Urogynecology Education, Training & Service in DR
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Hello! We are UGHI, Urogynecology Global Health Initiative, and we are excited to collaborate with you to improve global women's health care!
UGHI is focused on supporting the education and training of medical professionals in urogynecology and vaginal surgery and enhancing the high quality urogynecology services available to women in the Dominican Republic.
Gynecologic and urogynecologic conditions such as abnormal uterine bleeding (heavy vaginal bleeding), urinary incontinence (involuntary leaking of urine), pelvic organ prolapse (descent of pelvic organs through the vagina) and genitourinary fistulas (abnormal connection between the bladder and vagina causing constant leaking) are extremely common around the globe.
These conditions can significantly affect women's health, well-being and quality of life. Unfortunately, up to 90% of women suffering from these conditions do not seek care and many medical providers do not have the proper training to diagnose and manage these conditions. Unfortunately, women living in low-resource areas face even greater barriers to care than women in higher-resource areas, and many low and middle income countries (LMICs) have limited education about these topics available to health professionals. In the Dominican Republic (DR), for example, there is no fellowship training program in urogynecology, and there is a paucity of pelvic floor education in OB/GYN and Urology residencies.
UGHI is focused on supporting the education and training of medical professionals in urogynecology and vaginal surgery and enhancing the high quality urogynecology services available to women in the DR. We offer a longitudinal, free, and accessible urogynecology course to Dominican physicians with multi-disciplinary, international faculty that is supplemented by simulation activities to practice procedures and skills, journal clubs to review key urogynecology literature and expert-supervised clinical evaluations and surgeries to implement evaluation and management. We concentrate on ethical and sustainable activities, all offered free of charge to both patients and providers in a low-resource area.
As the COVID-19 pandemic ravaged the world, and changed the way we see and practice education and medicine, we have adapted our activities to enhance their accessibility, and the education and training aspects of the program have evolved to meet the current demands of the region. While UGHI is made up of a group of dedicated volunteers that donate their time and expertise, expenses for equipment, training materials, and logistical support are still sorely needed to be able to bring this mission to life. The women of the DR thank you for your support!
If you wish to support this global women's health initiative, focused on the often neglected topic of female pelvic floor dysfunction through education/training, capacity-building and service provision, please consider donating to this important cause. If you wish to donate a large sum, please reach out to our founder Anna Pancheshnikov ([email redacted]) to learn more about how to make a tax-deductible charitable donation.
If you would like to know more about UGHI and what we do, please continue reading, or reach out to our founder ([email redacted]).
You can also find us on Facebook or Instagram .
WHY UGHI?
*A 70 year old woman, from a small rural town in the DR, has been suffering from involuntary urinary leakage for decades. Aware that her mother and grandmother also experienced this for years, she was resigned to the idea of never getting better, avoiding any public transportation, social events and even church, living in constant fear of impending embarrassment, asking herself if "they can all smell" the urine on her.*
*A 55 year old woman from Santo Domingo with severe uterovaginal prolapse (her uterus descending/ protruding outside the vagina) was going through a list of impossible choices in her mind. "How do I tell my husband who is returning from work abroad about this ball of tissue hanging outside my vagina? How do I maintain our sexual relationship without losing my dignity and risking his leaving or infidelity?"*
*A 32 year old teacher has found herself in the hospital again, for the fourth time this year. She bleeds so much during her periods, that she is severely anemic, and every few months becomes weak, fatigued or loses consciousness from her blood loss during an especially intense period. She is done with her child-bearing and wants her uterus out! But has not been able to schedule a hysterectomy due to long waiting lists in her hospital. She is afraid of the pain and long recovery after an open abdominal surgery (the only hysterectomy offered to her), and even more so of losing her job if she needs to take another day off due to these symptoms. *
*A 45 year old mother of 5 stopped going to work, family or school events. Since her hysterectomy 2 years ago, she has started to leak urine from her vagina continuously. After being diagnosed with a vesico-vaginal fistula (an abnormal connection between the bladder and the vagina) she already underwent one corrective surgery which failed. She is retiring to the "campo" (rural area outside town) so she doesn't have to face the humiliation which comes from constantly leaking and smelling like urine. *
Despite the adversity that women like these face in addition to the rate of high birth trauma in the region, poor access to care, and minimal treatment options for gynecologic and urogynecologic conditions, these women demonstrate strength and resilience, improvising with limited resources.
Despite the lack of education and training in the realm of urogynecology and pelvic floor disorders available to Dominican OB/GYNs and Urologists, these health care professionals constantly seek opportunities to learn and grow, so they can offer management options to their suffering patients. The few urogynecology trained professionals in the country have teamed up with us at UGHI, in order to tackle this great need: investing in urogynecology education and training and thus investing in service to patients most in need.
UGHI is focused on supporting the education and training of medical professionals in urogynecology and vaginal surgery and enhancing the high quality urogynecology services available to women in the Dominican Republic.
Gynecologic and urogynecologic conditions such as abnormal uterine bleeding (heavy vaginal bleeding), urinary incontinence (involuntary leaking of urine), pelvic organ prolapse (descent of pelvic organs through the vagina) and genitourinary fistulas (abnormal connection between the bladder and vagina causing constant leaking) are extremely common around the globe.
These conditions can significantly affect women's health, well-being and quality of life. Unfortunately, up to 90% of women suffering from these conditions do not seek care and many medical providers do not have the proper training to diagnose and manage these conditions. Unfortunately, women living in low-resource areas face even greater barriers to care than women in higher-resource areas, and many low and middle income countries (LMICs) have limited education about these topics available to health professionals. In the Dominican Republic (DR), for example, there is no fellowship training program in urogynecology, and there is a paucity of pelvic floor education in OB/GYN and Urology residencies.
UGHI is focused on supporting the education and training of medical professionals in urogynecology and vaginal surgery and enhancing the high quality urogynecology services available to women in the DR. We offer a longitudinal, free, and accessible urogynecology course to Dominican physicians with multi-disciplinary, international faculty that is supplemented by simulation activities to practice procedures and skills, journal clubs to review key urogynecology literature and expert-supervised clinical evaluations and surgeries to implement evaluation and management. We concentrate on ethical and sustainable activities, all offered free of charge to both patients and providers in a low-resource area.
As the COVID-19 pandemic ravaged the world, and changed the way we see and practice education and medicine, we have adapted our activities to enhance their accessibility, and the education and training aspects of the program have evolved to meet the current demands of the region. While UGHI is made up of a group of dedicated volunteers that donate their time and expertise, expenses for equipment, training materials, and logistical support are still sorely needed to be able to bring this mission to life. The women of the DR thank you for your support!
If you wish to support this global women's health initiative, focused on the often neglected topic of female pelvic floor dysfunction through education/training, capacity-building and service provision, please consider donating to this important cause. If you wish to donate a large sum, please reach out to our founder Anna Pancheshnikov ([email redacted]) to learn more about how to make a tax-deductible charitable donation.
If you would like to know more about UGHI and what we do, please continue reading, or reach out to our founder ([email redacted]).
You can also find us on Facebook or Instagram .
WHY UGHI?
*A 70 year old woman, from a small rural town in the DR, has been suffering from involuntary urinary leakage for decades. Aware that her mother and grandmother also experienced this for years, she was resigned to the idea of never getting better, avoiding any public transportation, social events and even church, living in constant fear of impending embarrassment, asking herself if "they can all smell" the urine on her.*
*A 55 year old woman from Santo Domingo with severe uterovaginal prolapse (her uterus descending/ protruding outside the vagina) was going through a list of impossible choices in her mind. "How do I tell my husband who is returning from work abroad about this ball of tissue hanging outside my vagina? How do I maintain our sexual relationship without losing my dignity and risking his leaving or infidelity?"*
*A 32 year old teacher has found herself in the hospital again, for the fourth time this year. She bleeds so much during her periods, that she is severely anemic, and every few months becomes weak, fatigued or loses consciousness from her blood loss during an especially intense period. She is done with her child-bearing and wants her uterus out! But has not been able to schedule a hysterectomy due to long waiting lists in her hospital. She is afraid of the pain and long recovery after an open abdominal surgery (the only hysterectomy offered to her), and even more so of losing her job if she needs to take another day off due to these symptoms. *
*A 45 year old mother of 5 stopped going to work, family or school events. Since her hysterectomy 2 years ago, she has started to leak urine from her vagina continuously. After being diagnosed with a vesico-vaginal fistula (an abnormal connection between the bladder and the vagina) she already underwent one corrective surgery which failed. She is retiring to the "campo" (rural area outside town) so she doesn't have to face the humiliation which comes from constantly leaking and smelling like urine. *
Despite the adversity that women like these face in addition to the rate of high birth trauma in the region, poor access to care, and minimal treatment options for gynecologic and urogynecologic conditions, these women demonstrate strength and resilience, improvising with limited resources.
Despite the lack of education and training in the realm of urogynecology and pelvic floor disorders available to Dominican OB/GYNs and Urologists, these health care professionals constantly seek opportunities to learn and grow, so they can offer management options to their suffering patients. The few urogynecology trained professionals in the country have teamed up with us at UGHI, in order to tackle this great need: investing in urogynecology education and training and thus investing in service to patients most in need.
WHAT IS UGHI? WHAT DO WE DO?
UGHI, Urogynecology Global Health Initiative, focuses on urogynecologic education, training and service in the Dominican Republic through longitudinal course work, procedural simulation, and clinical-surgical training supervised by local and international, multi-disciplinary experts.
HOW DO WE DO IT?
Collaboration:
- Prioritization of local needs, local trainees, local experts, local involvement!
- Incorporation of multi-disciplinary, international instruction and mentorship
- Involvement of local non-governmental organizations and hospitals
leadership and trainees from HUMNSA, Hospital Universitario Maternidad Nuestra Señora de la Altagracia, a local women's hospital; leaders of Order of Malta (local NGO); Dr. Anna Pancheshnikov, UGHI founder, during the 2019 clinical-surgical weekEducation and training:
- Focus on the training of local healthcare providers including OB/GYN and Urology residents and attendings in urogynecology, pelvic floor disorders and vaginal surgery
- Creation of a free longitudinal urogynecology course with monthly classes and educational workshops held by international experts in Urogynecology, Urology, Colorectal surgery, and Pelvic Floor Physical Therapy (in collaboration with ALAPP: Latin American Pelvic Floor Association)
- Bimonthly interactive Journal Club discussion focusing on landmark urogynecology articles led by UGHI trainees
- Simulation practice in key procedural skills (vaginal surgery, incontinence sling placement, prolapse surgery, etc.)
- Quality improvement using satisfaction surveys, participants’ knowledge evaluation, and dynamic programmatic modifications
UGHI 2022 trainees during their 3rd Simulation training including activities such as: knot-tying, vaginal cuff closure, sacrospinous ligament fixation, and cystoscopyService:
- As a culmination of the UGHI longitudinal course, a group of dedicated local trainees are chosen to participate in clinical-surgical experiences to both increase their practical learning and provide necessary service to women from low-resource settings in the region. As part of this clinical experience, we provide:
- Clinical evaluations of patients with gynecologic and pelvic floor disorders such as heavy menstrual bleeding, fibroids, urinary incontinence, pelvic organ prolapse and genital fistulas
- Free surgeries to appropriate patients
- Close post-surgical follow-up
- All with the strict supervision and instruction of local and international urogynecology/pelvic floor experts
- Clinical evaluations of patients with gynecologic and pelvic floor disorders such as heavy menstrual bleeding, fibroids, urinary incontinence, pelvic organ prolapse and genital fistulas
- Free surgeries to appropriate patients
- Close post-surgical follow-up
- All with the strict supervision and instruction of local and international urogynecology/pelvic floor experts
Dr. Carlos Oviedo, OB/GYN attending Santo Domingo, Dr. Keila Muniz, Urogynecology attending USA (then urogynecology fellow), operating under supervision and teaching from Dr. Ami Acharya, Gynecologist and Urogynecologist, USA during UGHI's 2019 surgical program. Since the founding of UGHI in 2017, we have trained more than 100 gynecology and urology residents and physicians through theoretical and practical coursework in different public hospitals; we have evaluated more than 300 low-income patients and have offered 75 vaginal surgeries to treat their pathologies.
This year, UGHI 2021-2022, we have 60 Dominican OB/GYN and Urology trainees who have gone through a year-long urogynecology course, with monthly theoretical workshops, bi-monthly journal club review, and 3 surgical simulation activities. 15 of these talented physicians were selected to participate in the clinical-surgical program, including:
- Patient evaluations starting July 2022
- A week intensive including ~40 vaginal surgeries in October 2022
- Post-operative follow-up visits planned for November 2022 and March 2023
This year, UGHI 2021-2022, we have 60 Dominican OB/GYN and Urology trainees who have gone through a year-long urogynecology course, with monthly theoretical workshops, bi-monthly journal club review, and 3 surgical simulation activities. 15 of these talented physicians were selected to participate in the clinical-surgical program, including:
- Patient evaluations starting July 2022
- A week intensive including ~40 vaginal surgeries in October 2022
- Post-operative follow-up visits planned for November 2022 and March 2023
We have persisted through COVID-19, innovating and improving our curriculum and training activities, increasing the accessibility of our program and developing its sustainability and capacity-building, we are now ready to embark on our 4th clinical-surgical experience, with your help!
We are lucky to count on incredible support from medical companies, US-based and Dominican hospitals and clinics, collaborating non-profit organizations and too many individuals to count...so...
HOW CAN YOU HELP?
Any donation, large or small will help us with the following expenses:
- Materials, materials, materials!
- Medications not available at the public hospital pharmacy
HOW CAN YOU HELP?
Any donation, large or small will help us with the following expenses:
- Materials, materials, materials!
- Medications not available at the public hospital pharmacy
- Transportation costs for patients and families
- Food for patients, families, and trainees
- Required lab studies and imaging for patients without national insurance
- Printing patient evaluation forms, copying documents and other administrative costs
- Payment for low-paid hospital workers such as staff assisting with cleaning and transportation
- Providing small grants for expenses incurred by some of our low-income participants and trainees
- Payment for low-paid hospital workers such as staff assisting with cleaning and transportation
- Providing small grants for expenses incurred by some of our low-income participants and trainees
WHO IS UGHI?
· Dr. Anna Pancheshnikov: gynecologist, urogynecology fellow at Johns Hopkins, UGHI founder
· Dr. Ami Acharya: attending OB/GYN, urogynecologist, Yale New Haven Hospital (YNHH), UGHI supervising surgeon
· Dr. Oz Harmanli: attending urogynecologist and chief of Urogynecology, YNHH, UGHI supervising surgeon
· Dr. Ami Acharya: attending OB/GYN, urogynecologist, Yale New Haven Hospital (YNHH), UGHI supervising surgeon
· Dr. Oz Harmanli: attending urogynecologist and chief of Urogynecology, YNHH, UGHI supervising surgeon
· Dr. Nancy Ringel: attending urogynecologist, YNHH, UGHI medical and quality improvement director
· Dr. Keila Muniz: attending urogynecologist, St. Joseph's Health, UGHI surgeon
· Dr. Merycarla Pichardo: attending urologist and urogynecologist, Santo Domingo, UGHI local supervising surgeon
· Dr. Alberto Bassa: attending OB/GYN and urogynecologist, Santo Domingo, UGHI local supervising surgeon
· Dr. Mariatte Peralta: attending urologist, Santo Domingo, UGHI local supervising surgeon
· Dr. Deborah Wilson: attending urologist and urogynecologist, Samaritan Medical Center, UGHI local supervising surgeon
· Cher Richmond: Urogynecologic Women's Health nurse practitioner, YNHH, UGHI medical treatment supervisor
· Ludy Yambao: registered nurse, operating room nurse, YNHH, UGHI OR nurse manager
· Neisha and Michael Bethune: registered nurse, operating room coordinator, YNHH, UGHI OR nurses and OR coordinator
· Dr. Merycarla Pichardo: attending urologist and urogynecologist, Santo Domingo, UGHI local supervising surgeon
· Dr. Alberto Bassa: attending OB/GYN and urogynecologist, Santo Domingo, UGHI local supervising surgeon
· Dr. Mariatte Peralta: attending urologist, Santo Domingo, UGHI local supervising surgeon
· Dr. Deborah Wilson: attending urologist and urogynecologist, Samaritan Medical Center, UGHI local supervising surgeon
· Cher Richmond: Urogynecologic Women's Health nurse practitioner, YNHH, UGHI medical treatment supervisor
· Ludy Yambao: registered nurse, operating room nurse, YNHH, UGHI OR nurse manager
· Neisha and Michael Bethune: registered nurse, operating room coordinator, YNHH, UGHI OR nurses and OR coordinator
· Maria Limanovich: Stem cell program nurse manager, University of New Mexico, UGHI PACU nurse manager
· Dr. Viji Kurup: attending anesthesiologist, vice chair for medical education, division chief, YNHH, UGHI anesthesia instructor
· Dr. Nousheh Saidi: attending anesthesiologist, section chief non-OR anesthesia, VA Yale, UGHI anesthesia instructor
· Dr. Claudia Fernandez: attending anesthesiologist, YNHH, UGHI anesthesia instructor
· Dr. Orlando Suero: attending anesthesiologist, YNHH, UGHI anesthesia instructor
· Dr. Claudia Fernandez: attending anesthesiologist, YNHH, UGHI anesthesia instructor
· Dr. Orlando Suero: attending anesthesiologist, YNHH, UGHI anesthesia instructor
· UGHI trainees: 15 Dominican OB/GYN and Urology residents and attendings and 3 US-based OB/GYN resident (Dr. Xiomara Brioso) and Urogynecology fellows (Dr. Pedro Alvarez, Dr. Darlene Vargas)
· UGHI coordinators: Dr. Liz Yanes (lead UGHI coordinator), Dr. Andy Sanchez, Dr. Arantxa Suero, Dr. Lia Balcacer, Dr. Maria Bisono, Dr. Indhira Fernandez, Shamelle Lopez (local UGHI coordinators), and Chris Reynolds, Eesha Acharya, Rebika Khanal (US-based UGHI coordinators)
· UGHI alumni and teacher assistants: Dr. Franciris Vargas, Dr. Raul Villalona, Dr. Mario Estrada, Dr. Delta Asencio
· Local hospital: Hospital Moscoso Puello, Santo Domingo, Dominican Republic
· Local Hospital leadership: Dr. Enmanuel Silverio, hospital director; Dr. Tomás Caraballo, education chief; Dr. Claridania Almanzar, OB/GYN residency director; Dr. Delia Kiem, OB/GYN residency coordinator
· Local hospital nursing and staff
· Orden de Malta: local collaborating organization with Ariel Baez, executive director; Kellee Brown, Dr. Yajahira Garcia and staff
· UGHI advisors and board of directors: Dr. Abner Santos, Dr. Rene Genadry, Dr. Jean Anderson
· Our incredible patients and their families
Part of the the 2019 UGHI team
Tearful Dr. Anna Pancheshnikov receiving a gratitude plaque from the 2019 UGHI trainees
Dr. Estrada, a UGHI 2019 graduate, presenting M&M
Patients (posted with permission), UGHI trainees and coordinators during one of our follow-up activities
· UGHI coordinators: Dr. Liz Yanes (lead UGHI coordinator), Dr. Andy Sanchez, Dr. Arantxa Suero, Dr. Lia Balcacer, Dr. Maria Bisono, Dr. Indhira Fernandez, Shamelle Lopez (local UGHI coordinators), and Chris Reynolds, Eesha Acharya, Rebika Khanal (US-based UGHI coordinators)
· UGHI alumni and teacher assistants: Dr. Franciris Vargas, Dr. Raul Villalona, Dr. Mario Estrada, Dr. Delta Asencio
· Local hospital: Hospital Moscoso Puello, Santo Domingo, Dominican Republic
· Local Hospital leadership: Dr. Enmanuel Silverio, hospital director; Dr. Tomás Caraballo, education chief; Dr. Claridania Almanzar, OB/GYN residency director; Dr. Delia Kiem, OB/GYN residency coordinator
· Local hospital nursing and staff
· Orden de Malta: local collaborating organization with Ariel Baez, executive director; Kellee Brown, Dr. Yajahira Garcia and staff
· UGHI advisors and board of directors: Dr. Abner Santos, Dr. Rene Genadry, Dr. Jean Anderson
· Our incredible patients and their families
Part of the the 2019 UGHI teamTearful Dr. Anna Pancheshnikov receiving a gratitude plaque from the 2019 UGHI trainees
Dr. Estrada, a UGHI 2019 graduate, presenting M&MPatients (posted with permission), UGHI trainees and coordinators during one of our follow-up activities
Co-organizers (9)
Anna Pancheshnikov
Organizer
Baltimore, MD
Liz Yanes
Co-organizer
Maria Limanovich
Co-organizer
Cherrilyn Richmond
Co-organizer
Darlene Vargas Maldonado
Co-organizer