Physicians entering the field of urology do so for a multitude of reasons; inherent among these is a sense of service which can take on many forms. Humanitarianism in medicine is a related concept and may be achieved in a variety of different ways. This includes compassion and service for the communities in which we reside—and those that are far away and unfamiliar to us.

Indeed, endeavors in global surgery provide unique opportunities for residents to develop a humanitarian perspective in training that can carry into one’s lifelong practice.¹ Burdens in international health stem from multiple geopolitical factors resulting in extreme poverty and lack of basic health care resources and infrastructure. The consequences of inadequate health care globally are multifold including limited economic mobility, a seemingly unbreakable cycle of poverty, and significant reduction in length and quality of life.² The dearth of access to surgical services has been increasingly recognized as an important and historically unaddressed component in international health disparities.³

Urologic diseases comprise a high burden in this space, including strictures and benign prostatic hyperplasia disease, scrotal anomalies, complex stones, obstetric fistulae, and congenital anomalies,^4–6 representing multiple entities where intervention can positively impact the lives of individuals and communities.

This lack of routine access to urologic care outside the United States inspired the development of International Volunteers in Urology, IVUmed.⁷ The success of IVUmed no doubt derives from its dedicated leadership, generous donors, volunteer staff, engaged trainees who travel with the program, and—most importantly—local clinicians who collaborate to establish long-term and sustainable urologic programs in their home countries. Perhaps like no other program, IVUmed offers residents one of the most intimate humanitarian perspectives in urology.

Figure. Images during a humanitarian trip to Monrovia, Liberia (Jackson Doe Memorial Regional Hospital). A, Dr Joseph A. Smith planning with the hospital leadership for a busy week of planned surgical procedures. B, Massive benign prostatic hyperplasia (greater than 200 g) with hematuria, clots, and stones. Status post simple open prostatectomy. C, Local anesthesia staff performing a spinal prior to urethroplasty. D, Nursing staff from the wards. E, Fully trained local surgical technician. F, Watering can scrotum seen on retrograde urethrogram. Photographs by Harris B. Zaid. Reprinted with permission.

In addition to IVUmed, initiatives from the Urology Care Foundation™ include formal efforts such as its Humanitarian Grant Program, International Student Humanitarian Grant Program, and Health Equity Fellowship.⁸ These efforts further humanitarian causes in urology by targeting medical students, residents, and established urologists alike. Individual residency programs, including Vanderbilt University Medical Center,⁹ have incorporated rotations in global health into their residencies, with the latter having sponsored quarterly trips to a variety of collaborating sites in Africa including Sierra Leone, Liberia (Figure), Ethiopia, Tanzania, Kenya, Uganda, Rwanda, the Democratic Republic of Congo, Burundi, Malawi, Botswana, and Zambia.

Residency is a formative and demanding time in a urologist’s career—learning the fundamental “brick and mortar” clinical knowledge and surgical skill set for a life in urology. However, beyond the didacts of weekly conferences, clinical pearls on the wards, and the nuances of innumerable operative procedures, the benefits of a global rotation are multiple and include the following.

Perspective

It can be challenging to contemplate life outside of the hospital given trainees’ strong commitment to patients locally. Global health initiatives during training provide a chance to consider the many benefits of urologic training and the opportunity to improve health in the greater urologic community, beyond local hospital wards.

Resident Interest

Many trainees today think globally and often arrive to residency having already participated in global health endeavors. The ability to continue or to explore humanitarian efforts during residency training is strongly desired.

Service

Global health rotations provide an opportunity for service to the many countries known to be underserved in all aspects of surgery. These rotations offer an opportunity to provide enduring education and influence to an area in need.

Bidirectional Education

The opportunity for bidirectional education cannot be understated. Consider the spectrum of urologic disease which is markedly different throughout the world where urologic diseases may have varied pathology or presentation, for example—prevalence of obstetric fistula in certain parts of Africa.¹⁰

Urologic trainees can learn a great deal from seeing the delayed presentation of more common urologic diagnoses such as urinary retention, urethral stricture, bladder cancer, prostate cancer, and pediatric urology conditions. Additionally, trainees will learn the utility of open surgical technique where laparoscopy and robotics are not available, as well as creativity in problem-solving with more advanced cases/different presentations and limited access to our familiar tools.

Development of Meaningful Relationships

Humanitarian efforts allow for connection among the global community of urologists—to share ideas, knowledge, and camaraderie. Often, these connections serve as a reminder as to why we chose this profession while reinvigorating our desire to help others.

Ultimately, by emphasizing the necessity to understand the needs of the hosts and by carefully examining how humanitarian surgery can best achieve its goals, global health opportunities during urology training can equip residents with the skills, understanding, and motivation to continue lifelong efforts in humanitarianism.