Read the Full Video Transcript

Samuel Washington: Hello everyone. Samuel Washington with UroToday. I'm here with Dr. Kymora Scotland from the University of California, Los Angeles. She's an assistant professor of urology, director of endourology research, associate chair of the Endourology Fellowship program, as well as chair of the World Endo Committee of the Endourological Society. We're here today to talk about her work, both local and global within endourology and the impact that she's having right now. Happy to have you here.

Kymora Scotland: Oh, thank you for having me.

Samuel Washington: Now. You're doing so much. I wanted to make sure that we touch on the interesting work you're doing globally and how that's changing things outside of our US bubble, but also make sure that we go over what's happening in our own backyard so we understand how we can improve care within the endourology space and beyond for the patients we're seeing here. Why don't we start with the global work that you're doing. Would you be able to give us a brief summary of what's going on?

Kymora Scotland: Sure. There are sort of two main buckets. I'm really interested in education and training globally. So one of the things that I do is to work with colleagues in other countries in low and middle-income countries who do not necessarily have endourologic skills. And so a lot of the procedures that we do in the US and in Europe, endourologically, minimally invasively, do not get done in that fashion in other countries. And you have patients who could have a very small procedure having open surgery. And so instead of just going there to some country once a year and doing procedures, my thought process here and the work that I do with several colleagues is to go in and to train urologists to do these procedures and to support them by helping them have the devices and equipment that they need to continue to do those procedures long term.

And so I work with the Medi Tech Trust, which is a charity out of the UK and Graham Watson who is the CEO of that charity. And so what we do is we will work with folks in multiple countries. So I've personally worked with urologists in Benin and in Malawi, and we work remotely. So the plan has always been to go in person, get a foundation, but then when you go and you do cases with someone for a week, or if you're lucky two weeks, it's really hard for that person to then continue to excel in that specific procedure and to offer it to patients safely. And so, one of the things that happened because of the pandemic is that we really felt like we had to keep the momentum going. And so we started doing virtual trainings. And so what I do is work with folks in other countries to actually do cases with them live using technology that really wasn't available to us 10 years ago.


And so we use the Proximie setup and we also use glasses by a company called Vuzix. And I mention this because the Proximie setup is really quite involved, where we with the team in Benin have a setup where we can use almost like a GoPro, but we also have multiple screens. So I train with PCNL. And so if you're doing fluoroguided or ultrasound guided, you want to also see what's happening at the C-arm. You want to also see what's happening at the ultrasound. There are multiple screens, so I could actually see what's happening in the screen and he can hear what I'm telling him or... They're all men there. And he can also see on his screen where I'm pointing. So for instance, getting access doesn't just become something like me saying, "Point left." I'm actually showing him exactly where I want him to point. And that has made all the difference. So that's the PROXIM system.


And then we have the Vuzix glasses, which are smart glasses that we've been using in Malawi. And that's part of a collaboration with Ohana One, which is a charity actually based in Southern California. And we're working worldwide, we have colleagues all over the world who are doing this type of work. And through the pandemic, again, have been trying to keep things going by doing this work virtually. We've now moved out of the pandemic and we've seen the benefits of this. So we're continuing to do this work. So that is work that we've been doing globally ongoing.


The second thing that I've been doing is as chair of the World Endo Committee of the Endourological Society, we have put together two initiatives. And this is again, feeding in on this idea that we need to train people so that they can help the patients in their communities. We've just established two fellowships, and those are going to be regional fellowships. So we've got one fellowship that's going to be in Cape Town, South Africa. One is going to be with Dr. Mahesh Desai in India. And so somebody in that region, in Southeast Asia, is going to be the fellow there. And then somebody within Africa is going to be the fellow in Cape Town with Dr. John Lazarus. We've put out a call for folks to apply for these fellowships and we got 50 applications for two spots, unfortunately. So we're hoping that we can continue to get more funding because all of this is supported by generous funds.


And the idea there is to have somebody who's already a urologist but wants to get endourologic expertise to go to an area close to his or her home country. And the idea behind that is so that they can work in a setting that is going to be somewhat similar to the setting that they will return to, and that they will have a three-month to six-month period of just learning two or three skills so that they can take those skills back. And we've committed to help them to build their practice by making sure that we work with their institution to have the right equipment for them. So we're really excited about this. The application just closed for this year, so we're going to be going through and picking the finalists for that.


Samuel Washington: Very exciting work. Very exciting.

Kymora Scotland: Yes, really exciting. Yes, yes.

Samuel Washington: I was going to say that that really gets and hits home to the main issue of sustainability. So whether we're going somewhere else doing operations for a week or two weeks and leaving that knowledge leaves with us, or we have patients come to our institutions and train, but when they go back, there's no infrastructure there. There's no expertise or limited expertise to really bring that home and make sure it's sustainable in that locale.

Kymora Scotland: Exactly.

Samuel Washington: So you're building all of that there so it becomes a self-sustaining ecosystem, which is very exciting work, very paradigm-shifting and how we-

Kymora Scotland: Yes, that's exactly what we want to do. I'm from the Caribbean and I started my mission surgical trips in Dominica, which is where I'm from, going in doing procedures. And what made sense to me at the time was to go in and to do the procedures because there was no urologist there at the time, there's no urologist. And so we're working with that person. But the same thing happens all the time, as you mentioned. And so going through there and really meeting up with Mr. Graham Watson was what led to this work. And he's worked with folks in Sri Lanka, multiple countries in Africa. And what we've developed over time is this idea, the same paradigm that you're mentioning of not just going in and training people, but making sure that they have the equipment to continue to do this work. And what we found is that once you teach one or two people, they will teach others.


And so for instance, Mr. Watson started in Sri Lanka and taught one urologist. And that urologist has gone on to teach literally scores of urologists how to do PCNL in Sri Lanka. And so that I think is a really good example of what a handful of people can do to really make a sustainable difference.


Samuel Washington: And it's so exciting because even within the United States, we talk about systems disruption or changing organizations, but the other aspect is we need to actually build the right system in place so these things can persist, and that's kind of at the forefront. So it's exciting what you're doing globally.

Kymora Scotland: Yes.

Samuel Washington: I want to ask, what are you doing locally?

Kymora Scotland: So there are a couple of things that I'm doing. One is building off of this, I do think that we have amazing training in the US. And some of the things though that get, I don't want to say short shrift, but just don't get as much attention are some of the endourologic procedures like PCNLs that the majority of urologists may not necessarily do, specifically getting PCNL access. And if you've done a PCNL and it's been a situation where you did not get your own access, sometimes that can be difficult. And so, one of the things that we're trying to work on is to do, again, virtual training with residents to give them a sense of how to simulate that because it's really tough to learn as a resident on a patient doing PCNL access. And so simulation we think is the way to go with that.

And there are multiple people doing this work, so I won't steal their thunder. But the other thing that I'm involved in as well here is, and this is with one of my partners, or I should say colleagues, Dana Scott, who is a private urologist with Gold Standard Urology, but we have been working on doing screenings in the community. And of course everybody's done screenings, but the question is what do you do that's sustainable with screenings? If you do, say for instance, a prostate cancer screening once a year, that helps those people who come to the screening. But how do you build a relationship with the folks in the community so that they feel comfortable discussing their urologic issues, that they even understand that these things are issues that can be addressed by their physicians?


And so what we started doing was multiple screenings. So we've hit on doing four a year. And we do a prostate cancer screening, we do a female incontinence screening, we do an ED screening, and we do a kidney stone screening. I'm calling them screenings, but really what they are are education and screening sessions. And we've been partnering with a really well-respected community clinic in South Central LA. And what we want to do is to meet folks who are low socioeconomic status, who may not necessarily have the ability to go to see a subspecialist like we are, and in communities where there is some concern about what these folks are doing who are coming to do the screenings. And so we're trying to make it... If people who look like them and who understand the community, are from the community, we're hoping that that will be more helpful.


And so I was fortunate to be given a humanitarian grant from the Urology Care Foundation for this work. And so some of the things that we're doing there is we are involving medical students. So we have medical students, we have them set up the first station where they do a lot of the education to patients. So for instance, whether your question would be, well, how do you do a female incontinence screening? So we had the women come in and they had stations with the medical students talking about different types of incontinence because a lot of times what happens is that folks just think, "This is something that happens and I just have to deal with it, and it's not even something that I'm going to bring up to my physician." So the idea that this is an issue that could be addressed, that light bulb goes off, and then they come and they speak to us, they speak to the urologist, and we can talk to them about these issues.


And again, this is not work that we're doing to drum up business, we're here to help the community. But what it does is that enables them to go back and see their PCP and get that referral to see somebody in their community who can help. And we're trying to make this a sustainable thing so that we can continue to do this year-wide and then hopefully extend that to the rest of the country. I know that the R. Frank Jones Urologic Society, which I'm a member of, is very interested in doing this sort of thing on a larger scale. So I think everything that I try to do, I try to do in a sustainable fashion and to make sure that we're helping not just the one or two people who see you, but more people and in an ongoing way.


Samuel Washington: And I see a lot of parallels between the work you're doing globally and what you're doing regionally, we'll say, where a lot of the care access infrastructure is almost centralized or clustered. And part of that comes from us having centers of excellence in one thing or another, but that doesn't allow penetration and dissemination into communities, non-academic centers, so on, so forth. So it's exciting to see how these partnerships, you're starting to break down some of those barriers.

Kymora Scotland: That's what we're hoping to do. That's what I'm hoping to do. I think as urologists, we don't go into public health necessarily, but I think as urologists and as physicians in general, we really looking around have a responsibility to try to bring this type of care to as many patients as possible, as many people who need it. We're a very small specialty, and so it becomes hard to do that. And so one of the ways you can do that is really by going out and developing a network of people who can do the work.


Samuel Washington: Very exciting. I mean, I think we have something similar here through Umoja Health. So a group here in San Francisco, in East Bay really bringing care, directed, informed, led by the community. And we are there as kind of partners rather than us telling everyone what they should get. So it's good to see that... It'll be interesting to see how the recipe changes even within our same state with California, but also as you do work broader outside of California, outside the United States, how the impact will be over time. Very exciting.

Kymora Scotland: I can't wait to see it. And I think a lot of folks want to help. For instance, for the prostate cancer screening, and the most recent one we had was last fall, we had phlebotomists who came down and wanted to help nursing staff. And we've got just an army of volunteers who come to every one of our events and they're helping to get folks in. They're helping to get folks from station one to station two to station three. They're helping... We have folks in the community have been providing lunch. So that happens. And so people come in the morning and we have lunch at the end, and we have KTLA, which is one of our local radio stations who've been really working with us to advertise and to help us with marketing and that sort of thing.

And so I think when you go to all of these different people with this idea, you get a lot of yeses. People want to help. People want to be involved. People see the need. So I think it's just a matter of giving them an opportunity to help in a way that they can help.


Samuel Washington: My question for you would be, so hopefully a lot of urologists around you see this as well. If they have that same energy, that same interest, how are they able to seek out these opportunities, look for ways to help?

Kymora Scotland: I think there's a couple of ways. As I mentioned, R. Frank Jones Urologic Society is thinking about these sorts of things as well. And there's several folks within that society who have been strategizing and planning. And so they can always contact us to get involved in that work. And I'm happy to chat with anybody obviously about how this works. We have several colleagues who come and work with us, and people can come in and out. We all have different bandwidths. And so for folks who think, I'd love to help, I can't be helpful on an ongoing basis, but maybe I can help with one workshop, one screening, or one aspect of raising funds or something like that. Those are the kinds of ways that I think that we can all be of use.

Samuel Washington: One last question. I know I've been taking up some of your time. When you think of how to approach these problems, big picture, what would you say are the one or two things to really keep in mind when we talk about, okay, we have this energy or we have these resources, we want to do something. What kind of two guiding principles keep you focused? Does that make sense?

Kymora Scotland: Yeah, absolutely. The one we've already spoken about, this idea of making any work that you do sustainable. We have such limited time as urologists, and so you have to make what you do count and you have to make it be something that's not just a one-off. And so trying to find solutions that are sustainable is helpful.

The other thing is working together. A lot of what happens, and we published on this, a lot of what happens in terms of urologic surgical missions is one or two people going on a trip somewhere and then maybe going back, maybe not. And so you have this situation where lots of duplication of effort and lots of duplication of energy happens. One of the things that we've tried to do with World Endo Committee is, and I'm going to plug something else here. We actually have an initiative called the Uro Give Initiative where... And this is in partnership with the American Urological Society, with the SIU, with the Urology Care Foundation, with IVUmed, where we've come together and we've thought about an issue. And that issue is, again, how do you get devices, equipment to people who need them, who would love to do endourologic procedures, minimally invasive procedures, don't have access to these things.


And so we now have a website, which is going to be a clearinghouse. And what that allows folks to do is for somebody in L.A., for instance, who has a set of receptor scopes that they're not using, you can go to our website and you can donate. We've been working with Dr. Lee Ponsky who has the charity MedWish. He has a large warehouse in Cleveland, and so you can... Actually, we have you liaise with them so that you can send your equipment, your devices over to their warehouse. And then we have folks from other countries who need equipment devices, disposables, can now go onto the website and they can ask for these things. And if they're available, we ship them to them. And if they're not available, we try to source them. And this is something that is better done when you've got all of the organizations who do this kind of work on board.


And so I encourage anybody who has access equipment, devices, disposables to go to urogive.org, U-R-O-G-I-V-E dot O-R-G. You'll see our website. This is a new initiative that we just started a couple months ago. We'll be talking more about it in the coming year. But this is the kind of way that we can make a bigger impact is by having the folks in the space work together to achieve one goal.


Samuel Washington: So exciting, breaking down the silos that we often have in our academic space, regional infrastructure barriers that prevent care from really getting to communities or areas of the world that need it. Very exciting work. Thank you so much for taking the time. I know you're incredibly busy. Learned a lot during our time together and look forward to chatting with you soon in the future as well.

Kymora Scotland: Thank you for having me. It was wonderful chatting.