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