Incense, smiles and jabanah: ISUOG Outreach in Sudan

Incense, smiles and jabanah….three distinct words which describe Sudan. Describing the essence of the country and program is Prof Hisham Mirgani Mubarak, who is both ISUOG’s Ambassador to the Middle East and Project Lead for Sudan. He is contributing to today’s blog to give more details on a country hardly known by the world:

“As we sat in the plane taking us from Khartoum, the capital of Sudan, to El Obeid, 400 km away for our second Outreach visit, I looked at the faces of the ISUOG Outreach team Gesu, Reem, Angela, and Yasmin sitting on my left. On my right was Sami, Sudanese obstetrician, and Sohaib from the local NGO facilitating our logistic. They were all full of excitement, eager to go back to El Obeid and build on last year’s success. What a team!

We came down the plane to find smiling, welcoming faces of friends we made during our first visit. There was Dr. Faki, the Minister of Health together with the Dean of the medical College. Just behind them was Dr. Khidir, the driving force for El Obeid Outreach program, receiving me with a big hug and tapping strongly on my back, which is how Sudanese welcome their friends. As we drove to the hotel we could see the tall large Adansonia trees, known to the locals as Al Tabaldi trees, guarding the entrance of El Obeid. No wonder it is the emblem of the city.

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Adansonia tree, also know as Al Tabaldi tree in El Obeid

We spent the afternoon and evening discussing and preparing for our first day, which we were all looking forward to. The first day is always exciting meeting all the trainees. Everything was in place and ready. The rooms cleaned and ready, the ultrasound machines ready to function, and Hala, the director of the training site welcomed us with tea and coffee.

I was impressed to see Mohamed Khair, an obstetrician posted at the town Al Mijlad, who drove about 450 km on unpaved roads to join the second training week, excited and eager to develop his ultrasound skills and knowledge. His hospital caters for women from a wide catchment area including Darfur and some patients cross the borders from the neighboring newly founded country of South Sudan seeking care at his facility. His only referral hospital is in El Obeid, 500 km away! I was able to see the excitement in his eyes as he was telling me how the number of prenatal diagnoses of placenta previa has improved after the first ISUOG week of training.

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Prof Hisham Mirgani Mubarak and Dr Mohamed Khair

All trainees were engaged and motivated. It was inspiring to see how they were learning and helping each other. Mastora is a mother of three that had to travel for two hours to have her first ultrasound examination during her fourth pregnancy. She was found to be at her 30th week. The glance at her baby’s heart beating and movements lit her eyes. Fortunately, no abnormalities were noted.

Hospitality here is always great! We were invited to attend a football match between the host “Al Hilal” team and a guest team from Khartoum. Fortunately, El Obeid team won!

 

The Minister of Health also invited the ISUOG team and all trainees to dinner at the side of “Al Rahad” lake a 45 minutes drive from El Obeid. The view of the sunset was just incredible! Everyone enjoyed drinking “Al Jabanah” the traditional Sudanese coffee.

Tomorrow is our last day for the second visit. Each time we visit El Obeid we feel we make a difference to the healthcare of women in this region. What a feeling!”

Prof Hisham Mirghani Mubarak

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Enthusiasm for training and a trip to Lake Rahad on day 3 in Sudan

It’s day three of ISUOG Outreach in Sudan and days filled with lectures, hands-on training and famed jabana coffee are underway! Blogging on her experience is ISUOG Outreach Volunteer, Ms. Yasmin Casmod from South Africa, who writes:

“Today is the third day of the Outreach training program in Sudan.

As day three begins, we are halfway through the training and discuss the logistics for the day over breakfast. The day kicked off with a lecture by the team leader Prof Hisham Mirghani, followed by a lecture by Dr Sami Mahmoud, one of Sudan’s own.

Each group had an average of seven trainees and the practical sessions began with a specific focus on the intracranial anatomy, along with a revision of what has been covered thus far. Trainees are eager and enthusiastic to learn. It is certainly an honor and privilege to share knowledge and skills with professionals that are so motivated.

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Dr Sami Mahmoud teaching trainees

After the lunch break, practical sessions continued and the day ended off with a lecture on distinguishing between normal and abnormal appearances of the urinary tract.

We finished the day with a trip to the beautiful Lake Rahad and a delicious meal as well as the famous Jabanah coffee on the banks of lake.

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Trip to Lake Rahad

It is certainly rewarding to see tremendous growth and eagerness from all of the trainees and we look forward to continuous engagement and education.

-Ms. Yasmin Casmod

Trainees eager for more hands-on training! Day 2 in Sudan

Sabah al khair min El Obeid! Good Morning from El Obeid! The Outreach Team carries on with Day II of the program here in Sudan. Sharing her experience on the ground is Outreach Trainer Dr Angela Ranzini who describes her experience:

“Greetings from El Obeid! Today is Day 2 of our week in the Sudan. Once again, the week seems to be just flying by.

Our day today actually began on Sunday! One of the first things we did on day 1 was to ask for feedback from the trainees, and found that they are hungry for more “hands-on” training. Yesterday evening we compiled the results of the initial “hands-on” 6-step evaluation and reshuffled the trainees into new groups for today.

As sometimes happens, the best made plans change, and as trainers, we adapted. Last year, we had planned to have lectures in the morning and “hands-on” scanning in the afternoon, but when we got to El Obeid, we found out that the patients typically come to the clinic early in the morning, so we reversed the schedule to have “hands-on” scanning early in the morning and lectures after lunch.

This year, we found that patients typically come earlier in the week rather than later. So, given the trainees desire to have as much “hands-on” as possible, we adjusted the schedule. After an initial lecture on normal and abnormal heart (planes 7, 8, 9, 10) by Dr. Reem Abu-Rustum, the day was mostly spent doing directed scanning with the new groups, breaking for prayer and lunch, which was kindly provided by the International Planned Parenthood facility we are using for the training.

I have been consistently impressed with the trainees here in the Sudan. We have 28 trainees and lost only 2 over the past year (one relocated out of the country, and one was on her honeymoon) which I think shows an amazing dedication to the program. The eagerness to learn is palpable. The other thing that impresses me, is how hard these men and women work. All of the trainees are Ob/Gyn or Radiology physicians with their own practices here in the city or in the surrounding state. After class ends, many of them see patients in their offices until all hours of the night and some of them even into the morning. Despite being very busy and probably sleep deprived, they pay attention, don’t fall asleep and don’t get out their cell phones during lectures! During the lunch break, some did pull out their cell phones – to get second opinion consults for complicated anomalies that they recently identified in their patients.

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Attentive and hard-working trainees in El Obeid

My “hands-on” scanning group consists of both Ob/Gyn’s and Radiologists. Today we scanned one patient each ½ hour or so, and rotated trainees, so all people scanned at least one patient and some two. We used a portable Medison machine, which has quite a nice image and is equipped with color and pulsed wave Doppler, which proved useful in patients with small babies. Most of the trainees stuck around before and after their scan time to assist in offering scanning suggestions to the trainee.

The trainees are very supportive of each other and not shy about asking questions. After performing the “6 steps” with each patient, we progressed to doing axial “sweeps” of the fetus from bladder through the three vessel view, noticing all of the structures in between. We had good conversations about technique and management of some abnormalities.

Hands-on ultrasound training 

Most of the patients present were there for their first ultrasound between 26 and 34 weeks, although we did have one scan at 20 weeks. They are not hard to scan since they typically have normal BMI’s. They are eager to have an ultrasound, despite having 8 people in the room watching, and like women everywhere, want to know the gender of the child. Fortunately for the patients, we didn’t see any anomalies today in my group.

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Patients waiting to be scanned 

After the training session was over, the team relaxed with a Diet Coke and warm French Fries (chips) back at the hotel and traded observations about the day.

In the evening, we were invited to watch a football match by the Government. El Obeid played Khartoum and won 2-1. As the Government’s guest, we were escorted up the red carpet to our really comfortable red covered chairs at midfield. We were greeted by Dr. Abdullah, the Minister of Health, just after his arrival. What a treat!

The stadium was all lit up and colored flags ringed the upper wall. Two bands, one for each team competed for our attention with horns, drumming, dancing, flag waving and periodically, tongues of fire to celebrate a goal. Behind the stadium, two minarets were lit up with white and coloured lights as if to celebrate the game, and at half time, we were treated to jebena, a delicious spiced coffee served sweetened, in small glass cups. The heat of the day had dissipated and a bit of a breeze filled the stadium, making it a perfect evening to finish the day.

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El Obeid vs Khartoum soccer game

It is a privilege to be teaching ultrasound in the Sudan with such a dedicated partnership: ISUOG, The Minister of Health, International Planned Parenthood and Salamat NGO, all dedicated to improving pregnancy outcomes for the women of the Sudan and creating a sustainable ultrasound teaching program.”

-Dr Angela Ranzini

 

Trainers and trainees reunited in Sudan for Phase I Trip II

The ISUOG Outreach team has returned to El Obeid to conduct Phase I Trip II of the Outreach program in Sudan. Led by Prof. Hisham Mirghani of UAE  (ISUOG Ambassador to the Middle East), the team is comprised once more of Dr. Angela Ranzini of USA, Dr. Reem Abu-Rustum of Lebanon (also ISUOG Ambassador to the Middle East), Yasmin Casmod of South Africa, Sami Mahmood Abdelkhair of Sudan and ISUOG’s International Development Coordinator, Gesu Antonio Baez. The team was also accompanied by ISUOG’s local partner on the ground Salamat Doctors Charity President, Dr. Sohaib El Badami.

The week began with excitement as trainees were reunited with trainers who had been mentoring them all year via WhatsApp. Trainees sent their images for review and trainers sent them cases to go over to allow them to remain in touch with training.

The day commenced with an assessment of the trainees’ retention of previous materials covered via a pre-test assessment and a practical assessment examining their knowledge of both fetal biometry and their systematic approach to the six-steps. These assessments helped give the trainers a greater idea on how to tailor hands-on training for those struggling trainees so as to best help fine tune their skills.

 

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Prof. Hisham Mirghani delivering a lecture 

The day ended with lectures on the 20 planes approach to the routine mid-trimester scan, evaluating fetal anatomy from longitudinal section, as well as distinguishing between normal and abnormal appearances of skull and brain. Despite a long day, most of the trainees asked to start earlier to conduct more hands-on training. Stay tuned for more stories from the field this week as we cover more of ISUOG Outreach Trip II in Sudan.

 

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“Coming Full Circle Under the Sudan Sun…”
Collage by Dr. Reem Abu-Rustum 

Closing day of trip 1 to Oman: Phase 1 to be continued in April!

After an exciting week, Phase 1 Trip 1 of ISUOG Outreach in Oman officially came to an end. Trainers conducted post-assessments and noticed significant improvement in scanning. Trainees were anxious to know how they would keep in touch with their newly designated mentors. Both ISUOG Local Liaison Dr Mouza Al Salmani and ISUOG’s International Development Coordinator Gesu Antonio Báez reassured them that the WhatsApp groups recently created per team will help them keep in contact and help to fine tune their skills before the trainers return for Week 2 in April.

The day ended with a Closing Ceremony with the Omani Ministry of Health and distribution of certificates. Project Lead Dr Titia Cohen-Overbeek explains the day in detail:

“We left early for the Royal Hospital on the final day and started with the last set of lectures. ISUOG’s Education Committee had introduced for this project not only a theoretical assessment with pre and post-test questions, but also a pre and post practical assessment.  This meant that on the first day the trainees had to show whether they could obtain five specific planes before any teaching was done and the same planes had to be demonstrated today by them after four days of theoretical training and practical hands-on sessions. And what a difference!

If you are not familiar with ultrasound in obstetrics and the challenges the continuously moving fetus causes, this probably means nothing to you, but we could observe enormous changes in scanning abilities.  The trainees were also aware of the impact this week had brought. We had many discussions, particularly about the fact that a scan is only valuable if done correctly. The importance of using the same charts throughout the country so measurement obtained anywhere will reveal the same results, was also an issue the Ministry of Health would address.

WhatsApp groups with the trainees and their designated trainer were made to guarantee continuous communications for exchanging images, questions and education. The day ended with a happy closing ceremony in the afternoon.  

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Closing ceremony at the Royal Hospital in Muscat

This has been a very enjoyable first week and with the open and positive attitude of the Omani people we look forward to our return in April for the second week – inshallah!”

 

Dr Titia Cohen-Overbeek

A royal celebration on day 4 in Oman

Day four in Oman carries on with more exciting updates from the ground. ISUOG Outreach Trainer Dr. Valeria Angioni from Estonia shares her experience working in Muscat.

“Despite being 7am, we are already on our way to begin the fourth day of this incredible training week. While our driver leads us through Muscat to Royal Hopsital, Oman keeps spoiling us with yet another beautiful, sunny, and warm morning. It’s all so good that by now I’ve almost forgotten how cold and dark the mornings are in my hometown.

At our arrival, we find the Royal Hospital being beautifully decorated with the national colours and the portrait of his Royal Highness, the Sultan Qaboos bin Said al Said. The country is getting ready to celebrate the Sultan’s birthday on 18 November and even though the big day is still ten days away, the passion in the preparations for the event is a clear sign of its importance to people throughout the entire country. His Royal Highness, the Sultan Qaboos bin Said al Said is seen as a visionary, whose intuitions and wisdom improved the lives of the Omani people by, for example, going great lengths to develop a public education system that reached all parts of the country and included all sections of society.

ISUOG trainers in the decorated Royal Hospital 

One cappuccino later, we are all ready to begin yet another day of action. And by “we” I don’t mean only us the trainers, but also our great trainees who are all ready and eager to practice their scanning skills.

We start with the simulation training for transabdominal and transvaginal ultrasound and today the trainees can practice their skills on different obstetric and gynecological cases. Transvaginal ultrasound stimulation is particularly important as many trainees have a very limited experience in this field because of a troublesome acceptance of this approach due to cultural reasons.

Later during the day we move onto our hands-on training; today we are working on a checklist of competence for every trainee. It might not seem like much now, but this will be an enormous help when it is time to provide the feedback for further improvement.

On a personal note, I have to admit this is yet another moment that makes this experience so precious and special. For me, it is a true pleasure to have the opportunity to share knowledge with doctors that are so motivated and so enthusiastic about their job.

After our lunch break, the afternoon section features lectures on twin pregnancy, fetal growth, ectopic pregnancy, and gynecological pathology that can be related to pregnancy like ovarian cysts and fibroids.

Work doesn’t stop in the evening either, even though the settings change and the rooms of the Royal Hospital are replaced by the area next to the swimming pool of our hotel in Muscat. After a relaxing swim, it’s all about discussing how the day went at the hospital, sharing feedback on the training to learn from what went well and planning the activities for an amazing Day 5.

One could say Outreach work never stops in Oman – and, seen from a swimming pool in Muscat, I can promise you it’s amazing!”

Dr. Valeria Angioni

Practicing ultrasound with the probe on day 3 in Oman

We’re halfway through the Outreach Program in Oman and the trainees remain engaged while the trainers remain passionate and focused on delivering the program. Offering both an insightful and culinary insight is ISUOG Trainer Pauline Schut from the Netherlands blogging on her experience.

“Today was already the third day of the ISUOG Outreach Program in Oman, which means we are already halfway through the program; time goes by so quickly! We’ve also noted this during the hands-on training; so far we haven’t been able to stick to the time schedule. Fortunately, the trainees stay concentrated and motivated, which makes the teaching very rewarding.

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Busy day of hands-on training

Most of the trainees were even willing to come earlier to have more practice on the simulator, even though some trainees have to travel more than an hour to reach the site. Their eagerness to improve their ultrasound skills, together with the structured lectures provided by members of the Outreach Committee and Basic Training Task Force, have fulfilled their purpose and we’ve already seen a large difference in the quality of the images compared to the first day. Therefore, we are very curious about the results of the pre- and post-test assessments. 

Proper holding of the probe is still a challenging issue for the trainees, since most hold it as if it were a pen. Perhaps they handle it very carefully out of fear they might damage the delicate piezoelectric crystals (after the physics lecture), but we try to encourage a correct posture and ergonomics. 

 

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Pauline Schut helping trainees with proper holding of the probe

We’ve already encountered some interesting cases during the training, such as placenta praevia, growth restrictions and some structural abnormalities, which was useful from an educational point of view. In the meantime, we’ve learned a lot about the Omani health care system and antenatal care in particular. The differences are sometimes surprisingly small and problems that sonographers and obstetricians are facing can be quite similar. As an example, maternal obesity and its associated complications are an increasing problem in Oman.

After these days we can confirm that being on a diet seems like an impossible thing to do, as the food is very tasteful and served in huge portions.  This was once again clear when after a day of training and lecturing, we were invited for a dinner with Dr. Mouza, Dr. Fatma and Dr. Salwa of the Omani Ministry of Health: one delicious dish after another was placed on the table. We had a lovely night with these wonderful ladies, who explained us a bit more about family planning, premarital screening and also the improved educational level of women in this country over the last decades, of which they are the living proof of. 

Dinner with the Omani Ministry of Health and ISUOG trainers

During our after-dinner walk, we as trainers agreed that we are very happy to have been selected for this Outreach project. The organisation has been very welcoming and because of the positive attitude of the trainees, we feel that the goals of this project can be achieved.”

Pauline Schut

Applying concepts from image optimization on day 2 in Oman

It’s Day Two in Muscat for ISUOG Outreach with training still underway. ISUOG Outreach Trainer Dr Nimrah Abbasi reports her experience from the field as a trainer in the program:

“Every day our adventure in Muscat starts with early morning breakfast followed by a scenic drive to the Royal Hospital alongside the majestic mountains and mosques as we discuss the itinerary for the day and review our lecture material for teaching.  Today, the morning begins with ISUOG ambassador to the Middle East, Dr. Hisham Mirghani’s elegant presentation on probe movements reviewing sliding, rotation, dipping and angling motions as well as basic knobology.  Immediately following this, participants have the opportunity to practice these manoeuvres and review the 6 steps approach to carrying out a systematic obstetrics scan, which includes establishment of fetal lie and presentation, viability, number of foetuses, placentation, amniotic fluid volume as well as biometry in a hands-on workshop in the outpatient center.

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Muscat in the morning

It is only the second day, but it is clear to all of us trainers, that the enthusiasm is high and the learning curve is rapid among these highly motivated learners.  We are impressed to see participants quickly grasp and apply concepts from image optimization, as they learn to use various features and knobs on the ultrasound machine and begin to demonstrate proficiency in basic biometry.  What’s most inspiring to us is witnessing the relationships being built among learners during the practical sessions as we watch them encourage, teach and help one another complete learning exercises.  This further reassures us regarding the long-term sustainability of this Outreach project in Oman.

Hands on training and lecturing

Following a busy day of hands-on scanning and teaching about early pregnancy assessments and documentation we decided to spend our evening in the Frankincense scented alleys of the Muttrah Souq, which is one of the oldest Omani markets that sells traditional cloths, herbs, sweets, perfumes and gold.  After shopping for gifts and souvenirs, we were ready for a traditional Omani meal at Bait al Luban.  We chose traditional floor seating in true Omani style, and enjoyed famous local delicacies of shuwa, halwa and Omani coffee while debriefing about the day’s events, planning for the remaining sessions and discussing ways to improve the experience for our learners in the Oman ISUOG Outreach project.”

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ISUOG trainers enjoying a traditional Omani meal

Dr Nimrah Abbasi

Marhaban bikum fi Oman! Welcome to Oman for day 1 of ISUOG Outreach

Marhaban bikum fi Oman! Welcome to Oman, where ISUOG Outreach has just launched its inaugural program in Muscat, capital city of the Sultanate of Oman. A team of five have headed down to commence ultrasound in OB/GYN training, in partnership with both the Omani Government and GE Healthcare. They are training 28 key trainees from across the country who are destined to become trainers locally with intention to disseminate ultrasound training throughout the country. Leading this endeavour is Dr. Titia Cohen-Overbeek from the Netherlands, who shares her experience with the following blog post:

Yesterday the team arrived from different parts of the world for our first week of ISUOG Outreach training in Oman. The team consists of Dr. Nimrah Abbasi from Canada, Dr. Valeria Angioni from Estonia, Pauline Schut, myself from the Netherlands and naturally Mr. Gesu Antonio Baez (ISUOG’s International Development Coordinator) from London.

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ISUOG’s Mr. Gesu Antonio Baez and ISUOG trainers Pauline Schut, Dr Valeria Angioni and Dr. Nimrah Abbasi

We inspected the Royal Hospital of Muscat in the evening together with Dr Mouza Al Salmani – Local Outreach Project Liaison – who is one of the driving forces from Oman behind this project and the Head of the Fetal Medicine unit and the Obstetrics and Gynecology Department of this tertiary care hospital. The lecture theatre and four ultrasound rooms are excellent facilities for our teaching purposes.  To our pleasant surprise we found that the Ministry of Health had recently acquired an ultrasound simulator with both a transabdominal and a transvaginal probe, including a multitude of cases to use for teaching. This guarantees a continuing teaching program for the trainees between our visits and enhances the success of this project.

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ISUOG trainers Dr. Tita Cohen-Overbeek and Prof Hisham Mirghani with the Omani Minisrty of Health

During these first few hours in this new country, it is immediately confirmed how kind and open the Omani people are wherever you meet, and their hospitality to make us feel at home is tremendous.

On Sunday we are joined by Professor Hisham Mirghani (ISUOG Ambassador to the Middle East) and at seven in the morning, we are off to the hospital. During the Opening Ceremony by the delegation of the Omani Ministry of Health and the Department head of the Royal Hospital, we are informed about the mother and child health figures of Oman. They tell us that these figures have remained stable during the last five years while they aim for a reduction in maternal and fetal mortality, which they believe can be brought about through the introduction of ultrasound at a high qualitative level for all Omani women. It is clear that we have our goal set and we start to work with the 28 trainees selected from the 11 regions of Oman.

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Group photo of trainers, the Omani Ministry of Health during the first day

In the morning, we first took an assessment of theoretical and practical knowledge before the real teaching could start. We encountered different levels of experience  with some quite proficient compared to others with little familiarity with ultrasound. The trainees are a mixture of obstetric and gynecology experienced doctors, some even with fetal medicine experience, and even family medicine physicians. The kind nature of the Omani and their willingness to help each other is very evident, which is encouraging as the aim of our project is that these women trainees will become the teachers of the near future.

Following lunch, which included a very nice story on the origin of the famous Omani bread pudding Umm’Ali, we started the lectures in the afternoon. Many questions were asked, which was so encouraging! After this first day, we are all in good spirits and look forward to the rest of the week.”

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Dr. Titia Cohen-Overbeek

ISUOG Outreach is off to Oman!

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ISUOG Outreach is excited to announce that it will be launching Phase I Trip I of its Outreach Program in Muscat, Oman starting Sunday, 5 November. Led by ISUOG Outreach Committee Member, Dr. Titia Cohen-Overbeek and supported of ISUOG Ambassador to the Middle East, Prof. Hisham Mirghani, the team consists of an international group such as Dr. Nimrah Abbasi of Canada, Dr. Valeria Angioni of Estonia and Ms. Pauline Schut from the Netherlands, with ISUOG’s International Development Coordinator Gesu Antonio Baez joining the team to deliver the program. The team will be teaching a group of 30 trainees from across the country in basic ultrasound in obstetrics and gynecology. With the backing and official partnership of the Omani Ministry of Health and GE Healthcare in supporting machines on loan, the ultimate goal of the program is to train key doctors from vital regions of the country to spread ultrasound knowledge and training in order to foster a sustainable environment in OG/GYN ultrasound education. Stay tuned on our blog for updates on the field as they happen! For more information about our program, visit our website for more details.