2022 Humanitarian Grant Program Recipients Trip Reports

Victoria Y. Bird, MD

Dr. Bird's grant supported her work with the University of Florida’s Equal Access Clinic Network (EACN) in Gainesville, Florida. EACN originated as a once-weekly free clinic run by a handful of medical students and a physician out of Gainesville's Salvation Army. Now, EACN is one of the most robust student-run free clinics in the nation. As a Spanish-speaking urologist, Dr. Bird formed a niche within EACN, seeing patients with urologic concerns (kidney stones, kidney/bladder tumors, acute renal failure 2/2 obstructive BPH, UTIs, prostatitis, orchitis and hydroceles). EACN utilizes its referral options for patients who need specialized urologic procedures and/or cancer treatments, regularly enrolling them in Alachua County's WeCare program or UF Health's Fee Assistance Program, both of which can get patients in the door to a urologist at UF Health at reduced or eliminated cost. On other occasions, patients are referred to private practices in the area that can offer charity care or assist with insurance options.

Stephanie J. Kielb, MD

Project Summary – Empowering Women in Rwanda

Dr. Stephanie Kielb sits on the board of directors for the International Organization for Women and Development (IOWD), a charity which has focused on vesicovaginal fistula repair and prevention since 2003. IOWD brings teams of urologic and female pelvic medicine surgeons, nurses, anesthesiologists, medical students, and other volunteers three times every year to Kibagabaga Hospital in Kigali, Rwanda. Dr. Kielb leads the May mission and also participates in the October mission as the experienced urologist, working on research projects with both US and Rwandan medical students and residents. 

As the first return mission since COVID, the May 2022 mission met with tremendous success, with over 50 complex fistula repairs completed by the team.  The October 2022 mission also saw the addition of three excellent Rwandan gynecologists who actively took part in the work up and evaluation of the fistula patients and surgical techniques to repair fistulas. As always, an outstanding group of Rwandan medical students worked both missions with the IOWD team both interpreting for the patients and our team, learning valuable skills, and getting involve in research projects with Dr. Kielb.

An exciting new aspect of the IOWD program is working to enhance Rwandan urology residency training. During the October mission Dr. Kielb met with Rwandan urology residents and residency leadership, working to develop an educational exchange program with the residency program there. 

Dr. Kielb will be returning to Rwanda to lead the next May mission. Her research is focusing on the change in the type of fistula over time, regional variation in fistula occurrence to better direct the IOWD caesarian section training program and evaluating the impact of cystoscopic ureteral evaluation prior to fistula repairs. 

About

Dr. Kielb completed medical school and urology residency training at the University of Michigan, and a fellowship at Northwestern University.  She is currently a Professor of Urology and Program Director at Northwestern.

As a physician, the motivation to serve is what brought me to medical school in the first place. I became involved with IOWD through a close friend, and honestly have never looked back. The impact that genitourinary fistulas have on women is so profound, it is something women suffer from worldwide, and particularly in developing countries can result in devastating outcomes. In many countries, few resources are directed towards women's health, with fistulas being on reflection of this. In Rwanda like many other countries, women may be ostracized from their husbands, families, and communities. Local expertise is lacking, and these patients lack resources to travel to fistula centers elsewhere. IOWD's goal is to restore dignity one woman and child at a time. Our team does not just fly in and operate and then leave (as I tell the residents and students I bring, everyone's incision looks great on post op day 1), we work with the local physicians long after we leave, provide management until all patients are discharged, keep detailed patient records, encourage follow up for exams, and report all patient visits, surgeries, and outcomes to the Rwandan Ministry of Health. We have developed training programs for medical students, nurses, anesthetists, obstetricians, and urologists in Rwanda. I feel privileged to be a part of the IOWD team. If I can be part of restoring just one patient's dignity and giving her life back, it is worth all the effort. I was honored to be asked to be on the medical director board of IOWD, and know first-hand how much time, coordination, and effort go into organizing regular missions in Rwanda. As a mission leader, I have taken pride in working through all the expected unexpected issues which arise running surgical missions in a low-resource hospital, and have enormous respect for local physicians, nurses, and the entire health care team who are so dedicated to their patients every day in Rwanda. I truly know I have gotten more out of my participation with IOWD in Rwanda then I could ever possibly give back. As a long-time urology program director, I know how important well-developed curriculum and trainings are to residents and students, and our educational program makes me proud to be part of IOWD. Rwanda has very few practicing urologists, my time there and also remotely I continue to lecture and educate within the medical school. Our missions involve long days and little rest, however when I return each time, I feel not exhausted but invigorated. I am truly thankful to be a small part of the IOWD mission and part of the global health community.

Ian S. Metzler, MD

Dr. Metzler works to coordinate projects in Trinidad & Tobago. As he explains, surgical workshops have been hosted in-country for many years. However, the impact is narrowly focused on a few senior urologists who assist in the OR. During the workshops, there is tremendous interest to learn from medical students, residents and faculty alike. “There is, quite literally, a line out the OR door.” Dr. Metzler is working to incorporate surgical simulation into surgical workshops to allow for a greater breadth of skills to be taught to more trainees at every level. For the first phase of this project, he has developed surgical simulation tools and a curriculum and hands-on workshop that can be performed with low-cost, reproducible kidney models.

Timothy G. Schuster, MD

Project Summary – Working With Local Surgeons in Belize

In November 2022, Dr. Timothy Schuster led a surgical trip to Belize, where the team provided 40 surgeries and procedures to patients from all regions of the country.  In an effort to reach more patients, separate surgical teams were organized to provide focus on both general urology and FPMRS surgeries. Care was provided at Karl Heusner Memorial Hospital, the main public hospital located in Belize City.  A total of eight members from across the United States participated in the trip, including urologists, anesthesia, nursing, and surgical tech professionals.  Combined, the GSE teams performed surgery to treat BPH, pelvic organ prolapse, urinary incontinence, urethral strictures, and urinary stone disease.  A special focus was taken to provide surgical training to the local urologist and gynecologists.  In addition, surgical supplies were donated to the hospital and surgeons to improve future surgeries performed by the local surgeons.  Dr. Schuster commented: “We had the opportunity to work more extensively with the local surgeons on this trip as the long-term goal is to provide training to the local providers to allow for more comprehensive ongoing care.  We are especially grateful for the support we have received from the Urology Care Foundation to conduct these ongoing surgical missions.”

“We focused on teaching TURPs as the current management of most men with urinary retention is a chronic indwelling catheter.  One of the patients we cared for had a catheter for the last 2 years and 9 months and left the hospital voiding on his own after his surgery—one of the happiest people on the planet.  I’m amazed at the resilience of people in the face of hardships and the incredible opportunity we have as surgeons to change peoples’ lives for the better.”

About

Dr. Schuster completed medical school at Loyola University Chicago Stritch School of Medicine and residency training at University of Michigan.  He is currently an Assistant Professor Urology at The Toledo Hospital.

Founded in 2012, Global Surgical Expedition (GSE) is a global charity that delivers urologic care to underserved nations. Presently GSE organizes and sends five surgical teams annually for week-long surgical trips to sites in Belize and Rwanda.  GSE has a long-standing history of comprehensive initiatives to not only provide surgeries but also make a greater impact through research, education, and infrastructure growth. The UCF grant supported work in conjunction with GSE, specifically to support the delivery of urologic surgeries in Belize.  Dr Schuster has been leading a group of urologic surgeons to Belize annually through GSE since 2017

Support through the UCF/Richard J. Fox Humanitarian Endowment contributed significantly to the career of Dr. Schuster and is an investment in improving the lives of patients suffering from urologic diseases. Our deepest appreciation to the Fox Family for supporting the critical need to enhance urologic patient care for the underserved.

• GSE has maintained a commitment to providing urologic surgeries to men and women in underserved nations. To date, GSE has treated over 1,200 patients and performed over 450 surgeries. Dr. Schuster and GSE have provided a diverse range of surgeries to treat cancer (renal, penile, bladder), urethral stricture disease, urinary retention, urolithiasis, and female pelvic medicine. GSE has also placed focus on providing education to local surgeons to improve access to care. This collaboration with local urologists and gynecologists in Belize and Africa has expanded delivery of a greater number of surgeries and safer approaches to surgical care. In addition, GSE has intermittently undertaken the organization of out-of-country surgery, where patients were transported to the US for more complex care and recovery (e.g., cystectomy).
• GSE has sought to increase care infrastructure with its partner communities. GSE has donated extensive surgical equipment to allow for care delivery by local surgeons. In Belize, for example, GSE undertook the setup of necessary equipment and related training to allow for TURP procedures. In Rwanda, GSE provided a pelvic and vaginal ultrasound machine and maintenance required to facilitate better obstetric care and uro-gynecologic surgery. GSE was also proud to organize the first laparoscopic renal surgery in Belize to introduce this technique locally. Additional examples include the donation of surgical retractor systems, surgical lighting equipment, and surgical instrumentation to facilitate safer surgery.
• GSE has placed focus on providing educational experiences for students and residents. In doing so, GSE seeks to inspire the next generation of global surgery leaders. GSE has provided many residents scholarships to support resident experiences during a week-long surgical trip.  More recently, in collaboration with the University of Virginia through Dr. David Rapp’s involvement in the Center for Global Health and International Programs Council, Dr. Rapp has developed formal curriculum to help train residents with career interests in global surgery. This includes the formal Global Health Leadership Tract and separate curriculum developed and overseen by Dr. Rapp.
• GSE has emphasized research activities to help better understand surgical disease and poverty in the countries it visits. This research has been published and also presented at society meetings to include the Society for Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), the American Urogynecologic Society (AUGS), and AUA Mid-Atlantic Section. Ongoing projects include assessing the impact of urological conditions on job and caretaking responsibilities in developing countries. This project has provided insight into the impact of urologic disease not only clinically but also its relationship with poverty.

Amar Singh, MD

Project Summary – Education and Care in India

The humanitarian grant from the Urology Care Foundation was used in November 2022 to provide services at the Sadhbhavna Trust Hospital, Kalsar, Bhavnagar in state of Gujarat India.  Kalsar is a coastal village with a population less than 10,000. Sadhbhavna Trust hospital is a 100-bed hospital.

The first purpose of our trip was to deliver care in advanced cancer and complicated urological conditions to the local community and patients within a several hundred-mile radius.  The second purpose was to educate the local surgeons, as several trainees who work there were general surgeons who provide care in the local communities without much exposure to urology.  This allows us to expose and train them in treating basic urology as well as complex urological reconstruction and urological oncology. 

Our work spanned several days where patients who were screened previously were prepared for surgical intervention.  Postoperative care was delivered by trained local surgical residents as well as local urologists and other physicians in the hospital. During our camp, a total of 30 patients underwent urological operations.  The range of operations was vast -- from routine urological surgeries like transurethral resection of prostate, to complex surgeries including vesicle vaginal fistula repair, and radical cystoprostatectomy with continent urinary diversions.  Several stone procedures including percutaneous nephrolithotomy as well as ureteroscopy's were also performed. 

Prior to this trip, there was no set mechanism for routine long-term follow up and to help deliver adequate postoperative care in the long run due to the complexities of the surgeries, the distance these patients travel to receive care, and the lack of resources available.  UCF funds were used to help address these challenges – for a laptop and a display device/projector to help develop patient and staff training and educational videos.  These videos will help us conduct patient education seminars as well as to train hospital staff in delivering superior postoperative care.   Furthermore, a full-time dedicated person has been hired to develop and maintain a database with the patient's cell phone contacts and their demographics.  This will help us maintain future follow-up and also have a direct line of communication between the hospital and the patients for clinical questions that may arise in the future.  

About

Dr. Amar Singh completed medical school and residency training at SUNY Upstate in Syracuse, New York, and a fellowship at the National Cancer Institute, specializing in urologic oncology.  He is currently an Associate Professor of Urology at the University of Tennessee.

Sadbhavana Hospital is a rural underdeveloped village safety net hospital that is the sole urological care facility for impoverished farmers and the rural community in greater than a 100-mile radius.

As Dr. Singh explains, “The mission of our work is focused on providing basic urological care including necessary surgeries to one of the most underserved, poor, and rural communities in the state in partnership with the local health care team,  with a strong focus on clinical education for the surgeon and their entire team during each volunteer trip and is focused on building and developing clinical and surgical skill set in a progressive fashion.

The impact of these volunteer trips in alleviating suffering in the region from urological diseases is tremendous. The financial hardships, lack of facilities, and qualified urologists all make seeking care a challenge. Through these volunteer trips, we have been able to help take care of more than several thousand patients over the last fifteen years. These patients may have suffered from something as basic as urinary retention or as complex as a genitourinary fistula from a complex pelvic trauma from a motor vehicle accident. The secondary group of patients in the surrounding regions also have indirectly benefited from this work. Local surgeons who train and volunteer with us also go on to teach and take care of several thousands of patients in their own respective communities and have done this successfully over several years.”

The long-term objective of this grant will be to help further develop infrastructure to establish tangible measurements of clinical outcomes and other quality measures.

Alan J. Yaghoubian, MD

Project Summary – Treating Kidney Stones in India

In November 2022, I traveled under the mentorship of Dr. Mantu Gupta to the state of Gujarat, India for a medical mission focusing on treating kidney stones within the local population.  Our work was focused at the Charity Hospital in the town of Mahuva.  This hospital is dedicated to providing nearly cost-free genitourinary and gynecologic services to people from all over the state.  Our main purpose was the surgical treatment of urinary stone disease; however, we performed all types of endourological procedures as well.  Gujarat is part of a stone belt within India, and has a disproportionately high incidence of stone disease.  In our 4 days operating at this hospital, we performed over 60 percutaneous nephrolithotomy (PCNL) procedures and over 50 other endourological procedures.  We brought with us several suitcases of disposable surgical supplies for use in the operating room there.

I was truly humbled by everyone involved with the hospital, especially the determination of the patients.  The things patients do to receive care are quite unimaginable in the United States.  We first arrived at the hospital just before midnight, and upon driving onto the grounds and entering the hospital, I was shocked to encounter hundreds of people sleeping on the floor, both inside and outside.  We were informed that these were all patients and their family members, the majority of whom live in abject poverty.  They travel sometimes hundreds of miles with their families to have surgery or receive care.  Once at the hospital, they will sleep on the floor for days at a time, waiting for their procedure.  What, at first glance, appeared to be a scene of administrative chaos was actually handled with much dignity and patience.  Everyone was calm, and the patients all seemed to have a silent understanding that they would receive equal quality care.  There was no patient-to-patient or even physician-to-patient hierarchy.  Despite waiting for days away from their homes and their jobs, upon making eye contact with a patient in the hallways, we were invariably greeted with a warm smile and a welcoming bow.

This mission also provided us with an opportunity to work alongside urologists from across the world.  Some came from the next town over, and some (like us) came from other continents, all with the same goal in mind and the same level of dedication to improving care for these patients.  It was amazing to be able to operate side by side with other urologists to learn new techniques and share our techniques with them.  Unsurprisingly, the instruments and devices available to us were not those that we are used to.  For example, there are no flexible scopes in the hospital.  We use these routinely during nearly every PCNL to ensure all stones are cleared from the kidney.  Without this luxury, we were forced to choose our plan our access carefully to be able to retrieve all stone fragments.  The limited resources also gave us an opportunity to hone our creativity, as we were occasionally required to create makeshift devices to accomplish the task at hand.

The head doctor of the hospital told us that the Indian culture always emphasizes giving over receiving.  Despite our best efforts to give our time, energy, and compassion, I still came away feeling as though we received so much more than we gave.  From learning new surgical skills and ways to be creative in the OR, to instilling in me with a renewed sense of compassion, gratitude, and humility, this mission was truly unforgettable, and I look forward to the day when I am able to return in the near future.

About

Dr. Yaghoubian completed medical school at the University of California, Los Angeles, and residency training at Massachusetts General Hospital.  He is currently an Endourology Fellow at Mount Sinai.

The Jeev Sewa Santhan organization has been providing medical care and services to underserved parts of India since 1991.  Dr. Yaghoubian will accompany and assist Dr. Mantu Gupta (Mentor) to rural hospitals in Gujarat this fall.  Under the auspices of the organization, Dr. Gupta has performed hundreds of endoscopic procedures for kidney stones in India, including ureteroscopic laser lithotripsy and percutaneous nephrolithotomy. Without this surgical intervention, it is likely that each of these patients would have suffered grave consequences from their urinary stones due to delays in treatment or, in some cases, a complete lack of treatment.  This year’s mission in particular, is of utmost importance and holds a greater meaning to the community as a whole, as for the last two years, Dr. Gupta has been unable to provide his services due to the COVID-19 pandemic.

Kit Yuen, MD

Dr. Yuen's grant supported her work with the University of Rochester and the St. Joseph’s Neighborhood Center, which for more than 10 years has served a predominantly minority neighborhood in the heart of Rochester, New York.  At Urology Clinic Nights, residents and attending urologists work with medical students to evaluate patients as a team and have the opportunity to gain exposure to cost-effective patient-centered care. Dr. Yuen helped improve awareness of the barriers to healthcare access and inspire young physicians to take on the challenge of addressing health inequities. The team has evaluated many patients for malignancies as well as non-oncologic diseases, and in addition to surgical procedures, provides medical treatment for patients and helps decrease the need for emergency department visits.