IVUmed

Follow our team in Kenya!

2011-04-27T06:42:00.004-06:00

You can follow our team currently working in Kenya on Boston Children's Hospital Blog.

International Women's Day

2011-03-08T09:59:00.001-07:00

Join IVUmed in Celebrating International Women's Day!

IVUmed is deeply committed to empowering individuals through education and service. That is the spirit of our Women's Program, which focuses on helping women recover from urological and gynecological trauma and diseases as they rebuild their lives.

Join us in celebrating International Women's Day by donating to support the Women's Program. Your tax-deductible contribution will help our partners in Mozambique, Nigeria, Haiti and elsewhere to reach more women in need of quality surgical care.

The United Nations' theme for International Women's Day 2011 is Equal access to education, training and science and technology: Pathway to decent work for women. We put this theme into action by partnering with outstanding surgeons and nurses in expanding access to surgical care in poor countries worldwide.

Click Here to Donate

Watch a video featuring our woman's program in Nigeria here:

Women of Evangel

World AIDS Day

2010-12-01T13:00:00.009-07:00

December 1st is World AIDS Day. IVUmed is committed to the battle.

This year, IVUmed collaborated with the United States Agency for International Development (USAID), the American Urological Association (AUA), and Jhpiego (a nonprofit affiliate of Johns Hopkins University) to fight HIV/AIDS in Swaziland. IVUmed is providing volunteers to support an initiative there to combat the virus through adult male circumcision. According to recent studies, male circumcision has been found to contribute significantly to the prevention of female to male transmission. During a recent three-week “Back to School” campaign in Swaziland, over 7,000 men were circumcised. According to modeling studies, this translates into almost 2,000 HIV infections prevented. Our new partnership has made a lasting impact in the country hardest hit by the HIV epidemic.

"I hope that my efforts with the circumcision project safely contribute to fight against the HIV epidemic ravaging the people of Swaziland. I sincerely thank the IVUmed organization for allowing me this unique and enriching opportunity."
-Dr. James Wysock, IVUmed volunteer

IVUmed Volunteer, Dr. Shaun Wason, with staff at a local men's clinic

Operating bays at a men's clinic in Swaziland

Young men waiting to be circumcised at a clinic in central Swaziland.

Mozambique - November 2010

2010-11-29T15:49:00.003-07:00

IVUmed first began its collaboration with partners in Maputo, Mozambique in 2004. Formal workshops focusing on pediatric urology and women’s health began two years later in 2006. Training has continued since then with workshops covering pediatric, women’s, and general urology cases.

Our lead partner in Maputo, Dr. Igor Vaz, is a leader in reconstruction and fistula repair. His dedication and influence has been instrumental in advancing the level of training available not only for Mozambican medical personnel, but for urologists and surgeons throughout the region as well.

Twelve physicians from three different countries participated in this year’s workshop at the Hospital Central de Maputo. During the week-long training, 57 children and adults were served. As a rapidly improving hospital and city, the site is well situated to reach and teach surgeons from neighboring countries. The impact of previous trainings is readily evident in the sophistication and quality of the urology services provided as well as the progress of the local residents.

“It was amazing to see how much they have learned and improved in the 4 years since I’ve been back. I have been searching for Mozambique for most of my professional life. It is the ‘end of the world’ urologically speaking, with only 2 fully trained urologists to service a population of 20 million. It is an amazing place to visit as the need is so great.”

-Dr. Richard Santucci

“This was my first experience on a medical mission. I was honored to be part of the team and look forward to doing it again in the future.”

-Dr. Gregory McIntosh

“Simply put, this has been one of the greatest professional experiences I have ever had. I feel that all practitioners need to have this type of experience at least once in their lifetime.”

-Dr. Britt Zimmerman

Zambia 2010

2010-10-29T15:34:00.004-06:00

IVUmed launched a new surgical training hub in Lusaka, Zambia this October. Dr. Francis Schneck led an IVUmed team to conduct an initial site visit and surgical workshop at University Teaching Hospital, the primary training and referral hospital in Zambia.

Lusaka represents the wonderful potential for regional training efforts in Southern Africa. Sharing borders with eight countries and already selected by the College of Surgeons of Eastern, Central and Southern Africa (COSECSA) as a potential center of excellence, University Teaching Hospital has requested IVUmed’s services for some time. Thanks to our members, funders and volunteers, we are now able to help build the availability of quality urological care in the region.

Zambia’s young and growing population faces a number of challenges as the country develops. A major concern is the dearth of available pediatric urological care. IVUmed’s first work in Lusaka witnessed this need with a caseload of both common and complex surgical cases. During the assessment and workshop, the team was able to train ten physicians along with 25 nurses, as well as serve 15 children.

Dr. Mohamed Labib and his Zambian colleagues are partnering with IVUmed to make our shared vision a reality. Working with seven urologists and over a dozen nurses and technicians, the IVUmed team found a site with the potential to meet its population’s urological needs. With the support of our members, we will apply our proven education model to make this happen.

“The moment that stands out for me was when the father of one patient grabbed my hands and bowed in appreciation, saying over and over ‘thank you, thank you, thank you.’ He was so grateful. You see incredible appreciation on these trips, which reminds me why I came and why I love nursing.”
-Stacie Pearce, RN

Mongolia 2010

2010-06-10T15:24:00.002-06:00

Thanks to the generous support of our volunteers and donors, we have completed our third joint pediatric and general urology workshop in Mongolia. Volunteers trained medical personnel at State Central Hospital #1 and the Maternal and Child Hospital in Ulaanbaatar. The workshop brought together a highly skilled and dedicated multinational partnership with the shared goal of enhancing the quality and availability of urological training and care in Mongolia. The workshop served 60 children and adults while providing training for over 30 Mongolian physicians and nurses.

After successfully completing prior workshops, training at both hospitals has now advanced to include more complex procedures specifically tailored to be performed in Mongolia. This included advanced cystectomies and laparoscopic nephrectomies at the adult hospital. While building upon previous trainings, the goal is to help our Mongolian medical partners become independent in delivering much needed urological care.

Heather LeMelle, IVUmed’s Operations Coordinator, joined this year’s team and shares about her experience: “The Mongolian children have a trust beyond my imagination for the doctors and nurses within the walls of the OR. This is an experience of a lifetime. To my wonder and amazement, just hours after surgery, these little ones would smile at me. I witnessed the teaching of the procedures between colleagues and the devotion of the entire Mongolian and US team while breaking through language barriers. I am honored to have participated.”

Senegal 2010

2010-04-14T21:14:00.002-06:00

Day 4: Wednesday, April 7th
We had 5 surgeries today. They all had some kind of complication or discovery that extended the length of the surgery and we ended up staying in the OR late and had to cut some of our lectures. We went an African Art exhibition, which was fantastic and ate at the restaurant there. It was delicious to have Thioff (fish), fried plantains, rice, bouf (beef) among others. Serengie Gaye, the head urologist and coordinator of these trips gave us farewell before leaving on business. We also ate with the other head urologist residents and physicians from the host hospital. Their hospitalilty is amazing!
Day 5: Thursday, April 8th
We had 7 surgeries. Afterwards we went with Mohamed to his house. He showed us traditional Senegal life and to an authentic place to eat. We played with his cute 4 year-old son, Abdullah. It was interesting walking the streets. There were hundreds of people just walking the streets for no apparent reason except to visit. Imagine that, strolling and appreciating friends and family!! Its wonderful to see this and the way real Senegalese live! Julie and Nate went and had their hair braided, the power went out and they finished their braids under cell phone light. How adaptable are they! Their hair looks awesome.
Day 6: Friday, April 9th
Final surgeries performed today. They all went well. More surgeries. Final Surgeries. Went to dinner at the beach overlooking the ocean
Day 7: Saturday, April 10th
Day 8: Sunday, April 11th
Story Time
THE BUTTER STORY: We went to dinner at this fancy French restaurant. This was day one when we were getting used to the idea of the language barrier. Here’s the script:
Nate: “Excuse me, where’s the bathroom?”
Waiter: “Excuse moi?”
Nate: “Where is the bathroom?”

Waiter: “Excuse moi?”
Nate: “Bathroom? Bathroom?”
Waiter: Quickly exits room with haste
Nate: Leaves room frustrated and tries to find restroom on his own
Enter Waiter: Leaves a plate of butter in Nate’s place.
Ha ha ha! The waiter thought he was saying Butter instead of bathroom. For the rest of the trip we would ask “Where’s the butter?” when we needed to find the bathroom. Oh language faux pas, why are you so hilarious?
THE STICK STORY: I was abruptly awoken this morning at 2 am by a stick being poked into my side. Well, actually, that is what they tell me. I can’t remember a thing. Apparently, Gaayana came home last night and couldn’t get me to wake up to open the door (or so she claims, I deny everything). Here is the story according to Gaayana with Igor as witness. They arrived back at the hotel after the traditional African dancing at 1:30 am where I was asleep in our room.
Gayanna: Knocks on door. No answer. Calls my name through open window slats. No answer. Starts yelling my name. No answer.
Enter security guard who also starts yelling my name and running his flashlights along the wood slats on the door in attempt to awaken the sleeping giant.
Gaayana then went to get Igor: “I can’t wake up Stacie”
Igor: thinking to himself that people can’t sleep through that unless in Phase 1 anesthesia. He rapa tap taps on the door
Gaayana: “Stacie!!!”
Igor: “Shhhh, you’ll wake everyone” (however he soon was yelling and slamming the door eventually)
Security came by again. More knocking and yelling. They went to the back window of the hotel on the opposite side of the room of my bed.
Gaayana: “Should we throw a stone through a hole in the screen?”
Igor: “NO!”
Gayanna: Not at her head! At the floor
Security guard: Exits with haste
Igor: “Okay, the way I see it, you have two options. You can sleep in my room, I have a second bed…however there may be some funny questions in the morning from the team….or you can sleep with the security guard” Gaayana begins to panic
Enter security guard (to Gaayana’s relief because now she doesn’t have to decide on which guy to sleep with). The giant stick is approximately 8 feet long. He sticks it through hole in the screen window, across the room over Gaayanas bed and begins slapping my bed and laughing so hard the stick is all over the place.
Gaayana: “Don’t hit her head”
Security Guard: pokes stacie’s side
Stacie: “WHAT?!!!? Oh, Hi guys, do you need me to open the door? Here I come”
The rest of the trip was defined by the retelling of this story over and over and the amazement that I don’t recall this or the conversation I had with Gayanna that night.
I deny everything.
It’s a conspiracy.
I swear I’m a light sleeper.
Day 9: Monday, April 12th
We woke up this morning and took a nice, slow relaxing morning and early afternoon shopping, swimming, walking around, taking naps and going to the beach. Eat your heart out! We then began our drive to Dakar which was much shorter this time. We picked up some purchased items and headed to the airport. It’s always hard to say goodbye. Sarah kept thinking of excuses as to why she couldn’t go home. She’s a real trooper. We just spent 10 days in a hot, humid, culturally different country with many toilets without toilet seats, showers without warm water, water that is undrinkable, and a language barrier, however the 16 year-old girl on our trip is trying to come up with reasons not to leave. I feel this is good testimony to why we do these trips. Many friends and family members of mine consider these previous listed reasons first and foremost when I say I am going again, however the real purpose and enriching experience blocks out that list. Besides, it’s more of an adventure with those things. I don’t necessarily see them as negatives against the trip. “Everything is an adventure”….even going to the restroom.
We caught a late night flight into Paris and then to home.
Day 10: Tuesday, April 13th
I’m currently sitting in NY JFK airport reflecting on our trip as I wait for my connecting flight to Salt Lake City. I just sat on a toilet seat for the heck of it (heck: a word common to native Utahans to replace the expletive version). I also just drank 5 diet cokes, just cause. It’s nice to reflect on our wonderful experience that has, once again, put everything into perspective. Transitioning home can be a challenge: My 5 diet cokes came in 5 separate refilled glasses instead of just refilling one glass, the lady next to me complained about the table wobbling, someone just gave me the ‘ewwww’ look for putting my purse next to the dirty sink, the news is talking about making it illegal to panhandle and how much of a ‘burden’ panhandlers are on our society. It’s almost more difficult to come back to hear and see such things that are so minor compared to the disparity I witnessed. I always try not to be cynical. I try to just keep things in perspective and appreciate my job, my life, my country as well as respect and admire cultures different from my own and remember that just because there are very different cultural experiences, it is not “weird” it is just “different”.
The Senegal trip was wonderful. The effects of our efforts on the patients were great, but the effect that the patients, their family, our hosts and their country had on us are deep and everlasting. I am grateful for the perspective and education and I am more appreciative of the relationships we created and intensified. Can’t wait to go again next year.

Senegal 2010

2010-04-06T16:12:00.004-06:00

International Volunteers of Urology Blog Entries Senegal, Africa Team Members: Francis Schneck - Team leader – Urologist Mark Bellinger – Urologist Igor Seminov – Anesthesiologist Gaayana Rha – Urology fellow Julie Palmer – OR circulating nurse Nathaniel Cook – OR scrub tech Sarah Schneck – Trip logistician Stacie Pearce – Recovery room nurse

Day 1: April 4, 2010
Entry by: Stacie Pearce
Hi there everyone, we have arrived safely in Dakar, Senegal. My flight from Salt Lake City to New York City was uneventful except for the holding formation our flight had to endure, thus causing me to have to run to catch the flight to Dakar. Once on that flight we were about to take off and then the pilot announced that there were bags on the plane without the owners onboard…a safety concern….so we turned around so they could take off one or two bags. This was an one hour delay. However, the flight itself was not bad at all. Only eight hours. Not too shabby. We arrived in Senegal at 0500 this morning and was promptly picked up by Mohammed (Jalloh), a good friend and urologist from last year. He brought our equipment to the hospital and brought us to the hotel for breakfast and sleep. Afterward, he picked us up later that evening and took us to Senegalese Wrestling match. I have never seen anything like it! It was their national independence day and was held at a large stadium. They had multiple performances of traditional dancers, fireworks, and Akon, the rapper artist now famous in America showed up to Julie’s excitement. There were three wrestling matches and the wrestlers wear a loin cloth and fetishes. They are blessed and have to do multiple traditional blessings. The matches can last only seconds because the moment the wrestler’s head or four extremities touch the ground the match is over. Afterward we went to Dr. Seringe Gaye’s home and to dinner. It was a wonderful first day to start out our trip in Senegal. Tomorrow we have our clinic to decide what surgeries we will perform and to and set up the operating room.

Day 2: April 5, 2010 Entry by: Stacie Pearce
Today we had a fantastic breakfast at our hotel (I had 5 pastries myself….which would probably explain why my pants ripped already on day 2) and then we went to the Hospital de Grad Yoff to perform clinic and set up the operating room supplies. We saw 28 patients and only four were cancelled due to no shows or surgery deemed uneeded. The parents seemed very appreciative already just to have their children seen. It’s amazing to see what the urologists have been able to do with so few resources. Later in the evening we walked around downtown Dakar and had traditional Ivory Coast dinner. I look forward to starting the OR tomorrow.

Day 3: Tuesday Entry by: Stacie Pearce
Today we had our first surgeries. Much of our day was filled with “Do we have this supply?” “We can jimmy rig this or that” and “how do you say this or that in French?” The team from Senegal is very accommodating and gracious hosts. They are patient with us and happy to learn and teach. I worked in recovery and am always amazed at how tough these kids are.

2010-03-19T13:34:00.001-06:00

Day 2 Mongolia

2009-05-11T17:39:00.003-06:00

Today we were are the Maternal & Children’s Hospital. There were boys dressed in pink girlie clothes because that's all the families have to dress them in and there is probably a difference in culture with colors; it does not matter like in America. We saw over 27 children in clinic. Many difficult cases. We felt very honored to be able to work among the Mongolian doctors and to be able to help so many families.

The kids were sooo cute! They all wanted their pictures taken; we would take their pictures and show them and they thought it was so cool and they followed us around in herds while we went to see the OR to get more pictures. Some wanted to practice their English with us and others were just grateful and wanted to be around us as long as possible. It was so touching. The American doctors are like gods here in the hospitals. When the door would crack in the Clinic room, which was about as small as the kids room, probably smaller, with fifteen to twenty of us crammed in there, you would find kids peeking in to see what was going on. One cute fourteen year old girl stood in the doorway for about an hour waiting for us to be done (she had already been seen) to ask Dr. David Vandersteen, if she could have his daughter's email, because they both have diabetes...It was a sight to see.

After clinic the team ate Ukrainian food and Dr. Vandersteen kept saying “there are strange membranes I have never seen before and look at these vessels. Then we were off to the Gandantegchenling Monastery and shopping at the Cashmere shops.

What a grand day we all had,
Melinda & Michole
Executive Director and Student at the University of Utah

We are getting settled in Mongolia

2009-05-09T07:50:00.003-06:00

Most of the team arrived yesterday in Ulaanbaatar, Mongolia after 3 flights. Today was our first day at the State Central Adult Hospital where the team examined and discussed the surgical and treatment options for 12 men and 4 women. The people all appeared very excited, anxious and grateful to have the opportunity to receive life-changing surgeries.

After clinic we went to lunch and discovered that our host doctors are not only very intelligent but fun. We did some site seeing and saw the Parliament and went to a show which consisted of Mongolian cultural dancing, including the sun dance, contortionist and throat singing.

Tomorrow the team will be visiting the Maternal Children's Hospital. We are looking forward to another exciting day.

Packing for Mongolia

2009-05-05T16:48:00.004-06:00

We are packing for our Mongolia surgical workshop. The team is excited as we plan to operate in two hospitals with very skilled Mongolian surgeons along with our team of 10 dedicated volunteers. We are thrilled to include Allison Cumming, board member for her first IVUmed workshop. It is a great site and will be a wonderful excursion.

Melinda

Executive Director

From the Team Leader

2009-03-30T07:38:00.002-06:00

Good morning from Dharan,

We have completed our stay at Dharan and about to leave to go back to Kathmandhu.
It would be an understatement to say that it was an interesting experience.

We completed 30 major cases in 5 days. When I say major... I mean major: cystectomy, bladder recontruction, continent urinary diversion, complex ureteroscopic stone ablation, pyeloplasty hypospadias, urinary fistula and strictures, and stone removal.

All the cases seem to get more and more complex and unusual.

All the patients are currently doing well and many have left the hospital already, to the surprise of our surgical colleagues here at Dharan.

Yesterday, we went to clinic and consulted on some more patients. I thought my clinic was busy. I greatly apologize to my assistant, Ivette, and promise her to never complain about my patient load ever again... or at least for a couple of weeks. Anyway, we have had a great educational opportunity. Every morning we began with lectures for the residents and interns. We hope to have provided them with some better understanding about the current urological diagnosis and management. The residents and interns sent some very nice emails and letters about how much they enjoyed working with us. We feel the same way.

I could not have been more fortunate to have such a great team. We all pooled together and worked our behinds off. I thank every one of them for giving 150% effort all day long. To correct Rich, it was not a mouse that scared Jean and Barbara, it was a mole. He came back this morning and visited Norma and Claire and scared the heck out of both of them. I greatly admire each and every one of my team members for their spirits and generous hearts. John, Rich, Norma, Jean, Barbara and Claire are people who truly make the world they live in a much better place. Please do me a favor and let these guys know when they are home what an amazing thing they have done and remind them how great they are every day.

We will be starting our journey back home. We all miss our families and friends very much and hope to bring you all back some wonderful souvenirs from this beautiful country.

Bob

Our Final Days in Dharan

2009-03-27T14:37:00.006-06:00

Today was our final day in Dharan. Our morning was spent giving a few lectures on tissue engineering research, stomal care and stone management. We then completed packing our supplies, visiting our surgical patients, and participating in a farewell ceremony. Over the last few days, our hosts have been giving us an astonishing assortment of foods throughout the day. The quantity of food is definitely much more than we are used to back home, but is commonplace for special occasions and honored guests.

These are pictures from our Thursday dinner taken at the Dharan Kitchen restaurant. Take a look at those tikkas that the ladies on our team were wearing. The Nepali nurses were awesome to work with and extremely gracious. When interacting with them, they are called "sister" as a sign of respect.

On Friday morning, we met with the OT nurses outside the OT suites and they performed a traditional ceremony to thank the IVUmed team for coming to Dharan and for all of our hard work. Everyone received a red dye mark on the forehead and a scarf. The men were given some cool Nepali hats!

Well, it's getting late and I'm completely exhausted from a week of challenging cases and the workload. Tomorrow, we're working our way back home via Kathmandu. Bob has planned out the next few days and it sounds like it's going to be magnificent. I'll keep you posted!

Nursing Update

2009-03-26T09:18:00.002-06:00

We are so pleased with the receptive audience for our teaching efforts! About 30 nurses from the O.T. attended our talks on Practical Application of Sterile Technique (Norma) and Caring for the Patient with a Mitrofanoff (Barbara and Jean). It was great seeing the nurses in the O.T. that day attempting to gown and glove just like Norma had demonstrated. Now getting the Nepalese surgeons to adopt this new method is something else! We applaud our colleagues for trying. We have done Mits on two adult patients and the ward staff was anxious to learn more about the care and patient education. Yesterday, Jean and I had a great session with the residents (about 15) and ward nurses (8) and then went to the patients' bedside for further instruction with the patients. Those low-tech flip charts are working out just great for this type of teaching! We are scheduled for another nursing in-service today so we will let you know how that turns out. We have a great team-- meeting challenges and being innovative as we go. Such as fashioning a ileostomy bag from a empty IV bag secured with lots of mastisol and tegaderm! My WOC nursing colleagues will love this photo! As well as using the finger of a sterile glove for a penrose drain! Gotta love it!

More later,
Barbara
Jean
Norma

Snapshots of our work day

2009-03-25T14:11:00.008-06:00

Barbara is tending to the little ones with her Southern charm.

"Somebody has to watch over our brand new coffee table with matching chairs."

This photo was taken in the registrar's office.

Happy Birthday, Jean!

2009-03-25T14:05:00.000-06:00

Wednesday, March 25: Today is Jean's birthday. So we wanted to get her a little something and were able to arrange for a cake and a fruit basket. Jean has been a trooper during this trip despite multiple limitations at work and we love having her on our team. HAPPY BIRTHDAY

More From Nepal

2009-03-25T13:59:00.003-06:00

So here I am blogging at 3:30 in the morning. It's the best time to avoid the slow internet traffic using dial-up. Last night, we decided to forgo the normal dinner that is provided at our "guest house." Some of our team members discovered a cafe about 10 minutes away in the Nirvana country club. I think that we just needed to get away from the monotony of what we've been having for dinner since we arrived.

Things are going great with the OT and our patients are hanging in there. Yesterday, we found out that somehow our presence at the medical center was released to the local news. So, many people in the region know that we're here. Sanjeev, a 2nd year surgery resident who has been extremely helpful in answering our questions, mentioned that he spoke with a woman who brought her child a distance of 600km to consult with us on a congenital renal issue. That just amazes me considering how difficult it is to travel here, especially if money is an issue.

Oh yes, the latest bandh is over, which means that the roads are also open. Woo hoo! This means that we might be able to go explore the hill country and sightsee on Friday. This also means that patients will again be able to travel to hospital for medical treatment.

People updates:

Claire - went for an extended personal tour of Dharan and has adventures to tell you about.

Barb - just found a mouse that decided to spend the night in her room and was not pleased.

Jean - misses her husband immensely. We'll figure out something awesome for her B-day.

Norma - did not have Corona last night at dinner and thinks that her husband should come and visit.

John - has his own entourage of groupies composed of student nurses and is loving every moment of that.

Bob - is holding in there as team leader, despite our gripes and moans. Although, he played a great joke on the ladies yesterday morning. I didn't know he could be so mean!

Rich - is doing great and probably has said way too much on this blog already.

From the Team Leader

2009-03-24T15:19:00.000-06:00

Wow... what a crazy ride.

We are finally in Dharan and have operated for two days.

An amazing amount of stone disease and cancer.I am so thankful for such an wonderful team. Everyone has been working so hard.

There are some interesting politics here that prevent us from seeing all the patients we wanted to see. But nevertheless, we have already done 14 cases (many of them are major cases like nephrectomy, pyelolithotomy and URS). I think we were able to show them several new techniques. They were so impress with how quickly we do things and the size of our incisions.

Norma, Jean and Barbara have been the backbone of the group. Getting the OR set up and taking care of the patients post-operatively. They were able to doing some teaching and patient education. There is a nursing school here so there are alot of nursing students anxious to learn the way we do things in the States.

Claire is such the diplomat. Based on their culture, the Nepalises have some preconceived notions of what women can and cannot do. But with her charm and tact, she was able to show the anesthesia staff a few things about modern anesthesia.

What an awesome surgeon and person Rich is. Not only is he responsible for this blog, he has been doing cases (many of which are adult cases) with a big smile; and nothing seems to make him angry or frustrated. A team always need one such person.

Thank goodness for John. There are so many cancer cases here. His expertise is so much needed. They only do 2 cystectomies a year but have a ton of patients with muscle-invasive TCC. He will truly make a difference for these people.

Okay, got to start off another day... Stay tune for the futher adventures of the Stream Team Nepal 2009.

Bob

Bandhs

2009-03-24T15:17:00.000-06:00

Let me tell you about bandhs (sp?). They are organized protests that occur regularly in Nepal and usually are held by one of many tribes. Of course, each protest has certain demands which usually include increased representation at the local or national level. However, almost daily we hear some news about these protests because they effectively shut down almost all transportation between major areas in Nepal. I forgot to mention in my earlier blog that we rode in ambulances to this location because only ambulances (medical transports) would be allowed past any road blockades. When asked about the duration of protests in general, the locals always say it's unpredictable. However, that should not affect our departure.

The location that we are staying in is very safe because it is a self-contained city within a city with its own power generator and water purification plant. It has a communal feel to it. Honestly, it is paradise compared to the poverty that lies outside the walls of the medical center.

Well, in terms of the medical update, we are planning our remaining cases for the next few days and will perform surgical cases up to Thursday. Friday will be for sightseeing and Saturday we will be headed back to Kathmandu. So far, we have worked primarily on adult urology cases, which was quite unexpected and somewhat frustrating for most of our team members. Nevertheless, everyone is holding up well and just focusing on helping out as best as we can.

All my best to everyone out there and I'll blog with you again with more incriminating photos.

~Rich

Nursing Perspective

2009-03-24T15:15:00.000-06:00

It is always interesting to share information with the host nurses during IVUmed visits. Oops, short delay the power just went out! We are back in business with Rich's hand cranked LED light (you can tell he lived in Houston and is hurricane-ready)! Jean has also retrieved her head light!

Today we met several nursing students in the OT (operating theatre). All spoke Engligh allowing us to have a good conversation. They are so excited we are here and eager to share information about our nursing professions. After high school graduation (10 grades) nursing students take two years of basic science courses and then 4 years of nursing education leading to a BSN. Upon graduation they are qualified to be educators, researchers and administrators. Nurses work 8-hour rotating shifts. No one like nights! Tomorrow we will be presenting principles of sterile technique to the operating staff and later in the week presenting various topics on pediatric urology. All of the nursing staff are very helpful and good at their jobs!

More later we are in the middle of a thunderstorm!

Barbara (signing off)
Jean
Norma

Dharan

2009-03-24T15:13:00.002-06:00

Hello all. We have made it to Dharan, Nepal. The flight was great and quite scenic. We caught a glimpse of the Himalayas through the haze. Our host sent a 2nd year surgery resident to meet us at the airport in Biratnagar. We then climbed into two hospital ambulances and headed off to the BP Koirala Medical Center in Dharan.

Yesterday evening, we met a number of patients and selected some for surgery on Sunday and Monday. We operated this morning on several cases: re-staging TURBT for bladder cancer, EUA for advanced bladder cancer, posterior urethral valves, and open pyelolithotomy for a large kidney stone. Everyone on the team is doing well and we are trying to settle in.

Kathmandu - Day 1

2009-03-24T15:04:00.002-06:00

Well, we've arrived in Kathmandu. Sorry I didn't have a chance to update the blog sooner. We arrived in Bangkok early this morning - around 2 am - and slept overnight at the airport hotel. The flight to Kathmandu was smooth, but the troubles began at the airport in Kathmandu. Immigration control is absolutely abysmal. Bob and John were really getting worked up about our 2 1/2 hour wait for a sticker followed by a signature. Then, three of us piled into a tiny van with the baggage to get to the domestic terminal. The others walked... Check-in was nice and chaotic. We waited some more, watched a couple guys have it out with each other, and later found out that our flight to Biratnagar was cancelled due to "issues with the runway at the airport"???

Any hoo, we'll be staying for the night in Kathmandu at the Hyatt (NICE!) and will try again tomorrow. The sunset was gorgeous. We're headed out to explore Kathmandu and enjoy a nice dinner. Everyone sends all their best. That's all for now...

pre Nepal test

2009-03-14T13:03:00.002-06:00

just trying out the blog site! See you in a few days!

Jean

Moment of Truth

2009-03-12T14:05:00.004-06:00

We all sit in the conference room following surgery, another delicious lunch and lectures. As the discussion turns to the need for pediatric urology in Senegal, our host, Professor Gueye, asks who among the young doctors present wants to specialize in pediatrics. Although this part of the discussion is in French, we all understand what is being asked and what it means for our mission in senegal. Immediately, two hands go up. Then another. Then two more! This could be the beginning of something monumental.

Later that night we lighten things up by practicing clapping to the beat of the Bee Gees 'Stayin Alive' for Heidi's lecture (still trying to figure that one out). I hope lives never depend on the sense of rhythm of some of our less musical team members (mainly mine).

Clubbin' in Dakar

2009-03-12T13:57:00.006-06:00

As many know, the night life and music scene in Dakar are legendary...and what better way to rest up after a long day of surgery and lectures than to go to a raucus club? At least we're learning the latest dance moves, though some of us should think about taking up lessons (or a vow to never disgrace another dance floor) prior to the next trip). "Wow wow oui wow!" Truthfully, the artists here are amazing.

The workshop continues to go well with so much participation it can be hard to squeeze around the table for a peek.

Teaching Many (in French)

2009-03-12T13:52:00.004-06:00

This workshop marks IVUmed's first multi-national surgical workshop in West Africa. Physicians from at least 10 countries are in attendance, most of whom will return to their home countries following their training in Dakar. They will take with them the skills the learn from our medical volunteers. This is an excellent sit for such an exciting development. The hospital has over 25 urology residents.

The first day involved evaluating patients and planning for a very busy week. Our team will serve over 20 children, provide hands-on training to over two dozen surgeons and give multiple lectures.

One issue that has arisen during our first few days of surgery is the appearance of girls suffering from conditions that could potentially lead to their ostracism from their communities. Our team's fellow, Regina, got emotional when realizing the amazing difference she had made in one girl's life. "She would have been shunned," she said, "but now she has a chance." Our mission is to make these life-changing surgeries available to people everywhere.

Photo Journal

2008-10-28T18:12:00.000-06:00

Here are some photos of the trip. Enjoy!

Such Sweet Sorrow

2008-10-28T10:53:00.000-06:00

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

2008-10-26T23:55:00.001-06:00

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...

2008-10-25T10:46:00.000-06:00

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

2008-10-22T23:46:00.000-06:00

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

2008-10-22T18:42:00.000-06:00

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

2008-10-22T06:18:00.000-06:00

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

2008-10-20T19:36:00.000-06:00

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

2008-10-19T18:55:00.000-06:00

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

2008-10-11T15:11:00.000-06:00

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

2008-10-11T15:09:00.000-06:00

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

2008-10-09T15:49:00.000-06:00

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

2008-10-08T09:36:00.000-06:00

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

2008-10-07T14:20:00.000-06:00

~Croth

Tuesdays in Tanta

2008-10-07T14:13:00.000-06:00

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

2008-10-06T14:49:00.000-06:00

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

2008-10-05T12:45:00.000-06:00

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

2008-10-04T09:29:00.000-06:00

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

2008-10-03T01:54:00.001-06:00

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

2008-10-02T05:56:00.002-06:00

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

2008-10-02T04:15:00.000-06:00

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

2008-09-30T19:49:00.002-06:00

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

2008-09-28T18:47:00.000-06:00

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....

2008-09-27T01:58:00.000-06:00

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

2008-09-27T01:47:00.001-06:00

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

2008-09-25T11:32:00.000-06:00

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

2008-09-25T07:22:00.000-06:00

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

2008-09-24T14:59:00.001-06:00

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.....

2008-09-24T08:33:00.000-06:00

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

2008-09-23T09:54:00.000-06:00

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

2008-09-23T07:01:00.000-06:00

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

2008-09-22T06:49:00.000-06:00

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

2008-09-21T05:56:00.000-06:00

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

2008-09-12T10:51:00.000-06:00

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

2008-04-27T14:37:00.001-06:00

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

2008-04-25T12:03:00.000-06:00

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

2008-04-25T05:24:00.000-06:00

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

2008-04-24T12:20:00.000-06:00

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

2008-04-23T07:54:00.000-06:00

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

2008-04-19T12:54:00.000-06:00

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)

2008-03-10T08:04:00.000-06:00

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)

2008-03-10T08:00:00.000-06:00

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)

2008-03-05T05:43:00.000-07:00

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)

2008-03-05T05:42:00.000-07:00

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)

2008-03-05T05:40:00.000-07:00

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)

2008-03-02T08:59:00.001-07:00

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)

2008-03-02T08:55:00.001-07:00

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)

2008-02-29T06:37:00.001-07:00

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

Tim's Daily Nigerian Times (Day 6)

2008-02-29T04:36:00.001-07:00

Feb 27, 2008 – Day 6

Awoke with French toast and syrup on the table, we were all ready for a hearty breakfast knowing that another long day lay ahead….

The majority of the physicians’ time was now being spent at the OR, with Pauletta slaving away at the urodynamics and Sherri trying desperately to keep us all organized. We started the day off with a mid-shaft hypospadias for which we performed a TIP repair with Bill Ardill, the general surgeon missionary from California, looking on. We carried out another PV sling (thankfully more straightforward), and a urethral dilation to finish off the shorter day in the OR than yesterday.

After dinner we were serenaded with music at a loud volume until about 10pm by the other group staying at the guesthouse. Sherri, 10th degree black belt in Soduku, challenged Tom (a lowly green belt) to winner takes all, battle royal, soduku cage match. It really ended up in a nasty way with pencils being thrown and bloody paper cuts on both sides. We managed to pull them both apart and send to their rooms for a timeout. We all fell asleep exhausted after a full day and evening activities.

Lesson of the Day:
Use C Batteries wisely, misuse may cause shocking and corrosive results!

Tim “Blogman” Davies

~Catherine deVries

Tim's Daily Nigerian Times (Day 5)

2008-02-29T04:35:00.002-07:00

Feb 26, 2008 – Day 5

We started off the day with a hearty pancake breakfast. It is surprising how easily Rachel and Helen (our hosts here at the Baptist guesthouse) manage to put together authentic American cuisine each and every day for us. We packed down a couple of flapjacks and caught a ride with trusty Ezekil to the Evangel hospital.

We broke up into a couple of groups with Pauletta , aka Jummai(which is her Hausa name) carrying on with the urodynamics. She keeps telling us Jummai means Friday, but we are all pretty sure there is a more ominous meaning….

Sherri, Susan and Catherine carried on with seeing some patients who were not seen the previous day. They were again quite busy – the bature doctors are very popular here.

We were segregated along gender lines as the boyz(Tim, Tom and Kurt) went to the OR to start the first case of our trip – a urethroplasty. We managed to provide excellent exposure of the urethra prior to the placing the buccal graft in an onlay fashion that was a new technique to the surgeons here. Susan joined us for a couple of very difficult PV slings using fascia lata in women who had numerous VVF repairs. It was a reminder that operating on patients who have undergone multiple procedures is a humbling experience.

We returned to the guesthouse with one less team member, as Kurt had to return to the US for a conference. He will be missed by many, but not me. We learned over dinner that the constant sand in the air (causing dust and dirt to accumulate quite quickly on everything), is actually sand from the Sahara known as Harmatan. We with our brains full to the brim with all the information we can handle as we drop off to a restful sleep thinking of…………

Tim’s Lesson of the Day:
No matter how good the tissue looks, always remember the patient has had 3 previous repairs…

Tim “Blogman” Davies

~Catherine deVries

Tim's Daily Nigerian Times (Day 4)

2008-02-29T04:31:00.001-07:00

Tim’s Daily Nigerian Times
Feb 25, 2008 – Day 4

We were up early enough this morning to eat and be off to the VVF center just after 8AM. Again another enthusiastic greeting from the patients at the center. We got off to a slow start, blowing dust off the UDS machine and setting up the area/corner of the office where we would be examining the women. We did have some difficulty with the UDS pump and blowing from fuses. After we had abandoned the pump and attempted to set up a system to document the patients, we began to examine the patients…

Despite some more hiccups in the system and some other changes we managed to see approximately 60 VVF patients in about 5 hours…not bad! During that time, we also saw 6 male patients. We booked a full OR day for tomorrow in the first 2 hours of seeing patients.

Lunch provided us with our first taste of pounded yam - the local staple. It is pretty bland, but they put a sauce on it to spice it up. It was served with an unknown meat and we didn’t ask. Everyone is so nice and accommodating, we really feel appreciated.

We returned to the guesthouse for a quick meal (including the last of the yummy chocolate cake), and we were off to the internet café. We were all suffering from a bad case of internet withdrawal and thought we should take care of the tremors prior to operating on anyone tomorrow. We all pitched in and helped Pauletta with her algebra, probably driving down her average. What do you get when you have 5 MDs doing algebra homework? Probably a D+….

We retired to the guesthouse and dropped into bed…. And thought of the first of a regular series…..“Tim’s Lesson of the Day”:

Dogs that look unhappy about your arrival during the day, like to bark all night (and by all night I mean from 9pm until 7am).

Tim “Blogman” Davies

~Catherine deVries

Tim's Daily Nigerian Times (Day 3)

2008-02-25T11:43:00.002-07:00

Feb 24, 2008 – Day 3

After a legendary battle with an enormous mosquito, I dropped off to sleep….we were for the most part able to sleep well. We awoke to find Susan and Tom had successfully arrived on the 5:30am BA flight from London and joined us for a quick breakfast before we departed for Jos.

The ride to Jos was reminiscent of my last trip to Busch Gardens. We acted like a bunch of awkward fifth graders and decided to ride in gender segregated cars (Tom thought that the girls had cooties). The football chatter and grunting died down as we were humbled by the sights that surrounded us. No matter how many documentaries you have seen about Africa, you are astounded by how little these people have. It is impossible to put it into words the sights of the shacks that families share here. It didn’t help the mood in the car when we almost took our last breath with some crazy near death driving experiences. Fortunately, we were not around when a gasoline truck jackknifed on the road and was wedged between the hills surrounding the road. We had to detour through someone’s front lawn to get through. The biggest failure of the trip is we unsuccessfully tried to snap a pic of the oxen traveling alongside the road in several spots. A planted government forest was also interesting as the rows of the trees went on forever in perfectly straight lines. We arrived without a scratch and settled down at our guesthouse for the afternoon and evening.

Shortly after arriving we traveled down to the ECWA Evangel VVF center to drop off some supplies and were greeted by one of the most thankful group of patients. I have never experienced anything like that as a crowd of women are reaching out their hands. It was a glimpse of what celebrities experience. It truly touched each of us and I will never forget it. We then returned to the guesthouse for dinner. To our pleasure Dr. Sunday Lengmang and Sister Rose joined us for dessert. We sat and watched the outstanding movie by the IVUmed group and James Kenney – “The Women of Evangel”. After such a full day we were happy to drop off to a well deserved rest as we knew that we would have a long day ahead…..

Tim Davies

~Catherine deVries

Tim's Daily Nigerian Times (Day 1/2)

2008-02-25T11:15:00.002-07:00

Feb 22/23, 2008 – Day 1/2

Welcome to the blog of the IVUmed trip to Nigeria of 2008. We have just arrived in Abuja (the capital of Nigeria) from various locations around the US. Sherry Young and Pauletta Hampton set off from Tucson…and without a hitch arrived at Chicago O’Hare. They were joined by Catherine deVries who also had an uneventful flight from Salt Lake City. I (Tim Davies) had flown in from Norfolk and spied 3 women who matched their descriptions (from the FBI’s most wanted list). I managed to get up the courage to speak to 3 lovely women, and for the first time in my life…a group of women didn’t tell me to get lost! Having made the introductions we caught our flight to Frankfurt.

On arrival in Frankfurt(at 6am local time), we stopped for a pleasant sit down breakfast with Pauletta choosing the Munich breakfast. Nothing like starting your day off with 2 boiled German sausages, a pretzel and some mustard! The rest of us wimped out with some more standard fare. However, all of us did get treated to the traditional European form of greeting known as the $30 breakfast. Danke!

A few hours later we caught our flight to Abuja and surprisingly arrived on time with all of our baggage. The flight from Frankfurt was beautiful - I can’t remember the last time I spent hours peeking outside the windows of an airplane. It started with the towering peaks of the Alps and the clear skies continued over the Mediterrean. I, having never been to Africa, was stunned by the never ending sand dunes of the Sahara desert.

After a benign trip through immigration and customs, we met our drivers, Ezekiel and Ben at the airport. We traveled into Abuja to spend the night at a local guesthouse run by a missionary couple. The car ride into town was eye opening. Fires and garbage by the (paved) roadside and vans/buses stopping on the shoulder as cars zip closely by at 60-70 mph. Lots of people everywhere - buying bags of water, sprinting across the street, waving hello, sharing a laugh at a roadside table.

We retired to the guesthouse to enjoy a meal of lip lik’n good chicken and fries. A few hours later, Kurt McCammon joined us here in Abuja after a trouble-free KLM flight from Norfolk via Amsterdam. He enjoyed the leftover fried chicken – made him feel like he had never left Virginia. But he did claim that he

Unfortunately, Tom Hicks and Susan Kalota were not as lucky. They had to reschedule their flights and were now traveling through London (instead of meeting Kurt in Amsterdam). We are planning to meet them first thing in the morning at the airport as we travel up to Jos tomorrow.

Tim Davies

~Catherine deVries

Roadside market on the way to Kumasi

2008-01-23T10:55:00.001-07:00

~Stephanya Shear

Back to American Medicine

2008-01-23T10:44:00.000-07:00

My first day back and a bit of craziness. My mailbox is full of administrative things to take care of that require thier "Chief's" approval. Acquainting myself with a new set of patients (I missed a busy Pedicatric week) and my 7 am conference took a few hours this am. The jet lag is not too bad, I just feel a little tired - then again it might have been the snow I shoveled this monring at 5am. In a few hours of busy work, Ghana seem so far away. I am carrying around in my white coat a patient card- just to show people that I was there and we did operate all those days. Plus I remind myself of what we all accomplished over the week.

Now back to daily labs, post operative epidurals, and multiple cather options- none of which existed in Ghana.

I down loaded all 415 pictures I took in Ghana. My last few posts will be pictures only. Now that we are all back, you don't need me to tell you the stories.

Thanks for reading.

Goodbye and Stay Healthy.

Stephanya

~Stephanya Shear

Airport and then Home

2008-01-23T10:37:00.000-07:00

It is 4 am and I am back in Rochester. I can’t sleep. That’s OK because all my belongings smell like smoke from the fires in Ghana and I really need to do laundry.

Most of the team was able to adjust to the time difference in Ghana, but some especially Nate and Danielle, would wake up at 2 or 3 am. No one could tell because they were fresh and alert all day and stayed up pretty late at night. Pretty impressive. Stacie and I had no trouble sleeping except the last night. She thinks we were both dehydrated and a little nervous we would be late for our 6 am pick up time. Good thing we all made it out early for it took us 2 hours to go about 20 miles to the airport. Traffic was horrendous. For an hour we stood in place and moved maybe 1 mile 30mins. Once we got past the worst, Mr. Houdo got us to the airport at 8:40. Then we waited in lines.

Line Dancing

One line at customs to check our passports and mark our bags with chalk. No one is sure what the chalk signified since no one checked for it later.
Another line to weigh our bags.
A third line to check our itineraries and passports (again).
Fourth line at Check- in to weigh our bags AGAIN and take our passports after issuing a baggage tag.
A fifth line to search thru our luggage.
A sixth line to wait for the return of our passports and obtain our boarding passes (which incidentally does not happen at the “Check-in” desk- very Ghanaian).
A seventh line for customs where they take our declaration forms and check and stamp our passports (third time).
An eighth line for carry on baggage check and security. They do not let women take off their belts so I beeped and got padded down.
An ninth line where they check our passports for a fourth time and our boarding passes again.
And finally a tenth line where they search our carry on (even after it has been x-rayed) and physically pad everyone down (my second time).
All the IVU bins went thru without any problem and I don’t think they were padded down once.

To the Plane

We all got thru the ten lines and even had time to spend the last of our cedis in duty free. I was able to score on some of that hot pepper sauce. I found the correct spelling is Shito (the name amuses Stacie to no end). Luckily the glass jar did not break in transit. Yum smoke and pepper sauce on my clothes.

Speaking of the smell of smoke. Dr Bellinger said he was almost knocked out when he opened the overhead compartment when we arrived at JFK. The smell of Ghana smoke was overwhelming and may permanently etched onto his nose he thinks.

In JFK- a rush to get Brent and Stacie to their gate for take off and all the bins out. Luckily they were checked all the way thru. In Accra my check in person could not figure out how to code Rochester and was only going to check me thru to JFK. Luckily I gave her the airport code and she checked it thru or I would haven been delayed in JFK.

Charles stopped at Dunkin Donuts and four other people stopped at Starbucks when we hit the terminal. Our first coffee in 12 days. It will surprise all my friends that I was not one of them. I was feeling pretty hypoglycemic and needed real food before any coffee. And I don’t support Starbucks. But I assure you now at 5 am I have an Americano next to me as I type this. It is 18 degrees- a day ago I was sweating in 85 degree weather.

I did not make it home until the wee hours of Tuesday am and after about 2 hours of sleep I was up at 4 am. When I got home I put my smoky bag in the laundry room and went right up to see my daughter who was asleep soundly in her crib. She looks bigger than when I left. Sometimes I would see a little girl or baby at the hospital that would remind me of her. I had pictures of her, but nothing compares to seeing and holding her.
It was a great trip but it is good to be home.

~Stephanya Shear

Interview with the Anesthesia team- Drs Semenov and Yang

2008-01-23T10:34:00.001-07:00

Interview with the Anesthesia team

Ok I could not really interview them, they were pretty busy plus I think they thought it was a silly idea. Dr Semenov (Igor) and Dr Yang (Charles) however are two very funny guys and together they were like a non stop comedy duo. They also made a great team at the head of the table. They had the toughest most nerve racking jobs of the entire team. We are operating with different equipment and less than ideal catheters but they were putting children to sleep in challenging situations. They obviously are very experienced and really good at what they do, because they made it look easy- but we know better.

One difference here is that they us halothane for an anesthetic and no nitrous. It takes a little longer for the children to become sleepy, but Dr Yang like halothane as opposed to the much more expensive brand name stuff used in the States (halothane is generic). According to Dr Schneck, having our own anesthesia team made all the difference this year. They moved along quickly and were very focused. Both are pain specialist and they provided caudals and/ or epidurals on all the children. Dr Schneck noticed a considerable difference this year in both the efficiency of the OR as well as the tone. He said the children were all much more comfortable after surgery.

Igor spent a lot of time in the ICU taking care of our one ICU patient. She was the only patient who was able to keep her epidural after surgery. The other patients with large incisions were able to get some morphine on the wards.

Charles and Igor also did a lot of teaching. They were constantly teaching the CRNAs and even had Danielle doing caudals. I could not imagine the team without them. Note to the IVUmed staff- bring them back if not to Ghana to another country.

They were both helpful and kind and very generous.

They also ate fried bat. Honestly they ate it. And it did not taste like chicken.

~Stephanya Shear

Interview with Stacie Pearce

2008-01-23T10:33:00.000-07:00

My original interview did not load up, so here is my interview with Stacie Pearce, RN

Stacie Pearce is the team’s recovery nurse. Along with Dr Schneck she is the only returning member of the 2007 Ghana IVU team. Stacie is an RN in Salt Lake City where she has been working with children in the Rapid treatment unit (observation unit) and Emergency Department for eight years. She is also an instructor for the nursing school. When not at work she spends time with her husband Cody (last year’s Ghana mission secretary) and their many tropical fish tanks. She is also an avid dancer and musician.

In addition to the two IVU missions, Stacie has gone on numerous humanitarian trips. She organized several of the trips herself. She has traveled to Thailand and the Navajo Nation in the US.

Her assignment on the IVU trip is to take care of the children in the recovery room after their surgery. She also provides pain medications for the children when they are on the wards as well as making them comfortable in the PACU. It is often the case that IVU must provide medications for the children on the wards. She also gets a chance to come into the operating theatre and see the surgeries.

Stacie considers working with the mothers as a valuable part of her job. She has the job of explaining the surgeries and teaching them about the catheters. “The challenging part is to integrate their culture, traditions and expectations with our medical care.” This also goes for working the KATH staff as well. “There are things [in the recovery room] I would just do in the States, but here I must adapt to the Ghanaian way of doing things.”

“Here I really focus on the patient. Charting is minimal and we really only do what is necessary. I spend time with the children and not looking at monitors. When I come here I realize how in the States we are focused on paper not patients.” She also uses physical exam skills such as checking the color of the inside lip to check for oxygen saturation instead of focusing on a pulse oximeter. Another difference she notices is the lack of supplies.

She loves Ghana and the friends she has made. The genuine warmth and caring of the people here is what really impresses her. “People break into songs here and they are very grateful for what we do.”

Stacie is very humble but I can tell you she has been invaluable on this mission. Not only in her job as the recovery nurse but helping in the operating theatre and logistics of housing. She made sure we had a place to stay in Elmina and Accra. She has also been my roommate for the entire trip and she is a joy to be around. She is effervescent and very genuine. And she is one great barterer- this woman can really shop.

~Stephanya Shear

To the Airport

2008-01-20T22:42:00.000-07:00

In 30 mins we begin our trip back to the airport. Becxause of traffic we will need to start out very early. It is midnight on the East coast so we all should be home in about 24 hours.

Last night we watched the foirst match of the Africa cup. It is ebing held here in Ghana at three sites- one being Kumasi. Accra hosted the opening game between Ghana and Guinea. The city was craazy everyone evene babies on thier mothers backs were dressed in gold, red and green. Go Black Stars (the Team ) was everywhere. We watched in a big screen in our hotel., It was a great match and Ghana won 2-1. We passed many groups of people- on in th e fields of a secondary school- probabaly close to a thousand people watching on a HUGE screen. The cliusters of people in a small shop around on television. IT was a great time to be in Accra.

We ate our last meal and now we are going home. Some of my posts never made it onto the blog site, so I will re-enter them from the States. It has been a good mission, a successful one and a lot of fun. I think I speak for the entire team when I say we made many friends and felt the world get a little smaller this week.

My last entry will be from the States.

~Stephanya Shear

Back to Accra in the road

2008-01-20T12:14:00.000-07:00

Back to Accra

As we left Kumasi, we went to the Cultural center and picked up some gifts for friends and family at home, all those who have been taking care of all our families and patients while we were away. We had a long bust ride to the Coast. We did make one stop at the site of the Last Bath. This was where slaves from West Africa were washed before they were taken to the castles on the coast. No one knows how many Africans were sold into slavery or the number who died before being sold. Our guide left us down to the water. As it is the dry season, the water was far below the bank. Also at the site are the re-interned remains of one woman slave from Jamaica and a man from the United States. Both were reentered her in 1998. On Sunday we visited the slave castle at Elmina, the oldest European castle on the West African coast. Four hundred men were housed in one small square space with only a few small windows. No food, no water, little sunlight. They could be there for months. There were also one hundred and fifty women in a smaller room. When the boats arrived, they were shacked together in groups of ten and loaded onto boats. Originally the castle was for trade in gold and other items, and then it was used exclusively for the housing of slaves. After the abolition of slavery, the castle was used by the British for administrative purposes and was also used for training Ghanaians to fight for the British in the world wars. The Castle is now a museum. We spent about an hour there before leaving for Accra. It was a very moving tour and as our guide stated- it is not old wounds we seek to open but to speak to the enduring strength of the African people and to ensure that such a horrible event never occurs again.

~Stephanya Shear

Friday

2008-01-20T12:13:00.001-07:00

Friday night.

Rounds we done by 6:30, so we had time for a walk before our good bye dinner. The Staff of KATH held a nice dinner in our honor and many nice speeches were made. They presented us with a gift of appreciation after a delicious dinner of traditional Ghanaian food. We had given our gifts earlier to various people. We gave gifts of scrub outfits, hats, polo shirts, pens, books and water bottles we all individually brought.

The food was very delicious. OK so I now know what jollof rice should taste like now. Not unlike a tomato rice dish my mother used to make, just the Ghanaian version has more spice. Speaking of spice, I have really enjoyed this hot sauce that I think has ground bean in it- Sheento. Very hot and really good. The ingredients in Ghanaian foods are a mix of indigenous foods, foods from the Caribbean, Asia and the Americas. We had the best plantains at the going away dinner. A jazz group played and we ate outside. Fastina said the closing Thank you and our surgery resident and guide Dr. Yankey said the final prayer.

But to me, the most moving and meaningful moment on our trip would be Saturday when a patients mother said Thank you to the Team for tasking care of all the children. She spoke with great warmth as she shared her appreciation for the care we had given the children and for the healing work we had done.

~Stephanya Shear

Back to Accra

2008-01-20T12:13:00.000-07:00

Saturday.

Another early morning after packing until late in the night. No breakfast and we hit the wards at 8 am. I am the IVU resident scholar. This means that my application was chosen amongst the many and the IVU paid from my travel to Ghana. My contribution to the Team has really been in rounding. Danielle Sweeney, the Pediatric Urology fellow, has been the most help in the OR. So it was my job to find the children when they got to the wards- remember who was who (with the help of cards that had their pictures on them), now what surgery was done and when, and when the catheters should come out. I also had to keep track of who had medical issues or needed labs. Pretty much the standard job of any resident. Just remembering who is who and who had what was a big part of it. Drs Schneck and Bellinger did the exams, removed bandages and took out catheters. Danielle had the hard job of preparing the doses of medications we gave out. She also managed the ICU patient we had.

The entire team came to round the last morning. The bins, now empty were packed in the bus. I found myself a little sad to leave some of the children, as I had gotten very found of the little ones and their mothers.

After that, some went to see the site of the sword of the Asente people which is right next to the hospital in front of the new trauma center which really is under construction. One final good bye to our host Dr. Aboah, and we drove out of KATH for the last time this year.

The sign over the Gate says “Good Bye and Stay Healthy”.

~Stephanya Shear

Glimpses of Kumasi

2008-01-20T12:12:00.001-07:00

Some glimpses of Kumasi.
There is not a huge middle class here. There are people who are comfortable off but no one we have seen is exceptionally well off. We have managed to find a few nicer areas, but they are exceptionally modest by our standards. It would be more encouraging to see people who are able to get out of the poverty around us. It is also unclear how much of an infrastructure exists if people do become more prosperous.

After one week, all of our clothes smell like smoke. Trash is burned here. Now with more cheap products from China, there black plastic bags everywhere and mound s of plastic trash that does not burn completely. Even on the college campus, there are bins next to the professor’s homes that are used for burning trash.

Many of the areas power share. That means one night they would have power and the following night the next street over would have power. Water is usually piped into a central area of a compound or group of home. There are no toilets in most communities. Instead there are shared latrines. Some apartments have bathrooms but since a majority of people live in groups of wooden, cement, or stone small homes, most do not have indoor plumbing.

For this and other reasons, all children stay in the hospital until their catheters come out, unless they are well off and have a way to keep everything clean.

There are a lot of unfinished buildings- building with no sign of construction. We are not sure of the story behind this as UI have been told- “Oh they are under construction”. Very Ghanaian. It is true they are under construction, but that is not really what you were asking. All along our routes we see these unfinished buildings.

It a very safe here. Until late you see many people out on the streets, even children with their parents are out after dark.

IN the mornings on our way to the hospital we see many children off to school. All schools, private and public have uniforms. They get to school by walking, taxi or some of the private mini buses fill with school children and drive them. And there are parents who walk their children. Fathers as well as mothers get them to the primary school. They prefer to eat their lunches form one of the thousands of food stands along the road rather than take a lunch pail. Salmonella infections are very common here.

Also common as you can imagine is malaria. So common that the blood bank does not screen for malaria and it is common for people who receive a blood transfusion to react to the malaria and get what is called a “blood fever”.

~Stephanya Shear

Interview with Nate Cook

2008-01-20T12:11:00.003-07:00

Interview with Nate Cook.

The next person in our team was Nate Cook. Nate has been a pediatric general surgery tech for over eighteen years. He is the proud father of two teenagers. This is his first trip with IVU med. His role here is to “make sure the cases go smoothly and help with the equipment, both ours and the KATH equipment” He also scrubs in as the nurses some when Afia and Fastina need a break. Those two have been a valuable part of the team, staying late with us every night and became close friends of Nate’s. Nate spends a lot of time adapting equipment and supplies. He shuttles back and forth from our store room and the theatre. He has a calm disposition which helps when things get challenging.

The biggest differences in the operating room that he noticed were fewer choices such as fewer suture options, a general lack of instruments. There are no “packs”- groups of supplies and instruments packed together. Most of what is here is linen. There are few disposable drapes.

“Ghana is great,” he says. “But not what I expected. It is more technologically advanced than I thought it would be.” Ghanaians have access to some technology thought the infrastructure is sometimes inconsistent. Our hotel’s internet being a prime example. The best parts of the trip have been the way the IVU team and the KATH staff have come together and work as one. The sense of brotherhood in Ghana is what stands out to him.

He would recommend An IVU trip to anyone. Nate believes that you find out what kind of person you really are when you are put in a new environment. From what I have experienced of Nate, he is generous, intelligent, resourceful and very considerate. We have been lucky to have him on our mission.

~Stephanya Shear

Friday

2008-01-20T12:11:00.002-07:00

Friday

Very early day. We skipped breakfast and rounded as quickly as we could. This morning at the general surgery grand rounds, Dr. Bellinger and I gave lectures. There were medical students and attending surgeons in attendance there. As before, there was a prayer at the start, but we needed to get back to the theatre before the Thank sand closing prayer. At this point, we have only had one no show and one cancellation. But we have also had a few add on surgeries to fill the places.

We lost power both Thursday and Friday. Not for very long. The anesthesia machines were on battery back up. We lost the electro cautery and no lights. The theater lights are not that powerful anyway, but all we had was ambient lighting for a while.

There is a man in our theatre who has been helping us. He is never said one word, but followed everything we do and anticipated what we needed. His name was Sunday and he tried to run a few goose neck lamps off of a backup outlet when he lost light. Those lights did not work but they thought was great. The power came back on but we lost a few lights.

In spite of wanting to be done early- we finished with rounds at 6:30.

~Stephanya Shear

Thursday

2008-01-20T12:08:00.000-07:00

Since the internet was down, I kept a journal with hopes to down load entries.

Thursday

So we have been operating for three days now. Wednesday was another long day as we left the hospital close to 10. We could not find the restaurant we wanted so we went back to the p lace we had eaten at the night before. Our driver Mr. Houdo tried very hard to find the place and we rode back and forth on the same road a half a dozen times before we gave up.

There are only a few road signs (that we can see) and we do not always go the same way each day. Without our driver we would get lost not to mention by at the mercy of the taxis. Mr. Houdo has to put up with a lot. He must pick up us early and be available to get us home late at night. He has dinner with us every night and has to take out time to get us back to Accra. So for the week, he too is away from his family.

We have now seen some Westerners, mostly school tours. There are a few European medical students at KATH. There are not a lot of tourists in Kumasi.

We stopped operating early to give two lectures. The medical system is based on the English system, so the operating room is called the “theatre”. So we are in the Main Theatre. I have not seen the secondary one. Once we left the theatre, two of us went to see all the patients and give out evening doses of antibiotics while the others were finishing the last procedure of the day. Dr Schneck and Danielle each gave a lecture.

The ether screens do not work very well and the first few days I was pretty lightheaded. We all got used to it after a few days, so by Thursday we were all fine. Those of use used to caffeine in the am, have gotten through our withdrawal phase. However a nasty head cold is making its way though the group. It lasts about three days, no cough but a lot of sinus congestion and runny nose.

All the meetings we have attended start with a prayer. Some one is chosen to say the prayer and they have all been oriented towards the meeting. After the meeting, some one is designated to give Thanks. This is not a prayer- but the person thanks the speakers, the people attending, perhaps the hospital for giving the room. After the Thanks, another prayer is given and the meeting is over. Ghanaians are very respectful and polite. The men are all very respectful towards the women in our group and all the people we have met have been genuinely appreciative of what we have done.

~Stephanya Shear

FINALLY INTERNET

2008-01-20T01:22:00.000-07:00

I am so sorry. The internet has been down since Tuesday. For all those families and freinds checking in, we are fine. We have been exceptionally busy but we are all OK. SO let me catch you all up- Tuesday was a busy OR day. We closed a 21 year old woman with bladder extrophy and that took one table all day. The other table was busy wth some tricky reconstructive issues as well. The tally for the for entire trip- Dr Bellinger said "I have never seen this before" five times, and Dr Schneck said a similar thing three times. MOst of the time he just shook his head. The days have gotten hotter and there are some occassional flies in the OR. But we have settled into a routinue and move smoothly. The resdients at KATH faculty scrub in foe most of the cases if not all after 10 am. There are currently no urology residents but the general surgery residents have been assisting. The recovery room has gotten very crowded. There was a man boarding down there for days- pretty much fending for himself. I think at one point some one gave him water. No one rounded on him and he just lay there. The second day a dorsal slit was performed on him by the general surgeons for a paraphimosis. We heard about that after the fact - poor guy. What was more heart braking was a baby there fro three days- no one held him or bathed him. We gave him water and some toys and one of the nurses gave him one meal a day. We never say his mother. We were told it was because there was no room upstairs- but since some of our babies were sleeping only one to a bed- that could not be true. We alos were told his mother was waiting outside- but our mothers were allowed to come back and be with the babies. So either they were treating our children differently or there was something up. We all agreeed it was the later with a samll element fo the former. But finally the nurses from the wards came to collect him. The nurses here are very dedicated but they do less nursing and caretaking that in the states. IN our wards the mothers take care fo teh children and the adults have to be pretty sufficent and take care of themselves. Stacie Pearce and Mrs Bellinger have been doing a great job in recovery room. They have been caring for the children as well as educating the mothers. IN addition they have been dealing with a lot of the logistics and helping find our supplies. The do a fair amount of trouble shooting. We finished late on Tues and left the OR at 9:30. Our dedicated driver took us to dinner and we got a little carried away with a lazy susan on the table and a few dishes went flying. We do not stop for lunch and a fwe mornings also had to skip breakfast. We much on granola bars between cases and then wait to dinner to eat. Just like resisdency... If I SEE ANOTHER GRANOLA BAR IN THE NEXT THREE WEEKS I am going to scream.

~Stephanya Shear

OR Day One

2008-01-14T16:03:00.000-07:00

Well this is what we came here for- operating Day One. It is now 11pm and we left the OR at 9:30 this evening. A long day in the OR. We started a little late after going to Surgery Rounds. Surgery is surgery everywhere. The resident was being pimped in front of everyone. And I saw the pit they were digging for him- I was thinking "Don't jump". It is so sad. They are like sharks as soon as a little blood is out- they circle around. Made me feel right at home...

Our first two surgeries were surprises in fact Dr Bellinger said in TWICE in ONE DAY "I have never seeen this before" . Truly some rare and surprising things, but then again some typical pediatric urology such as hypospadius and UDT. The kids are just a little older than we usually see. The OR staff is great-- we have two scrub nurses assigned to us all week, two CRNAs for the morning and Pam our PACU nurse is still here. Today was really busy with medical students, nursing students, and residents in the room all day. The first few surgeries took longer for the surprises but we managed to get thru the rest in good time. Our Ghanian lunch was welcome at about 2 in the afternoon since we had been working all day. Very good and spicy rice with chicken.

The OR room can get crowded with 2 tables and all of us around both- not to mention HOT. I managed to stuff cold towels down my clothes to stay cool. We also drink alot of bottle waterIN THE OR. The insanity of the OR is nothing comapred to the Wards. There is one big room, filled with beds and cribs- no dividers no seperate rooms, most of the time two kids in one bed. First you have to find your patient among the seventy kids in teh room and since we have only seen them twice and the room is packed with kids it gets a little crazy. We have cards that indentify the pateint and list thier medications (we give out the pain meds for the first night) and when the catheters come out. All the kids come in the night before and leave 2 days after for the small surgeries. There are no IVs in the floor- those are removed in PACU. All medications are oral. Tomorrow is our first big surgery- an extrophy in at 21 year old girl. We pretty much have one or two big procedures each day- and a list of smaller ones on the same day.

The parents, usually moms, wait in the hall on benches all day. Often in thier fine clothes in the heat, they sit first with thier child and then alone. They help bring thier child up to the wards with the nurse. They are truly a patient lot. They get no calls during the procedure, they are not seeing the doctor before hand, they just wait. And wait. And still at the end of teh day when we are leaving they say "Goodnight, Thank you, and God bless."

We fixed alot of kids today and on the rest, we started the reconstructive process. WE will do that again tomorrow and for teh next three days after then.

~Stephanya Shear

The campus

2008-01-13T03:16:00.001-07:00

This morning I had the opportunity to run thru the campus. We are the KN Univerisity of Science and Technology in Kumasi. We are not far from the hospital- perhaps 30mins in our bus, given the traffic. Early in the run the sky and air was clear and I could hear birds the the loudest frogs I have ever heard. But after 30mins, the smog and smoke from burning trash gave the air thick quality. I see trash burning every where. Even behind out hotel which is very nice. There is very limited trash collection and people burn trash in piles or in cement boxes. The campus is large but most of the students are on a long break. The African Cup is being hosted by Ghana and the games are being played in Accra and Kumasi. The streets are all cleaned up and posters everwhere. The campus will house many of the teams in the dorms, so the campus will not open until Feb 5th. Isaw a group of players on campus on my run, stretching and running. There were other Ghanian people running too, just like me out there sweating before it got too hot.

I saw the dorms, some pretty old but some very new and nice. They are building all over the campus. New dorms, a new law school, a new technolosy building a new agriculture building and that was just on my run. I am sure there is more. I also saw the art college and the sculpture lab. Next to it was a impromptu sculture garden where dozens of sculture are just lying in the grass. The grass is growing around them and it gives it a mysterious quality. I saw the small health clinic and a new student center that is styled after the newest buildings in US campuses. It is not in use, in fact the lights are still wrapped up in plastic.

The run took me over a bridge over water. The vegetation was dense and lush and the smog was just coming in- and the frogs were singing. After a run uphill to the end of one long road I turned around and went back to our guest house. I ran past the professor's homes (thier names are on the outside of the houses). Very modest by our standards, but they were nice homes with porches, yards with grass and windows. The kids were outside and people where getting ready for church.

It was a nice run and I was happy I did not get lost.

~Stephanya Shear

Clinic Day

2008-01-12T12:23:00.000-07:00

I wish We could send you some pictures, but the internet connection is just not able to handle that much information. The sights here are amazing

We had clinic today. We saw 38 children (well one was 30 years old) and we scheduled surgeries on 34. Monday will be busy with eight procedures and the rest of the days will have fewer but longer and more complicated procedures. The families were all very pateint as there was a lot of wiating. After we saw them, then the waited for us to organize the OR week. Some need studies so we needed to arragnge those today. There is a CT scan and MRI here at KATH. We can also get VCUGs which took one phone call to arrange. The children are mostly older than we see in the US and they are all small for thier age. But act like kids- once he pulled out our camera's they were all little hams. They were very good too, since they had to wait with their parents and sometimes siblings too. All the kids get admitted the day before and stay for days after surgery. Old school yes but they need to be watched and since I doubt many of thm have access to clean water all the time.

We worked thru the day (taking a quick break for lunch) and then late afternoon we did a little sight seeing to the Kente village to see the cloth being made and get some gifts for people back home. I bought a little trinket in return for asking a 19 year old boy about his school and his livig conditons and a sign of the times he wanted my email address to write me. I was not bold enough to ask him if he went to the doctor at all for check ups. After all that is was late so we traveled back to the guest house. The streets were calmer than in the morning.

One the way to KATH we drove through the heart of Kumasi. It is a busy place in the morning. A lot of people selling out of there shops or on the street- people waiting for buses, on buses a lot of people out on the street. People everywhere. Traffic traffic. We saw teh new trauma center they are building- in one eyar they have made a lot of progress.

The OR is set up and we just have a few things to do before Monday.

~Stephanya Shear

Travel

2008-01-11T13:05:00.000-07:00

The FDA inspects all the IVU bins one week before departure. They are sealed at that time. Going thru cutoms in Ghana was easy. As we traveled o Kumsi we passed many housing areas groups of mud or cement brick homes. We also passed many shops. It is customay to put a religous message in the business name- God is truth brake shop, God is stable cold foods, God is good salon.

The roads were underconstruction most of the way- part of the time we were on diort roads.

Better go- losing connection

~Stephanya Shear

Arrival in Ghana and Kumasi

2008-01-11T12:30:00.000-07:00

We all arrived safely in Ghana and Kumasi. There is so much to tell in only one day but since email connection is iffy, I will try some small posts. Other people will be posting as well. Our gear arrived as well- six tubs of IVU eqiment and 2 large duffel bags. We all managed to sleep some on the plane so we were all not too tired. The weather is a warm 74 degrees.

The people are lovely here and vert sweet. Our host Dr Aboa was happy to see us and his resident Yoyke was a weath of inforamtion about the medical insurance for Ghanians as well as medica education. Everyone i Ghan had access to health insurance. It is free for those people who pay into sical security and 12 US dollars per year for a family for those self employed. It covers everything but plastic surgery and some rare congential syndromes. I also saw examples of public health measures- for HIV and TB as well awarenss for prenatal care.

It si a rough here by Western standards. Ghanias have a higher quality of life than may W Africans, but it is still alow standard of lining. Most homes have no electricity, no water and no sweage. The bigger cities have more amenities but not every day. The infrastructure is also inconsistent. We traveled on some very rough roads and we stood in traffic a lot. Everytime we were still however gave many young women and boys opportunity to sell us all sorts of things- most resting on there heads. Water, plantains, some small fried bird, palm nuts, fried cake, boiled eggs, and planety of thoer things we could not identify.

These children should be in school-there are public schoold that are mostly free- but I have the feeling they are working for thier families either selling or hauling water from a well or pump, burning trash or the like. There have been some imporvments froma report I read in 2000 about city governemnt and povery in Kumasi. Some of the services may have improved and at least now health care is covered for all. There is a doctor shortage outside the teaching hosptitals in the districts, but the governemtn is working on sending people there.

We start tomorrow at 6 am and start clinic we hope at 8am. There is more surgery here than we can hope to do in one week, but after we meet the children we will plan to rest of the week. One half the staff will unpack the OR and set up.

The food is pretty good but we only had one meal given we were on the bus for over 6 hours. They have this awesome hot sauce that reminds me of a spicy Chinese bean paste. It is really good on fried potatoes.

~Stephanya Shear

Last Post Before Leaving

2008-01-09T18:36:00.000-07:00

Preparation for this mission to Ghana began months ago. Once the date was set, I began the process of getting time off from residency, compiling a to do list and begin investigating Ghana. My first stop was the library where I found the most useful books in the Children’s section. Short books, concise and perhaps a bit rosy (one paragraph on the slave trade out of Ghana), they set the stage for at least some basic information. Also I found two great picture books, both Asante tales. One about a spider who learns the value of sharing and the other about a Leopard who was boastful and greedy.

I tried making a few Ghanaian dishes- Jollof rice and Groundnut (Peanut) Stew. The rice, well I need to work on my recipe. It was a thick gob of tomato and rice- I think too much tomato paste. The stew was good (Black beans, carrots, peanuts and tomato) but very rich compared to my usual diet. Dr. Schneck said he knows of a place that sells fried bat. I have eaten insects, but I draw the line at flying mammals.

The CDC site was also helpful (yellow fever vaccinations are required for entry) as well as a local travel agency that specializes in trips to Ghana. Our host site- an engineering college also had a web site. Very happy looking students go there. December was my month for vaccinations and we had a conference between team members and Josh Wood, the IVU director. I was so busy doing everything BUT pediatric surgeries, before I knew it; our trip was two weeks away. I began my lists of things to get, things to do and now there are so many notes around the house now it looks like a post-it note factory exploded. I was able to get a least a few pediatric surgeries in before today, so at least I can operate with my surgical magnifying glasses (aka loops).

What I learned about Ghana-

It is in on the southern coast of western Africa, next to Togo and Ivory Coast. It is about the size of Missouri. Accra is the capital and Kumasi, where we are going, is the second largest city. Accra is on the coast and Kumasi north of there but not quite at the center of the country. It is a tropical place and some of the trees are the most ancient type of grass-trees. I hope to see sausage and baobab trees there. Elephants were once plentiful but are now gone. There are still a lot of snakes.

The ancient kingdom of Ghana was actually more north than the modern country and refugees from a bloody revolution in 1100 settled in present day Ghana and four of the original tribes are still present. Ancient Ghana was conquered by the Mali Empire, which was then overtaken by the Songhai kingdom. Eventually the Moors led by Prince El Mansur captured Ghana in 1591. The arrival of the Moors, led to a strong anti-Moslem faction and tribes were brought together, and the Asantes, an Akan people, became very powerful.

The Portuguese came to trade gold, ivory and pepper and then slaves. Eventually after Great Britain outlawed the trading of people, Ghana found economic success in exporting agricultural products such as palm oil, cocoa, cotton, rubber, and gold. Left to govern itself until the late 1800s, exports made some Ghanaians very wealthy. In 1872, Britain expanded its African colonies and went to war with the Asante people. In 1874 the British entered the heart of the Asante people, Kumasi, where a terrible bloody war ensued. The Astante confederation was broken and the king was exiled.

The British controlled the politics of Ghana and excluded any native person from holding any office. The only education was from missionary schools as the British government feared a revolution would occur if the Ghanaians received any formal education. This did not stop them from conscripting Ghanaians to fight with the Allies in World War II. Returning form war the feeling of the Ghanaians began to change. The United Nations was recognizing small countries and the United Gold Coast Convention was born from that came the leaders of free Ghana. In 1960, Dr. Kwame Nkrumah became the first president when Ghana became the first former British colony to gain independence. Ok so there were a lot of coups and rebellions and makes for a brief early history especially when I am reading from a few books at the seventh grade level.

So that is some of the basics. I have only started reading about Kumasi in earnest. So perhaps I will write about that next. My next post maybe from Ghanaian soil as we head to the heart of the Akan- Asante people.

~Stephanya Shear