Dr. Joanna Chon says having good communication skills is very important in urology and medicine in general.
"When you're in your residency," comments Chon, "you publish papers in medical journals and have to be able to write technical professional papers. You are also expected to give lectures and make presentations on topics in your field. I've always thought that it was good that I had experience with essay contests in high school and junior high school. That has helped me a lot."
Urologists are needed throughout the world, especially in developing countries where health care in general may not be very advanced. Many urologists travel to other countries to teach or learn from their colleagues overseas.
The following story is by a Mongolian urologist who has been traveling back and forth between the U.S. and Mongolia to solve a scientific riddle.
Read this report and then write a brief press release (300 to 500 words) that publicizes the medical discovery the author made. Imagine that this press release will go out to the entire population of Mongolia and the U.S. medical community. The press release should be direct and clear and should answer the following questions:
Urinary Stones in Mongolian Children: A Truly International Project
by Gotov Erdenetsetseg, MD
In March 1996, a delegation of urologists, led by Dr. Terry Allen, came to Mongolia and visited the urology department of the Maternal and Child Health Research Center at Ulaanbaatar, where I worked as a pediatric urologist.
I showed Dr. Allen my large collection of urinary tract stones removed from children, which immediately caught his attention and subsequently led to an international study combining the clinical material from Mongolia with the technology from the West.
Mongolia lies squarely between Russia to the north and China to the south. It is a large country, five times the size of Texas and about the size of Western Europe, but boasting a population of only about 2.5 million people, most of whom live a nomadic life.
I attended the Mongolian Medical University, graduating in 1984. Following graduation from medical school, I went to work at the Maternal and Child Health Research Center in Ulaanbaatar as a pediatric surgeon.
The center has 870 beds, of which 450 are reserved for children, making it the main children's hospital for the entire country. We lack almost everything, from medicines and dressing to cystoscopes and, consequently, our medical care is about 30 years behind that of the U.S.
After eight years in pediatric surgery, I made the move to pediatric urology. Almost immediately, I became fascinated by the large number of stones in children that we were seeing, accounting for about seven percent of all our pediatric urology admissions. Most of the doctors simply removed them and began to save and catalog them.
I also reviewed the records of these patients, looking for common features that might help to explain them. Lacking the facilities to analyze the stones or study the patients in greater depth, I could go no further with my investigations.
When Dr. Allen came to Mongolia, I was one of the few doctors who could converse with him in English. He was suspicious that the stones were probably ammonium acid urate and wanted me to send him some of the stones for analysis in the U.S.
When he returned home, he mentioned his experience in Mongolia to his colleagues and Dr. Evan Kass contacted me, telling me that Dr. Jose Gonzales had funded a fellowship for foreign scholars that allowed them to come to William Beaumont Hospital for study. Dr. Kass, therefore, invited me to Michigan and I immediately accepted, bringing some 98 stones with me, which I sent to Dr. Allen for analysis.
He was able to get Dr. Donald Griffith in Houston to analyze these for us. As we suspected, the analysis showed that ammonium acid urate was indeed the most common constituent of the stones, being present in 72 percent of them.
From the results of the stone and urine analysis, along with a detailed medical and dietary history, it was possible to put together an explanation for the development of these stones. Basically, these children are maintained on breast-feeding for an excessive period of time and, when other dietary supplements are introduced, they are heavily based on processed wheat.
Both human breast milk and processed wheat are low in phosphorous and, since the diet is acid and phosphorous, the primary buffer of the urine is inadequate. The kidney must make additional amounts of ammonia. This ammonia, coupled with an increase in urate excretion, brought about by the acidosis and the introduction of meat into the diet, increases the risk factors for ammonium acid urate in the urine.
This problem peaks between about 1.5 and three years of age as the child comes off breast-feeding and starts on meat. Urinary risk factor analysis studies have shown that the level of ammonium acid urate in these children may reach as high as 15 times the normal saturation.
With a clear picture of why these stones form, we should now be able to develop countermeasures that might keep these stones from forming in the first place. Stopping breast-feeding by one year of age and supplementing the diet with cow's milk, which has a higher phosphorous content, while increasing the intake of vegetables and especially fruit, should help substantially. We are currently exploring options which may allow this goal to be achieved.
G. Erdenetsetseg is a pediatric urologist at the Maternal and Child Health Research Center, Ulaanbaatar, Mongolia