Sharing our knowledge and expertise worldwide: Meet Dr. Karen Milford, Johannesburg, South Africa

Meet Dr. Karen Milford, a clinical fellow about to complete her sub-subspecialty training in urology at SickKids. Thanks to the generous financial support received by the SickKids Foundation through the SickKids International/Nelson Mandela Children's Hospital Education Initiative, Karen is the fourth clinical fellow to have completed her training under this partnership and return to South Africa to directly apply her newly acquired knowledge and enhanced skills in improving the health care of children.

Karen shared her fellowship experience with us, describing what this opportunity to learn at SickKids has meant to her.

Please tell us about your background and professional role back in South Africa

I trained as a general paediatric surgeon at the Red Cross War Memorial Children's Hospital in Cape Town, South Africa. I had some exposure to the basics of paediatric urology during my residency, and felt that this was a field that I wanted to explore and expand my skills in. Upon completing my training here, I will take up a post as a paediatric surgeon at Nelson Mandela Children's Hospital (NMCH) in Johannesburg, with a special interest in urology and renal transplant.

Explain to us a little more about your clinical subspecialty and the current situation and opportunities in South Africa

Paediatric urology is not currently considered an official sub-specialty in South Africa. There are clinicians who do offer excellent urological care to South African children, but as is the case with many sub-specialties, there are not enough of these clinicians to provide the volume of care required. There will be a lot of scope for urology work at NMCH, which already has an established nephrology unit. I will work with this unit and my surgical colleagues to provide urological care at NMCH, including renal transplant and the other surgeries needed to support children with end-stage renal disease.

Tell us about your experience and learnings from this fellowship experience at SickKids

My fellowship has been a truly remarkable and rewarding experience. I came to Toronto with fairly rudimentary urological skills, and through the patient teaching and mentorship of the division faculty I feel that I have refined my skills and further enhanced my urological experience.

After participating in excess of 500 surgical cases, I am now comfortable with the diagnosis and management of many urological disorders, and in performing the surgery needed to treat these conditions. I have had exposure to the surgeries performed to correct congenital and acquired kidney abnormalities to allow renal replacement therapy (such a dialysis and kidney transplant), and to treat cancers of the urinary and genital tract in children. I have also had the opportunity to be involved in the surgical management of some rare and complex genitourinary tumours. Being involved in urological reconstructive surgery and hypospadias care was also extremely beneficial.

Perhaps one of my most important take-aways from this fellowship is that there is almost always more than one way to do things, and the value of applying tailored solutions to individual patients. The staff of the division here are extremely innovative and always pushing the boundaries of what is possible. Being here has also reinforced for me that establishing good, respectful relationships that allow for productive two-way conversations and rational, interdisciplinary decision making are in the best interests of everybody: my patients, their parents, and my colleagues.

On a more concrete level, I had the opportunity to undertake dedicated training in the field of quality improvement and patient safety and completed a certificate in this with the University of Toronto. I think the principles and processes of quality improvement are highly applicable in the South African setting, where resources are often lacking and we need to find innovative solutions to better navigate complex problems, providing care that is efficient but also safe and of high quality.

Regarding my own personal growth as an educator, it has been a privilege to be able to teach residents and junior fellows in the Operating Room. There are certain procedures I was very familiar with prior to coming to SickKids, and I was able to fine-tune these here, but I was also allowed to operate somewhat autonomously and pass these skills on to more junior trainees. I co-authored two textbook chapters on urological subjects, and when COVID-19 made in-person academic sessions impossible, my co-fellows and I set up a webinar series that is now broadcast and recorded for all interested parties worldwide to watch. It has been very gratifying to see colleagues from all over South Africa logging in for these. In terms of collaboration going forward, I am very fortunate to be involved in a cross-borders project with the Children's Hospital of Philadelphia, looking at the outcomes of children with posterior urethral valves. I am hoping to expand this collaboration to Johannesburg. I am also a co-applicant on a GCH-Catalyst Grant application looking at the use of artificial intelligence in the diagnosis and prognostication in prenatally diagnosed hydronephrosis. I am hoping that I can involve my colleagues in South Africa in this project once I am home. These projects aside, I have met many wonderful surgeons, clinicians and other allied professionals during my time here, and I am sure I will be calling on them for various reasons in the years to come.

What impact do you expect to have upon your return to South Africa?

Upon my return, I will still provide general surgical care to children in Johannesburg, but this fellowship has given me the opportunity to expand my skill set, which will allow me to provide much-needed sub-specialist care to a deserving population. I recognize that there is still much work for me to do in terms of continuing to learn and refine my practice, but my experience here has given me an extremely solid foundation to work from. I believe that going forward I will be able to provide high-quality urological care to South African children.

The relationships I have formed in the division here have been invaluable, and I hope will allow for continued collaborative opportunities going forwards. I also hope that I can provide teaching and insight in a sub-specialty to trainees who may not have previously considered paediatric urology to be of central importance to their practice. Finally, I hope that I can set an example to aspiring doctors and surgeons and show them that although the path I have walked has been long and full of detours and unexpected changes in direction, every step has been valuable, that the toughest stretches may ultimately be the most rewarding, and that all the sacrifices that are made and all the hard work that is put in, is ultimately worthwhile.

I would personally like thank the donor, SickKids Foundation and SickKids International for this generous gift enabling this golden training opportunity. I would also like to extend my most sincere appreciation to my program director, mentors, colleagues and staff for their tremendous support during my time at SickKids.

For an overview of SickKids International's current projects visit SKI's Projects page. To learn how you can get involved in these exciting projects, contact Lutfi Haj-Assaad, Executive Director, SickKids International.