Frequently Asked Questions (FAQs)

Visa

Check in advance if a visa is required, whether this can be obtained online, on arrival, or if it is necessary to apply to the relevant embassy. Take the correct amount of money required, this is usually in US dollars or have a credit card available for online purchases. Beware of commercial organisations who puport to be the contiries visa office, they will arrange a visa for yoo but charge more.

Work permit

If you will be carrying out surgery during your visit, you may need a local work permit. Check this with the local surgeon(s). He/she will need to arrange this for you and will require the following:

• a curriculum vitae;
• a letter of invitation stating your length of stay;
• a passport photograph;
• the last page of your passport; and
• your certificate of registration with the GMC

HIV, hepatitis-B & other blood-borne viruses

You may be asked for evidence of your HIV and hepatitis status. For information about the prevalence of HIV and hepatitis-B in Africa, and what to do if you sustain a needestick injury or other exposure to contaminated body fluids, see the document prepared by Philip Thomas, Co-Chair of Urolink on HIV and Blood-Borne Virus Infection.

Working in a different environment can be both challenging and rewarding. Urolink generally advises that, when undertaking a first visit to work abroad, you travel as part of a team or with another member of the Urolink faculty who has experience of the locality the lead local surgeon, the environment and the link institution.

The developing world provides a myriad of different experiences for the trainee previously only exposed to work in the developed world. Trainees wishing to work abroad, however, needs a basic skill set to capitalise on the experience available, which may be exposure to different conditions not commonly encountered in the UK and different surgical options within an environment with substantially limited resources. You need to have the resilience to make any work worthwhile in very different conditions to those seen in the UK, so you are best advised to make such a trip towards the end of training when it least conflicts with the pressures of accreditation exams and hunting for Consultant posts. It often takes a surprisingly long time to arrange an extensive trip - so adequate planning early in your career is essential.

Urolink has agreed learning objectives and has signed a memorandum of understanding with the five, principal link centres. Educational activity is designed to enhance your UK based training and to give you experience of working outside your home health service. As part of this process, it is essential to document and record outcomes from both educational and operative interventions.

Trainees can play a vital role in data collection and quality improvement during Urolink visits, as well as carrying out theoretical and practical teaching sessions for local trainees.

Urolink does not specifically recommend locations for medical students wishing to have an elective period in the developing world; they are advised to seek advice from their faculty's elective office.

However, anyone wanting to become embedded in a Urolink team going to a specific centre for part of their elective period is encouraged to contact one of the team leaders for designated centres, and apply for Urolink Medical Elective Grant.

A survey of BAUS members has highlighted the benfits of undertaking work overseas:

• renewed energy and motivation;
• a more open-minded attitude;
• a better understanding of different cultures;
• a greater desire to train and teach others;
• better operative skills;
• a more innovative approach to service delivery;
• greater confidence in clinical decision-making;
• increased awareness of the limitations of NHS practice; and
• enhanced communication and leadership skills.

The benefits of working abroad are, however, more than professional. Experiences outside the UK help to foster durable relationships with the centres visited, and these relationships may last for the remainder of your professional career.

Working abroad has the potential to renew your enthusiasm for medicine, and may be an experience that is not part of routine UK-based practice. It goes without saying that a period abroad enables you to travel and maximise opportunities offered in the locality during your leisure time.

Your professional indemnity cover will entirely depend upon where you are going and what you are going to be doing. You would be best to approach the organisation providing professional indemnity cover to sort out what cover you will be provided with.

If you are travelling to the developing world then short periods of experience abroad will often be covered by your UK indemnity. Longer periods, on an entirely humanitarian basis, may be covered by a reduced cost "missionary" level of cover.

The arrangements are often agreed on a case-by-case approach so take the opportunity to discuss your arrangements personally with your protection society.

Before leaving the UK, you should:

• ensure that you have adequate travel insurance;
• ensure that you have appropriate medical indemnity cover;
• check with a travel clinic about immunisations and anti-malarial prophylaxis; and
• check with the Foreign Office regarding general travel safety.

Other than the obvious and immediate benefit to patients, who receive improved access to good urological care, durable solutions appropriate to the locality are often left behind after visits. in addition, there are now well-recognised and compelling reasons for investing in improving global surgical care. Further details about this can be obtained in the policy brief from the Lancet Commission on Global Surgery 2030: "The powerful economic case for investing in surgical care in LMICs". **

(** Low & Middle Income Countries)

The older concept of training out of programme (OOP) has now been refined, and categorised, by Health Education England (HEE). Only OOPT (T for training), or OOPR (R for research), to an accredited centre will not have an impact on your Completed Certificate of Training (CCT). Most experience in the developing world, the categories OOPE (experience), OOPC (career break), will not count towards your training time despite its significant value to you as an individual.

The HEE PGMDE site has useful FAQs about when, how and where to apply for your OOP

Be aware of what visits are coming up and plan well ahead with your Educational Supervisor, where you are or would be working, and the Training Programme Director (TPD) in your region. The COPMED Gold Guide 2020 OOP form is a useful thing to have for your discussion with them:

OOP Form will need to be signed off by the Postgraduate Dean responsible for your training programme, before you can take significant time out.

It is essential to check with the local surgeons, before you leave the UK, what equipment and disposables are available.

Equipment donations need careful planning. Any equipment donated should be recorded on a spreadsheet, along with the serial numbers, make & model. These details should be passed to Urolink, to ensure that the appropriate disposables are organised for future visits. A letter of donation should also be provided to the host institution.

There are some important points when considering equipment donation:

• ensure that the equipment is in full working order and that all components are present;
• consider whether repair and maintenance of the equipment will be possible;
• check compatibility (e.g. appropriate manufacturer);
• get import documentation (including a letter from Urolink);
• get agreement from the local surgeons that the equipment is "on loan" and is for use primarily in the public sector by all trained surgeons in the department;
• if you are carrying the equipment, check excess baggage policy;
• agree in advance what is being "loaned" and to "whom";
• request feedback after use of the equipment; and
• notify the hospital services of new equipment.

There are plenty of examples of broken or unwanted equipment (pictured below) being "donated" to hospitals in Africa. This can be a burden because it may be difficult to dispose of damaged equipment.

Further guidance on the donation and maintenance of medical equipment can be found using the links below:

Health Partnership Scheme	New Medical Equipment Program	Medical Equipment Life Cycle	Hilditch Group	Amalthea Trust