Countdown to Egypt '08

Salam ‘alaykum (Hello, I think),

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

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

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

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

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

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

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

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

Maas salaama (Goodbye) for now,

Chip

~Croth

Leaving Bangladesh

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

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

~Jhtamola

Goodbye....

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

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

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

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

Signing off in Ulaanbaatar,

Ellen & Edd Thorp, Trip Secretaries

~Mongolia2008

Friday....last day of surgery

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

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

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

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

~Mongolia2008

Bangladesh Day 3

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

~Jhtamola

Thursday - Firing on all cylinders

Hospital Number One, Day 5 in Mongolia.

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

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

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

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

~Mongolia2008

Bangladesh Day 2

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

~Jhtamola