SIU Scholarship: Dr. Azfar Uddin Shaikh

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The Société Internationale d'Urologie offers Training Scholarships for young doctors with basic surgical or urological qualifications. The SIU Scholarships involve training in a recognized Urological center of excellence located in the candidate's geographical region. These SIU-accredited centers provide an excellent environment for learning and, in many instances, hands-on experience, so that candidates may acquire knowledge and skills that they will be able to transfer to their own setting of practice. In this series of short communications, SIU Scholars write about the impact that these training opportunities facilitated by the SIU had on their quality of care and career development. Information about applying for an SIU Scholarship is available at http://www.siu-urology.org/.

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• Azfar Uddin Shaikh, SIU Scholar

The All India Institute of Medical Sciences (AIIMS) was founded in 1956 as a medical college and hospital in New Delhi, and very soon it became the best medical institute in India. This autonomous institute is funded by India's Union Government. It is considered the best medical college and public hospital in India and is globally recognized for providing low-cost medical care to a large number of patients. This unique institution provides postgraduate training in about 42 specialties and recruits the best students from all over India. I was lucky that I had the opportunity to work with those talented doctors in a fully equipped academic environment.

The AIIMS was originally built as a superspeciality tertiary care center with a primary emphasis on research and specialized training facilities. India has a 3-tier health system, with primary clinics, which refer patients to secondary district level hospitals, which in turn refer patients to regional tertiary hospitals. The healthcare system in my country (Bangladesh) is similar to that of India, and it was an extra advantage for me to have my SIU scholarship training at the AIIMS. The tertiary care hospital in Dhaka where I worked is also dedicated to providing standard healthcare within the reach of every individual. All complicated cases from all over India are referred to the AIIMS for specialist management. Therefore, I had good exposure to general urology cases and had the opportunity to obtain experience with some rare cases also.

I was one of the first hands-on clinical SIU Scholars at the AIIMS after it became a recognized SIU training center. With the kind effort of Professor N. P. Gupta and the Secretary of the SIU, the $200 per month tuition fee required by the AIIMS was waived, for which I am especially grateful. No vacancy was available in the hostel for postgraduates, so I found accommodation at the Ansari Nagar Staff campus as a paying guest, which was about 1.5 km from the main hospital campus. Sometimes, I used the AIIMS staff bus free of charge. Because the 2 countries have an almost similar cultural background, I did not face too many problems living in New Delhi. The food was good, especially in the hostels and hospital cafeteria.

The Department of Urology of the AIIMS is famous for being the first robotic urology center in the Indian subcontinent. The department included 4 professors, 2 pool officers, and 8 residents. My job was similar to that of a pool officer (ie, to supervise the junior residents in procedures such as ultrasonography, prostate biopsy, lithotripsy, and urodynamic studies and to assist in major operative procedures). I shared on-call duties with the resident doctors and participated in departmental academic activities and floor rounds. All staff members were cooperative and friendly. The professors were enthusiastic to teach and to contribute to my fellowship training. As at many institutions in Southeast Asia, not much research work was done in the department, and I did not have an opportunity to participate in research.

One of my goals was to learn how to provide standard urologic care with limited financial resources, using the methods that the AIIMS, New Delhi, has been using for the past few decades. I benefited very much from my training, because I could apply innovative techniques to reduce the costs to my indigent patients in Bangladesh without compromising the quality of my service. Accessories that are used as disposables in Western countries (eg, ureteral catheters, guidewires, biopsy needles, laparoscopic instruments) are reused many times after sterilization in India and Bangladesh. Before my training, I had no idea that India was producing almost all these accessories at a low price. I can now procure them for my center from India. All these will significantly decrease the treatment cost of urologic procedures, as well as increase patient satisfaction.

I have upgraded my surgical skills during my SIU scholarship training at the AIIMS. Notably, I learned some operative tricks for percutaneous nephrostolithotomy, especially use of the miniperc/miniport. The use of the holmium laser for ureteroscopic lithotripsy, for enucleation of the prostate, and for the “core through” operation for complete urethral stricture was new to me. We are waiting for a holmium laser at our center in Dhaka to be able to do these procedures.

After my training, I have started doing transrectal ultrasound-guided prostate biopsy. I have taught my residents to perform urogenital ultrasonography in the procedure room. I have updated my knowledge of urodynamics, and my residents have benefited from this. I observed and assisted in a significant number of laparoscopic nephrectomy, robotic radical prostatectomy, robotic pyelolithotomy, and pyeloplasty procedures. My current goal is to develop our center for standard laparoscopic urology within 2 years.

The academic environment was very good, especially the journal club and radiology meetings, and I learned a great deal from those discussions. I am grateful to the SIU Scholarship Committee for providing me with such a great opportunity.

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Abbreviated CV 

Dr. Azfar Uddin Shaikh qualified as a Bachelor of Medicine and Surgery in 1993 and a Master of Surgery in Urology in 2002 at the Dhaka Medical College, Bangladesh. Since 2002, he has worked as a consultant urologist at the Dhaka Medical College, Bangladesh. He had a fellowship training in general and laparoscopic urology at Tan Tock Seng Hospital in Singapore in 2004. He has published 4 studies in scientific journals in Bangladesh. He undertook short-term training in endourology in Singapore and New Zealand in December 2003. At present he is working as a specialist urology and renal transplant surgeon at Apollo Hospitals in Dhaka. His volunteer experience includes participation in nationwide campaigns for the prevention of urethral stricture disease and the early detection of prostate cancer, and conducting a “Free Friday Clinic” for the treatment of poor patients in his own village.