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