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Department of Urology

October 11, 2017

Pediatric Urologists Paul Merguerian and Margarett Shnorhavorian Participate in Medical Mission to Armenia

Dr. Merguerian, at right, in the Arabkir Medical Center OR with a local surgeon

Dr. Merguerian, at right, in the Arabkir Medical Center OR with a local surgeon. [Photo courtesy Paul Merguerian]

For the sixth year in a row, pediatric urologist Paul Merguerian, MD, has taken his skills to Arabkir Medical Center in Yerevan, Armenia, on a medical mission to provide assistance with and management of complicated pediatric urological issues.

In an ongoing collaboration between the Urology division at Seattle Children’s Hospital (SCH) and Arabkir Medical Center, the goal of the mission participants is to both perform complex surgical procedures and, perhaps more importantly, to train junior doctors how to perform these procedures themselves. Arabkir Medical Center is the largest pediatric medical services provider in Armenia.

In past years Dr. Merguerian has typically had two days of clinic and three days of surgery. This year the need for his services is such that his stay was increased to two weeks, with four full clinic days – providing consultation on approximately 40 children – and six surgical days in the OR.

Dr. Merguerian, who is Division Chief of Urology at SCH and Professor of Urology at the University of Washington, hopes to lay the groundwork for providing safe care to the children treated at Arabkir. This includes recommendation for name bands to identify patients, surgical time out, and more comprehensive communication regarding care after surgery.

“A major cultural hurdle is to implement a ‘Morbidity and Mortality’ conference [at Arabkir], as surgical complications are not discussed because of fear in losing referrals,” Dr. Merguerian notes.

Since 2016, fellow SCH pediatric urologist Margarett Shnorhavorian, MD, has joined Dr. Merguerian on this mission and has provided invaluable help in management of complex patients with differences in sex development, such as ambiguous genitalia in a newborn. Dr. Schnorhavorian’s expertise – she is surgical director of the Differences in Sex Development Program at SCH – has been particularly well-received at Arabkir and with the local pediatric endocrinologists who treat these children.

“We perform the most complex of pediatric urology surgeries in a low resource setting,” says Dr. Shnorhavorian. “Not only do the patients and families benefit, but we also train the local surgeons. It has been wonderful returning for a second year and seeing the impact of our work on improved patient care and on the training of the next generation of surgeons.”

Drs. Merguerian and Shnorhavorian treat an infant with bladder exstrophy

Drs. Merguerian and Shnorhavorian treat an infant with bladder exstrophy at Arabkir Medical Center. [Photo courtesy Paul Merguerian]

This year, Drs. Merguerian and Schnorhavorian treated a two-week-old girl with bladder exstrophy (photo at left), who is recovering well. They performed several complex hypospadias repairs and bladder reconstructive procedures, as well as a difficult bladder reconstruction on a young child following multiple previous failed surgeries. Additionally, Dr. Merguerian taught the local surgeons new techniques for repairing hypospadias using an inlay graft for some of the primary repairs.

Global urology has long been part of the mission of the department, beginning with Dr. George Brannen’s early efforts in Cameroon. Since then, the communities to which our doctors bring their expertise have uniformly had an overwhelmingly positive response to the intervention. More recently, our doctors have observed the symbiotic effect of their work, in which they bring lessons learned in the resource-limited environment to bear back in Seattle.

The philosophy of recurrent and meaningful engagement with local urologists, trainees, and patients received its full development through the passion of late pediatric urologist Dr. Richard Grady, who participated in several medical missions to Mozambique and India.

“As we focus on value, defined as improving quality while reducing cost, these global mission experiences are directly relevant to the continued excellence of our institutions,” notes Department Chair Dr. Hunter Wessells.

Dr. Merguerian’s participation in the mission this year was sponsored by the Armenian Fresno Mission to Armenia led by the Honorary Consul of Armenia in Fresno, Mr. Berj Apkarian.

“I am hopeful that the Armenia Fresno Mission will continue to sponsor upcoming missions and include Dr. Shnorhavorian,” Dr. Merguerian says.

And though the two week period comes to a quick end on the ground in Yerevan, the mission doctors and medical personnel involved continue to help manage their patients from afar, receiving regular updates from staff at Arabkir and providing ongoing consultations via email and video conferencing throughout the year.