediatric urology workshop in Kumasi Ghana from February 8-17, 2019. He was joined by:

• Paula Cruz (Operating Room Nurse)
• Dr. Bhalaajee Meenakshi-Sundaran (Pediatric Urologist)
• Dr. Vanessa Ortiz (Urology Resident)
• Dr. Sunil Patel (Urology Resident)
• Dr. Scott Stenquist (Pediatric Anesthesiologist)
• Dr. Laurie Steward (Pediatric Anesthesiologist)
• Dr. Kelly Swords (Pediatric Urologist)
• Andrea Van Lierop (Pediatric Nurse Practitioner)

The team worked with local surgeons and nurses at Komfo Anokye Teaching Hospital, including Drs. Ken Aboah & Arhin Addai, who helped plan the workshop.

IVUmed’s dedicated volunteers performed 35 surgeries throughout the week. The workshop exemplified IVUmed’s motto Teach One, Reach Many. IVUmed’s volunteers worked hard with local staff inside the operating room. Beyond this, Paula Cruz and Andrea Van Lierop dedicated ample time to ensuring local nurses gained a thorough grasp on the best way to handle perioperative and postoperative care.

The group thrived and enjoyed an outstanding and collaborative work dynamic. Dr. Yu commented, “this was by far the most satisfying [trip] that I have been on. In my mind, the trip was extremely successful in all of the critical areas – education, service, patient care – and every team member was fully engaged in the experience.” He added that “team cohesiveness was outstanding.”

Andrea Van Lierop beamed, “I felt like I was part of a wonderful team and so appreciated all of the opportunities to use my skills.” She left Ghana happy, commenting, “this trip made me more aware of the need to reach out to our fellow humans and help in any way we can. The most memorable experience was seeing the children after the operations and realizing we had made a difference.”

The success of every IVUmed workshop hinges on IVUmeds’ partners’ eagerness to learn and improve their understanding of urology. As always, the staff at Komfo Anoke Teaching Hospital shined during the workshop. Van Lierop commented, “the people were inspiring and so welcoming. They want to learn everything.”

We are grateful for our incredible volunteers, partners, and donors! You make it possible for IVUmed to continue expanding access to quality urological care. Thank you!

IVUmed Resident Scholar Andrew Eschenroeder Describes His Workshop in India

Thanks to the generous support of the Southeastern Section of the American Urological Association, Dr. Andrew Eschenroeder had an outstanding experience in Mahuva, Gujarat, India, where he volunteered his time at the annual Mahuva Camp at the Sabdhavna Trust Hospital in February 2019.

Dr. Eschenroeder shares his experience:

“In February 2019, I traveled to the Sadbhavna Trust Hospital in Mahuva, Gujarat, India to participate in the annual Mahuva Camp, a weeklong urologic surgery workshop. I accompanied Dr. Gopal Badlani and Dr. Joel Hancock from the United States and worked alongside four other Urologists from elsewhere in India who volunteered their time and expertise to the camp. Dr. Pravin Baldaniya is the Surgical Director of the hospital, a charity organization that serves a predominantly indigent and rural population. Along with a staff of two gynecologic surgeons and one general surgeon, Dr. Baldaniya and his team routinely perform 30-40 cases each day in a single operating theater containing 4 tables.

“Operatively, our days were busy with a wide variety of cases. There was a significant number of pelvic organ prolapse cases, as the camp was focused on training local surgeons in these techniques, while simultaneously covering the gamut of general urology cases. I personally performed 26 cases in 4.5 days and assisted on several others. At least half were endoscopic cases including ureteroscopy, monopolar TURP, TURBT, percutaneous cystolitholapaxy, and one table dedicated to PCNLs, which ran for the duration of each day. The remainder of the operative experience consisted of open pyeloplasties, pediatric ureteral reimplants, simple orchiectomies for metastatic prostate cancer, and laparoscopic renal cases.

“The experience was demanding—once familiar cases were cast in a new light with the paucity of equipment available, and several techniques were entirely novel. I was pushed to the limits of my abilities several times and felt grateful for the improvement I achieved under the guidance of the other visiting urologists. For cases that I had more experience performing, I was granted much more autonomy in this setting. The scrub nurses were excellent. Even though we couldn’t converse over the language barrier, we were able to operate efficiently with an unspoken understanding of the work at hand. My most memorable moment from the OR was during a ureteral re-implant, when the 9-year-old girl (who had spinal anesthesia) introduced herself and said ‘thank you” while I was finishing her operation.

“Outside of the OR, Dr. Baldaniya shared his community with us. We were able to meet the families of patients and other members of the small villages in the region. All were incredibly welcoming; we were invited into strangers’ homes for tea, meals, and we even attended our fair share of individual and group weddings—83 in total. Gujarat knows how to throw a party.

“The surgical and social experiences were equally affecting. The role of the surgeon in the community—his sense of duty to those he cared for and the gratitude they felt for his care—was manifest in all settings. He took consultations during social events as a matter of course. With his abilities, he could certainly have more for himself, and practice in any setting he desires. And yet, the obligation to serve his community both rewarded and motivated him more than any remuneration or fancier hospital could. This idea— the primacy of the patient and the duty, as a surgeon, to serve a community— was reflected in everyone serving at the camp. The staff, visiting surgeons, local surgeons, those who could converse with patients and those who couldn’t, were all guided by this motive that was rarely articulated. It struck me as the obvious reason why we go into medicine, and yet novel; maybe because the day-to-day of US medical practice obscures these ideas. I’ll keep this experience with me as I navigate my own career and seek out similar service opportunities in the future. I have experienced no better way to feel a true sense of purpose as a surgeon.”

“Purest Surgical Experience of My Life”

Thanks to the generous support of the Southeastern Section of the American Urological Association, Dr. Eugene Cone had an outstanding experience in Bhopal, India, where he worked with Jeev Sewa Sansthan (JSS) in December 2018.

Dr. Cone shares his experience:

“In December of 2018 I travelled with Dr. Gopal Badlani and Dr. Dima Raskolnikov to Bhopal, India to participate in the 93^rd “Mega Free Urology Camp” sponsored by Jeev Sewa Sansthan (JSS). My time in Bhopal was both challenging and inspiring, and I returned to the US with a renewed sense of purpose and passion for the work we do.

“Jeev Sewa Sansthan (JSS) is a philanthropic Bhopali organization that provides education and healthcare opportunities to the area’s impoverished. Since 1994, the organization has sponsored urology camps that take place over a period of 5-7 days at a local eye hospital. Bringing together surgical staff, residents, and attendings from all over the world (including Dr. Badlani and other IVUmed volunteers) these camps offer completely free care to patients regardless of background or religion.

“The camps, at this point, are a well-oiled machine. The on-site clinics hum with a steady stream of patients undergoing pre-operative evaluation and treatment of non-operative problems. The three ORs have a throughput of 20-30 patients per day, decreasing turnover time almost to zero with all cases performed under spinal anesthesia and cases staggered between the two beds in each room. The post-operative ward (a large space, roughly the size of a gymnasium) is filled with patients in various states of convalescence, being tended to by family members and volunteers. The deliverance of such high quality care in such logistically challenging circumstances is truly impressive.

“I spent the vast majority of my time operating, with a heavy mix of TURPs, DVIUs, PNLs, and occasional open cases for bladder stone removal or circumcisions. Although the cases were familiar, I found myself continually challenged to do more, faster, with less. All equipment was reused (wires, dilators, resection loops/buttons, scopes, etc. were sterilized in an autoclave or in basins of antiseptic between cases), all scopes were rigid (the concept of a disposable flexible ureteroscope felt embarrassingly lavish), and catheter selection was limited. The hardest thing to get used to was operating in flip-flops (a mandatory aspect of these ORs), especially for longer, bloodier TURPs. Nonetheless, I never felt as though we were compromising on the quality of care, and the team spirit of the camp was contagious.

“When I reflect on my time in Bhopal, it shines as one of the purest surgical experiences of my life. There were no concerns about billing, compliance with documentation, or insurance coverage. Operations were performed without regard to anything other than medical indication, and the gratitude that each patient and their family members expressed will stay with me forever. I am now considering how to incorporate international volunteerism into my future practice in a way I never previously have, and will be forever grateful to IVUmed, its donors, and my mentors in Bhopal for an eye-opening experience.”

Career Changed Forever – Dr. Smith’s Workshop in Senegal

Thanks to the generous support of the New York Section of the American Urological Association, Matthew Smith, Jr., MD had an outstanding experience in Dakar, Senegal where he worked with Kurt McCammon, MD from January 13-18.

Dr. Smith shares his experience:

“I recently returned from my trip to Dakar, Senegal. I arrived in Senegal on Sunday and immediately felt at home. The entire trip was amazing. There was time for sightseeing, visiting museums, and learning to surf off the coast of Africa. Although I do not speak any French whatsoever, I was able to negotiate cab fares and barter for souvenirs.

“When we arrived at the hospital it was clear that Dr. McCammon was thoroughly loved by everyone in the urology department. Over the next few days, Dr McCammon took me, the other American resident, and the few Senegalese residents through complex urethroplasties. We preformed retrograde urethrograms and evaluated the results of pelvic traumas from years before. Patients’ charts told stories of multiple attempts at reconstruction, anastomosis to false passages, and failed buccal mucosal grafts.  Most importantly the attending urologist told stories of techniques he learned and surgical success as the result of past trips.

“This trip definitely changed the course of my career forever. There will be a substantial component of international medicine and I would love to be an attending taking residents through surgeries and teaching surgeons overseas. I can’t wait to visit more countries and would be honored to do so through IVUmed.”

Fulfilling, Inspiring, & Humbling – Dr. Raskolnikov’s Workshop in India

Thanks to the generous support of the Western Section of the American Urological Association, Dr. Dima Raskolnikov had an outstanding experience in Bhopal, India, where he worked with Jeev Sewa Sansthan (JSS) from December 8-14, 2018.

Dr. Raskolnikov shares his experience:

“With the support of the IVUmed Traveling Resident Scholar Program, this December I was fortunate to volunteer in Bhopal, India under the mentorship of Dr. Gopal Badlani. To say that I was excited for this opportunity is an understatement. For months before the trip, I read everything that I could about the organization with which we would work, prior residents’ experiences through IVUmed, and Bhopal itself. Even then, I was unprepared. Our work quickly reinforced what I had already grown to believe: the best approach to international medical volunteer work – and only approach, really – is to be flexible, open-minded, and willing to help in whatever way is needed.

“Founded in 1994, Jeev Sewa Sansthan (JSS) is a philanthropic organization based in Bhopal that works to improve education, reduce poverty, and expand access to healthcare. As part of its mission, JSS sponsors urology “camps” at the Sewa Sedan Eye Hospital. These week-long events bring surgical teams from across India and abroad to provide free urological care to anyone who requests it. Patients are evaluated, treated, and directed to follow-up with local urologists. In a typical camp workday, 20-30 patients would undergo surgery in our 3 ORs. Even more impressively, this was the 93rd such urology camp sponsored by JSS. It is truly a massive logistical undertaking.

“On my first OR day, I was greeted by a familiar sight: a list of patients scheduled for TURPs, PCNLs, and a mix of open general urology cases. Perfect, I thought. I have some comfort with these cases, and while the list looked long, I was eager to get to work. What followed were days of surgery that were fulfilling, inspiring, and humbling. These first two reactions are easiest to explain: everyone at the camp – ranging from urologists, to technicians, to support staff behind the scenes – was excited to be there. The patients we were helping truly had nowhere else to turn. Even with a language barrier limiting our interactions, the gratitude in the expressions of patients and their families was obvious. I felt truly fortunate to be a part of the surgical team. At the same time, the cases themselves proved humbling; the surgical techniques I had developed in the U.S. just weren’t entirely translatable. When talking through a PCNL, for example, how do you explain your plan for “clean-up ureteroscopy” in a place that can’t afford even one such instrument, let alone one for every case? The thought that some of these tools are considered disposable back home was even more difficult to reconcile.

“Ultimately, these and other limitations proved to be obstacles to overcome rather than true barriers to providing excellent care. I learned a tremendous amount from my time in Bhopal and am immensely grateful to IVUmed, Dr. Badlani, and the local staff for helping to make this possible.”

“Wonderful Opportunity” in Senegal

With the support of Caldera Medical, a three-person IVUmed team, led by Dr. Susan Kalota, traveled to Dakar, Senegal to lead a urogynecology workshop from November 16-25, 2018. Dr. Kalota (urologist) was joined by Dr. Lindsey Kerr (urologist) and Dr. James Daucher (obstetrician-gynecologist).

The workshop truly embodied IVUmed’s mission to “Teach One,Reach Many.” Rather than focusing on completing as many surgeries as possible, the goal of this trip was to adequately train local providers. Dr. Kalota reported, “Each case we did was done by a resident or local attending, with us doing only the first procedure or stitch. We ended the week with a case conference, going over each of the cases and what worked, what didn’t, what we thought was important, etc. The participants got to ask questions about the surgeries and the “what ifs.” They expressed the sentiment that they felt it was very useful because they actually were doing the surgeries and we could guide their hands as needed and keep them out of trouble as needed.” Dr. Kalota reported that this was the best IVUmed trip she’s been on and would like to maintain the focus of coaching residents to do cases during future trips.

Dr. Kerr finished the workshop and reported, “it’s been a great week.” She and Dr. Kalota agreed that having a gynecologist, Dr. Daucher, was very useful. They hope future trips will be staffed with a gynecologist as well. Dr. Daucher commented that the trip was a “wonderful opportunity to teach physicians in training and attending physicians basic and advanced urologic procedures.”

Potential in Mongolia

An IVUmed team traveled to Ulaanbaatar, Mongolia for a pediatric urology workshop at the National Center for Maternal and Child Health from October 20-28, 2018. Dr. Carlos Angel (pediatric surgeon) led the team and was joined by Dr. Angela Arlen (pediatric urologist), Dr. Jennifer Lovin (urology resident), Dr. Scott Stenquist (pediatric anesthesiologist), and Dr. Laurie Steward (pediatric anesthesiologist). The IVUmed team collaborated with local medical providers, including Dr. Khurelbaatar, who helped organize the workshop.

The IVUmed team served children suffering from pediatric urological conditions while training local doctors and nurses. During the workshop, the team served 81 children with complex conditions. They performed 30 surgeries on 26 patients.

Dr. Angel reported that the site was incredibly organized and that the workshop ran like clockwork. The staff was eager to learn and collaborate. He related that there are only six pediatric urologists in Mongolia, which has a population of 3 million people, demonstrating a need for these workshops. Dr. Angel noted that this site has a lot of potential and recommends that IVUmed lead two workshops at this facility per year going forward.

Dr. Arlen echoed Dr. Angel’s positive impression of the site. In addition to recommending two IVUmed workshops per year, Dr. Arlen wishes to return as a member of one of those teams. She said the site is ready to take off and eager for IVUmed’s support.

Dr. Scott Stenquist reported that the local staff was very engaged in the workshop. He commented that the facility was very nice and that there was “excellent local anesthesia staff.” He noted that “the Urology Chairman [is] very committed to improving urologic care in his hospital.”

Dr. Lovin assisted the team as an IVUmed Resident Scholar and thought the experience was very rewarding. She returned home saying that she felt like she had gotten more out of the trip than she gave. She added, “I am very fortunate to have been given the opportunity to volunteer with IVUmed in Mongolia.” She reported, “I could not have asked for a better group of people to complete a mission with! Carlos was an excellent leader. Angela, Scott, and Laurie were all very engaged and eager to learn. The Mongolian urologists went out of their way to make sure we were well taken care of, and the patients and families were so grateful for the work that we did. At the end of the workshop, all of the patients pooled their funds and gave us each a cashmere scarf and an authentic Mongolian game. It was so special to be able to help these children and families.”

Teaching and Learning in Mozambique

An IVUmed team traveled to Maputo, Mozambique for a pediatric urology workshop at Hospital Central de Maputo. Drs. Heidi Stephany and Christina Ching led the team and were joined by Tina Zeigler, RN (pediatric nurse), Dr. Christine Ayoub (anesthesiologist), and Dr. Molly Elmer-DeWitt (resident). The team was joined by a photojournalist, Tate Drucker, who documented part of the workshop.

The IVUmed team served children suffering from pediatric urological conditions while training local doctors and nurses. During the workshop, the team served 47 children with complex conditions. They saw five kids with disorders of sexual differentiation, four suffering from bladder exstrophy (one of which an IVUmed team saw last year and was doing very well), three pelvic trauma/urethral strictures, and many children with complex proximal hypospadias. The team scheduled a total of 17 surgeries for the week and successfully completed 15 complex cases. The two cases they were not able to complete due to their busy schedule were performed by local surgeons the following week.

Dr. Molly Elmer-DeWitt stated that the workshop, “was an incredible experience.” She added, “the need was so great and the local team so enthusiastic and excited to learn. I wish I could have stayed for longer and wish I could go back a few times a year! I hope that IVUmed continues to support this vital work and I hope to get more involved in coming years.”

After the trip, Katrina Zeigler said, “this was my fifth trip with IVUmed. They are always humbling. These are the kindest families who are so thankful. As a retired pediatric nurse I am able to keep my skills current and learn to work with the supplies on hand. Dr. Stephany is the best. Her skills are like ‘magic.’ I always enjoy being with her on these trips. Seeing the smiles on the faces of these young boys that we have given a new life to is overwhelming.”