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UK Urologists Working Abroad

The Urolink faculty welcomes members to visit established centres, discussion about the logistics of setting up a new link, and encourages collaboration with other interested parties to share resources and experience.

If you are thinking of volunteering with a Urolink team you should read the 2021 THET document. Click here to read the "Volunteer toolkit - Your guide to volunteering in global health" which looks comprehensively at every aspect of the process.

A request from a centre for specific assistance is essential before every new visit, and there must be clear aims and objectives as to what you will be trying to achieve during your visit.

Before any attempt to set up a potential new link, the Urolink committee recommends that you look at the information below, and at the FAQs about Urolink, for guidance.

Making a New Link

Assessment of need

Initial assessment of needs should be carried out with the members of staff from both institutions. Objectives in terms of research, service provision, management of resources, supply of learning materials and proposed visits need to be discussed and prioritised between leaders of the institution overseas and link members from the UK. This ensures that the expectations of both groups are similar. Any link should initially be small with limited goals that are achievable. This will give both partners confidence and provide the foundation upon which additional components can be established. Each link will develop at its own pace and each group must have an equal input, in the knowledge that imposition of Western priorities is inappropriate and likely to alienate the partners in the LMIC involved.

Communication to maintain the link

For any twinning venture to be durable, the key is communication. This should be by formal visits both to and from the developing centre concerned, and by remote communication between visits. The latter can be difficult because postal, telephone and computer links can be unreliable but regular contact is essential, particularly in the period after a visit. Ideally, e-mails or WhatApp messages should be exchanged regularly to assess the progress of both partners and to provide each with the relevant information and other support to ensure the visit has been a success for everyone. Good communications help to maintain momentum and strengthen longterm relationships.

Visiting

Twinning is not designed to make an overseas institution dependent upon visits although such visits are a means to enable the institution to recognise its weaknesses and to identify methods to overcome them. Visits between hospitals or departments are a very effective tool, but, alone and without proper planning, can achieve little. When both groups have agreed who should visit and in which direction to proceed, clear objectives need to be set out for the visit:

  • What is the purpose of the visit?
  • How will the objectives be met?
  • Who will be involved from each side?
  • How long is the visit? (Shorter than one week is not acceptable as climatic, medical and cultural adjustments take time; an ideal visit would last for more than two weeks).
  • These issues should be agreed in advance so that there is adequate preparation and so that each group has similar expectations.

The visit should then be followed up by a report that highlights:

  • what was achieved in relation to the goals set for the visit.
  • what was not achieved and why.
  • unforeseen benefits/problems.
  • plans and recommendations for the future.
  • The report should be circulated to the relevant parties so that lessons can be learned and clear plans devised for the future.

Urolink is keen to encourage longitudinal relationships with visit centres, because they facilitate ongoing educational activity.

You are advised to visit the Urolink Publications & Social Media page for further useful information about setting up a link and sustaining it.

 

Logistics & Planning Your Visit

Visits to overseas centres need careful planning to ensure that the centre benefits from you, and your team, being there. Working in an environment without many of the facilities, techniques and instruments you rely on back home can be extremely challenging; this needs to be taken into account when planning the trip.

Remember that as a member of a Urolink team you should follow all of the expectations contained within the General Medical Council's 'Good Medical Practice'. This is enshrined in the 2023 Urolink Code of Conduct; this can be accessed here or by clicking on the GMP image.

 

 

 

 

 

 

 

 

 

 

 

 

Urolink's 'short' code of conduct - bourne out from experience!

The BMA has published a very useful guide to working abroad called 'Volunteering abroad as a doctor', which contains much useful information for you to consider before you travel professionally. Again, it cannot be over-emphasised the  value of the THET Volunteer toolkit as a guide to the dos and don'ts, the why's and wherefores of your potential time as someone potentially working with Urolink. This also gives invaluable information about helping keep yourself safe from a professional point of view.

A "Personal Survival Guide" has been developed by Urolink which gives information about what you may need to plan for before you depart, and after you arrive in your host centre. This can be downloaded here as a printable checklist before you leave the UK.

Preliminary planning phase:

  • You need to identify the local surgical lead and have a robust means of communicating with them, usually mobile, WhatsApp and email.
  • Ask when is convenient for you to be there, taking the seasons, religious festivals and other locally-relevant factors into account.
  • Determine what the local team want you to achieve during your visit, and then work out the logistics of building a team, finding the funding and organising the travel to provide the help required.
  • Try and make as many arrangements as practicable, about your timetable during your visit, as you can ahead of arriving in country.
  • Urolink has found having patient information on a secure common platform, so that clinical data, radiology and the like available to all parties is extremely helpful and aids in patient identification for follow up after your visit.

Once you know you are going:

  • Create a team WhatsApp group amongst those you are travelling with.
  • Find out where you will be staying, who is paying for the accommodation and what the facilities there are.
  • Arrange tickets, visas, medical council registration and work permits, if required.
  • Ensure relevant inoculations, and documentation, are in order and buy/prescribe malaria prophylaxis, if necessary. If there is any prospect of you being pregnant then you should look at the RCOG guidance about malaria and pregnancy.
  • Sort out any relevant equipment and operative materials, and know how you will get them to their destination.
  • Check you have the relevant personal kit, and money, with you. ATMs are not universal in rural locations so carrying some US dollars with you (which are almost universally accepted) is a wise thing to do.
  • Ensure you have sorted out transportation from the nearest airport to your accommodation, especially if you are arriving in the middle of the night!

When you are there:

  • Don't forget that, most people communicate using data only, via WhatsApp, in many countries. Data only local SIM cards are a good way of communicating, are often very cheap and usually available at the arrival airport. Enough data for a week will cost around $5 but you can get unlimited data for around $20 for a month (dependent on the country). Tortuga  and Travel TomTom have really good advice on their sites for understanding about the options for using your phone abroad. You will need your passport and, often, the payment for the service you buy in local currency. Don't forget to take something so that you can store your UK SIM in it securely. You don't want to lose that! A SIM tool, or a paperclip, are also useful to open the SIM port on your phone.
  • Meet the local team and do a ward round to see the patients they want you to operate on
  • Have a robust mechanism for archiving patient details as local notes are often scant, or incomplete
  • Work out a review schedule and agree operating lists
  • Don’t overfill lists, start slowly and increase capacity if you can, which usually you can’t!
  • Take plenty of bottled water with you to operating sessions
  • Keep a record of what you do so you can provide Urolink with a report 
  • Have a really good time!

After you you get back:

  • Submit your report to the Urolink Committee so that it can be published on this website and so that others can learn from your experiences. Click here to download the visit report template. Ideally, Urolink would hope to see visit reports, which contain statements of achievement similar to those below:

  • “ ... the Urolink team met with local surgeons & agreed to help with development of the curriculum & support examinations (COSECSA) ..."

    " ... Consultants in the department are now performing regular TURP & collecting audit data to assess complications, length of stay etc ... trainees are performing flexible cystoscopy lists in the outpatient clinic (Zambia) ... "

    " ... initial assessment of the service identified the need for TURP training performed under the supervision of the Urolink faculty (Zambia) ....

... and in the longer term:

  • Keep in contact with your host and make plans for your next visit!
 

Teaching Abroad

The major component of any Urolink visit or of any collaborative twinning programme, in terms of benefit to the recipient, is undoubtedly teaching. There is only limited value in undertaking visits which solely concentrate on management of a small number of clinical problems or cases prepared by the host Department. Any long-term gain can only be achieved by teaching staff to manage clinical problems once the visiting team have returned home.

Teaching essentially takes two forms; first, performing procedures and training individuals to undertake them on their own, and, second, formal teaching through lectures, seminars and presentations.

Planning the educational visit

  • Before leaving home to embark on a visit to a developing centre, it is essential that you are organised
  • Agree teaching/training goals
  • Agree areas specified by the developing department rather than to teach on subjects or cases judged as appropriate in the UK
  • Establish who the target audience will be and what their perceived goals are for the teaching programme
  • Establish what teaching facilities are available including audiovisual equipment
  • Assist with organisation where appropriate to maximise the teaching opportunity.

What to take with you to teach

For formal teaching Powerpoint® presentations are probably he most appropriate but do depend on the facilities available locally. It is usually helpful to bring a number of "props" which will help to get messages across and to add an element of variability to lectures and presentations. Taking examples of catheters, ureteric stents and X-ray images is, therefore, well worth the extra luggage space required. A general supply of "handouts" is also advisable, summarising the salient points of any teaching undertaken, including both formal presentations and surgical techniques that may be demonstrated.

How to teach abroad

  • Know what your host thinks is relevant and plan your teaching around those topics.
  • Pitch the level and the topic of any teaching session appropriately to the audience; ensure that the messages are simple and brief.
  • Remember that English is the second or, sometimes, the third language of the medical staff from LMICs so you need to ensure that appropriate language is used with minimal abbreviations and a degree of repetition of the salient points.
  • Small presentations broken up by periods of audience involvement, and the opportunity for the audience to ask questions, are preferred to long didactic lectures. MDT or case-based discussions are a good way of putting points across.
  • It is important never to underestimate the knowledge of medical staff in developing countries, particularly relating to clinical conditions they commonly encounter locally.
  • Get feedback.

Inevitably, both formal and surgical teaching are mutually beneficial, with knowledge being shared by both parties. Always allow plenty of time for formal, or informal, discussion.

You may find these papers useful

Watson GM, Niang L, Chandresekhar S, Natchagande G, Payne SR. The feasibility of endourological surgery in low-resource settings.BJUI 2022; 130(2): 18-25

Moore M, Mabedi C, Phull M, Biyani CS, Payne SR. The utility of Urological Clinical and Simulation Training for Sub-Saharan Africa. BJU Int. 2022; 129(1) 563–571

Hill E, Gurbutt D, Makuloluwa T et al. Collaborative healthcare education programmes for continuing professional education in low and middle-income countries: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 65. Med Teach. 2021: 1-14.

Campain N, Kailavasan M, Chalwe M et al. An Evaluation of the Role of Simulation Training for Teaching Surgical Skills in Sub-Saharan Africa.  World J Surgery 2018; 42(4): 923‐929. 

Campain NJ, Parnham AS, Spasojevic N, Reeves F, Venn S, Biyani CS. Use of a simulated model to teach male adult circumcision in sub-Saharan Africa.  World J Surgery 2017; 41(1): 10-13.

Dreyer J, Hannay J, Lane R. Teaching the management of surgical emergencies through a short course to surgical residents in East/Central Africa delivers excellent educational outcomes.  World J Surgery 2014; 38(4): 830-8.

 

Trainees working abroad

UK urological trainees may wish to spend a longer period of time abroad than can be provided by a 'workshop'. This can be taken as an Out of Programme Experience or "OOPE".  In most circumstances you must seek approval for an OOPE from both your Programme Director and Deanery; you should allow plenty of time for any deliberations which may be needed. Your OOPE is more likely to be successful if you set clear aims and objectives in advance of your departure.

For further information, click here to go to the Urolink section, "FAQs About Urolink" and select the dropdown "Can I take study leave for a visit abroad?" You may also find the following links useful.

Reports by UK-based urological trainees; their experiences:

Generic links relevant to UK surgical trainees wanting to work abroad:

When planning your visit:

Remember that as a trainee member of a Urolink team you should follow all of the expectations contained within the General Medical Council's 'Good Medical Practice' (GMP). This is enshrined in the 2023 Urolink Code of Conduct; this can be accessed here or by clicking on the GMP image.

 

 

 

 

 

 

 

 

 

 

 

 

Urolink's 'short' code of conduct - bourne out from experience!

... and after you get back you may want to follow some of the guidance enshrined in the following two documents:

 

Volunteering

Urolink only supports urologically-related teams, surgeons, nurses, technicians volunteering to work, usually for short periods, in the developing world.

It recognises, however, that some individuals may wish to volunteer for other humanitarian reasons, including in disaster relief. There are a huge number of things to consider when volunteering, particularly the ethicality of what you are doing. THET has an extremely comprehensive Toolkit for potential volunteers which can be accessed here, or from the link below. Everyone should read this! You are recommended to go to the relevant organisation's website links on working abroad for organisations such as the ICRC, MSF, Mercy Ships, RedR and VSO. THET also runs a global community called "Pulse Partnerships", which allows you to get further information about what volunteering opportunities there are out there, as well as allowing access to new resources refined to help you advance your programmes or meet your global health objectives. In addition, you might find looking at these articles of help:

Volunteering

Disaster Medicine

Missionary Medicine

 

Useful Websites

All Party Parliamentary Group on Global Health has produced this report. It shows that the UK plays a leading role in each sector: its global contribution being second only to the US, which it surpasses in some areas.

Cambridge Global Health Partnerships works with hospitals, governments and health organisations in countries across Africa, Asia and Latin America to provide specialist expertise, support shared learning and encourage sustainable change.

College of Surgeons of East, Central & Southern Africa is an independent body that fosters postgraduate education in surgery and provides surgical training throughout the region of East, Central and Southern Africa. It operates in Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe.

Department of Health, Department of International Development (DFID) and NHS have collaborated  to produce a report on "Engaging in Global Health" which establishes a framework for voluntary engagement in global health by the UK health sector. DFID has also authored the Health Partnership Scheme – Evaluation Synthesis Report".

G4 Alliance is a surgical, obstetric, trauma & anaesthetic care collaboration which exists "to increase  political priority and mobilise resources to help provide safe surgical care for patients in need".

Global Anaesthesia, Surgery & Obstetric Collaboration (GASOC) aims "to build a cohesive advocacy  movement for global surgery amongst trainees across the surgical specialities" and allows trainees across all three specialities to share educational resources, research & publications.

Global HELP (Health Education Low-Cost Publications) has produced "Primary Surgery" which is the most used reference text for surgeons in poor-resource settings. It is aimed at those with only basic surgical experience, and has advice about what to avoid, as well as what to do if things go wrong.

International Collaboration for Essential Surgery premise is that surgery should - and can - be safe, accessible, and affordable to people worldwide regardless of income or geography even in limited resource settings. Often, this requires only a modest investment in infrastructure.

International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of armed conflict and other situations of violence, and to provide them with assistance. The ICRC recruits people, signs a contract with them and gives them special training before they head off to a conflict zone. If you would like to work for the ICRC, either as a field delegate or at headquarters, please visit the Human resources section of their website. Those wanting to work in the field will usually do so for 12 months at least; more information can be found here.

International Volunteers in Urology encourages volunteers but has a different sphere of activity from Urolink, with connections mostly in South America.

Lancet Commission on Global Surgery believes that universal access to safe, affordable, surgical and  anesthetic care - when needed - saves lives, prevents disability and promotes economic growth.

Médecins Sans Frontières (MSF)  are probably the best organization to approach if you want to help in specific disaster situations. Remember that MSF does not usually accept volunteers who cannot commit to 6-12 months in the field. Donations are their preferred method of dealing with those who have limited time to spend abroad; they prefer volunteers who are multi-lingual. The roles for a surgeon within MSF can be found here.

Mercy Ships is an organisation, founded in 1978 to provide medical care, and surgery to the developing world, wherever the charities ships can dock.

RedR is an international charity that improves the effectiveness of disaster relief, helping rebuild the lives of those affected. They aim to relieve suffering from disasters by selecting, training and providing competent and committed personnel to humanitarian programmes worldwide.

Pan African Urological Surgeons Association  aims to bring the highest standards of urological clinical care through education, research and collaboration, to the urology patient on the continent of Africa.

The Royal Australasian College of Surgeons (RACS) has extensive and highly detailed information on many aspects of working abroad in its pages on Global Health Policies. It's sphere of operation is mainly in East Asia and New Guinea, but it also has some links in Africa.

Royal College of Surgeons of Edinburgh (RCSEd) Global Surgery Foundation exists to build sustainable surgical capacity in communities suffering from a chronic shortage of care.

Royal College of Surgeons of England (RSCEng) has a section devoted to international affairs and delivers an internationally-renowned programme of activities and collaborations, including an active International Surgical Training Programme (ISTP).

Royal College of Surgeons in Ireland (RCSI) has a strong collaborative programme with COSECSA created to develop surgical skills in sub-Saharan Africa.

Société Internationale d'Urologie Foundation (FSIU), created in 1998, has educational scholarships, provides teaching fellowships, conducts research and advances medical education in urology in LMICs. In the last 10 years, more than 200 urologists have received a total of $1 million in funding.

The Urological Foundation (TUF) provides a number of Fellowships for UK-based trainees to get experience of the provision of global urology in resource limited environments. These are awarded annually; further details about application can be found on the funding page.

Tropical Health & Education Trust (THET) forges partnerships with healthcare experts to deliver targeted training programmes in LMICs. Read Lord Crisp's 2007 report on "Global Health Partnerships" and the 2016 report on "Lessons learnt from monitoring & evaluation experiences in Zambia".

Voluntary Service Overseas (VSO) can be a useful way of utilising your expertise in a less-medical way and your help may be employed in a number of different ways. For information about volunteering with VSO please visit their website which will introduce the concept of the mechanism of application, looking for opportunities, what those opportunities may bring and an on-line application form.

West African College of Surgeons represents surgeons in 17 west African countries, and aims to establish advanced skills, simulation centres and educational resource facilities within the sub-region.

The World Health Organisation leads global efforts to expand universal health coverage. It directs and coordinate the world’s response to health emergencies and helps promote healthier lives. WHO currently (2023) works with 5 hosted partnerships, more than 100 collaborative arrangements and over 800 collaborating centres. It produces a huge amount of data, and publications that may be helpful to those thinking of volunteering abroad.

 

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