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Yale Urologic Surgeons “Teach One, Reach Many”

January 24, 2024
by Cheri Lewis

It is a crisp, cool day and two Yale Urology professors head to the airport. Their surgical scrubs are replaced with casuals, for now. But after 17+ hours in the air, they will soon be back to work. For the next week they are joining a small, yet mighty urologic care team in the East African country of Burundi.

They will operate and share their expertise in especially complex pediatric cases. They will also receive things that are, perhaps, immeasurable.

“I always get more out of these trips than what I put into it,” says Associate Professor and Yale Medicine urologist Angela Arlen, MD. “I’m reminded how much can be done with very little.”

Conditions on the Ground

Both Arlen and Professor John Colberg, MD, also a Yale Medicine urologist, have been on mission trips before but never to Burundi. Their contact and colleague there is Gallina Kazobinka, MD, MMed. She is one of only five urologists in the country serving a population of 12 million.

“Practicing in resource-limited public hospitals is very challenging,” admits Kazobinka. “We have a shortage of both health care workers and surgical supplies.”

She has specifically set aside 14 cases for Arlen and Colberg’s short visit, primarily consisting of severe hypospadias [where the opening of the urethra is in an unusual place, causing urination problems, etc.] and epispadias [another birth defect involving the urethra and voiding complications].

Volunteer Help is Critical

The Yale Urology team has brought its surgical skills and 80 pounds of supplies on behalf of IVUMed, which organized the trip. The non-profit helps make quality urological care available worldwide.

Kazobinka explains how important both the people and their gear are. “An extra pair of experienced hands is always necessary … also, we were lacking some equipment such as catheters, suture materials, etc.” All are basic to most any urologic procedure.

Practical, Sustainable Assistance

Arlen provides further perspective. “It doesn’t do any good to bring fancy stuff that the local medical team are not going to have after we’re gone or won’t be able to regularly use. Their hospital doesn’t have a cystoscope, for example. Most of our clinics in Connecticut use disposable scopes.”

There are other differences. In the U.S., nearly all the patients Kazobinka, Arlen, and Colberg operated on would have gone home the same day. In Burundi, where primitive conditions in many patients’ homes are not conducive to healing, they will likely stay until their catheter is removed [usually 1 to 2 weeks].

Families bring their own food while in the hospital. Typically, they eat one meal a day.

Scrub techs do not exist in Burundi operating rooms. Residents hand instruments to the surgeon.

And the surgical waiting room consists of benches lined up outdoors.

Servant Leadership

These conditions are commonplace for the highly skilled and trained Kazobinka who is a Burundi native. She could have served anywhere, but her passion and humility brought her back home.

“During my internship year in Burundi, I was appalled by the length of time urological patients had to wait to be operated on due to a lack of qualified surgeons,” says Kazobinka. “This is what motivated me to embark on my training in urology. I then felt the need to return and make my modest contribution.”

I was appalled by the length of time urological patients had to wait to be operated on due to a lack of qualified surgeons.

Gallina Kazobinka, MD, MMed, on why she got into urology care in her home country of Burundi

Arlen notes that physicians in Burundi are paid much less than even those in nearby countries. “It says a lot that Dr. Kazobinka and her team have stayed here … they’re clearly committed.”

Between surgeries, Arlen snatches a few pictures of the hazy blue sky and swaying palms, but mostly, the camera catches her hard-working Burundian colleagues, moms serving as makeshift nurses, and 3-to-4-year-olds looking back with tired, curious eyes.

At least one thing is universal.

“The kids are exactly the same as anywhere else,” Arlen chuckles. “You smile at the kids and they smile right back.”

Submitted by Cheri Lewis on January 24, 2024