Lauren Wood Thum, MD: On a Mission to Restore Health, Hope, and DignityMay 21, 2019 09:15AM ● By Med Magazine
Story By Alex Strauss/
Photos by Philip Norman/Medlend
Long before she became a doctor, urologist Lauren Wood Thum, MD, of Urology Specialists of Sioux Falls, was drawn to medicine’s ability to impact more than health. In high school, she started a club to raise money for cleft lip and palate repair. In college at the University of Virginia, she established a new major in global health policy.
By the time she was a fellow in female pelvic medicine and reconstructive surgery at UCLA in 2017, she jumped at the chance to apply her skills to some of the world’s most complex urological cases on a medical mission trip to Uganda with California-based MedLend.
“You don’t see nearly the breadth of pathology here that you do there,” says Wood, who made the trip again in March, this time as an attending physician with internationally recognized fistula expert and Bay Area pelvic surgeon Tom Margolis, MD, who leads the MedLend Uganda missions. Besides surgeons, the approximately 15-person team includes anesthesiologists, nurses, anesthesia techs, ObGyn physicians, nurses, and residents, and a few volunteers.
“When I first went there, I struggled,” says Dr. Wood. “I thought ‘Why are we doing complex pelvic surgeries when most people here don’t even have access to basic things like clean water?’
But, as she understood the Ugandan culture and healthcare landscape better, Wood realized that she and her colleagues were doing more than repairing fistulas; they were also restoring lives.
“Many girls there are very young when they first have kids and android or narrow pelvis is also more common,” says Dr. Wood. “After obstructive labor, they might have 3rd or 4th degree vaginal tears that go unrepaired. These poor girls are totally ostracized. Their husbands will kick them out. They lose everything. After surgery, they can often reintegrate.”
These are complex cases. Many require repair of a rectovaginal fistula, perineorraphy, and anal sphincter repair. In one case, a woman with a urethrovaginal fistula underwent distal urethral reconstruction utilizing vaginal flaps to recreate the distal urethra. In another case, a patient with a ureteral injury and a failed Boari flap was leaking urine through her skin.
“We contemplated an ileal ureter,” Dr. Wood explained to MED in an email. “But due to devascularization of the proximal ureter and patient becoming unstable intraoperatively, we were forced to ligate the ureter and allow her to have a functionally solitary kidney. However, she is dry and happy.”
The team has repaired many vesicovaginal fistulas, some of them close to the cervix. Other surgeries include neovagina creation (from a split thickness abdominal skin graft), reconstruction of the urethra, ureteral implants, cystocele and rectocele repairs, and prolapse repairs such as transvaginal hysterectomy with vault suspension.
Wood says congenital problems are also more common in this population and often go untreated or even undiagnosed for years. One 11-year-old patient with an ectopic ureter to the vagina (something rarely seen in the US) had never been able to attend school because of urine leakage. Ureteral reimplantation saved more than just her dignity; it gave her a future.
“The week I spend in Uganda is the most tiring but also the most rewarding week of the year,” says Dr. Wood. “In one week in Africa, you do more complex cases than you might see in a year back home.”
But it is not only the volume and complexity of cases that makes the trip so challenging.
“The Ugandan doctors routinely work without so many things that we take for granted in the US - a ventilator, retractors, a Bovie cautery unit, suction, staplers,” says Wood. “You learn a lot of tricks on how to manage because you are basically MacGyver for a week. You have to problem solve and you learn to be a little less demanding.”
“It’s almost like going to surgery camp.”
Wood is married to her Urology Specialists colleague Dr. Joseph Thum, whom she met during residency at Cedars-Sinai Medical Center in Los Angeles. She has been in Sioux Falls since August and says she expects overseas medical missions will continue to be a big part of her life.
“It would be selfish not to do it,” she says. “We go through so much specialized training and we have so many skills. We probably use 10 percent of what we could do.”
“It is also medicine at its purest. It is how I imagine it must have been in the early days of medicine. You just do what needs to be done and patients are appreciative. It is incredibly rewarding.”