|This article relies too much on references to primary sources. (April 2009)|
IVUmed is a nonprofit organization based in Salt Lake City, Utah, USA. IVUmed (formerly International Volunteers in Urology), incorporated in 1995, is the only nonprofit organization worldwide dedicated to teaching urology in developing countries. In fulfilling this mission, IVUmed provides medical and surgical education to physicians and nurses and treatment to thousands of suffering children and adults. In contrast with other surgical nonprofit organizations, IVUmed’s mission is to teach the teachers. This approach ensures the long-term sustainability of programs and fosters the professional independence of IVUmed’s partners abroad.
IVUmed’s founder, Dr. Catherine deVries, began forming IVUmed’s teaching and service model in Honduras in 1992. There, Dr. deVries saw the unmet need for pediatric urology education. Children in developing countries with problems of the kidneys, bladder and genitalia fell through the cracks in healthcare. Adult urologists did not care for children, and pediatric surgeons had little experience with urology. At the request of the Honduran pediatric surgeons, Dr. deVries began implementing IVUmed’s model for teaching pediatric urological reconstruction in developing countries. Over the years, IVUmed has refined its approach to address complications and problems stemming from the difficulties of doing complex urogenital reconstruction in resource-limited settings where nurses have limited education and pain management is poorly understood. In 1992, Dr. deVries began working with Honduran plastic surgeons and general urologists, and over the years moved to a more sustainable relationship with pediatric surgeons specializing in pediatric urology. Nearly 100 patients are seen during each workshop while educating primary care providers, ward nurses, pediatric surgeons, and most recently, pediatric urologists. IVUmed’s Honduras program has grown to include physicians from across the country now capable of performing relatively complex operations independent of IVUmed.
Pediatric Program Accomplishments
Following on the model developed in Honduras, IVUmed took its expertise to Ho Chi Minh City, Vietnam to the 800 bed Children’s Hospital #1. Before IVUmed began work in Ho Chi Minh City, South Vietnam did not have any academic pediatric urology. Between 1994 and 2005, five hundred operations were performed by the IVUmed teams and Vietnamese surgeons. Independently, and after training by IVUmed teams, local doctors have now operated on more than 7,000 patients, ages 1–22 years. Since IVUmed’s first workshop in Vietnam in 1994, its Vietnamese partners have increased surgical output (number of patients treated annually), by ten times, or 1000%.
Primary successes in Vietnam include the development of a pediatric urology program at Children’s Hospital #1 to include treatment of the most difficult urological malformations and the introduction by IVUmed of advances in pediatric anesthesiology such as epidural anesthesia for hypospadias repair. Most importantly, IVUmed’s Vietnamese partners train 3 pediatric residents and 3-6 fellows each year. They also train 4-6 adult urologists from various provinces and host urology residents for 1–2 months every year. Training provided by IVUmed in this vitally important surgical field once virtually absent from South Vietnam is now passed on by local experts to 10-15 physicians every year. IVUmed applies this model to each of its partner sites to develop sustainable, self-reliant surgical programs capable of meeting each region’s pediatric urology needs.
Women's Health Program
Building on the success of its pediatric urology program, IVUmed expanded to other areas of urological care and teaching. The women’s health program teaches physicians to treat the devastating effects of vesico-vaginal fistula (VVF), a condition that causes a woman to constantly leak urine and/or feces, typically after a long, obstructed labor.
IVUmed works with its international partners to address the enormous need for urogynecological care among women in sub-Saharan Africa, particularly in Nigeria. Women in developing countries suffering from pelvic floor injuries and incontinence, often the results of prolonged and obstructed labors, have little or no treatment available to them. In fact, experts estimate that over 2 million women in sub-Saharan Africa, and approximately 800,000 in Nigeria alone, suffer from vesicovaginal fistula (VVF), a condition in which a woman leaks urine and/or feces constantly, often as a result of injuries incurred during labor (source: Lengmang, 2007). Meanwhile, on the entire continent of Africa, there are only 388 urologists currently in practice serving a population of around 770 million. This compares to over 9,000 urologists in the United States. The ratio of urologists to the general population in the U.S. is approximately 1:30,000 whereas in most African countries the ratio is between 1:2-10 million. Several countries in Africa have no urologists at all (sources: Pan-African Urological Surgeons Association, Societe Internationale d’Urologie, 2007). This dearth of available care, along with other factors, including cultural and transportation issues, necessitate sustainable local solutions. Throughout the region, urological care is given by general surgeons, general practitioners and others. Training from IVUmed’s experts is needed among specialists and non-specialists to help address this enormous need.
Traveling Resident Scholar Program
IVUmed also sends 12-15 North American urology residents each year accompanied by mentor urologists to developing countries to exchange ideas and practices with host physicians and residents. This program affords residents from the United States and Canada many benefits, including the opportunity to work with experienced US mentors, to practice urological procedures not seen in the US and to be challenged by the unique qualities of developing world medicine. Most importantly, they develop relationships with their foreign colleagues and provide service to children and adults in desperate need of quality care. IVUmed hopes that this experience will begin a lifetime of international service for each scholarship recipient.
Awards and Recognition
IVUmed has received a number of awards in recognition of its efforts. In 2006, IVUmed founder and president, Dr. Catherine deVries, was awarded the prestigious Dr. Nathan Davis Award for Excellence in International Medicine by the American Medical Association. IVUmed was named “Best in State” in 2003 as Utah’s premier humanitarian organization. In 2002, Dr. deVries was named a “Health Care Hero” by Utah Business Magazine. In 2000, IVUmed was selected as the only surgical organization to partner with the World Health Organization, the Centers for Disease Control and Prevention, and others in the Gates Foundation’s Global Alliance to Eliminate Lymphatic Filariasis (Elephantitis). IVUmed was cited in 1999 by the Cuban Ministry of Health as the best organized and most valuable teaching team serving Cuba. In 2007, Dr. deVries was named as the first woman ever to the Societe Internationale d’Urologie (SIU) Board of Chairmen. IVUmed was consulted in the presentation of the award-winning film A Walk to Beautiful about female urological conditions.
Few people realize that urinary tract and genital abnormalities are the third most common congenital abnormality in children, ten times more common than cleft lip or palate. Hypospadias, a crippling deformity of the male genitalia that prevents normal urinary and sexual function, occurs in approximately one in every 150 boys. Other urological conditions such as urinary incontinence and bladder and kidney malformations require specialized care, yet there are very few medical personnel worldwide trained in pediatric urology. In fact, the entire continent of Africa has fewer than five pediatric urologists despite the fact that 50 percent of the region’s 750 million people are under the age of 18 and 17 percent are under the age of 5 (source: UNICEF, 2008). This enormous patient population often has nowhere to turn for the care it needs. Physicians in the developing world lack the resources to travel outside their home countries for training. Up to date textbooks and other teaching tools are also in short supply.
IVUmed works to meet the immense demand for training in urology by implementing the model it has refined throughout its 15 year history. This involves a holistic approach intended to assist partner physicians and nurses in the development of self-reliant surgical programs.
Following a request for its services and locally obtained support from ministries of health and other governing entities in partner countries, IVUmed conducts a site visit and assessment. Once specific needs and goals have been outlined, IVUmed typically engages in a series of annual 6-14 day surgical workshops spanning 3–4 years. The first workshop involves further evaluation of the host site and personnel while instruction begins on less complex procedures, such as hypospadias repair during pediatric workshops. This is a good focus for the first workshop since it requires less sophisticated equipment and patient recovery than more complex procedures. Also, since hypospadias is the most common urological birth defect, the first workshop begins to address one of the host site’s most pressing demands. During each successive workshop, IVUmed’s goal is to effectively teach more complex cases while reinforcing training from the previous workshop. IVUmed’s ‘Teach one, Reach many’ model aims to replicate the success of sites like Vietnam, helping each partner learn the skills necessary to independently meet the needs of their patients while passing along the skills learned from IVUmed to future generations of medical personnel. This will develop a sustainable solution to an enormous healthcare need capable of growing to meet increased future demand.
To reinforce its surgical workshop training, IVUmed is developing online education tools that will present information taught at each of its workshops. Video and slideshow modules detailing surgical and patient care techniques will be available to IVUmed partners. Interactive components of the website will enable participants to communicate directly with each other and with IVUmed physicians and nurses. This approach will serve to teach techniques not directly addressed during workshops, to supplement workshop trainings and to evaluate the acquisition of knowledge by training participants. IVUmed online media is designed to be accessible in locations with low bandwidth to ensure access among partner sites.
Additionally, IVUmed has begun the Dr. Pieter A. deVries Pediatric Surgery Scholarship Fund that enables partner physicians to travel to the USA to observe and learn from IVUmed physicians and nurses. In 2007, IVUmed brought its principle Vietnamese partners to the USA for collaboration in Salt Lake City, Boston and Los Angeles. This program affords IVUmed partners the opportunity to see firsthand surgical techniques performed in the American setting.
IVUmed also assists its hosts in the acquisition of textbooks and specialized instruments and supplies. These items, scarce in the developing world, are needed to implement the training provided by IVUmed.
Locations of IVUmed's International Partners
IVUmed has partners in Bangladesh, Bolivia, Brazil, Cameroon, China, Cuba, Dominican Republic, Egypt, Ethiopia, Ghana, Haiti, Honduras, India, Jamaica, Kenya, Mexico, Mongolia, Morocco, Mozambique, Nepal, Nicaragua, Nigeria, Palestine, Peru, Senegal, South Africa, Tanzania, Togo, and Vietnam.