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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.”

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“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 93rd “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.”

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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.”

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

Drs. Eugene Cone (left), Gopal Badlani (center), & Dima Raskolnikov (right)

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.”

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“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.”

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Dr. Maggie Lovin Shares Her Experience in Mongolia

 

Thanks to the generous support of the Southeastern Section of the American Urological Association, Dr. Maggie Lovin had an outstanding experience in Ulaanbaatar, Mongolia, where she worked with local urologists and patients at the National Center for Maternal and Child Health from October 20-28, 2018.

 

Dr. Lovin shares her experience:

“Our team was composed of two pediatric urologists, Dr. Carlos Angel and Dr. Angela Arlen and two pediatric anesthesiologists, Dr. Scott Stenquist and Dr. Laurie Steward, and myself. Our group bonded immediately, making working together effortless and enjoyable.

“We were hosted by the Pediatric Urology Department at National Center for Maternal and Child Health under the direction of Dr. Kurelbaatar Lkhagvademberrel. The 1500 bed hospital in the capital city is the main government referral hospital in Mongolia and provides free medical services to its patients through the national government insurance plan. There are six pediatric urologists serving approximately 1.2 million children in the country.

“After our flights, we got to work immediately the day we arrived to Ulaanbaatar. We conducted a busy 40 patient clinic that Sunday afternoon, booking 28 cases for the following week’s operating room schedule. We encountered a great variety of disease pathology including proximal hypospadias, ureteropelvic junction obstruction (UPJO), vesicoureteral reflux (VUR), urethral stricture, nephrolithiasis, epispadias-exstrophy complex, posterior urethral valves and disorders of sexual differentiation. We concluded our clinic Monday around mid-day, seeing 81 children in total.

“Monday afternoon, we began our surgical cases. We operated simultaneously with two surgical teams in separate operating rooms. This allowed ample time to teach the Mongolian surgeons the intricacies of several pediatric urologic procedures. The pediatric urologists were very eager to learn, and their enthusiasm for the workshop and their patients alike was contagious. In addition, this trip would not have been possible without our incredibly hard working operating room team, including the anesthesiologists, nurses and surgical scrub technicians. Together, we were able to treat several children with proximal hypospadias, ureteropelvic junction obstruction, vesicoureteral reflux and posterior urethral valves.

“On the last day of the workshop, we made rounds handing out soccer balls and toys to our patients to thank them for allowing us to be a part of their journey. The Mongolian parents presented us with Mongolian cashmere scarves and a traditional Mongolian game to thank us for helping their children. It was very touching to see people with so little to give, give so much.

“The Mongolian pediatric urologists made a conscious effort to make us feel at home in Ulaanbaatar. We worked hard all week, but took the afternoon of the last day off to have some fun. The Mongolian urologists took us sightseeing in the countryside. We rode camels, held eagles, and visited the Genghis Khan equestrian statue. The day ended with a Mongolian barbeque with our entire team.

“While this was my first global health mission, it certainly will not be my last. The people I met and the experiences I had in Mongolia have made an everlasting impact on my life. While there is great need for further pediatric urologic care in Mongolia and worldwide, organizations such as IVUmed are helping to bridge that gap. I would like to thank IVUmed and my physician mentors for this opportunity and I hope to use this experience as a stepping-stone to a lifelong commitment to international service.”

 

 

 

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“Amazing Opportunity” in Uganda

Drs. Eric Richter (urologist) and Edward Cobb (anesthesiologist) led general urology workshops at Fort Portal Government Regional Hospital and Mount Elgon Hospital in Uganda from October 26-November 10, 2018. Dr. Richter has led several IVUmed teams before and served as the team leader. The IVUmed team collaborated with local medical providers, including Dr. Fred Kirya, who helped organize the workshop.

Drs. Richter, Kirya, and Cobb served a multitude of patients, ranging from two-days-old to 90-years-old. They saw 86 patients, performed 51 surgeries, trained 21 doctors, and instructed six nurses. They would have operated on even more patients, but there was a lack of blood for possible simple prostatectomies.

Among others, Dr. Richter worked with two residents who traveled to Uganda from Tanzania for the workshop at Mount Elgon Hospital. He said training them was “very enjoyable and rewarding” and that they “were very interested in improving their endoscopic skills and TURP.”

The workshop at Fort Portal Government Regional Hospital was very busy. It was well publicized and there were many patients to see. Dr. Richter reported that they could have done cases for a few weeks and suggests that future IVUmed teams arrive a day earlier. He also reported that there is an anesthesiologist program at Fort Portal Government Regional Hospital and that those in the program seemed to learn a lot from Dr. Cobb.

Pleased with his experience, Dr. Richter said, “as always it is an amazing opportunity to conduct the workshops. Great satisfaction providing patient care and working with local medical staff. I look forward to continuing and growing my relationship with them.”

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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.”

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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.”

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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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