Ray Williams Travelling Fellowships: Ben & Louis’ Story

Elective Report by Benjamin Tanner & Louis Gower – Recipients of the Ray Williams Travelling Fellowship

The generous bursary from Prostate Cymru allowed us to spend our medical elective in the academic year 2018/2019 in the Paediatric Urology department at the Philippines Children’s Medical Center (PCMC). This is a large tertiary paediatric centre that is located in Quezon city just outside of Manila in the northern part of the Philipino archipelago in the island of Luzon.

As PCMC is the largest government run paediatric tertiary centre on the island of Luzon it serves as the main referral centre of the islands’ paediatric population as well as being the main paediatric service for the local populace of Quezon city and metro Manila. As a result of this we were able to see a good mix of common paediatric urological presentations and rarer cases that had come from further afield. PCMC is also a training centre for trainee paediatric urological surgeons from all over the Philippines with many rotating in for a few months at a time before returning to their sponsoring institutions. As a result this meant that the faculty we met were usually very keen to engage us in teaching and surgical procedures.

In many ways the practice of urology in the Philippines was not dissimilar to my experience of the specialty in the UK. Patients are seen in clinic, assessed and either treated conservatively or listed for theatre should that be the appropriate intervention.  However, the volume of patients was far greater than any we have seen in Swansea and the culture of medicine was entirely different, not just between staff in the department but also the interactions between surgeons and their patients.

The more common presentations we saw were undescended testicles and hypospadias. As we only have very limited exposure to urology (one week in year 3/4), let alone paediatric urology, in our Swansea course, it was an invaluable experience to see such presentations. As we were at PCMC for around a month we were able to follow some of the patients we saw in clinic through to their operation and eventual discharge. This was quite a rewarding experience and we were able to see how basic urological interventions such as a circumcision for a phimosis (when conservative interventions had failed) and Orchidopexy for undescended testes not only helped to physically cure a problem but also relieved anxiety in a child and their family.

During my time we were also able to see the surgical management of hypospadias and in one case concurrent chordee.  This is a reconstructive surgery we had never actually seen in the UK, although we had briefly studied the condition, so it was a superb learning experience to be present in theatre to watch the surgeons carry out the procedure. It was interesting to note the impact that hypospadias had on young boys and their families as although in one sense it does not pose an immediate problem to the child it does mean that they cannot urinate whilst standing up. This can create a huge amount of anxiety for a young boy when he is socialising in his peer group, which is something we had not given much thought to previously. Unfortunately, many of the patients that attended the clinics for assessment were several years old or even teenagers, much older than those that would present in the UK. Most boys in the UK are assessed when a few months old with treatment planned for between the age of 6 and 12 months of age.

Urological clinics also allowed us to hone our urological examination skills, something we rarely get the opportunity to do as a medical student. This has given us more confidence when examining such patients.

Our time with the PCMC Paediatric urology department gave a great insight to the practice of paediatric urology as well as medical practice and training in a non NHS medical system. Being able to see paediatric urological conditions rather than just in a textbook consolidated our medical school learning and allowed us to further our interest and knowledge in the field of paediatric urology.

Healthcare in the Philippines is part funded by the government through the PhilHealth scheme, although everyone is eligible for this it usually only ever covers the cost of an initial consultation or treatment. As a result families are often reluctant to return to follow up appointments for their new born child if they feel that there is nothing amiss. This results in many children presenting late with conditions such as hypospadias and undescended testes. Conditions which have a much better outcome for the patient if diagnosed and treated early. This has given us a real appreciation for our NHS where we are fortunate enough in the UK to have a state funded healthcare system that helps to prevent such a scenario happening.