In my life, I have been fortunate to have been welcomed into the homes, hospitals, and operating rooms of colleagues around the world. It has been an education for me and for all of us who work together to alleviate suffering from urologic illness wherever it occurs. There is a broad community of people who work under the banner of “humanitarian surgery” or “global surgery,” including those who work in disaster and war zones, low- and middle-income countries with limited resources, and rural areas. Most of them are not urologists, yet they care for patients with urological conditions because in these settings, trained urologists are rare. They include pediatric and general surgeons and general practitioners, as well as nurses and public health officers. It is truly a large community.

I was introduced to global urology by mentors in plastic surgery. My professors in medical school had been working for many years in poor countries correcting cleft lips and palates, burn scars, and assorted congenital deformities. Yet they struggled with reconstructive urology—hypospadias in particular—and invited me to come along to see the problems they were encountering. As it turned out, the waiting lists and backlog of hypospadias and other congenital urological disease was staggering—far more, actually, than the clefts. It was clear that there was a huge need to develop not only service, but also training programs to build sustainable service in these countries. Yet my first trip—to Honduras—was a disaster. We had complications I had never seen in the States, and it drove me to find out what went wrong.

What I learned was that much of the world cannot take for granted the resources that we can count on in hospitals at home—resources like clean water, soap, antibiotics, suture, electricity, even toilet paper. For every type of surgical service or education we provide, there is a system that supports that success, but we surgeons rarely fully appreciate it until forced to deconstruct and reconstruct it in a challenging new environment. It requires looking into closets, saving unused supplies and serviceable equipment and instruments, learning inventory management, begging and borrowing, and recruiting the wisdom of all the specialists we rely on daily both at home and around the world to make things work. Critically, at the most basic level for pediatric urology are the colleagues, including anesthesiologists and nurses. For adult urology, they also include radiology. The late, great Dr Paul Farmer distilled global health principles to include the 5 S’s: Staff, Space, Stuff, System, and Support.¹ Neglect of any of these can lead to failure, or at best, to short-term success. But helping colleagues to build their systems, to train young surgeons, and to initiate their own outreach is a joy beyond words.

It goes without saying that no individual surgeon can work without the support of dedicated teams. Teams are even more important when we are working outside our comfort zones, where language, customs, and systems may be unfamiliar. I have had the opportunity to learn from many as we built the urological nonprofit, IVU (International Volunteers in Urology). Logistical, financial, and material support underpins the ability to engage continuously or with recurrent educational workshops with colleagues over the extended time necessary to develop surgical capacity. From my experience, it is clear that the lack of training in systems is perhaps the biggest challenge we face.

It is exciting that the American Urological Association and the Urology Care Foundation^TM (UCF) are placing new focus on underserved regions of the world. I was honored to receive the inaugural UCF Humanitarian Recognition Award in 2021. UCF’s humanitarian grants and outreach efforts will provide essential support to many urologists as they build careers and make important contributions to underserved communities and colleagues at home and abroad.