“So HOW long has this urinary catheter been in?”
By the twentieth time that I had to ask the question to yet another patient in urinary retention, neither myself or Dr. Brett Lebed, my Urologist compare-in-arms, was surprised by the answer. The Urology clinic at Central Regional Hospital in Cape Coast was brimming with anxious individuals with indwelling catheters placed long ago, for unknown reasons. These proud people who could neither understand or remember the rationale for the catheter placement, sometimes 5 or 10 years ago, simply wanted it removed. They came from all over the region including neighboring countries such as Ivory Coast and waited without complaint for hours and hours in the stifling heat of the overcrowded clinic area.
Some had benign enlarged prostates, some had urethral stricture disease and some had locally advanced or widespread prostate cancer. They all wanted to simply urinate freely without the need for an appliance, one of the most basic human functions that most take for granted.
In a country of limited resources where there are perhaps 2 or 3 Urologists for a population of 23 million, they often will never receive even the simplest treatment for their condition. The result is a catheter for a lifetime.
It was my first medical mission after 15 years in academic medical practice. Dr. Lebed had been on a prior mission to Central America years before. We were not anticipating this much prostate disease and voiding dysfunction. We came expecting to repair obstetric vesicovaginal fistulas in women, and although we did a few of these cases, we treated far more male lower urinary tract disease. Despite operating every day except our first and last days in Cape Coast and seeing a full clinic of patients every day, we barely scratched the surface.
For every case that we saw, there were probably 100 more that could not be seen. Nevertheless, both of us were profoundly moved by the seismic need for Urologic services of all kinds in Ghana, but even more so by the warmth and dignity of the locals. We did what we could this mission. There is more to do. A lot more.
Eric Rovner, M.D.
Department of Urology
University of South Carolina School of Medicine