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An Incredible Learning Experience in Mongolia

Dr. Amy Lim shares her experience from Mongolia, which was sponsored by the Society of Urologic Oncology:

“I have always been interested in participating in a global health trip. However, unless your home institution has an established global health program, it is very difficult to find opportunities to volunteer and participate abroad as a resident. As a result of the generosity of the Society of Urologic Oncology’s sponsorship of an IVUmed resident scholar, I was able to fulfill a longtime aspiration of participating in a global health trip, which ultimately solidified my plans to make global health a part of my practice in the future.

“Ulaanbaatar is the capital of Mongolia with almost half of the entire population residing in the city. The host hospital was the First Central Hospital of Mongolia and was located within walking distance of our hotel. My mentor on the trip was Dr. John Colberg, a urologic oncologist who practices at Yale. This was the first time I had met Dr. Colberg and realized very quickly that I was lucky to have the opportunity to work with him.

“We started seeing patients in clinic the day after we landed. Prior to our arrival, a summary presentation of some of the patients we would be seeing that day was available for our review, which helped the day run efficiently. Every patient brought their paper medical record and their images for our review. By the end of the day we had scheduled 13 major oncology cases to be done over the next 4 days. The high yield learning cases for the local surgeons included partial nephrectomies and cystectomies with neobladders as these were rarely, if ever, done at this hospital.

“The next four days were spent operating all day. There were two first start rooms with Dr. Colberg starting in one room and a senior faculty member starting in the second room. The faculty crowded around Dr. Colberg as he took them through the cases. Once he finished in one room, he would check in on the next room to see how they were progressing and would scrub in and offer tips and suggestions. It was a very collaborative learning environment. I also had the opportunity to share what I have learned throughout residency with the staff and vice versa. In addition to our own scheduled cases, there were occasions where we were called to assist with other cases throughout the day. The days were long and physical, but very rewarding. Operating with their staff and Dr. Colberg is one of the highlights of my entire residency.

“The fifth day was used as an opportunity to explore Mongolia with a junior staff member. We saw the beautiful and vast countryside, an impressive 130ft tall status of Genghis Khan and were able to check out some famous Mongolian cashmere. Our farewell dinner was followed by karaoke and gave us the opportunity to really get to know the staff. Their generosity and kindness was overwhelming and left a lasting impression on me. They have continued to keep in touch keeping us updated on the pathology and post-operative course. I cannot express my gratitude enough for the SUO in supporting a resident scholar, the IVUmed program, the Department of Urology of the First Central Hospital of Mongolia and Dr. Colberg for making this incredible learning experience a possibility.”

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Dr. Chip Carnes Shares his Experience in Haiti

Thanks to the outstanding support of the Southeastern Section of the AUA, Dr. Alan Chip Carnes had an excellent experience in Cap Haitien, Haiti where he and his mentor urologists, Dr. Joseph Costa and Dr. Joseph Babiarz, worked with local urologists on reconstructive urology and served patients in need.

Dr. Carnes relates his impressions of the experience:
“We arrived in Haiti on Saturday. Our team leaders consisted of two Urology attendings, Dr. Joseph Costa and Dr. Joseph Babiarz. Additionally, I attended as Urology resident and Dr. Sabine Nguyen attended as an internal medicine resident with interests in Urology. We had a great support staff with a veteran anesthesia team with many Haitian trips under their belt as well as a knowledgeable and enthusiastic perioperative nurse, Statia Smith. I had previously visited developing countries in Central America and the Caribbean with other trips whose purpose was providing aid of some sort, but this was a new and unique experience for me.

“Of course, the most rewarding and memorable experiences from the trip involved the Haitian attending Jori Desir and his several Urology residents who were eager to learn. It was Dr. Desir who initially picked us up from the airport and served as our introduction to the city of Cap Haitien. We hit the ground running with a tour of the hospital, urology facilities, the operating room, and some of the patients we would later be operating on. It was soon clear that the Haitian doctors were competent and greatly valued their patients. We saw how they made do with only one working operating room even though they were often boxed out by other services.

“The next day we began our work in earnest by meeting more patients and completing workups for specific problems. It was this day that I first learned what a “wet read” really was. Several of our patients were suffering with urethral stricture disease prompting us to obtain retrograde urethrograms. Dr. Nguyen and I helped an efficient X-ray staff operate an ancient X-ray machine and develop the films. We met several men who had been previously treated for BPH but now had developed urethral strictures. The Haitian Urology team had successfully diverted their urine with placement of suprapubic catheters, but they were unsure how to proceed. We also met two women in particular who had endured prolonged labor resulting in vesicovaginal fistulas. Each history was meticulously recorded by us and the Haitian team as we set the schedule for the week.

“Over the next four days we were able to repair two vesicovaginal fistulas and six urethral strictures, two of which required buccal mucosa grafts. These were complicated surgeries, but Drs. Costa and Babiarz always focused on the Haitian Urology team and making sure they were leading the operations. We quickly developed a routine that maximized learning for all participants. For each case we demonstrated to the Haitian team what supplies would be needed, many provided by us. Dr. Nguyen showed lower level residents how to operate a back table which allowed for greater speed and efficiency during cases. This all facilitated the American attendings teaching Dr. Desir and his upper level residents, who by the end of the week were able to perform an end-to-end anastomosis urethroplasty almost without assistance. On the other side of the drape, our veteran American anesthesia counterparts were teaching their Haitian anesthesia team as well. Furthermore, we were able to leave the Urologists with gifts we knew they would take care of and use well: a new flexible cystoscope and Bovie electrocautery machine.

“I greatly enjoyed my time in Haiti, and have already put in practice some of the things I learned there doing similar cases in the US. I am most thankful, however, for the chance to meet a great team, work with caring people, and have an opportunity for future work with IVU.”

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Read Dr. Prabhakar Mithal’s Insights from Senegal

“Ever since I encountered their booth at AUA as a medical student, I had been hoping to take part in one of IVUmed’s trips. Now, as a 4th year urology resident, the wait was over and I was about to land in Dakar, Senegal – a city and country on a continent to which I had never been! We were greeted warmly at the brand new airport by Dr. Mohamed Jalloh and, after piling our suitcases atop a van, we zipped towards our hotel through the arid red desert-like land punctuated by gnarly baobab trees and flashes of bright color on the traditional dresses of Senegalese women walking on the road.

“After a brief rest at the hotel, we visited the urology clinic at Hopital General de Grand Yoff (HOGGY). Dr. Jalloh led us through a maze of airy corridors to the clinic where about 20 patients with complex urethral injury were waiting to be evaluated as operative candidates for the upcoming week. Patients came in one by one, were laid on a simple examination bed and their imaging held up to the light. I encountered about as many PFUDs, often the result of motor vehicle accidents, as I had in my entire residency.

“Because our trip coincided with URODAK, a biannual Pan-African conference held in Senegal, several urologists including those from IVUmed, were demonstrating surgeries at HOGGY to resident and faculty observers from across Africa. In addition to complex urethroplasties, procedures being performed included VVF repairs, perineal prostatectomies, ureteroscopies and PCNLs. There was more going on than I had time to witness, though I was able to assist on multiple complex urethroplasties and a perineal prostatectomy, as well as observe VVF repairs and ultrasound-guided PCNLs.

“I came away from my IVUmed experience with feelings of admiration for the people I worked with in Senegal who helped me broaden my understanding of what it means to work internationally in urology. The urologists at HOGGY operate with limited resources by our standards back home. On a daily basis they work hard to improve the care they give their patients and the education they provide their trainees, in part by engaging with experts from abroad who can at times come with unrealistic expectations.

“Visiting urologists sacrifice their time regularly, even if it means travelling across the world during vacation on an annual basis. It is more apparent to me now that international work is almost never built in to a urologist’s job and is especially challenging for young urologists to engage in due to the demands of their training and early career development. Thus, I’m grateful for the rare opportunity afforded to me by IVUmed and the many pathways it has opened for me going forward. Perhaps most importantly, I’m excited to have made valuable connections with so many people who are passionate about furthering the level of urology being practiced around the world. I look forward to many more international endeavors in urology!

“Thank you to all who made my experience in Senegal possible including our hosts in the Department of Urology at HOGGY, IVUmed, the Northeastern section of the AUA, and the University of Rochester Department of Urology.”

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As another stellar team of IVUmed volunteers heads to Vietnam, read about Dr. Tiffany Perkins’s experience there

“Traveling to Hue, Vietnam with IVUmed was an amazing opportunity, and I am grateful for being invited to participate on this trip to experience a different culture and practice of urology in a different part of the world.

“On the first day, I arrived very exhausted from 24 hours of traveling yet overcome with excitement to begin the week’s journey. The staff picked me up from the airport and drove me to my hotel. As we drove into town, beautiful scenery as well as the countless number of motorcycles speeding along the streets amazed me. At the hotel, I met with the rest of the IVUmed team – Dr. Colberg, Dr. Sonmez, and Tania Hossin (NP). Dr. Hung, one of the local urologists in Hue, picked us up and we went to Hue Central Hospital to meet and discuss some of our patients for the week.

“We gathered in a small conference room along with a few urologists and urology residents from Hue to review the patients for the week. We met each of the patients individually in the conference room while we reviewed their medical records and discussed our surgical plans. The urologists and residents were very friendly and welcoming to the IVUmed team. They asked for our suggestions and input on each of the cases.

“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.

“Most of the urologists in Hue spoke English, but majority of the patient’s did not. We depended on our Vietnamese colleagues to help us translate and communicate with the patients. Despite the language barrier, all of the patients, staff, and students we interacted with were very friendly and welcoming to us.

“We spent a significant amount of time working with the medical students in the OR as well as in the classroom. We had daily class discussions pertaining to urology as well as medical training in general. On the last day of our trip, Dr. Sonmez gave a great lecture on renal cell cancer for the medical school and staff.

“Immersing myself in a different culture and way of life in Hue, Vietnam was an amazing experience. I appreciated the opportunity to see how urology is practiced in a different country, and to exchange both ideas and surgical techniques. Finally, I enjoyed the opportunity to work with a diverse group of people with a common interest in urology and global health.”

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Follow our volunteers to Haiti

Dr. Frank Burks and his reconstructive urology team just returned from Port-au-Prince, Haiti. Later this month, Drs. Joe Costa and Henri Lanctin lead another group to Cap Haitien. Thank you to all of our dedicated volunteers.

 

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Read about IVUmed’s collaborative work in Trinidad through the experience of Dr. Ian Metzler, IVUmed Resident Scholar and new board member

“Global health has been a long-time interest for me, and providing more specialized care to less fortunate people has been a priority. I started working with IVUmed in medical school to develop a data driven intake form to track hypospadias patients. I travelled to Senegal and Vietnam to perform this research and was thrilled to see the productive and personal relationships that had developed between US-based urologists and their local counterparts over the years. This experience fueled my career goals when applying to a urology residency.

“Thanks to the generosity of the SUFU IVUmed resident scholarship I was given another opportunity to work with IVUmed during the end of my residency. In the fall of 2018, I was able to join Dr. Kurt McCammon and his team, including his fellow and pelvic floor physical therapist, to travel to San Fernando General Hospital in Trinidad for a female reconstruction workshop. Clinically, the opportunity to work with Dr. McCammon on female reconstruction was extremely valuable to me because the female cases was one of the least strong areas of exposure during residency. Learning the preoperative assessment of prolapse and incontinence, and when not to operate, was as critical as the surgical techniques demonstrated through the workshop. This was particularly clear with a young woman who had seen so many local doctors and was scheduled for incontinence surgery as part of our workshop. When appropriately questioned, it became clear that she was suffering from pelvic floor dysfunction and had urge incontinence. We were so lucky to have Erin Glace, pelvic floor PT specialist, who worked with the local PT and the patient on exercises she could do at home. This patient, and several asymptomatic prolapse patients, demonstrated how important the preoperative work up and counseling was to proper treatment, especially in female urology.

“In addition to the clinical exposure, I was able to attend the Annual Conference of the Caribbean Urologic Association. The presentations were varied and interesting, although sometimes lacking in the numbers needed for rigorous statistical analysis, they were commendable given the structural challenges of doing research in these settings. Meeting with the urologists that were performing this research was very insightful regarding the challenges they face. Currently at UCSF, I am working with faculty and other interested residents on a survey of international urologists to identify the most common challenges in providing urologic care in low-resource settings. Continuing my relationship with IVUmed and participating in the Caribbean Urologic Association gave me more connections and future partnerships to continue this work.

“Some of the most impressive research was undertaken by the residents of the San Fernando Hospital Urology Department. Each resident gave a short talk on their research project. These were generally small cohort disease or treatment studies. There was a dedicated afternoon session for resident research where talks were on academic development, although during one of these sessions it was admitted that many of the urology faculty had no published papers and many of the residents were more advanced in this than them. After discussing the need for further academic mentorship with the senior urology residents, we developed the idea to create a collaborative forum for students interested in pursuing further research and to run ideas by those in large academic centers and the US. The IVUmed Academic Urology Collaborative was born, the goal of which is to identify US-based mentors in academic urology and pair them with residents and junior faculty at IVUmed sites that have research questions and potential projects that need more guidance. The goal is to broaden the effect of IVUmed partnerships and begin fostering academic growth at centers in developing countries to prevent brain-drain and diversify the academic urologic literature.”

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Read Dr. Paulas Vyas’s Reflections on His Experience in Mexico

Reflecting on his experience in Mexico, Dr. Paulas Vyas wrote:

“The IVUmed trip to Mexico was a wonderful experience, augmented by a great host and trip leaders. While volunteerism has been a long-standing passion, IVUmed provided the ability to do so specific to my training and specialty. I was able to meet Drs. McCammon and Aube at the Atlanta airport on the way to Monterrey, Mexico; both proved to be great mentors and companions for the duration of the trip. Upon reaching our host, Dr. Suarez, lived up to every compliment spoken about him prior to arrival.

“Our first hospital in Saltillo was a great example of the purpose of our trip; the reconstructive surgeries Dr. Suarez and his colleagues had arranged for us proved to be perfect surgeries in which the OR attendees included general surgery residents, Ob / Gyn residents, and their faculty. We were able to not only describe to them the procedures, but also help guide them through the steps with their active involvement. These surgeries and the hospital also provided an insight into how a resource-limited environment is able to practice within its means yet still provide good quality of care.

“Upon completion of our time in Saltillo, we traveled to Monterrey. Monterrey exhibited a completely different environment; we were able to meet and connect with local physicians, including some from various locations, while operating with local urologists and urology residents. We were able to share knowledge of our practice while watching presentations and lectures regarding their techniques. During our time there, we were able to operate alongside the local urology residents and understand their training and how their hospitals and practice function. As part of the educational aspect of the trip, we performed a video broadcasted surgery of a urethroplasty with a buccal mucosa graft.

“Culturally, the trip provided a fulfilling experience of the local cuisine and activities. Dr. Suarez arranged for us to not only try many of the local restaurants, but also attend a local soccer match. Thus, this IVUmed trip was a very fulfilling trip – both in its mission of providing an educational experience for local healthcare professionals, but also in the personal growth and development of us as urology practitioners in the US. It was obvious that there is the opportunity to help in other countries, and in our discussions, we learned that there may even be a further need for specialized care such as pediatric urology, in these locations. I will certainly recommend IVUmed to co-residents and anyone interested in reaching out beyond our day-to-day practice.”

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Nate Jung, MD reflects on his experience in India

Thanks to the generous support of the Southeastern Section of the AUA, Dr. Nathan Jung had an impactful experience in Bhopal, India where he worked with local personnel to provide care for people in need.

Dr. Jung stated about his experience:

“India was my first choice and fortunately I was able to receive the opportunity to work there.  I was able to work with some of the leaders in my field including Dr. Raju Thomas.  I was also able to work with a colleague from a different program, Katie Rydze.  She was a 5th year resident who was also volunteering at the camp. Our standard days at the camp were much different than the days I experience at my “regular” work week.  We would wake up early in our lodging have breakfast and then go to the camp to get started with rounds.  Rounds needed to be translated and notes were written.  After starting the day by rounding we would then proceed to the operating rooms where we would get started on our cases.  The simple things we take for granted could not be taken for granted in Bhopal.  One striking example of this is a patient in “pre-op” who had to hold their own IV bag above their head as there were no IV poles available.  We also operated in operating suites with two beds per room, something I had never seen before.   After our cases we generally went back to our lodge and had dinner and usually went to sleep.

“Many unique things happened while in Bhopal.  I got to participate in three major cases which included some anatomy I had rarely seen before.  We also had plenty of opportunity to improve as we did about 35 cases per day while in Bhopal.  We were also doing all of these cases under a high spinal anesthetic.  This was new to me as we rarely use spinal anesthesia in our institution.  I was impressed with the results.  Fortunately for me my trip was not only for medical learning but also for cultural learning as well.  I had the opportunity to see the Taj Mahal!  This is truly something I will never forget.

“In the end I think that I can identify three things that were truly special about this opportunity.  The first thing is that it allowed me to re-examine why I became a physician and re-explore that choice.  This is something that I think we all need to constantly remind ourselves of as this can get lost quickly in the day to day struggle of running an effective service.  The second thing that I will keep with me forever is the perspective gained on healthcare around the world and how different each system is and how fortunate I am to train in a system with many advantages.  Thirdly, I think that it is obvious that from a purely medical/surgical perspective I have become a better urologist through the opportunities I had to struggle through difficult situations requiring adaptation without the comforts of my own equipment. Thank you for the opportunity!”

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Thank You!

Thank you to everyone who supported our 2018 Teach One, Reach Many Benefit in Salt Lake City. It was a wonderful event and will help support our life-changing programs in the months to come.

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IVUmed is committed to making quality urological care available to people worldwide.