Photo Journal

Here are some photos of the trip. Enjoy!

Such Sweet Sorrow

The trip is finally over. The last day in Tapachula, we rounded on our remaining patients, and then spent the rest of the day exploring the city. Tapachula is a bit different from a lot of cities I've visited in Mexico, in that there are almost no American or touristy places. It's also a good bit poorer, as is frequently seen in southern Mexico, meaning there are a lot of people making ends meet by selling wares on the street. We visited the museum in the town square which detailed the Olmec history of the area and its former glory. We ended the day with a dinner at the hotel and getting ready for the long trip back.

After a layover in Mexico City where we all said our goodbyes (except myself and Grant, we flew on the same plane to ATL), I finally made it back home intact. In all, we performed 44 cases in 5 days with few morbidities, no mortalities, and a boatload of memories to last a lifetime. I expanding my surgical armamentarium, refreshed my spirit, and grew as a person from this experience. I feel blessed and grateful for the opportunity given to me by IVU, GHO and CMDA. This trip has reaffirmed my decision to take care of those most in need, and my desire to do this at home and abroad.

I'm glad to be home amongst my friends and family, and I hope you enjoy the pics.

Peace, Love, Kelvin

~Kmoses

Week 2 in Ho Chi Minh City

At the end of one week Matt and I probably assisted/performed ~44 cases combined - everything from anatrophic nephrolithotomies to lap adrenalectomy to mitrofanoff diversion and varicocelectomies. The majority of cases revolve around stone disease with other pathology sprinkled in. The retroperitoneal surgical skills of the urologist here in Vietnam, whether lap or open, continue to impress us as well as their speed in the OR. The efficiency of the OR is also quite impressive- one patient is barely out of the room before the next one walks in with IV bag in hand and gets situated for anesthesia (if only this happened in the US).

Everyone has been very friendly and welcoming and excited to practice speaking english with us. We've become fairly adept at getting around the city and crossing the street without risking limb from a moped collision. This past weekend we were invited to take a trip with the GU department to the "Highlands" about 2-3 hrs by car north of Ho Chi Minh City. We worked a 1/2 day Saturday and the departed arriving early evening to a bonfire and cook-out Vietnamese style in the fresh air of the 'Highlands'. Cuisine included grilled shrimp, small wild birds (like pheasant?) - head included, squid kabobs and large chicken feet among other things. We went for a hike and jeep ride to see ancient caves, the bamboo forest, rode horses and went swimming as well. overall a great break from the city minus the dicey highway driving that can occur in Vietnam.

Have lots of great pictures to post and will do so upon return to the US in several days. In the meantime, will continue to enjoy the great operative experience and sights of this fascinating city.

~Twill

Rolling Stones...

Thursday was our last day operating, and as it usually happens, all heck breaks loose on days like that. Things started pretty well with a gentleman who had been having trouble urinating for years, who was found to have a large prostate and a `stone`. We decided to scope him first, and I saw what appeared to be a large jack stone, and a slightly enlarged prostate. We decided to open him up, and lo and behold, he had a HUGE stone in his bladder, at least 4 or 5cm. The pics will be quite illustrative of our surprise after digging this thing out. Later we spent over an hour trying to get a larger suprapubic tube in our Fournier´s patient from earlier this week. The last case was a Jehovah´s witness patient who had previously had a channel TURP earlier in the week, and we were now bringing back for stone retrieval. Using a Lowsley grasper (which before this trip I didn´t even know existed), I pulled out about 6 stones, with minimal visualization. After a long day, and literally a pain in my neck, we finally wrapped up with rounds and headed back for a delicious dinner.

I´ll let you guess what the weather was like.

Friday, we rounded on the patients while the rest of the team packed up the OR. Our patients have done amazingly well. All of our flank incision patients have done remarkably seeing as how there are no narcotic drugs available, and other than a couple of doses of toradol and tylenol, have basically gotten by with ice packs and were ready to go within a couple of days. Our prostatectomy also did very well and is already home.

After rounds we took a bus ride up into the mountains and ate a deliciuos lunch at a roadside cafe, where the main dishes were walking around in the front yard. We then went further up into the mountains, close to the Guatemalan border, where the coffee growers live and work. We stopped at a house that was built in the 20s by the brother of Eva Braun (wife of Adolf Hitler), who was a coffee plantation owner. Because it was such a high altitude, it was actually much cooler than in Tapachula, and there was a pretty constant drizzle, broken up by sporadic rainshowers.

We got back to Tapachula later in the evening, and after a short siesta, we had a fantastic dinner at a restaurant on the edge of the city. Dr. Rodriguez sent us off with a beautiful message, and we also celebrated Ricardo´s 34th birthday.

Again, I cannot say enough about how spiritually fulfilling and refreshing this trip has been for me. Despite working just as hard as I do at home, I feel no stress, I feel closer to my patients and co-workers as we are working towards a similar goal without layers of paperwork and nonsensical rules separating us, and I appreciate the training that I have received thus far, which has guided me even in unfamiliar cases.

I do miss home and look forward to returning soon.

~Kmoses

Vietnam -- Saigon

Greetings from Vietnam! The three of us (Steve, Tom, and Matt) are here blogging for the first time. We've spent the past four days in a large public hospital with 260 devoted urology beds. To all of our suprise, the laparoscopic skills of the urologists here in Vietnam are at the forefront of the field. They also continue to perform large volumes of open renal surgery, particularly for stone disease. As of today we have done several open pyeloplasties, varicocelectomies, TURPs, ureterolithotomies (both open and laparoscopic), among others. The food and weather are both hot and sticky. We feel a little left out without a motor scooter, but it is probably safer that way. Pho ("noodle soup") has become a staple for breakfast, lunch, and dinner...pho sho'. The Vietnamese have been wonderful hosts. Tonight we have been invited to attend a dinner with the hospital president and the urology staff. We'll keep you updated along the way. We're enjoying the experience. Steve will be leaving on Saturday, much to the disappointment of the Vietnamese women.

~Twill

A Little Excitement Goes A Long Way

Another stone bit the dust today. I did a pyelolithotomy with Dr. Singleton today on a 34yo woman who had a stone for over three years. All went pretty well. The rest of the day was TURPs, which thankfully, so far have been pretty uneventful. But today it seems as though something was in the water. One of the patients went into bronchospasm on the table, requiring quick conversion from spinal anesthesia to intubation. His sats didn´t get better, and he suddenly tanked. So the ET tube was pulled and an LMA was placed even more quickly and he settled out nicely after that. Afternoon rounds were fairly benign except for one patient who went into retention and was febrile. Hopefully he´ll be ok.

Tomorrow we have only cysto/TURP cases so I hope to get some more TURPs under my belt.

Yesterday´s nice weather was an aberration, as I suspected.

I haven´t had a better trip in years.

More later.

~Kmoses

At Least It Didn't Rain

Yesterday was one of the busiest as far as cases, yet, although we only did 5 total. In my room, we did 2 pyelolithotomies, which is about 2 more than most residents in the US do in their enitre training. This is something you only read about or hear about from the older attendings. Both patients did well and I look forward to checking on them in rounds this morning. Those cases took all day, and as we were about to head out, we heard the most dreaded word in the world of Urology uttered by Dr. Rodriguez. ´We have a patient with Fournier´s´ Oh boy! This unfortunate man had been sitting in another hospital for 18days after initial debridement, and he showed up here with a dry gangrenous penis and urethrocutaneous and perineal fistulas with a tenous Foley hanging on for dear life. The hospital administrators seemed to be pretty unhappy that he showed up here, so all we could do for him was put in an SP tube and hope for the best for him.

On the ride home, we encountered a pretty serious car wreck involving a 8mo pregnant lady on the side of the road, and a lady in the car with a pretty good head injury. We stayed with her until the paramedics could arrive.

Our adventurous day ending quite pleasantly, which was nice without rain.



Later

~Kmoses

I'm Glad I Know Fray Marshall

Well, today was just perfect. We started with a wonderful breakfast at the hotel. Our team has grown, another surgical technician, Tina Bartels, from Missouri, Ricardo Rodriguez, Dr. Rodrguez´ son from Monterrey, and Randy Singleton, a urologist from SAn Antonio. Unfortunately, the urologist with whom I was going to do the prostatectomy had to leave suddenly on a family emergency, so it was up to me and Grant. We arrived at the hospital, and the patients started rolling in. The first case was an open ureterolithotomy, a case that has been made somewhat obsolete with the improved endoscopic and shockwave techniques, but still a great surgery (I´ll post pics later). The case went swimmingly, skin-to-skin in just under an hour. After that came the prostatectomy. Having assisted on several with Dr. Marshall , my chairman, and done a couple, I took it upon myself to do the case as surgeon with Grant assisting. Before I describe the case there are a couple of things to know about how the hospital works. First, if we need blood, there is not a blood bank at this hospital, so the patient´s family members have to go to another hospital, give a sample, and then bring the blood in a cooler to our hospital, and the blood is only good for the day. Secondly, there are no narcotic medications in the hospital, and toradol is given sporadically. Third, the anesthesiologists aren´t completely familiar with the machine, so this case was going to be done under spinal anesthesia. All that being said, the case went about as well as it could have, and I´m quite happy to say Grant and I did the case in just over 2hrs. By the time we were done, the other OR was just about done, so I just did a cysto and stent removal on a young lady who had undergone renal transplant recently.

I really cannot express how happy I feel being here, not only because of the awesome cases I´m doing, but the other folks in the group, as well as the nurses and docs from here have made this a pleasurable time. The layers of beaurocracy that exist between caretakers and patients in the States is not so here. Although there are certainly difficulties in getting adequate care for people, once they get to us, the level of care and gratitude on both sides is very fulfilling. And despite a big day in the OR, I don´t feel the fatigue and stress I normally do on a daily basis.

Speaking of daily basis, it rained again today. I could be a weatherman in Tapachula no problem. It would go something like this:Ít will be warm today with cloud cover later, and a rainshower in the evening. Back to you Raul.´

I´ll post pics later.

~Kmoses

When it rains it pours

October 19, 2008

Well this is my first time blogging, I don´t know if there are any rules to the game, but here goes. The trip has been nothing short of adventurous so far. My flight from Atlanta to Mexico City was fairly uneventful. In fact I was pleasantly surprised at the upgrades in the Mexico City airport since the last time I flew through. Upon arriving to the gate of departure to Tapachula, I met our program leader, Dr. Theron Hawkins, and his lovely wife Joy, Grant Taylor, a urologist from Johnson City, TN, Doug Doehrer, our surgical tech from San Antonio, and Herb Barstow, a recently retired urologist from Columbia, MO. We ate, got to know each other (I knew immediately that Dr. Hawkins is a first-rate Texas story-teller), and prepared for the flight to Tapachula. Here´s where things got a little more adventurous. Initially the flight was going really well until I noticed an electrial storm off to the far right horizon. I really didn´t think much of this until the flight started getting bumpier and bumpier, the cloud cover was getting denser, and the rain was pounding the plane like we were flying through a sea of quarters. Judging by the length of time we had been in the air, I figured we should be close to our destination, however, our descent was anything but smooth. In fact, other than Doug who was fast asleep, everyone else was wide awake with firm grips on the arm rests. Each time we appeared close to landing the pilot pulled up and swung around. This happened about three times, at which point the pilot came on the speaker and announced that he couldn´t land because of the weather and he was going to Merida. Knowing a little Mexican geography, I knew Merida was way east and we probably could have flown back to Mexico City in about the same amount of time. I should mention that this is a tiny plane that maybe had about 3h worth of gas. We landed at the very small (read: tiny) airport at Merida and refueled. As we loaded back onto the plane, they announced that we were now going back to Mexico City. After some murmuring amongst ourselves, we made our way back to Mexico City. Now here comes the real drama. By this time, it is past 2am, we have literally hundreds of pounds of equipment for the mission trip, and they expect us to unload all the equipment from the conveyor, load onto a van to the hotel, unload everything again, recuperate, load everything back up and be back at the airport by 9am. Well fortunately, Dr. Hawkins, being blessed with the gift of gab, had made friends with one of the airline ticket counter ladies, and after a good bit of cajoling, phone calls, begging of security, and slow movement down the hallway, we were finally able to recheck all the equipment around 4am, get to the hotel and rest. The next morning we got up and had a marvelous breakfast and made our way back to the airport. We finally got on the flight to Tapachula, which went off without a hitch. As we approached the city, I noticed a couple of things: 1) we are really close to the coast, which I hope to be able to visit during our time here, 2) the landscape is quite green and lush, which only meant one thing, lots and lots of rain. More later. Anyway, we finally arrived Saturday afternoon, checked into the hotel and had a pretty chill day. It rained in the evening.

Sunday morning, we had devotional time and breakfast, then headed to the hospital, which is about 10 minutes outside the city. I should mention that now our group has grown to include Paul Church, a urologist from the Boston area, Jim Gallo and his wife, from Suffolk, VA (anesthesia), Dr. Roberto Rodriguez, a surgeon from Monterrey and facilitator for this trip, three nurses from Monterrey, Mayra, Ynes, and Sonia, and an Anesthesiologist from Monterrey, Dra. Mayra. We initially had word that we had only three cases, and we would spend most of the day unpacking and getting organized. Well, as it turned out 3 cases turned to 11, but I had a blast. I performed 2 orchiectomies, 3 or 4 cystos, and as the only doc with servicable Spanish, mucho, mucho translacion!

Tomorrow we have a prostatectomy, several TURPs, a few suprapubic prostatectomies, a cystolithopaxy, and I´m sure a few surprises. I can´t express how excited I am about the rest of the week, I am very happy with our team, and even happier that I am aboe to provide medical help to those in most need (without a pager in sight!). More on the patients later...

~Kmoses

Final Pics

OR Team: Local anesthesiologist (forgot name); me; Soheir, scrub tech; Angele, scrub tech; Carlos; Fady, House officer at American Hospital

Nile View at Night

Nile view during the day

Pyramids of Giza (more interesting view from the outside than inside)

~Croth

Blog like an Egyptian

Puns aside, Egyptians do things on there own schedule and I guess I’ve picked up the habit. Actually it has been a whirlwind few days and I actually just now have time to make my last post. I’m sitting in the Cairo airport with my flight to Paris leaving at 1:35 am on Sunday. I’ll make it back to Oklahoma City via Houston around 7:30 tonight. Needless to say, Monday will be a challenge.

We had a really good day on Friday considering the relative urgency to get things wrapped in time for the first round of departing guests to make their flights. We did another 9 cases utilizing our two bed OR as well as rotating cases in another room. Our plastic surgery friends had finished their cases earlier than we did and they actually helped us out by closing skin incisions. We had a great week given the number of cases we were able to get done and the number of kids we were able to help out.

I expected that the operative experience would be different than anything I had done before, and indeed it was. Typical challenges to any given case would be flies in the OR, dim lights, rolling OR tables, multiple Arabic conversations going while you operated (even if they weren’t talking about you, you’d never know), so-so surgical instruments, etc. Despite all this I feel like I was able to hold my own and realized how lucky I am to work in conditions that are optimized for good outcomes.

The entire staff of the hospital was great to us all week. I could sense they were very proud of their hospital and they did everything they could to make us feel like we were part of their team. The hospitality was not limited to the hospital but extended into pretty much everything we did all week. One of the former house officers was visiting the hospital on Friday prior to our departure and was a huge help in arranging for my trip back to Cairo. He took Joseph, an anesthesia resident from New York, and me to the train station and even tried to pay for our train tickets himself. Just before boarding he brought us to a neighboring market so we could be some local confections to bring back home. I can’t say enough about how hospitable our hosts and, in fact, all Egyptians were to us throughout our stay.

The train ride to Cairo was the first time I really felt like I was on vacation. I was able to get a room in Cairo overlooking the Nile and was impressed with the enormity of the city. I walked to a local restaurant and feasted on grilled pigeon which tasted great though consisted of about 3 ounces of actual meat. It was worth the try. Today I did a Griswald-paced tour of the Cairo museum and the pyramids of Giza. I get the sense that you really need 3-4 days to get the real feel of Cairo. It was a great conclusion to my week abroad.

I hope these posts gave a good sense of what we were up to while we were on the mission trip. As designed, these trips truly benefit the patients and the medical team to an equal degree. Thanks for reading.

Chip

~Croth

Too Late for Real Blog

We had a long day which didn't wrap up until after nine. We did make it back to the rooftop restaurant in time to catch a wedding party. This entry will be the visual variety.


Cornerstone at Hospital, View from Hotel Room, Two Tables in One OR, Rooftop Wedding Bash.

~Croth

Groundhog Day

Everyone is settled into their roles here and we are definitely more efficient. We have a particular routine to our day (breakfast in the same restaurant, bus ride to work, fast-paced day, bus back to hotel, dinner at rooftop) that would make Bill Murray jealous. Tonight we are going out for a party at one of the hospital administrator’s house and we are look forward to mixing it up a little bit.

Today in the OR we did another seven cases. We did 3 redo hypospadias and 2 urethrocutaneous fistulae following hypo repair. The frequency of complex cases is unlike anything I’ve experienced in the course of my training. I guess that speaks well for the quality of urology we are practicing back home. We had more visitors in the OR today – a plastic surgeon from Cairo came to visit (he was also interested in the craniofacial cases that the plastic surgeons with us were doing). He states that his service in Cairo does over 300 cases a year. It nice to see so many people interested in hypospadias surgery. It is disconcerting that at the same time we will probably operate on over 30 kids who have either not had access to someone who can provide the operation they need or have complications following surgery. I’m obviously not informed enough to dwell on the issue too much and it may simply be an issue of surgical volume. Regardless, I do feel better about healthcare in America.

I will get off the soapbox now and get freshened up for our night out. I will attach some more pics since it now seems to work. We again had lunch in the OR hallway (notice the food on stretcher).

~Croth

Pics at last: The hospital, OR, Rooftop View at Night

~Croth

Tuesdays in Tanta

We had a regular day at work today. Today was the first day back in school for the local kids so traffic this morning was terrible. We started rounds around 8:30 and our first cases at 9:00. Hospitalizations here are a family affair and it’s not unusual that each patient was 3-4 family members with them at the hospital. There are few private rooms and most kids are in common wards. On rounds the entire room full of people, relatives or just onlookers, gather around the patient of interest. It seems they all have something to say, of course only a fraction makes it through the interpreter. We eventually make it through.

Towards the end of our third case I started to smell food in the OR. Sure enough, lunch was being served in the hall outside of the OR. We had a nice traditional Egyptian meal which consisted of various pastas, beans, and vegetables which you top with fried onions and a spicy tomato sauce. It was great.
We made it home around 6:30 this evening and had a nice dinner at the rooftop restaurant which has turned out to a nice surprise. Overall, work is work and Tuesdays are Tuesdays, even in Egypt

~Croth

Back to Work

We left the hotel for the hospital at 7:30 this morning. We should have probably left at 6:30 but I guess the OR starts later here. We quickly got settled in. We were given sandals to wear with our scrubs. I was wearing white socks as opposed to the locals who wear just sandals in the OR. After feeling out of place for a while, I scratched the whole thing and went back to my Nikes. We had two OR tables in one room which was very efficient. My last patient was 11. I walked him into the OR and he didn’t bat an eye and the redo hypospadias patient laid out on the neighboring table. He never asked for his mom and didn’t even need root beer flavor in his facemask. Expectations are just different I guess.

We did have a productive day. We got eight cases done though were at the hospital until 7:30 this evening. Today was an Egyptian national holiday, Oct. 6th fittingly enough (to commemorate victory over Israel in the 1973(?) war), so we had a number of local urologists and residents who came by to watch us operate. I did one case with a peds surgery fellow and another with a local urology resident. It was nice to get to work with people from such different backgrounds.

Tomorrow calls for more of the same. I will eventually post some pics, hopefully before I return to the states.
Chip

~Croth

Day Trip to Alexandria

Today we left Tanta around 9 to head up to Alexandria. I’ve learned more about the police escort which we always have. Realizing the importance of tourism to the national economy, Egypt now has a special Tourism and Antiquities police force. Any groups of foreigners traveling by bus has to be escorted. Each state has their own division of police which escorts you through their state. Our trip to Alexandria required at least 4 changes of escorts which could take up to 20 minutes. So the 1.5 hour trip took us 2.5 hours.

Once we got there we went to the new Alexandria library which is meant emphasize Alexandria’s prominent place in the ancient world just like the original one did centuries ago. Alexandria was been ruled by the Greeks, Romans, Turks, French, and British though, due to a tumultuous political climate and the occasional earthquake, very little evidence of the previous occupants remain. Archeologic efforts are underway to help preserve as many sites as possible. We had a great local lunch at a restaurant overlooking the east harbor and finished up by Montazah, a former summer retreat of the Egyptian kings.

Tomorrow we have a full OR day. I’ll let you know how it goes.

~Croth

Screening Day

Following a long couple of days of traveling, we finally arrived in Tanta around 10 pm last night. We are staying at the Panorama hotel in Tanta which is very comfortable. Typical of a nice hotel, clocks with the current time in various international cities are displayed behind the front desk. It is currently the same time in New York as London, though you get the point. They do in fact have wi-fi which makes this blogging much easier.

Our group is complete and our IVU group, me and Dr. Angel, are joined by Surgical Volunteers International run by Tom Flood. SVI largely focuses on craniofacial defects and there are two pediatric craniofacial surgeons in our group. To coordinate all the surgical activities we have a pediatrician, two peds anesthesiologists, an anesthesia resident, a peds anesthesia fellow, two OR nurses, three recovery nurses, and some additional support staff. It takes a while for our group to get moving and to compound the issue we never go anywhere without a police escort.

Today we had our clinic to screen and prioritize patients for the upcoming week of surgery. We will be working at the American Mission Hospital in Tanta. The hospital was founded in the early 20th century and is devoted to treating citizens of Tanta and the surrounding communities. Since the last trip here one year ago, the medical staff, including the pediatricians and surgery residents, have been keeping a running list of patients to see. In addition, word that we are coming has spread and a number of patients just show-up at the clinic.

Dr Angel and I saw approximately 45 patients today of which close to 40 are scheduled for surgery. We saw a lot of hypospadias with about have of these patients presenting with urethrocutaneous fistulae following repair. I got a little frustrated with the lack of any medical records for the patients. We saw one kid with a pfannensteil incision scar, non-palpable testes, and a somewhat repaired proximal hypospadias (i.e intersex until proven otherwise). Mom thinks her kid has testes and the surgery was an attempted orchiopexy. We’re going to take a look and see what we find. This is just an example of how you make do and treat the patients as well as you can in the given situation. Our last patient of the day was a bed wetter; the only bed wetter I've ever been glad to see.

Anyway, we have tonight on our own though can’t go anywhere without our guards. Maybe we will check out the views from the rooftop bar of the panorama hotel. Tomorrow we have a day off and most of us are going to check out Alexandria for the day.

Later,
Chip
Uploading pics is going really slow, i'll try to work on it later.

~Croth

Rainy day in Paris

The trip is uneventful so far. We are currently at Charles DeGualle airport in Paris. We have a 5 hour layover; too long to sit in an airport, not long enough to go do anything. The view from the airport window is European, overcast with lots of very economic-looking small cars and trucks on the tarmac. Our group now consists of about 11 with a few more people still to meet us. Once we arrive in Cairo we have an hour-long bus ride to Tanta which puts us getting there around 7pm local time. I’m told we have an internet café at our hotel in Tanta so I’m hopeful I’ll be able to get the posts out on time.

~Croth

Some pictures from Bangladesh and Bhopal, India

Here are some of the pictures from my trip:

LAMB hospital at Parbatipur, Bangladesh.

One of the inpatient rooms at LAMB hospital.

The vesicovaginal fistula ward at Dhaka Medical College with Dr. Das and Dr. Sayeba Akhter.

Morning rounds at Sewa Sadan Eye Hospital in Bhopal.

Dr. Das and I with the OR staff in Bhopal, India.

~Jhtamola

Bhopal India

I'm writing this after leaving Bhopal. I did not have good internet access so I was unable to put in an entry. This will probably be the last entry for me. I'll put some pictures up also.

Jeev Sewa Sansthan (JSS) is a charitable organization which holds a urology camp twice a year. Patients receive free urological care. The camp was held from Sept 20 to Oct 8th. It starts with a triage process in which 1600 patients arrived from the surrounding areas and 200 were found to be surgical candidates and healthy enough to undergo surgery. Once a patient is scheduled for surgery they stay free of charge. The ORs started on Sept 29th and 10 urologists came for the camp. Dr. Das and I were the only two from the US. We had 3 OR rooms and six OR tables. There were a number of cases including large TURPs, DVIU, PCNL and URS.

When we arrived in Bhopal there was a big welcoming party at the airport complete with flowers. We went straight to the hospital to visit our patients for the following day. Everytime I walk into a hospital here, I'm reminded of everything I take forgranted in the US. The ward is a large room filled with beds of people. There's no privacy. Men, women and children were all in one room.

The ORs were better. The had decent equipment and all were donations. I did several interesting cases. The first one was a little boy with a solitary kidney with an obstructing megaureter. He previously had a reimplant but comes in with a chief complaint of urinary retention. On cystoscopy he had a large cavity 1cm away from the bladder neck which was the residual ureteral stump. It was likely causing the bladder obstruction. We went ahead and excised it.

Another interesting case was a little girl with XGP. We performed a subcapsular nephrectomy. That was a very difficult case because of all the inflammation. There were no planes. The last interesting case was a 40 year old woman with solitary kidney and UPJ obstruction s/p open pyeloplasty. She restrictured and it was treated with an endopyelotomy which failed. She had a nephrostomy tube in but her creatinine was increasing. We did a ureterocalicostomy and nephropexy. That was another very difficult case because of the amount of scarring from her other procedures.

The people here are so friendly and very dedicated to the patients. It's inspiring. All the urologists here go out of their way to teach me. I've learned so much during this trip and I'm sad to be leaving. At the same time, I'm utterly grateful that I had this experience. Dr. Das has been a wonderful mentor and I've operated with excellent surgeons during my time here in Bhopal and in Bangladesh. I'll never forget it.

~Jhtamola

Countdown to Egypt '08

Salam ‘alaykum (Hello, I think),

My name is Chip Roth and I am a pediatric urology fellow at the Children’s Hospital of Oklahoma and the University of Oklahoma Health Sciences Center in Oklahoma City. I have the privilege of being the resident scholar on the 2008 Tanta, Egypt IVUmed trip. Josh has asked me to be the trip blogger for our group. I guess he was impressed with my writing skills on the personal statement portion of the application. I must disclose now that I’m a terrible speller and novice blooger.

We are scheduled to leave for Egypt in two days and will be in Tanta until we return home on the 12th. Our trip is being coordinated by Tom Flood, a RN from Houston, who seems to be a veteran of international medical missions. My mentor for the trip will be Dr. Carlos Angel from Knoxville, TN. He is a pediatric surgeon who specializes in pediatric urology and has been on several IVU trips including Tanta last year. Tom tells me that we will be joined by several pediatric anesthesiologists, OR nurses, and several other people who are generally interested in urology and foreign countries. I’m looking forward to meeting all of the trip participants and hope to be able profile each of them on my daily blog entries.

When I tell other urologists that I’m going to Egypt all they can think about is schistosomiasis. I’ve assured them I will wear shoes whenever I wade in stagnant water. Seriously, they do ask why we would go to Egypt for a medical mission. Egypt is generally recognized as a country that practices medicine, particularly urology, at level similar to that in the United States. Anyone familiar with urologic literature should have seen at least one manuscript from Egypt, likely from the University of Mansoura. That being said, I do look forward to learning more about how our trip helps meet the needs of the citizens of Tanta.

Non-urologists most often ask if we are going to Cairo (like myself prior to this trip, most people are only familiar with Alexandria and Cairo). This has given me an opportunity to review my geography, and I now have a better understanding of where we are heading.

Tanta, no thanks to Wikipedia, is Egypt's fifth largest city (the largest in the Delta) and is located 94 km (59 miles) north of Cairo and 130 km (81 miles) southeast of Alexandria, in the heart of the Gharbiya province. (Here is a map, Tanta) It is that governorate's capital. There are about 335,000 people in Tanta, and a major university is located here. Tanta is reached by the Damietta branch of the Nile and northwest and by way of Birket el-Sab.

Tanta has cotton ginning factories and textile industries and is also a university town with an institute attached to the El-Azhar University in Cairo and a medical school associated with Alexandria University, as well as the seat of a Metropolitan of the Coptic Church.

This city comes to life in late October at the end of the cotton harvest. About two million people from around the Delta and other parts of the Arab world come for the Moulid of Sayid Ahmed el-Badawi, which is an eight day celebration. Unfortunately, I think we will be gone before the festivities begin.

Thus far, my preparation has consisted of gathering some OR supplies and buying Imodium and pepto. That being said, I need to go pack. I hope that the internet connection in Tanta will allow for me to reliably post my updates as well as post pictures from out trip.

Maas salaama (Goodbye) for now,

Chip

~Croth

Leaving Bangladesh

I didn't have internet access for a few days so this is the first time I've been able to put an entry. Thursday night they threw a party for us as a thank you for coming. The following day was a Friday and a holiday but we were still operating. The staff agreed to work on their day off for us. The last day at LAMB hospital was amazing. We did a Turner-Warwick scrotal inlay on a person with BXO involving the urethra. I've never seen that before. I also did another adult hypospadias and a meatal advancement and chordee. The people here are very friendly and dedicated to the people. I'm sad to be leaving.

On Saturday we made the 7 hour drive again to Dhaka and dropped off Dr. Ganesh at the airport. We stayed at Dr. Das' friends' house in Dhaka. On Sunday we went to the Dhaka Medical College and met with Dr. Sayeba a prominent gynecologist and the best vesicovaginal fistula surgeon in Bangladesh. She showed us her fistula program. We visited the ward and their training center. It's amazing what she's built here and it's appalling what these women had to go through. We met several during our tour. Now we're on our way to Bhopal and the next part of our trip. Will write more later. I'm running out of internet time.

~Jhtamola

Goodbye....

We made rounds at the Maternal and Pediatric Hospital this morning. All of the patients are doing very well, which is great. Dr. DeVries is a highly revered person. When we walk down the halls people look at her with gratitude and wonder. As one of the patients wrote on a thank you gift to her: "You are an angel sent down to us from heaven."

The Hospital No. 1 doctors came to the hotel late morning for final goodbyes. They also brought some lovely and generous gifts for us. They already want to know which of us will be back. Every single person on this team wants to return someday. Of course it's a long trip...but worth every moment of flying and layovers.

Dr. DeVries, Dr. Hamilton & Dr. Reddy left this morning. The remaining team members went to the black market and had an opportunity to see some of the sights in the city including a palace, the Parliament building and the National Theater. This evening we will go to another concert. This time in addition to music there will be contortionists.

There is a saying: "It's not where you go, it's what you do when you get there." We stand in awe of Dr. DeVries, Dr. Hamilton, Dr. Reddy, Dr. Kuritani, Janet Vogt & Pam St. Louis for all they have done for the people of Mongolia. They will be long remembered.

Signing off in Ulaanbaatar,

Ellen & Edd Thorp, Trip Secretaries

~Mongolia2008

Friday....last day of surgery

Both teams had excellent days. Thirty seven surgeries were performed in five days -- WOW! It was sad to say goodbye to the staff at the Maternal and Pediatric Hospital, but it was wonderful to see how much better the children felt. Dr. Sujith Reddy joined the team there today in order to experience both locations. The local surgeons were very happy to have mastered some new techniques. They were also pretty thrilled with the donations we were able to leave behind.

Our days have been long but we have been very lucky to have had two young ladies as interpreters -- Zaya and Ayuna. They have been our lifesavers in and out of the hospital; staying by our side through late dinners and shopping. Everyone here has taken excellent care of us.

We were able to take the whole team to a Mongolian concert this evening. It was fascinating. We were all mesmerized by the "throat singers". They make multiple sounds at once, all with different tones. Remarkable! We also enjoyed listening to the Mongolian National Orchestra and watching folk dancing. Things are not very expensive here: the entire 1.5 hour show cost $10.00. Meals cost about $5.00-$10.00. Cashmere.....well, that's a different story. It's cheaper here than in the US, but it still can be a little pricey.

The local doctors are already looking forward to IVUmed's next visit.

~Mongolia2008

Bangladesh Day 3

Bangladesh day three is another busy OR day. We planned 3 cases today but we were only able to do 2. The first case is our 8 year old patient with extrophy. We removed his extrophied bladder, re-tubularized his penis, created a ureterosigmoidostomy for him and closed him with a rectus flaps. It was a very interesting case and the first extrophy I have operated on. The second patient was a young girl with incontinence and female epispadias. We did a Young-Dees bladder neck wrap and a Burch colposuspension. Both of these cases were new ones for me. I’ve also never seen a female epispadias. We operated past the time when the OR staff was supposed to go home. We’re lucky that they were nice enough to stay late for us. Tomorrow, Friday, is a holiday for them and they’re working just because we’re in town. We have smaller cases tomorrow so hopefully we’ll be done in time. At the end of the evening, we were invited to Dr. Bower’s house for dinner. We met more new friends. The people here were really happy that we came, especially Dr. Ganesh because of all the reconstructive cases. Dr. Das joked that instead of sending patients to Velore hospital (Dr. Ganesh’s hospital), he brought Velore here to LAMB. I’m really learning a lot from both Dr. Ganesh and Dr. Das. I’ve seen a Young-Dees before but never really understood the operation until now. Dr. Das has such a calming presence and has been able to negotiate the longer operating hours for us. I keep thinking that this is a rare experience and I’m soaking up as much as I can.

~Jhtamola

Thursday - Firing on all cylinders

Hospital Number One, Day 5 in Mongolia.

I have been working closely with Dr. Hamilton. His experience in endourology has served as a great resource for me as well as the local doctors. We have been performing kidney stone surgery this week in attempts to help improve the techniques of local surgeons. Early in the week we struggled with a few cases and realized the technology available was the problem. We have sicne made adjustments and emphasized the need to make the best use of resources available. Today we felt our surgical cases were performed with efficiency and success. We are excited at the vast differences from Monday to today. We hope that our few days in teaching will allow many years improved patient care.

Today, we also presented scopes donated by the Storz endoscope company to the local doctors. They were most grateful as the last donated scopes were showing their age. The local doctors are compassionate and skilled surgeons and have been adaptable to the equipment available to them. With modern equipment, they have the ability to provide patients with minimally invasive procedures with great surgical prowness.

I find the mongolian people to be friendly and happy people. The local doctors and nurses, the patients, and our translator have all been great hosts. We even have found time in our busy day to laugh, share stories and culture, and even family pictures with the local people.

The team at the Pediatric hospital also had a productive day. The patients' families have been most gracious and shower the team daily with praise and gifts. It is touching to see such display of gratitude. Late in the day we met the team and headed to the local department store for souvenier shopping. We then headed back to the hotel and met for dinner at the Japanese restaurant in our hotel. Nori, our pediatric anesthesiologist, showed us a great time and introduced us to his favorite cuisine. We did have to say goodbye to one of our wonderful nurses. She had an unexpected family matter and had to rush home. We are sorry to see her leave us early but have shared some great times. All in all another great day in Mongolia.

~Mongolia2008

Bangladesh Day 2

Day 2 in Bangladesh is a surgery day. I woke up and had breakfast with Dr. Das and Dr. Ganesh. Then I packed up some of my supplies and headed to the operating rooms. As a side note...Differences in culture are always interesting. We had to take off our shoes to go into the ORs. The shoes they had there were flip flops. Luckily, I found a pair of clogs. They had two OR rooms. The schedule was cleared out just for us. We were able to do our big cases in the main room and smaller cases in the other. They had one cystoscope set that Dr. Das had donated the last time he was here but no camera. They had a decent stock of supplies which Dr. Bowers said was all donated. They still lacked several things like new light bulbs for the cystoscope, good tape, and they really need decent surgical instruments. We did a hypospadias repair with instruments that that would shock our pediatric urologist, Dr. Joyner. We had 5 cases today. I scrubbed in for a redo urethroplasty and an adult hypospadias with Dr. Ganesh. Dr. Das worked on 2 UC fistulas and a cysto on our epispadias patient for tomorrow. The OR staff are really nice except I keep getting the wrong instruments when I ask. I think I don’t speak up enough in the OR. I’ve been working really hard on saving suture. Dr. Koyle and Dr. Joyner would be proud of me. At the end of the day, we walked out of the operating room to find 2 young men waiting for us. They were patients of Dr. Ganesh who heard he was in Bangladesh and wanted to come see him. They came all the way from Dhaka just to catch a few minutes with him. The patient was a young orphan who had a urethral stricture from a pelvic injury. It was operated in Bangladesh and restructured then Dr. Ganesh operated on him. I was able to use my new bladder scanner to check his PVR. I thought that was cool. He had <50cc. We wrapped up our day by meeting four new friends. We have new roommates at the guest house, Mitch and his family. The family is American but has lived in Bangladesh in the last 7 years. They have two kids both born here in LAMB. His daughters are beautiful and ran around the house with a lot of energy speaking both English and Bangla. I’m going to bed early because we have big day tomorrow. Good night.

~Jhtamola

A very long day.....

Ellen Thorp, trip secretary here. Today was a long and wonderful day. The first surgery at the pediatric hospital began at 8:am and the last surgery ended at 7:30. Dr. DeVries is amazing to watch. Her last case was four hours and she remained highly focused in spite of the hour or fatigue. We all stand in awe of her abilities, including the Mongolian staff. We are all a little more comfortable with each other as the days go by. Today we showed them pictures from home and the Mongolians were really interested and curious. They spent a lot of time studying the map that Janet Vogt (nurse) brought, asking where we were born, where we live now and how long it takes to get from city to city. We have a terrific interpreter, Zaya, but we are also finding ways to communicate without words.

Dr. DeVries completed five surgeries today. One of the surgeries was slightly delayed when the local folks plugged in our Bovie machine and it started to smoke...a lot! The cameras whipped out to document the event as if we were at Disneyland. Anyone want to donate a new machine???

Our day at the Maternal and Pediatric Hospital ended in a very touching manner. At the end of our clinic day (Sunday) there was a dad who had waited in the hallway and wanted to carry our bags down the three flights of stairs for us. His little boy ended up being our first case yesterday. We remembered the child well because he was very upset and crying before he was put under. The child did very well. I had the pleasure of seeing him this afternoon when a few of us handed out crayons, coloring books and Beanie Babies (all donated). Hours later the father and mother met us as we were leaving the hospital. We were pretty tired but our spirits and our hearts were lifted when they approached us with flowers, chocolates and Mongolian dolls. Then the dad insisted on carrying our bags out again. I don't think we'll ever forget them.

Hospital No. 1 had a visit from the new Minister of Health today and that slowed things down a bit. They completed three surgeries, one of them a five hour kidney stone procedure. The doctors at that hospital speak more English than at the Pediatric hospital so it's easier for them to form personal relationships. The Hospital No 1 staff took all of us out to dinner at a Mongolian restaurant. One of our members ordered horse ribs (they were out). Dr. Nori Kuratani order a soup that had many different organs in it; we renamed it "Donor Soup". The evening was lovely including a musical performance by one of their doctors and another by our own Dr. Blake Hamilton.

We are all looking forward to tomorrow!

~Mongolia2008

Bangladesh Day 1

My name is Josephine and I am a 4th year resident from University of Washington. I’m traveling with Dr. Sakti Das to the LAMB hospital in Parbatipur, Bangladesh and Bhopal, India. I left Seattle on 9/20 with an XL REI duffel bag full of sutures, gloves and catheters plus a brand new bladder scanner and glidescope from Verathon. My trip to Bangladesh took a total of 19 hours of flight time and plus 11 hours stop over in San Francisco and Singapore. I arrived in Dhaka, the capital, at 11pm in the middle of a thunderstorm and stayed at the LAMB guest house in Dhaka. The following day, I met Dr. Das and Dr. Gopalakrishna at the Dhaka airport. I was standing outside the car when I hear a cry "Josephine" and saw a tall Indian gentleman walking towards me. Together, the three of us and 2 other LAMB employees drove to the hospital. It was a 7 hour trip through a beautiful countryside with a lot of rice fields. The LAMB complex consists of several buildings around the hospital. It provides comprehensive medical care for the surrounding areas. When we arrived, we went straight to the hospital to meet our patients for tomorrow. One young man has recurrent stricture disease who will need a redo posterior urethroplasty. A young woman has urinary incontinence and female epispadias. After seeing the inpatients, we walked to clinic and were surrounded by patients asking to come in. Since there is no in house urologist, patients with urological problems are either referred to other hospitals or wait until Dr. Das’ yearly visit. In clinic, we saw an 8 year old with cloacal extrophy, adult hypospadia, urethrocutaneous fistulas and others. We made a list of patients for surgery and management plans for non-operative patients. As our list of surgical cases grew, I became more excited. This is only the first day. I can’t wait until tomorrow.

~Jhtamola

Day 2

Today the teams separated to their designated hospitals. At the pediatric hospital Dr. deVries did 4 successful surgeries and 4 consults, ending the day around 6pm. Children were each given a handmade donated blanket for warmth after surgery. The local nurses were very greatful. Dr. Hamilton did 4 surgeries and 3 consults ending the day after 7pm. We have identified a great need for basic equipment maintanance and troubleshooting. By the second half of the day we finally procured a light source that enabled the surgeon to actually see what he was doing thereby reducing the need for exposurre to x-rays. We have lovely and gracious interpreters for each site making life simply wonderful. Our patients here are very stoic and forgiving of the amount of time they must wait for their procedures. The number 1 hospital was visited this morning by the new Minsiter of Health, causing much delay in the start of our surgery schedule. Hopefully this new Minister can bring many needed improvements to the Mongolian health care system.

Nurse Pam

~Mongolia2008

Monday - day one of surgery

The entire team spent the day at Hospital No. 1. We were greeted by the Director, Dr. Sonin Sodov. He gave us an overview of the hospital history as well as some background information regarding medical availability in Mongolia. Hospital No. 1 opened in 1925. It is the largest hospital in Mongolia. There are 21 provinces and each has a general hospital with about 200 beds. The villages have hospitals with 10-15 beds. According to Dr. Sodov there is a great shortage of doctors in rural areas but a surplus in the capital, Ulaanbaatar. There is also a shortage of nurses so the doctors often do nurse's work. He was very kind and expressed gratitude for IVUmed's visit and acknowledged the power of volunteerism.

Drs. DeVries, Hamilton and Reddy performed a total of seven surgeries today. The sanitation conditions are very different from those in the US. For example, there are many items used during surgery that are thrown out in the US but reused in Mongolia. The autoclave machine was an antique according to one of the nurses. It was covered with rust and had an open lid. It was more like a bubbling pot than an autoclave.

Patients in Mongolia are responsible for carrying their records with them. I even witnessed a patient holding onto a disposibile camera on her way into surgery, perhaps with the hope that anything that needed to be in her record would be photographed. The families take a lot of responsibility for the patient's care and nutrition. I guess they can't complain about hospital food with that being the case!

Tomorrow we will split up in to two teams: one will go to Hospital No. 1, the other to the pediatric hospital. There is an ambitious case load and it seems the local doctors would like to add even more. IVUmed is so highly regarded here that the local physicians really want to maximize our staff's time. Although our hectic schedule doesn't leave much time for rest it is invigorating to think of the positive results the IVUmed team is accomplishing.

Ellen Thorp, Trip Secretary

~Mongolia2008

Clinic Day - Sept 21, Sunday

What an incredible day it was!

Our morning was spent at Hospital #1, the afternoon at the Maternal and Child Hospital. We saw a total of 60 patients with ages ranging from 2 months to 84 years old. The doctors did an incredible job of assessing the cases and the patients just kept coming. There is so much need. It is very humbling to watch the IVUmed doctors and nurses work -- they clearly know what they are up against. It would be easy to become frustrated quickly but instead they work through the situations dealing with what is and isn't possible given the equipment and after care available.

It was very touching to witness the children -- they were fearful but stoic. Their cases range from hypospadias to possible bladder reconstruction. An effort is always made to select cases that will provide a teaching opportunity as well as help the patient's quality of life. The local doctors show so much concern and tenderness towards their patients; it is heartening to know that in addition to helping patients they will also be learning how to perform the surgeries once IVUmed is gone.

We are still awaiting the arrival of Dr. Nori Kuritani who was detained by a typhoon that hit Tokyo. Once he is here our team will be complete. A good night's sleep is much needed by all!



Ellen Thorp, Trip Secretary

~Mongolia2008

Pre-trip entry, Mongolia

September 12, 2008

Blog for ivumed.org

Submitted by Ellen Thorp, Trip Secretary

Re: Mongolia trip, September 18-28, 2008

When I went to bed last night I thought: “wow!” this time Thursday we will be on our way to Mongolia! Then, when I awoke this morning my first thought was: “wow, we’ll still be on our way to Mongolia!”. When I go to sleep tonight, I might think…..well….you get the picture!

My husband Edd and I are very honored to be trip secretaries for this IVUmed mission to Ulaanbaatar, Mongolia from September 18-28. We live in SLC so we have had the benefit of being able to visit the office regularly and get wonderful training from Josh. It was a pleasure meeting our team members via conference call, but we are really looking forward to getting to know them and work with them. As non-medical people (my husband is a retired commercial pilot; I’m a retired marketing/sales executive) we are admittedly a little intimidated by the equipment, supplies and medical terms. Imagine our surprise when we were told we needed to bring scrubs and a lab coat. We never dreamed we might be in an operating room….and still be awake!

The team will be doing two workshops: one is pediatric and the other is for adults. The team members are: Blake Hamilton, MD (Salt Lake City), Norifumi Kuratani, MD (Japan), Sujith Reddy, MD (New Orleans), Janet Vogt , RN (Missouri), & Pamela St. Louis, RN (Vermont). We are privileged to have Catherine DeVries, founder of IVUmed, as our esteemed team leader.

We’re excited to be bringing the pediatric patients some gifts (all donated). They will have coloring books and crayons to play with as well as hard candy while in clinic. And, when they wake up from surgery they will have a new fleece blanket and a soft toy to cuddle.

Well, we’ve read our guidebooks and packed our bags. Here’s to a productive and wonderful IVUmed adventure!

~Mongolia2008

Final Report

Dear Friends,

Our trip is over and I find the time and energy to write a final entry. A small group of us spent six intense days working together. Many of us did not know each other, but we came together, formed a tight knit group, and worked well as a team. All of our days were very long, leaving the hotel at 6:45 am and not returning until about 8:00 pm that evening. Who at home could work twelve to fourteen hour shifts six days straight? Not me :)Above is the line of patients waiting to be screened on our first day at the hospital. I do not have the actual numbers of patients screened but more showed then anticipated. The day was very hot and humid. People waited very patiently and the children were well behaved. No tears or misbehaving on their part, their need for treatment was very obvious and well appreciated.

As you can see above, our Honduras OR is very similar to our OR rooms at home. The equipment is a bit older, but so are the volunteers on this trip. Some of this equipment was used back in the good old days of our training. There was no problem figuring out how to use it!The electrical wiring was a bit questionable but worked just fine. No power outages this trip! As an OR nurse, it is my job to keep the room running smoothly and keeping all happy.Keeping in touch with your home base was another important part of this team. Here is a great image of our Catherine balancing home in Salt Lake with work in the OR on her Blackberry.

On the last night at dinner, each of us guessed the number of surgeries done on this trip. The official number is still unknown, as is the grand prize or the winner

In closing I would like to thank all the members of this team for a wonderful trip. I will miss you all. This team blended their talents together well and the final numbers should prove this statement.

My greatest respects to you all,

Annie

~Ann Spencer

Honduras Workshop 2008

I always wax philosophical as we approach the end of an IVU-Med workshop. So many tragically deformed children treated but oh so many left who are in need. As is so often the case I find that I seem to learn as much as I teach and that the reward I receive personally far outweighs anything that I provide.

This trip is very exciting since our local peds surgeons/urologists continue to prove their interest, dedication and thirst for work. Other than lacking the materials, diagnostic aids and specialized colleagues and nurses their skills are impressive. It must be difficult for them to realize how challenging the lack of funds and hospital support stifles their efforts.

The other excitement is the presence of Founder Dr. C. Devries on the mission. I stand in awe of the woman´s brilliance as a physician and visionary who has accomplished great things in a short time. She provides the means for so many to obtain life altering and often life saving care which previously was only a dream. I thank her particularly for giving me and so many others the chance to give back. As one anesthesiologist said in response to the ubiquitous poverty "I wake every day and remind myself that I have won the lottery". I have begun a campaign to have our founder canonized Saint Catherine of Salt Lake. Sadly me efforts have been unappreciated by the powers that be.

How has this trip been? Consider a great group of comrades all energized and tireless, incredible pathology and all day OR time, a tropical environment and the chance to help so many chilren needing our services. What's not to like!?!? The real currency however comes from the smiling faces of the moms and kids being treated. They consider the presence of IVU a miracle. Thank you St. Catherine. Thanks also th our super Docs and nurses and to our Honduran hosts who always make me feel at home. Lily you are a wonderful childlife resource and have an unlimited potential to achieve greatness.

Adios,

John Gazak


~Ann Spencer

Last Day in Honduras

Friday morning. It is the last work day here in San Pedro Sula for the team. I am Catherine deVries, founder of IVUmed. This has been a nostalgic trip for me, since this is the first place that I visited 16 years ago when Interplast's founder, Don Laub, invited me on a surgical team trip. At that time, I was overwhelmed by everything. The poverty. The smells at the hospital. The long hours standing on our feet at the operating table. The long lines of patients who had traveled for days waiting to be seen.

Since then, much has changed here. The local nonprofit that we work with, the Ruth Paz Foundation, has become a highly efficient organization that runs everything from contacting the patients to long-term follow-up. They feed the team, arrange our transportation, and generally run the Honduran side of the show. We now have a team of Honduran surgeons that have developed excellent skills in pediatric urology. They just need a little tune-up on some specialized procedures, which is understandable, considering that in their practices, they cover the full range of pediatric surgical diseases and also practice general pediatrics. They are truly amazing. We have a group of volunteer anesthesiologists as well, and they help us to run the 3rd room.

Some things remain the same. The poverty. The exhaustion at the end of the day. And the wonderful sense comraderie between team members. The patients and their families are a great source of good spirit. They are doing well, even after some major operations. Lily keeps the kids entertained with games and art projects. We will be wrapping up the surgery this afternoon, but will stay in touch with the Honduran team by email throughout the year. It is sad to be leaving so soon. It feels like we just arrived and yet we can all feel the intensity of a week of 14 hour days in the OR in our knees and necks. It will be good to take a rest tomorrow.

~Ann Spencer

Honduras

Hi, my name is Lily Morrison. I'm 14 years old, and I've never been on an IVUmed trip before. Neither have I ever written a blog. My job on the trip has basically been to keep the patients entertained, and help keep their minds off their surgeries. I've met tons amazing people over the last few days, kids who spend days in bed and are in so much pain but hardly complain. And parents who walked for miles in order to bring their kids to a bus to the hospital, and nurses and doctors who work so hard all day. Everyone seems so happy and grateful, despight everything. I brought along with me tons of paper, pens, play doh, crayons, coloring books (thanks to Becky and Virginia), and toy cars. The kids (and parents, too) seem to like everything so far, and can spend hours making things out of playdoh or playing tic-tac-toe.

Yesterday I watched a surgery for the first time ever, which was pretty cool. At first I thought I would get woozy or naucios, and Ann even had me sit down just in case. But I didn't feel sick at all, I just thought it was pretty amazing. Its cool that they can cut you up and then sow you back together, and then you get better.

Well, over all Honduras has been an amazing and rewarding experience so far.

~Ann Spencer

San Pedro, Honduras '08 Day 4

I was given the opportunity today to enter the blog as a guest of IVU . My name is Carlos Angel, I am a pediatric urologist and practice in Knoxville, Tennessee. I was born and grew up in Colombia , so being back in a Latin American country is both familiar and reminiscent of my roots. As usual, upon our arrival, the team was inundated with many patients that needed care for severe congenital malformations of the urinary tract. It is now our foutrh day of operating and we have been able to perform most scheduled cases, fortunately, with few complications. As usual, on a trip like this, there are some glitches and this year´s was the resectoscope, which, no matter how much everyone tried, refused to cooperate. A special treat for me when I participate in a team trip with IVU is the chance to meet intresting people of quite diverse backgounds . We do have some things in common, however, curiosity about other peole and other cultures and the realization that we can do our part to help less fortunate human beings. To experience life vicariously through the eyes of the people we meet in these trips and the kids we care for is for me the greatest reward. We are working with three great local doctors, namely Drs. Tome, Gomez and Velez that are caring, extremely hard working and dedicated to the welfare of their patients. The staff in the OR wil do anything they can to make us feel welcome and to help the team, although for them it only means long days, extra work and none of them have a finacial incentive to do any of this. This is what I would call true altruism. Now, about Honduras, a small Central American country still plagued by many of the ills of the developing world such as violence, poor sanitary conditions, poverty and lack of education. What I have noticed is that, while all of the above may be true , as in many Latin American coutries life is experienced with joy and people( often complete strangers) tend to naturally come together and help each other. The children we operate are trusting, very calm, seem happy and do not experience as much separation anxiety as we are used to see in the US. Well, it is back to the OR now...

~Ann Spencer

First Day

Good Morning Friends, April 19, 2008
I would like to introduce myself to you before plunging in to writing this blog report of IVUmed’s trip to San Pedro Sula, Honduras. My name is Ann Malcolm Spencer RN and work in a small rural hospital on the Oregon Coast. Our hospital is a 21 bed (not 21 OR suite) hospital that treats a wide variety of patients. Surgery is my love and has been my home for the last 18 years. Traveling with Medical Missions has become my second love, making this trip to Honduras my 11th in the past 6 years.

At the present time, 4 of us, Catherine, Lily, Becky and myself sit in the Houston Airport waiting for our 7pm flight to Honduras. I have time to reflect over my reasons of why anyone would want to spend hours in an airport waiting to work over their vacation. I have over heard what others on the plane are going to do on their vacations. Golf and drink tequila in Mexico. Another family is on their way to a cruise in the Caribbean. Basically my reasons are very selfish, my life as been blessed. Blessed with a safe and comfortable childhood. Blessed with good health, great friends, incredible son and a loving husband. I have much to give back in this life and what a better way that to help the children of world. Each trip I swear will be my last but only time will tell.

More to come in the following days.

~Ann Spencer

Tim's Daily Nigerian Times (Day 14)

March 6, 2008 – Day 14

After enjoying the last breakfast at the guesthouse (warm biscuits and jam) we set off to the hospital to perform a last minute cysto and tie up a lot of loose ends. The cysto patient was a no show and that allowed for us to split up all the jobs – paying multiple bills, picking up some finished sewing, giving out some donations and gifts, handing over the numerous patients that we had operated on over the last couple of weeks. On a personal note, it was interesting to see how our urethroplasty patient with buccal graft did over the 2 weeks. We never see those patients every day and I think it was interesting to see him each day and the course of his convalescence (the patients in Nigeria don’t believe they are getting their money’s worth if they are sent home “prematurely”) and he’ll stay until his foley comes out 3 weeks postop.

We then had enough time to dart out to the HIV widows quilting shop and got some last minute shopping. Many spent more than they planned when we saw the wares and it couldn’t go to a better cause. The beautiful fabrics of the region were on display in a traditional art form (apparently they do American style quilting….whatever that means) J…

We popped back to the VVF clinic and the OR for a final lunch of rice/pounded yam and the red stew. It was nice to have the time today to say a proper goodbye to all the new friends that we had made. Many nice and thoughtful words were shared on both sides. Lots of “Kodak moments”. With a tear in our eye we set off back to the guesthouse to pack up for Abuja.

After bringing out the baggage we realized that there was no way we were going to fit all the baggage in the back of the Peugeot station wagon. Fortunately Sunday and Chima arrived with the upgrade – Land Cruiser. Despite the upgrade we still ended up sitting four in the back seat…with Pauletta on the floor behind Tom’s seat. With knees and elbows everywhere, backs cramped and everyone hot (and most of us smelly), we set off. Another truly Nigerian experience. The trip was as harrowing as I remembered from the arrival, with multiple passing attempts being “white knuckle” moments, although Ezekil did an excellent job of avoiding other cars/potholes/bikes/motorbikes/people/goats/roosters thanks to his trusty car horn. With bags all around (and on top) of us we pulled into the Abuja airport….

The Abuja airport (aka Danté’s Inferno) was as hot as I remember. I was the only one in shorts and I was sweating buckets. The long lines and cramped quarters made me glad that we had come several hours early….After negotiating security, check-in, 2 surveys, and emigration we sat down for quick and well-deserved beer in front of the only (and small) air conditioner. The ice cold Heineken and Pringles were a very satisfying dinner. We then had to say goodbye to Tom and Susan as they were taking an earlier flight to Amsterdam. I am sure that we’ll sit down for a dinner/drink at the AUA. After seeing them off, we waited for our flight – basking in the glow of the icy cold A/C. We were called in a couple of hours prior to our departure into the preboarding lounge (after another security check). Even though I didn’t believe it, it was true….this room was even hotter.

Equipped with bright lights that were blinding if viewed from the proper angle in addition to the 110+ heat, I felt like I was in an interrogation room from the former Soviet Union. After an unending session in the hot box, I was ready to give up any of the classified information I was privy to…fortunately they called us to board just as I was about to break down. Realistically, how much information can you give up as a Canadian? The specs on the 6 helicopters we have available for military service? J

We got aboard and fell asleep quickly. Economy class seating seemed like first class when compared the car ride down….

Tim’s Lesson of the Day:
“Traffic rules aren’t a bad idea”

Tim “Blogman” Davies


~Catherine deVries

Tim's Daily Nigerian Times (Day 13)

March 5, 2008 – Day 13

As we wind down the last full day in Jos, I’m realizing a couple of things, one of which I will miss the breakfasts in the morning (French toast again this morning). Another epiphany was the fact that I have really grown comfortable here in Jos. It was a seamless transition from anxiety about going to and performing surgery in Nigeria, to now comfort in a new location/OR. It is amazing to see what these surgeons can do with very little in the way of instrumentation and equipment. The term general surgeon definitely means something here. It really tests what a new grad like me has learned about urology. I have learned much from the more senior urologists on the trip and from the local surgeons as well.

We set off to finish up the remaining cases. A couple of PV Slings, 2 more injections for bulking agents and we managed to fit in a couple of last minute cystos. As usual a lot of pathology was around. 2 obliterated bladder necks and a couple of bad strictures were seen on the cystos. But a failed catheterization from another hospital resulted in the worst urethral perforations Tom has seen in 32 years in practice(fat all around the membranous and bulbar urethra). Throughout the day in the OR a plethora of interesting cases rolled through the door – a fungating axillary carcinoma, myelomeningocele, open tibial fracture, flexor tendon repair, all in one day. Wow!

As we winding off the trip, the paperwork has really picked up and last minute consults have really come up today. We do the best we can in the short time that we have remaining. We returned to the guesthouse for a quick Sloppy Joe dinner and more paperwork. We were bid adieu with another sing along from the other group staying with us which thankfully stopped just before 10pm. We gratefully fell asleep in silence….

Tim’s Fact of the Day:
The city of Jos is actually the initials for “Jesus our Savior”

Tim “Blogman” Davies


~Catherine deVries

Tim's Daily Nigerian Times (Day 12)

March 4, 2008 – Day 12

Another All-American (or in my case – Canadian) breakfast of eggs and toast. We spied the “Quick and Easy Cookbook” in the kitchen this morning – one quick glance told us this was the secret to the meals we had been receiving.

We started off the day with a couple of cystocele repairs with PV Slings with fascia lata. We were able to harvest plenty of fascia with 2 pretty small incisions over the lateral thigh in the first case. In the second case, the fascia was harvested in 1 incision for both the sling and the cystocele repair. The second case was performed by Dr. Sunday Lengmang, with Susan assisting. They both went well. Tom chipped in with the general surgeons as they perfomed a suprapubic prostatectomy and a cysto that revealed a large stone in the proximal bulbar urethra. We looked at our limited options and decided that an open urethretomy was his best option. I certainly haven’t seen one of those in my residencies!

*During the day, I had the unexpected pleasure of having my wife call to see how we were making out. It was very sweet of her. I can’t believe she was able to get a call through to be honest. She reached the VVF ward office and Pauletta was right there, she checked to make sure that it was my wife and ran the 500m to the OR to get me. When she arrived she could only say 2 words breathlessly: “Wife” and “Phone”. She then collapsed to the ground unconscious….disaster was averted when Simon the local anaesthetist began to perform CPR. A few cracked ribs later we had her back performing urodynamics.and I was on the phone with my wife.

We finished off the day with a couple of PV slings, and all the procedures went well. We had another long day with our arrival back to the guesthouse at 830PM. A quick burger and fries (although not sure if it was hamburger), although not exactly like home, prior to sitting down to do some

Tim’s Lesson of the Day:
“Check with your physician before starting an exercise program (or run to give someone a message)”

Tim “Blogman” Davies

*Portions of this paragraph may have been fabricated/exaggerated for effect (Don’t worry Paul, Pauletta is just fine)


~Catherine deVries

Tim's Daily Nigerian Times (Day 11)

March 3, 2008 – Day 11

Awoke with the sweet smell of pancakes and syrup making its way through my Sahara sand filled nose to my smell receptors…..

After a lovely weekend we are back to the daily grind. We have really settled into a groove here. We have been splitting up rounds to be efficient prior to the OR getting started (although there is no rush as the 8AM start is Nigerian time). We have been reviewing the patients the night prior, with Susan cranking out the paperwork like a champ. The patients undergoing UDS have their results reviewed and plan outlined the day after the testing.

We performed 2 more PV Slings today and 2 bulking agent injections in the OR. Thankfully all were uncomplicated. We have started the transition from teaching the procedures to having the local surgeons performing the operations with our guidance. I feel (as a recent resident) that I can relate to their process pretty well.

These days have been pretty long as we return back to the guesthouse after dark every night, eat dinner and sit down to do paperwork/review patients until we are all pretty sleepy. This definitely isn’t a vacation…..

Tim’s Lesson of the Day:
“Monday’s come early in Nigeria too”

Tim “Blogman” Davies


~Catherine deVries

Tim's Daily Nigerian Times (Day 10)

March 2, 2008 – Day 10

We ate, we napped, we did paperwork and blogged. Nothing interesting happened.

Tim’s Lesson of the Day:
“Sleep when you can”

Tim “Blogman” Davies


~Catherine deVries

Tim's Daily Nigerian Times (Day 9)

March 1, 2008 – Day 9

We were all looking forward to a well deserved weekend away from the hospital. Again we started the day with a French toast breakfast with warm syrup. Kingsford (Bill’s driver), came by to pick us up for a day of local shopping.

We dropped into an art shop and some fabric shops prior to lunch. Kingsford was a masterful shopper providing us with much needed savings. The shop owners didn’t have a chance when he started in with his strong-armed negotiation tactics. They have the brightest fabrics with the most vibrant colours here. All the local women wear them fabulously. After spending our cash, we managed to save enough for lunch at the Net Café. Not surprisingly, the internet connection was down again and Pauletta’s academic prowess was slowed by the lack of communication. We made a couple of other quick purchases prior to heading back to the guesthouse.

We had to say farewell to our fearless IVU leader Catherine as she had to return to the U.S. Again, Ezekil was kind enough to drive one of us back to Abuja to catch her return flights. And then there were five…

Bill returned to the guesthouse to take us to the local school’s carnival for the elementary students. Hillcrest School has approximately 250 students(K through 12) and the grounds were impressive for such a small number of students. They follow the California curriculum and many of the students (both missionary and local) carry on to college – either Nigerian, American or European. This private school certainly provides a good education and multicultural experience for all who attend. The carnival, put on by the high schoolers, seemed to hit the mark with all.

We then returned to Bill’s house (on the Evangel Hospital grounds) for another meal. We were very happy to spend the afternoon and evening meal with his 4 kids and his wife Dorothy. After some chili, we had a pleasant conversation with the 2 of them. Bill had told us a little of his surgical experience, but we were all impressed by Dorothy’s good work. There isn’t room here to explain all of her exploits, but her most recent projects - Seeds of Life(to feed the widows and orphans) and recycling wedding dresses(including hers) to give the widows a chance to get back on their feet are worth mentioning. After a fascinating and insightful evening with Jos’ “power couple”J, Bill was kind enough to return us back to the guesthouse.
Tim’s Lesson of the Day:
“It’s true that one person can change the world”

Tim “Blogman” Davies


~Catherine deVries

Tim's Daily Nigerian Times (Day 8)

Feb 29, 2008 – Day 8

I have never eaten as many hearty breakfasts as I have on this trip….again with a large serving of scrambled eggs and toast. We can’t seem to get away from eating big meals at each sitting. We have a large lunch each day served by the staff at the hospital. All of us feel guilty if we don’t have it, not that Simon gives us a choice : ). I suspect that we will all put on a couple of pounds over these 2 weeks….when we return everyone will ask – did you leave any for the starving children? Obviously not.

We started the list as Tom joined Bill for his cysto list. He performed a cysto with dilation and DVIU for a proximal bulbar stricture. One of our VVF patients required a cysto for what we thought might be an ectopic ureter but it turned out to be a severe case of schistosomiasis. She had a large inflammatory mass in her bladder, with punctuate calcifications and a golf hole ureteric orifice. Very interesting!!!

We also performed our planned buccal mucosal augmented vaginoplasty without any problems. The harvested graft was a reasonable size and the graft looked good after being laid into place. We also performed a few more PV slings with facia lata which we demonstrated for the VVF team.

Continuing with the theme of overeating, we went out for a dinner with the VVF team. This was traditionally done towards the end of the trip, but with Catherine leaving tomorrow we decided to have it tonight. We went to the Elysar restaurant for a traditional Lebanese-Chinese fusion meal. It was a great meal (filled with kibbe, spring rolls, beef, shrimp, chicken) with the food seeming to go on and on. The company was very pleasant and we were sad for it to come to an end (although we were tired from the week’s work). We said farewell to the VVF team and retired to the guesthouse.

Tim’s Lesson of the Day:
“When you come to Africa, bring pants with elastic waistbands”

Tim “Blogman” Davies


~Catherine deVries

Tim's Daily Nigerian Times (Day 7)

Feb 28, 2008 – Day 7

We scarfed down a quick breakfast of hot biscuits with jam… there is something very comforting about warm carb-filled food. Suprisingly we didn’t fall asleep on the ride to the hospital. We got there early to start a pediatric laparoscopy for bilateral undescended testes at 8AM, but we didn’t get going ‘til about 10AM. Here in Nigeria they are on Africa time and things happen at a certain pace, so it is best to relax and go with the flow…

We assisted with multiple VVF and vesico-uterine fistula repairs (all secondary to obstetrical complications). It was very interesting to see the techniques used by Drs. Langmeng and Chima to repair these so called straight forward cases. I would hate to see the complicated cases!!

We also watched a couple of vaginoplasties for FGM. We put our heads together and thought that a buccal graft to augment the dilated vagina might be helpful so we will perform one tomorrow. One of the local gynecologists had a case of a mullerian abnormaility with a shortened vagina which we all agreed likely needed an intrabdominal procedure to bring down the uterus (after some vaginal dilation).

We left the OR well after dark and were back to the guesthouse by around 845 PM. We settled down to a Mexican feast. Sherri was especially excited by the tacos, as she had made the request the previous day. We were tired, so no chichat or Sodoku, and we were off to bed (to the sweet melodies of the local dogs).

Lesson of the Day:
When the OR lighting is dependant on the daylight from the windows, try to finish before dark.

Tim “Blogman” Davies


~Catherine deVries