Wednesday, October 17, 2012

Schools taking the leap to Global Health education

Leading universities are taking the next step in developing effective global health practitioners. Collaboration among health professional schools nationally, or even internationally, will create unity to battle the need for care across the world.



http://globalhealth.unc.edu/2012/10/ujmt-fogarty-global-health-fellowship-consortium/

Tuesday, October 16, 2012

Understanding International Volunteerism - Focus in Haiti


After the 2010 Haiti earthquake, there was an influx of medical volunteers and desire to help in such a traumatic eventWhile this displays admirable initiative, there are many factors that go into international medical volunteerism outside of the desire to do good work that require experience and understanding of local culture.  In one study, co-authored by Richard Gosselin of UC Berkeley’s School of Public Health, almost two-thirds of the surgeons who volunteered in Haiti had no prior disaster experience.



When a nation has declared a natural disaster, "disaster relief" is primarily in the first 24 to 72 hours following the event. In this situation, outside aid must be completely independent of local resources; providing their own medicines, staff, food, water, sometimes electricity and anything else needed to perform their role. The troubled area cannot be depended on or depleted of remaining resources when providing assistance. Many medical volunteers do not recognize or have the capacity to provide these resources when traveling to provide assistance; military and governmental organizations, primarily, are able to.

As days, weeks and months go by, the focus is on humanitarian aid. Many organizations will have developed a base for care and semi-permanent facilities. At this point, medical volunteers are able to connect and work with a well-experienced and community-integrated group to efficiently provide care. In this setting, doctors are able to use resources immediately available to them to perform surgery in a safe and effective way for the nation in need.
 
With social media and news outlets, charitable organizations and medical providers have expressed the consequences of "inexperienced" medical volunteers. Questions we need to ask ourselves are:

When are we doing more harm than good?
Is this the best use of our skills and time?

How can we avoid recreating the wheel?

What can I learn before going into a culture completely different from my own?

Whether you are a community volunteer or a volunteer with a specific skill set, it is crucial to consider these questions when helping in disaster relief or humanitarian aid.

In the coming months, IVUmed is performing two surgical workshops in Haiti, one in Pignon and one in Deschapelles. Both the leaders and many of the volunteers going on these trips have been at least once a year for the past two years. This has given us the opportunity to develop relationships and partner with other organizations, such as Project Haiti and well established hospitals in the region.

To hear an informative podcast on the consequences of volunteering, please click here: The Tragic Consequences of Crisis Volunteering, by Amy Costello.

Wednesday, October 10, 2012

RWANDA Photos 2012

Go HERE

To see photos from our recent IVUmed Workshop in Rwanda!

Wednesday, October 3, 2012

Urology workshops show promising future for urology advances in Kigali, Rwanda





As our first surgical workshop in Rwanda, the IVUmed team was encouraged by the opportunities for surgical education there. The team worked in two sites: Kigali and Gitwe. Our volunteers, led by Drs. Hiep Nguyen and Richard Santucci taught pediatric and reconstructive urology in Kigali, while in Gitwe, reconstructive urology was the primary focus.
Dr. Nguyen and the pediatric urology team were based at King Faisel Hospital and the University Teaching Hospital of Kigali where they had the opportunity to provide surgical education and conclude the workshop with a day-long educational symposium. IVUmed and our Rwandan partners plan to continue pediatric and reconstructive urology education in Kigali. The facility is well-suited for surgical training and includes a faculty that is eager and capable. Dr. Nguyen has already made plans for a follow-up visit in late spring.
“This trip provided me with more experiences than I ever could have expected. I was able to conduct research, help out with a mobile EMR system, assist in the OR, and generally get a much better feel for the needs in East Africa," mentioned David Miller, MPH candidate and IVUmed volunteer.

With minimal resources available in Gitwe, Dr. Santucci and fellow IVUmed volunteers were able to assess the need and discuss opportunities for the physicians in Gitwe for continued education.

During their time in Rwanda, the IVUmed volunteers served 24 patients at the two sites. Twenty physicians were able to attend the one-day symposium from the surrounding area.


DID YOU KNOW?
Surgical need on the international level has dramatically increased, only 3.5% of surgical procedures are performed in the poorest one-third of the world.

How can you help?

American College of Surgeons Present Surgical Humanitarian Award

American College of Surgeons' Clinical Congress officially presented Dr. Catherine deVries, Founder and President of IVUmed, with the Surgical Humanitarian Award:

"Dr. deVries received the Surgical Humanitarian Award for dedicating 20 years of her career to improving urological care around the world. A practicing pediatric urologist, founder and director of the Center for Global Surgery at the University of Utah, Salt Lake City, and professor of surgery at the university, Dr. deVries recognized the unmet needs of children with genitourinary conditions and anomalies, and developed a model of care tailored to the needs of these patients. In 1994, she founded International Volunteers in Urology, the first not-for-profit organization specifically focused on teaching urology in resource-poor settings. Using a comprehensive, sustainable approach, IVU (now IVUmed) oversees highly skilled teams that train physicians and nurses in most areas of urology throughout Asia, Africa, and the Americas. The far-reaching impact of these educational partnerships can be seen in countries like Vietnam, where early IVUmed trainees have established a urology training center in Ho Chi Minh City, which treats more than 1,000 patients annually and trains local physicians. In Honduras, local partners now conduct their own surgical outreach workshops. Similar successes have been achieved in the 30 countries where IVUmed is active and further leveraged by a wide range of international partnerships."

We are thankful to have a leader among leaders here at IVUmed, Dr. deVries has established an organization that now sits at the table of leaders in global surgery, recruiting some of the most-skilled, humble and dedicated surgeons to teach surgical skills around the world.


For the rest of the article and award announcement, please go here: http://www.facs.org/clincon2012/press/volunteerism.html


Wednesday, September 5, 2012

President and Founder, Dr. Catherine deVries' with Dr. Ray Price are awarded for their efforts.

IVUmed's President and Founder, Dr. Catherine deVries was awarded the Surgical Humanitarian Award from the American College of Surgeons along side Dr. Ray Price, who was awarded the Surgical Volunteerism Award through the same organization.

Dr. deVries' efforts in surgical education worldwide does not go unnoticed. With the formation of IVUmed over 20 years ago, Dr. deVries has developed with the help of staff and fellow board members, a surgical urology education platform embraced by physicians around the world.

"It's my career," deVries said to KSL 5 News, "It's what I do. This is my passion."

This passion has lead to IVUmed's successes in building relationships with 30 countries since its inception. Building these relationships, local healthcare professionals have learned valuable urological skills to treat their communities.

For the full KSL 5 News Interview: World-traveling surgeons awarded for humanitarian work
American College of Surgeons: Fellows honored for volunteerism





Friday, August 17, 2012

"Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?" - New Yorker

“Scaling good ideas has been one of our deepest problems in medicine. Regulation has had its place, but it has proved no more likely to produce great medicine than food inspectors are to produce great food. […] One study examined how long it took several major discoveries, such as the finding that the use of beta-blockers after a heart attack improves survival, to reach even half of Americans. The answer was, on average, more than fifteen years.”

Read more http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande#ixzz23pRWUXwK

Friday, August 10, 2012

Global Surgery Matters

According to the World Health Organization, the statistics are staggering:
  • 11% of global burden of disease can be treated with surgery
  • 2 billion people worldwide have no access to basic surgical care
  • 30% of the world's population receive 75% of surgical care

IVUmed is trying to change that by training more surgeons where they are needed most.

Dr. Sherry Wren discusses the importance of surgery as a global health priority:


Visit our website to find out how you can help and get involved. 

Thursday, August 9, 2012

"Repairing the Surgery Deficit"

surgical education

Zambia currently has 44 licensed surgeons to serve its population of 13 million.  That is less than one surgeon (.33) per 100,000 people.  To put that in perspective, in the United States, there are about 45 surgeons per 100,000 people.  

Next month we have a team of volunteers heading to Lusaka, Zambia to conduct a pediatric urology workshop.  The volunteer experts will work at the University Teaching Hospital there, focusing on training and transferring skills to the local surgeons and professors so that they in turn can train more surgical students.

To read more about this pressing need for surgical training in Zambia, please read this recent article:

Repairing the Surgery Deficit
By SARIKA BANSAL
The New York Times
There are solutions to these problems.  IVUmed is committed to making a difference both in Zambia and throughout the world through surgical education.

volunteer surgical education

Tuesday, August 7, 2012

IVUmed Traveling Resident Scholar Report

Nitya Abraham, MD 
New York University 
 Kampala, Uganda – June 15-24, 2012 
Mentor: Dr. Susan Kalota 
Sponsored by: SUFU 

urology surgery

Through the generous sponsorship provided by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), Dr. Nitya Abraham traveled to Kampala, Uganda with mentor Dr. Susan Kalota to collaborate with the Urology Department at Mulago Hospital. While participating in cases and delivering lectures on female urology, Dr. Abraham was able to develop an understanding of the discrepancies in healthcare due to limited resources. As she now begins a female urology fellowship at Cleveland Clinic, her experiences in Uganda have helped shaped her career goals.

Reporting on her experience, Dr. Abraham stated:

resident scholar mentor
“I saw the photographs, I read the books, I watched the documentaries. I knew the need for medical assistance was great in places like Africa. Now finally I would be going to Kampala, Uganda for a female urology workshop through IVUmed. I embarked on the trip with excited eagerness, cheerful enthusiasm, and grandiose hopes to transform lives. But my high expectations were replaced with unanticipated disappointment. I left with a heavy heart, feeling powerless. Our trip seemed to me a ‘drop’ of help when an ‘ocean’ was needed. My idealistic naïveté was humbled by the unexpected challenges I encountered.

“My disappointment and remorse at the end of my IVUmed trip to Kampala stemmed from my inability to provide world class care to the patients there. Why should there be such disparity in the treatment of my patient in Cleveland and my patient in Kampala? What always seemed to be an abstract aspiration has now become a concrete goal after the IVUmed trip: I want to bring world class care to places like Mulago Hospital in Kampala, Uganda. This endeavor will be expensive, require a lot of time and effort, and will be difficult to accomplish, but I do believe it is possible.

  “I am grateful to IVUmed and SUFU for providing me this invaluable experience. It has opened my eyes and has changed how I envision my future career. One trip is just not enough. I strive to include international health care as a long-term commitment and integral part of my career because ‘every life deserves world class care.’”

For more information about IVUmed's resident scholar program, including the current application and deadlines, please visit our website

Friday, June 1, 2012

Our Purpose for Service

clip

In just a few short weeks, an IVUmed volunteer team will be heading to Kampala, Uganda to conduct a female urology workshop. IVUmed workshops give our volunteer urologists the opportunity to change the lives of their host colleagues and their patients. The local doctors will gain essential surgical skills through training and educational models developed by IVUmed and its volunteers, who maintain professional contact throughout the year to continue the learning process.  Our international partners can then use their new capacity to help patients in their community, even after the volunteers have left.

This is a monumental event for our partner physicians, as well as patients like Veronica Nandego, shown above. Veronica Nandego mentions, "I have urinated on myself for 50 years." Not only has she suffered countless years of public humiliation but has lost three children, lost ability to bear children and no longer presents proper urinary function. Veronica's story is very common across Africa due to lack of capable physicians to perform the proper surgeries to deter maternal issues from becoming this severe.

IVUmed was contacted by local medical professionals in Uganda in hopes of coordinating for the upcoming workshop. We have had the opportunity to arrange travel arrangements for Veronica to reach Mulago Hospital, where the workshop will be hosted, approximately 45 kilometers away from her one-room hut in Bugembe.

Working with IVUmed's volunteer physicians will better equip the local doctors with the skills they need to help many African women like Veronica return to society and  live a normal life.

IVUmed's motto, Teach One, Reach Many, guides our continuing successes in improving the quality of life for individuals worldwide through building the confidence and skill sets of local medical professionals.

To read more about Veronica's story and personal life, continue to this article.


Map of Uganda from Jinja district, where Veronica lives, to Mulago Hospital in Uganda.

Wednesday, May 2, 2012



Mary Frances James, MD
Eastern Virginia Medical School
Nairobi, Kenya – March 3 – 13, 2012
Mentor: Dr. Kurt McCammon
Sponsored by: The Mid Atlantic Section of the AUA

Through the generous sponsorship provided by the Mid Atlantic Section of the AUA, Dr. Mary Frances James traveled to Nairobi, Kenya with mentor Dr. Kurt McCammon.  Dr. James had the opportunity to experience grassroots surgery and its value in a developing nation.



 Reporting on her experience, Dr. James stated: 

“At the time of our arrival there was a nursing strike going on throughout the city including Nazareth Hospital.  This situation was very stressful for the sisters and added strain to the daily hospital management as the patient census continued to increase each day. …Despite this ongoing struggle within the hospital we were graciously welcomed by the FIHM sisters on our arrival.”

“The operating room staff was very hospitable and allowed us to use one of the two main operating rooms.”



“The first couple of days consisted of several second stage urethroplasties.... This was a wonderful experience as it was the first time I had seen this operation.”

“Overall my IVU trip was a wonderful experience. Traveling to Africa and working within the constraints of limited resources was an eye-opening and humbling experience.  In a field such as urology that has transformed with development of robotics and minimally invasive care I think it is important to remember how different healthcare is throughout the world.  I am extremely grateful for having had this opportunity and look forward to a lifelong commitment to urologic mission work."



Thursday, April 12, 2012

Resident Scholar Reflections

Judith Hagedorn, MD
Stanford University
Hebron, West Bank – March 15 – March 24, 2012
Mentor: Dr. Scott Eggener
Sponsored by: Verathon

Through the generous sponsorship provided by Verathon, Dr. Judith Hagedorn traveled to Hebron, West Bank with mentor Dr. Scott Eggener to learn and assist surgeries at Hebron Hospital. Although in a politically turmoiled area, Dr. Hagedorn was able to develop an understanding of the diversities in healthcare due to limited resources.

Reporting on her experience, Dr. Hagedorn stated:

"Every morning we got picked up with the Ambulance of the Hebron Hospital. Our Palestinian driver made a daily pit stop, either to get some strong Arabic coffee or freshly fried falafels. 

"The hospital was quite simple, but clean. The staff was very friendly and showed

their appreciation for our visit. In addition, the patients were overly thankful and there was never a day we didn’t leave the hospital without a small present from one of the patients’ families.

"The clinical decision-making was also quite interesting and different from what I had learned in the Western World…. I had a wonderful, eye-opening, and rewarding experience, which definitely strengthened my passion to contribute to global health, and I am already looking forward to my next international medical/surgical trip."

Interested in learning more about our resident scholar program?

Find more information at our website, www.ivumed.org.

Friday, April 6, 2012

Jonathon Wu, MD
Stanford University
Hue, Vietnam – February 17 – March 4, 2012
Mentor: Dr. Walter Beh, MD
Sponsored by: The Western Section of the AUA

Through the generous sponsorship provided by the Western Section of the AUA, Dr. Jonathon Wu traveled to Hue, Vietnam with mentor Dr. Walter Beh. Dr. Wu and his mentor collaborated with Dr. Hung and his colleagues of the urology department, focusing on 19 patients with difficult cases. Dr. Wu was able to perform his first open pyelolithotomy under the supervision of a Vietnamese colleague, Dr. Tuan.
Reporting on his experience, Dr. Wu stated:

"In our two weeks of working mainly with Dr. Hung, I was very impressed by his surgical technique. Open surgery involved tediously dissecting out important structures and controlling all bleeding quickly with cautery or ligatures. He moved very quickly in the OR but was very purposeful with his movements. No suture was wasted as instrument tying was performed whenever possible. Bigger cases would often involve 2 attending surgeons intertwined in a well-rehearsed ballet.“What was even more impressive was the efficiency and resourcefulness of the hospital.
We mostly worked with Dr. Hung who has been on the urology staff for 6 years. He is quite motivated and very enthusiastic.
"This disparity was made much more obvious to us when we observed a kidney transplant on our last day.… During the course of our 2 weeks, we were able to see the kinds of needs our Vietnamese colleagues had."

Friday, March 30, 2012

A Dynamic Paradigm in Global Health and Surgery



Innovation, collaboration, sustainability were common themes of discussion at the first annual "Extreme Affordability: Innovative Solutions of Surgical Care" conference hosted by the Center for Global Surgery at the University of Utah School of Medicine. Focusing on providing affordable surgery globally, this conference called together surgeons, policy makers, bioengineers, anthropologists and non-governmental organization leaders to discuss the need and accessibility of surgical care to the international community.

Mark Harris, M.D., co-founder of the International Anesthesia Education Forum writes about his experience at the conference, “I am left with a sense of enthusiasm, optimism and community. There are so many people from different fields and countries collaborating and using innovative approaches to the myriad problems facing the low resource world.”

Speakers from around the world shared their perspectives on these current themes of global health and surgery. Keynote speaker, Clayton Christensen, Kim B. Clark Professor of Business Administration at the Harvard Business School, discussed the decentralization of healthcare providers and technology to develop affordable and sustainable healthcare in resource-limited and rich settings. Christenson is regarded as one of the world's top experts on innovation and growth.


With a pattern recognition-based concept, Christensen's message was well-received by conference attendees.

"The speakers were thoughtful and captivating which was no small feat!" Rhiana Menen, resident with the East Bay Surgery Program at UCSF, commented. "I am so grateful to have had the opportunity to attend this wonderful conference. As someone early in my career but very much trying to incorporate an emphasis in global surgery, I now have a much better idea on how to proceed and have made some invaluable contacts."

As one of the few non-governmental organizations presenting at the conference, IVUmed was able to share its perspective on global health. Josh Wood, executive director, provided an in-depth look at how to develop and sustain global partnerships for dynamic change in an economical and efficient manner.

During his presentation, Wood explains, "When you start to become aware of surgery, how much need there is and the potential we have to relieve that need, it may seem overwhelming; but there are extensive opportunities, especially if programs are carried out in a sustainable manner so we can get more bang for our buck."

A staggering one million African infants are estimated to die in the first 4 weeks of life and there are only 24 urologists for the 9 million people living in Haiti. With these, and other outstanding statistics, the developed world recognizes a preventable epidemic. Through technology and innovative collaboration, these leaders are truly developing a paradigm shift in global health.

Discussing the role of surgery in global health, Steve Alder, Chief of the Division of Public Health at the University of Utah, comments, "You have to talk about the elephant in the room; is it the scalpel or the syringe?"

Thursday, March 29, 2012

Resident Scholar Reflections

Julie Riley, MD
University of Missouri
Hue, Vietnam - February 17 - March 4, 2012
Mentor: Dr. Walter Beh, MD
Sponsored by: South Central Section of the AUA


Through the generous sponsorship provided by the South Central Section of the AUA, Dr. Julie Riley traveled to Hue, Vietnam with mentor Dr. Walter Beh. Dr. Riley and her mentor collaborated with Vietnamese colleagues

Reporting on her experience, Dr. Riley stated:
in the urology department. During her time in Hue, Dr. Riley was able to experience the differences in international healthcare.
“I did enjoy that we were able to give daily presentations. The conversations following these topics were very interesting to further understand the culture as well as understand some of the limitations on the Vietnamese surgeons. In addition most of the Vietnamese doctors wanted improved English particularly medical English and this provided a forum for them to practice.

I feel that the experience was very positive and I look forward to continuing international urology through active patient care as well as education and support to local urologists. I am very grateful to both the South Central Section and International Volunteers in Urology for

allowing me to participate in such a remarkable program. In addition, I am very glad that I was able to experience the culture and the medicine of Vietnam and to provide the local urologists with equipment and all knowledge that I could.”

Wednesday, March 14, 2012

Oreoluwa Ogunyemi, M.D.
University of Wisconsin
Accra, Ghana - January 14, 2012 - January 22, 2012
Sponsored by: Oceana Pharmaceuticals

Through the generous sponsorship provided by Oceana Pharmaceuticals, Dr. Ogunyemi was accepted as a Traveling Resident Scholar to work in Accra, Ghana under the supervision of mentor, Dr. Sunny Mante. During the trip, Dr. Ogunyemi was able to give back to an area that faced similar issues as her home country, Nigeria.


Reporting on her experience, Dr. Ogunyemi stated:

“During medical school, I traveled to Central America to volunteer in Guatemala in obstetrics and family medicine, but I have never had the opportunity in the field that I will devote my career. I have always known, as an immigrant and child of immigrants, that it would be vital to provide to me to provide care globally and foster relationships that would make this possible. IVUmed is my opportunity to begin this work.

“Clinic was a fast and furious experience. Each few moments, one of the charts from the stack was pulled, a patient appeared and a story was told.

“My week in Accra was a wonderful experience and one that I will cherish for the rest of my professional career. I truly appreciate the opportunity from IVUmed to make this a reality and look forward to repeating similar endeavors in the future.

“The patients, with teeth gritted and anxious faces, put their care into our hands despite the language barrier between us. It was gratifying to be able to care for these patients and provide comfort.

“My arrival at the halls of 37 Military Hospital was welcoming. I found welcoming smiles and genuine interest in my urologic perspective and actively encouraged to challenge ideas and bring forth alternative treatment plans and opinions. There was a true collegial excitement at exchanging ideas and patient experiences and learning from each other.
"

Thursday, March 8, 2012

Resident Scholar Reflections

Jessica Casey, MD
Northwestern Univeristy
Mahuva, India - November 4-28, 2011
Mentor: Dr. Sakti Das
Sponsor: Resident Scholar Alumni

Through the generous sponsorship provided by the Resident Scholar Alumni, Dr. Jessica Casey traveled to Mahuva, India with mentor Dr. Sakti Das to participate in a free urology camp organized by the local Indian organization Jeev Sewa Sansthan (“Service to the Living”). During the camp, over 130 patients received much-needed urological care

“During my six days in Mahuva at Sadbhavna Trust Hospital, I operated like crazy – running back and forth between the 6 operating beds that filled 2 operating rooms. As I was finishing one case, a patient behind me was getting their spinal anesthesia injected and being prepped by assistants for me to operate on in a few minutes.

of the work being done while I was there.
During those short six days, I participated in 34 operations which
ranged from delicate hypospadias work to minimally invasive percutaneous nephrolithotomy to a reconstructive extrophy repair; and this was only a fraction

“In Mahuva they did not have all of the fancy equipment we have in the states; there was no fancy LigaSure, no argon beam, no laser lithotripsy. They had a scalpel, cautery, suction, a light and a patient who needed surgery. If something is bleeding, quickly put an “artry” (i.e. hemostat) on it and move on. If the suction isn’t turned on, use one of your two laps to stop the bleeding and move on.
If they don’t have the needle driver you want, make do with another.

“If I was struggling with a maneuver and blaming everything around me (the lighting, the instruments, the angle, etc), Dr. Das would calmly remind me to focus on my own skills and not blame my sur

roundings. Dr. Das’s influence made me
reflect at my own actions. Often at Northwestern, surgeons complain about not having the right gloves, the right assistant, the best light, etc. in order to make excuses for their own
skills. It’s best to just focus at the task at hand, not make excuses, and just get the work done.”

For more information on getting involved with our Resident Scholar Program, please visit our website at www.ivumed.org.



Thursday, March 1, 2012

Haiti - November 2011

1,500 man hours, 15 physicians, nurses and technicians and true dedication compensate for the $320,635 worth of medical services contributed to over 150 patients in Haiti. In November 2011,IVUmed sent two medical teams to Descheppelles and Pignon, Haiti to train local physicians. Partner doctors received training and lectures from volunteer surgeons to create a sustainable program for urological procedures.

“We were there to help pioneer and teach innovative ways to help alleviate a female reproductive issue…They are very eager to learn yet they were filled with tremendous humility and appreciation.”

- Laura Springhetti, Nurse Anesthetist volunteer, Pignon.


Our work there was established through two partnerships, with Promise for Haiti and Hospital Albert Schweizer of Descheppelles.

On March 10th, 2012, a group of IVUmed volunteers are returning to Pignon to focus on female urology. To stay connected with trip updates and volunteer opportunities, “like” us on Facebook.

Wednesday, February 22, 2012

Resident Scholar Reflections

Dr.John Mancini - Uganda 2012

As I stepped off the plane and onto the tarmac in Entebbe, a short distance from Kampala, I quickly realized I was no longer in my familiar world. The air was hot and dry, and though it was the middle of the night, I could
see a think dust lingering in the air. I was greeted in the airport by Joseph Musaba, a very bright-eyed and energetic Ugandan in the final year of his fellowship training at Mulago Hospital. Right from the very start, he was so kind and gracious that I felt right at home, even in such an unfamiliar place. The trip from Entebbe to the apartment in Kampala took about one hour. Kampala was busy, bustling with traffic, motorbikes which outnumbers cars three to one, and many people walking along the side of the road, despite it being after midnight. I was immediately struck by the notion that this place is full of life!


We arrived to the apartment, which was adjacent to the property of Dr. Watya, the senior urological consultant at Mulago Hospital. He greeted us
outside the apartment, and together we entered the building. The power in our section of the city had been out for several hours. I would later come to realize that power outages were very common and unpredictable. Dr. Watya had brought a portable florescent light, which ran out of juice after thirty seconds. We toured the apartment by the light of our cell phones. I was very pleased with the apartment as it had most modern amenities and, by the dim of my cell phone, appeared to be nicely decorated.

My first full day in Kampala consisted of recovering from jetlag and making a trip to the local shopping center with another urology fellow, Dan. In the daylight, Kampala was certainly a very interesting place - a mix of tall modern glass buildings and slums, where people lived in little more than cardboard boxes. The roads turned from pavement to dirt without any notice, and large potholes were more common than smooth pavement. The sidewalks were mostly dirt, and a thick haze of dust covered the entire city. The traffic was intense, where motocycles (called boda-bodas) darted in and out from between cars and trucks, not seeming to pay much attention to traffic laws, other vehicles or pedestrians. Despite the chaos, I was impressed with Dan's cheeriness. He alaways had a smile on his face, and when he got cut-off by a boda-boda, he just laughed. I found this to be a common theme among Ugandans; they were able to find joy outside of less-than-ideal circumstances.

The next day we went to Mulago hospital - a very large and impressive structure that appeared to have been last renovated in the 1970s. Most of the hospital was open to the air. It was very busy with people, mostly patients and their families, everywhere. In most corners and in open hallways, patients and their families were camped out, women breastfeeding babies, men holding small children. The urology ward consisted of two large
open bays, one for men and one for women. The men's bay had approximately 40 cots, and they were all full. Huddled around each patient were their family members, at times numbering six to eight individuals per patient. The family members were primarily responsible for the non-
medical care of the patients. They provided food and helped keep the patients comfortable, doing a lot of what is done by nurses in the United States. During rounds, I was struck by how thankful and appreciative everyone was for the care they were receiving. Some patients had been on the ward for weeks, waiting to get their change to go the operating room. The operating room time was precious, only having two dedicated days per week. Surgeries for many patients with non-acute issues were delayed week after week as more urgent cases needed to be done. Then, after the weeks of waiting, when the patient was finally able to undergo surgery, there was much gratitude and appreciation, without plaint of their delay.

The operating room in Kampala is adequate for most surgical procedures, and I was certainly impressed with the skill of the Ugandan surgeons I worked with. I was most impressed with how they are able to accomplish so much with so little. Poor lighting, old operating tables, limited
instruments and scarce disposables, that would have made frantic most any attending from home, were well-tolerated and accepted by the Ugandan surgeons. By Necessity, they have had to become very creative in the operating room to accomplish the surgeries that vitally need to be performed.

We did several endoscopic cases during my time at the hospital. They have a very nice tower and camera, but otherwise are quite lacking of endoscopic equipment. I became frustrated on a couple occasions because simple endoscopic procedures that typically take less than 30 minutes at my home institution took over two hours at Mulago. The excess time was spent looking for pieces of equipment that would adequately finish the job, or struggling through the procedure using something that was barely sufficient. In one ureteral stone case, in particular, we found a large stone in the distal ureter with a semi-rigid ureteroscope. It was easily grasped with a stone basket, but could not be removed because of its large size. Eventually, a stent was placed, and the patient will have to come back and have an open procedure for stone removal. It was difficult for me to grasp being so close to being able to make the patient stone-free, but ultimately being
unsuccessful. If we would have only had a laser or even a handheld penumatic device like the Stonebreaker, we could have easily treated the stone.

I was also fortunate to have the opportunity to travel to the small town of Bundabugio on the western border of Uganda to experience what life is like in this very remote region of the country. The region is extremely isolated, about a three to four hour drive over very rough terrain from the nearest "city". There is a small medical clinic in the town. Small clinics like this across the country are run by medical officers, who have the training equivalence of an intern in the U.S. They are responsible for whomever walks through their doors and are expected to perform surgery if required. It is not uncommon for these medical officers to perform C-section and appendectomies on a regular basis. They must take care of every situation they can as there is not a good system of referral and transport to larger
hospitals.

As I reflect on my trip, what I a most impressed with is how Ugandan urologists do so much with so little. They treat a very wide range of diseases, similar to what urologists treat in the US, but with fewer tools at their disposal. I take for granted training at a large hospital where we have essentially everything at our fingertips. Ugandan surgeons use creativity and excellent open surgical skill to bridge the gap. They are truly remarkable surgeons and people, and I have been blessed to learn from their skill, creativity, positive attitude and friendship.

I found my time at Mulago to be beneficial to the urology fellows, in that I was able to share my experiences, provide needed equipment and supplies through generous donations from both IVUmed and Duke University, and teach several endoscopic procedures they rarely perform. I highly recommend IVUmed continuing to assist the Ugandan people by sending more resident and attending urologists, as fellows would be able to travel to the United States. I would be willing to assist in having Duke University be a potential place where international students could come and learn.

Thank you very much for this incredible experience.

For more information on getting involved with our Resident Scholar Program, please visit our website at www.ivumed.org.

Thursday, February 16, 2012

Founder and President, Catherine R. DeVries, M.D - Transform 2012 - Mayo Clinic

Global Surgery and Public Health



Watch on YouTube

Catherine R. deVries, M.D., Founder of IVUmed, Clinical Professor of Surgery and Public Health at the University of Utah School of Medicine, addressed the Transform 2010 Symposium sponsored by the Mayo Clinic Center for Innovation.

Sunday, January 15, 2012

Resident Scholar Reflections

Dr. Marc Bjurlin, DO - Bhopal, India

Through the generous sponsorship provided by the
North Central Section of the AUA, Dr. Marc Bjurlin traveled to Bhopal, India with mentor Dr. Gopal Badlani. Dr. Bjurlin and his mentor participated in a free urology camp organized by the local Indian organization Jeev Sewa Sansthan (“Service to the Living”). During the camp, over 140 patients received much-needed urological care.

Reporting on his experience, Dr. Bjurlin stated:

“The urology camp patients of Bhopal came from miles away to receive their care. Graciously they would await their turn, one at a time, slowly moving up in the line, until it was time for surgery. There was no complaining of the long wait, no one complained that they wanted to be operated on first. There were no irritable patients being hungry from not eating prior to surgery. Everyone sat patiently with a face that expressed their gratefulness even though I knew no Hindi to communicate.

“The hours of surgery were long but the time passed at the blink of an eye. The pathology, scope and variety of urologic cases was remarkable. Equally remarkable was the efficiency of evaluating patients preoperatively based almost entirely on symptoms, urine analysis and a select intravenous pyelogram.

“Over the course of the urology camp, I learned much about the urologic diseases of India, their ailments, and surgical treatments. I expanded my knowledge of urology in a culturally sensitive manner. Yet, as my knowledge of urology grew through interaction with patients, my understanding of the human spirit matured. Instead of simply operating on patients who had urologic diseases, we provided respect, dignity, and compassionate urologic care to a community that taught me an indispensable lesson.”