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A chance encounter with my urologist

Patients waiting to be seen at a urology clinic in Rwanda
Photo courtesy of Dr. Lee Ann Richter
Patients waiting to be seen at a urology clinic in Rwanda

Who should I find sitting in the Moynihan Train Hall at Penn Station recently but my urologist. This isn’t some set-up for a Rodney Dangerfield or Henny Youngman joke. For those who visit the spanking newish facility and fear its architects forgot to include seating – a Google search comes up with lots of Reddit posts in often colorful language decrying the absence of benches -- there’s a ticketed waiting area adjoining the main concourse on the east side of the station.

It was there I found Harris Nagler, my esteemed urologist, pecking away at the keyboard on his laptop while waiting for his train. By the way, the seating area comes with charging stations and, speaking of urology, restrooms. I asked Dr. Nagler, who I’d seen at his office only days before – I’m discovering that once you reach a certain age you may see your urologist more often than you do your grandkids – where he was headed.

He explained he was on his way to Washington, D.C. The news filled me with a sense of well-being because I assumed he was traveling to some medical conference about the current science or breakthrough techniques that might eventually accrue to my benefit. In fact, he told me he was on his way to a meeting of the Urology Care Foundation, the world’s leading urology non-profit.

During our brief conversation – I didn’t want to bother him, and also I had to join the line a full half hour before departure to better the odds of scoring a river view seat on the 3:15 p.m. Empire Service train to Hudson, NY – he gave me a thumbnail sketch of the foundation’s good work in the United States and abroad. He also offered to put me in touch with the Urology Care Foundation’s staff.

I don’t know whether it’s because urology’s been on my mind lately or because it seems that urology doesn’t attract as much attention as specialties such as cardiology or cancer care but I was eager to learn more about the subject, let alone a foundation devoted to the cause. So a Zoom meeting was arranged.

The foundation awards millions of dollars in grants in areas such as prostate cancer and bladder health research. It’s also established humanitarian endowments that award grants to doctors that provide direct urological patient care to underserved communities in the United States and around the world.

“Most of the individuals who have given are urologists,” Patricia Banks, the foundation’s executive vice president told me, referring to their endowment funding. She didn’t disagree when I suggested that what urology needed were a few megadoners whose names, such as Koch, Langone and Weill, are festooned across the front of state–of-the-art research hospitals in New York City.

I was interested in learning more about the foundation’s humanitarian work so I was put me in touch with doctors such as Lee Ann Richter, a urologist and an associate professor at Georgetown University School of Medicine. Every year Dr. Richter spends two weeks in May in Kigali, Rwanda performing surgery on women with urological problems.

One of the most frequent is fistula, a potentially devastating condition caused from complications during childbirth because Rwandan women often give birth outside hospital settings and don’t have access to C-sections. The result can be profound incontinence, the damage as much psychological as physical, including ostracism from the mother’s rural community. “The implications are so great for a lot of women,” Dr. Richter told me. “Their partners may leave them. They may not be able to have more children until the problem is fixed. Being a woman is so wrapped up in bearing children.”

For all the deficiencies of the American health care system her work in Rwanda has given the doctor greater appreciation for our medical sophistication, especially as a young parent herself, since complications can arise in even seemingly routine pregnancies.

Urologist Dr. Kit Yuen’s fieldwork happened closer to home – at primary care clinics run by the University of Rochester. URWell provides physical exams and screenings for conditions such as diabetes and hypertension to the uninsured and underserved communities in Rochester, NY.

“A lot of people in the community need specialty treatment,” Dr. Yuen said. Many of the patients are woman who arrive with urinary incontinence, frequency or fertility issues. Blood work for men may reveal high PSA levels indicating the possibility of prostate cancer. “They’re not even aware there are urologists who manage a lot of these things,” the physician said, or that tests exist to detect prostate cancer.

Dr. Yuen said her clinic work served as an eye opener, making her aware of the barriers to adequate health care in the United States – a particular problem in rural areas where doctors may be few and far between – and devising strategies to surmount them. It has also made her appreciate that medical care is as much about striving toward social equity as it is breakthrough science.

Given the urgency for top quality urological care at home and abroad – no pun intended – perhaps it was frivolous of me but I wondered whether Dr. Richter, on her many trips to Rwanda, had gotten time any off to trek to see the country’s endangered mountain gorillas?

She had. Typically operations are performed six days a week, she told me, leaving Sunday for sightseeing. As a treat or incentive first-year doctors are given priority to make the organized three-hour journey to the gorillas, as Dr. Richter did on her inaugural visit to Rwanda. As memorable as the journey was, she hesitated speculating about the sorts of urinary issues gorillas might face in the wild, or share with their human cousins.

Ralph Gardner, Jr. is a journalist who divides his time between New York City and Columbia County. More of his work can be found be found on Substack.

The views expressed by commentators are solely those of the authors. They do not necessarily reflect the views of this station or its management.

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