Malaysian Urogynaecology Mission to Vientiane, Laos

A team of Malaysian urogynaecologists participated in a mission to Vientiane, Laos on the invitation of the officials from the Ministry of Health, Laos & The Obstetrics & Gynaecology society Of LOAS  . This team comprised Dato Dr Aruku Naidu ( Team Leader  from Hospital Raja Permaisuri Bainun, Ipoh), Dr Ng Poh Yin (Senior consultant urogynaecologist of Hospital Kuala Lumpur), Prof Lim Pei Shan (consultant urogynaecologist  from Hospital Universiti Kebangsaan Malaysia), Dr Ida Liliwaty Latar (consultant urogynaecologist from Pusat Perubatan Universiti Malaya), Dr Tan Gaik Imm (urogynaecology fellow from Hospital Pulau Pinang), Sr Tan Lee Khan (Hospital Kuala Lumpur) Sr Lee Fong Hoo (Hospital Kuala Lumpur). This mission was partially sponsored by the Obstetrics and Gynaecology Society Malaysia (OGSM), with the support of The Malaysian Urogynaecology Society (MUGS). 

       

 The team arrived in Vientiane on 28^th October and proceeded to work soon after arriving. The mission was held at the Women and Neonate Hospital Vientiane. This was the first and only Maternal & New born Hospital in Laos.  After a quick tour of the hospital premises and facilities, the team proceeded to assess women with urogynaecological problems, who had been screened beforehand by the local hospital doctors. Out of 10 women was reviewed, but only 3 patients were identified for surgical intervention, including 2 women with advanced Stage 4 pelvic organ prolapse and 1 patient with  3^rd degree tear repair with bad wound dehiscence.

The following day, the Malaysian team conducted the Obstetric Anal Sphincter Injury (OASIS) Workshop for the benefit of the local obstetric specialist and registrars. This workshop was attended by 60 participants. They were junior doctors and specialist from all over Laos. The workshop comprised lectures delivered by the mission urogynaecologists. The topics discussed include pelvic and anal sphincter anatomy, risk factors and prevention of OASIS, and methods of repair of OASIS. The lectures were delivered with the help of a local translator. The afternoon was spent on a hands-on workshop using life animal models & life porcine specimen. The participants had the invaluable opportunity to practise their skills in the repair of the anal sphincter tears on sow perineum.

On the 31 October 2017, the team performed pelvic reconstructive surgeries on the 3 patients who had been identified and prepared for surgery. Two teams of Dr Ng/ Dr Ida and Dr Aruku/ Dr Lim performed the surgeries which included vaginal hysterectomy, pelvic floor repair, McCall culdoplasty and perineal body reconstruction. The aim of the surgical workshop was not only to offer symptom relief to the patients but also to demonstrate surgical techniques and train the Laotian doctors in repair methods, and this was aptly demonstrated by the team. The nursing team of Sr Tan and Sr Hoo were also able to educate the local nurses on the proper technique to safely assist and sterilize equipment for the operation.

 

On the final day of the mission, the team visited the hospital to conduct a post operative ward round to ensure that the patients were on the road to an uncomplicated recovery. We found that the 3 patients were nursed in the recovery area of the operating theatre. Although somewhat uncomfortable for the patients, this enabled them to have better monitoring in the critical post operative period due to logistic reasons in the local setting. All 3 patients were recovering well, and we educated the local registrars about post operative management for urogynecology patients, which included pain relief, prevention of thromboembolism, catheter care and the trial of void protocol and follow up. As with the common problems with mission such as this, the importance of post operative care cannot be overemphasized as the team cannot be present onsite throughout the entire recovery period and also to assess patients in the immediate and short term post operative period, which would be the ideal situation. We however ensured that the local doctors would be able to contact the operating team for advice should the need arise so as not to compromise patient care.

Overall it was a very successful inaugural mission to Vientiane for both the Malaysian and Laotian teams. We were able to build networks and learn from one another. It was enlightening to experience working in a different country’s settings with challenging logistics, manpower, experience and equipment. We hope to assist our foreign counterparts in setting up and running an organized urogynaecology service by periodical missions over the coming years and hope to foster goodwill and better friendships for future collaboration within the Asia-Pacific region.

Last but not least, the Malaysian urogynaecology Mission Team likes to thank all the team players for their valuable support either morally or physically. A very big thanks to OGSM for the timely partial financial support to make this event a successful event.