The flexible curriculum of the Department’s Residency Program allows for enhanced experiences including the option for international electives. International electives add a valuable educational experience for our residents and at the same time assist areas of the world in need of medical help.
Below is an assortment of different locations and medical specializations:
Daniel Oberlin, MD traveled to Vienna, Austria with the generous support of the Andlinger Residency Exchange Fellowship.
Daniel Oberlin, MD traveled to Vienna, Austria with the generous support of the Andlinger Residency Exchange Fellowship. Since 1992, the American Austrian Foundation has sponsored over 150 residents through the residency exchange, allowing American and Austrian residents to supplement their education and broaden their experience through exposure to a foreign healthcare system. Dr. Oberlin spent four weeks interacting directly with the urology faculty and housestaff at the largest hospital in Austria, Vienna General Hospital, a 1,500 bed hospital and outpatient clinic with over 1,600 physicians. During his rotation in Vienna, Dr. Oberlin worked closely with chairman Dr. Shahrokh Shariat and urology faculty in the clinic, operating room, and research facilities.
Dr. Oberlin learned not only about the field of urology but in particular the nuances of European urologists, which differ from American urologists. “During my time in Vienna, I was able to fully integrate myself into the department of urology with significant interactions with the urology staff, housestaff, nursing, and research department.” In particular, Dr. Oberlin enjoyed discussing salient topics in urology such as PSA screening and neoadjuvant chemotherapy with the urology staff. Through these discussions, he was able to learn new perspectives and management techniques.
In particular, he appreciated the differences in the way medical care is provided in a different health system. “I enjoyed learning different perspectives on clinical management and how medical management differs in the Unites States when compared to Austria. For example, healthcare in the United States is burdened by ever-increasing costs, especially with regard to prolonged hospitalization and the cost of hospitalization. To counter these rising costs, there is a significant importance placed on shortening hospital stays in order to maximize efficiency and cost to taxpayers. While in Austria, there is less emphasis on decreasing hospital stays. In many ways, this was refreshing, and many patients are given a couple extra days in the hospital to recuperate and recover.”
Joceline Liu, MD spent two weeks in Kigali, Rwanda to work with the fistula program at King Faisal Hospital.
The fistula project served a population of women with a great medical need in a specialized surgical field that was largely unavailable in Rwanda. The patients seen in the fistula clinic were often unable to obtain employment due to their urinary and/or fecal incontinence and were relegated to living in small groups of women with fistulas. These patients did not have access to consistent urologic care, nor were they able to afford to pay for the necessary medical care. Advertisements for the biannual fistula program are broadcasted nationally over the radio, with hundreds of women traveling from throughout Rwanda and surrounding countries to be seen. While urinary fistulas are infrequently seen and treated at Northwestern Memorial Hospital, fistulas of the bladder, vagina, and rectum are significantly more common in underdeveloped nations, where prolonged and obstructed labor are widespread. As a result, the frequency, severity, and breadth of complex female urogenital reconstruction in Kigali, Rwanda far exceeds that of the United States.
Over the duration of the fistula program, Dr. Liu and her peers had the opportunity to evaluate over 100 patients and performed over 30 surgeries. The majority of these surgeries were for fistula repairs, with approximately half managed from an abdominal approach and the remainder via vaginal approach. Over the last decade during which the fistula program has become established in Kigali, a distinct shift in types of fistulas encountered has occurred. Previously, most fistulas resulted from prolonged labor and distal vesicovaginal fistula, which are best treated vaginally. In more recent years, with improved access to medical care and more common cesarean section with failure to progress during delivery at local health centers, many fistulas are now more proximal. Involving the ureters, uterus and cervix, these fistulas are repaired from an abdominal approach.
Amanda Chi, MD traveled to Vienna, Austria in April 2014 with the generous support of IVUmed’s Traveling Resident Scholar Program and the Andlinger Residency Exchange Fellowship.
Amanda Chi, MD traveled to Vienna, Austria in April 2014 with the generous support of IVUmed’s Traveling Resident Scholar Program and the Andlinger Residency Exchange Fellowship. The Andlinger Residency Exchange is organized by the American Austrian Foundation and encourages training of American residents in Austria or Austrian residents in the U.S. to supplement the residents’ education and broaden their experience through exposure to a foreign healthcare system. Since 1992, this fellowship has supported the exchange of more than 130 residents.
Dr. Chi spent her rotation at Vienna General Hospital (Allgemeines Krankenhaus a/k/a AKH), which is affiliated with the Medical University of Vienna. During her rotation in the urology department, she primarily worked with Dr. Harun Fajkovic and Dr. Shahrokh Shariat, in addition to the other urology residents. She was able to observe and participate in daily conferences, operating room activities, clinics, and on the wards. Through her experience, she gained an appreciation of how the cultural mentality can drive patient expectations, from patient-physician interactions to how medical resources are shared. According to Dr. Chi, “our medical education systems differ greatly in that surgical training in the U.S. tends to be distributed more evenly throughout our education while the system I observed focused on surgical training in latter parts of residency and beyond. I also noticed the frequent use of ultrasound by the physicians in clinic and in the operating room – a method we are trying to incorporate into our current practice.”
Matthias Hofer, MD, PhD spent two and a half weeks in Accra, Ghana to work at the 37 Military Hospital on a clinical rotation organized by the International Volunteers in Urology (IVUmed).
Ghana is a county with 25 million people and a size comparable to Oregon. The annual income per person is roughly $1,800; however, there is a wide gap between the low-income population living mainly in rural Ghana, and a middle class located in the urban areas. Dr. Hofer noted that unlike other African countries, Ghana has both a significant middle class and a health insurance system that is financed either by the insured member or an employer. In 2003, a universal-type health care system was introduced to cover all children and pregnant women. Because there is a lack of physicians in rural areas, many of the patients Dr. Hofer observed were people from the countryside seeking treatment, requiring several days worth of travel. Patients were expected to bring all required medications, fluids (IV as well as irrigation fluids needed in the OR), dressing supplies, gloves, glucose strips, etc. to the hospital.
There were five operating rooms in the 37 Military Hospital, all of which were equipped with standard ventilation, lighting, anesthesia machines, endoscopy, and sterilization facility access. Dr. Hofer noted that he unfortunately saw several patients with advanced renal or prostate cancer upon retuning to the clinic months after their initial visit. Many patients were from outside of Accra, sometimes several hours away by car, so they did not always return for surgery. Many rural populations also seek care from traditional healers and herbal medications, causing a delay in treatment resulting in inoperable disease.
Laurie Bachrach, MD signed up for her International Volunteers in Urology (IVUMed) trip, which took her to Ulan Bator, Mongolia.
Dr. Bachrach's group arrived to Ulan Bator on a Wednesday night. The next morning, they arrived at the hospital and were immediately ushered into a conference room. With little introduction, they immediately began to see patients who were preselected by their Mongolian colleagues as potential operative candidates. The patients were almost exclusively candidates for urethroplasty or laparoscopy. The IVUmed team evaluated the patients’ brief histories and appropriate imaging. Their first case was performed that first afternoon. For Dr. Bachrach’s own records, she took notes and photos of every patient along with relevant imaging and organized it into an ad hoc medical record. This ended up being utilized by the rest of the team and enhanced their experience, as it allowed them to think about and discuss their surgical approaches in advance and anticipate challenges in the operating room.
Many patients were waiting in the hospital for IVUmed’s arrival with their families and were assertive about being seen. Patients also seemed surprisingly well-informed about their disease process and the treatment options available. Dr. Bachrach believed this was a testament to the Mongolian doctors. The existing knowledge and skill of the Mongolian doctors, coupled with a highly focused teaching mission, contributed strongly to the success of the trip.
One of her concerns early on was that it would be tough to balance her desire to pursue her own training and education without taking away from their training. A former resident was very helpful in negotiating this by defining specific roles for each case. In the end, they became so busy that there was room for all of the IVUmed members to work at the same time. That allowed them to take care of more patients, while also permitting everyone to get a richer training opportunity. Dr. Bachrach says she was very impressed with the organization of the trip.
In Spring of 2012, Jessica T. Casey, MD spent a month rotating in India through the program IVUmed.
Dr. Casey then traveled to Sadbhavna Trust Hospital in Mahuva, Gujarat with Dr. Sakti Das, her mentor from IVUmed who hails from Alameda County Medical Center. Over six days, she performed 34 operations, ranging from delicate hypospadias work to minimally invasive percutaneous nephrolithotomies to an exstrophy repair. During the last case, Drs. Casey and Das worked with a local gynecologist turned urologist to do a primary exstrophy repair, ileal cecal pouch and epispadias repair on a 16-year-old boy who had been living with an open bladder since birth. He had been coming to Sadbhavna Trust Hospital for 2 years hoping for a surgery to make him dry. During her stay in Mahuva, Dr. Casey met Amithi, who underwent bladder augmentation and Mitrofanoff construction one year earlier for her neurogenic bladder from spina bifida; she came to the clinic to thank Dr. Das for changing her life.
During her time in India, Dr. Casey learned how to operate with minimal technological advances and get difficult cases completed with the basics (scalpel, cautery, suction, hemostats and donated suture.) Her travel to India highlighted the international need for urological care and she hoped to continue to operate internationally in the future.
Lee Zhao, MD, took advantage of the Department’s elective option with a two-week trip to Vietnam.
Dr. Zhao and the other residents had brought with them medical equipment that they presented to the chair of the department. Guide wires and catheters appeared to be hot commodities in Hue. He felt this supply of donated guide wires might be all that the department would use until Americans returned in 6 months.
The visiting residents fell into a surgical routine of two or three hours in the morning, a break for lunch, and surgery for two more hours in the afternoon. Differing from his time at Northwestern, Dr. Zhao noted he could easily scrub into six different cases per day, have time for lunch and still get home by 5 pm. A similar day back in the US would keep him in the hospital until 7 or 8 pm.
What Hue Hospital lacked in modern medical equipment they made up for in efficiency. “I was impressed with how fast the Vietnamese surgeons were and that nothing was wasted in the hospital. Since all the surgical drapes were cloth, they were washed, re-sterilized, and re-used. It truly is amazing how much waste there is in the United States. In Vietnam, pretty much the only things which were thrown away were the gloves,” reflected Dr. Zhao.
Brian Le, MD spent 5 weeks in Delhi, India on an international medical rotation in Delhi.
Dr. Le split his time between two major hospitals. He was based at a private hospital that was part of the Max Healthcare Hospital System and also spent time at the public hospital, where the line for services stretched out the door. Jumping right into the fray, Dr. Le was in the operating room with local Indian urologists every day. While technologically modern, the operating rooms were run cost-efficiently. All equipment was utilized for maximum usage. Nothing was thrown away unless absolutely necessary.
While India itself is an affluent country, many of its people are quite poor. Because of this, costs are kept at a minimum to ensure patients are able to take advantage of the modern technology. Due to this access to modern medicine in an area of the world populated with poverty, India is also a travel destination for those seeking treatment from neighboring countries. Dr. Le repeatedly saw patients seeking treatment in India to only to later return to their home countries after recovery.
Dr. Le kept close ties to those he worked with in India, including Dr. PB Singh, the president of the Urological Society of India, whom Le reunited with at the 2011 AUA conference in Washington D.C.
Vishal Bhalani, MD traveled to Tanzania, located in eastern Africa, to complete his elective rotation.
Bladder cancer, specifically, is of major concern in this region, in part due to a phenomenon known as “male menstruation.” Young men who start working in rice fields around puberty are susceptible to acquiring schistosomiasis, resulting in hematuria, which unknowing locals relate to the male version of a woman’s menstrual cycle. Left untreated, the condition results in bladder cancer and constitutes 80% of the cancer cases found in this region.
In August, 2008, Brad Erickson, MD spent a month of his elective time in Egypt on a resident scholarship from the International Volunteers in Urology (IVU).
Contact Kelly Ross, our education coordinator, for more information about our residency program.