Wrapping up Ghana – inspire and empower

It’s been an incredible week but as the saying goes “time flies when you’re having fun”! The Outreach Team wrapped up Phase II Trip II of the Ghana project on Friday, 17 March. At this point, many of the strongest trainees felt comfortable enough to actually assist in training the other trainees on scanning techniques. This served particularly useful when the trainees had to undergo the competency checklist under the supervision of their trainers to determine their strength in scanning. After an intense morning of more practical training and scanning, the day finally ended with a closing ceremony presented by the Kumasi Metro Health Services and local representatives of the Ministry of Health.

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Dr. Janet Horenstein filling out Trainee Scanning Competency form for one of the trainees after evaluation
Image courtsey of G.A Baez for ISUOG Outreach

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Dr. Alberta Britwum-Nyarko, Director of Kumasi Metro Health Region, addresses the audience during the closing ceremony
Image courtesy of G.A Baez for ISUOG Outreach

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Outreach Committee Chair, Dr. Anthony Johnson, goes over what will be expected of the trainees in the coming months.
Image courtesy of G.A Baez for ISUOG Outreach

Throughout the week, some trainees really stood out as potential trainers to consider for the next and final trip of Phase II of the Outreach Program in Ghana. These trainees – Jonah Adams Abbekah, Bernice Nsobilla, Prince Owusu, Osei Sarpong, and Albert Adu Poku – in addition to our local trainer in Kumasi, Dr. Buah Hamilton, will take the efforts made by ISUOG in the Kumasi Metro region since 2010 to the next level. ISUOG Outreach is looking forward to working with the Ghanaian Ministry of Health, our on the ground partner Women’s Health to Wealth (WHW) and GE Healthcare to empower local practitioners with ultrasound training and provide the quality scanning and care that all Ghanaian women deserve – stay tuned as we’ve only just begun.

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It’s only just the beginning! Group picture at end of Phase II Trip II
Image courtesy of G.A Baez for ISUOG Outreach

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ISUOG’s International Development Coordinator, Mr. Gesu Antonio Baez, takes a selfie with the trainees from Old Tafo Hospital
Image courtesy of G.A Baez for ISUOG Outreach

Gratitude for ISUOG ultrasound training

Trainee Adam Abekkah and selfie with Sarah Stephens and the training midwives in Old Tafo
Image courtesy of G.A Baez for ISUOG Outreach

For day 3 we’re following Dr Janet Horenstein and Dr Theodora Pepera-Hibbert training the group at Old Tafo.  Dr Pepera started the day with a review of gynecological scan techniques which carried on into conducting transvaginal scans during a good portion of the day. The strongest of the group, Adams Abekkah, even began training the other trainees (under the watchful eye of Dr Horenstein). The Old Tafo clinic was lined with patients. About 20 were scanned today, which gave plenty of opportunity to practice for the group!

Midway through the training, the chief clinical director paid a visit to the team and expressed his gratitude to ISUOG and the training being given in Kumasi. He explained seeing a notable difference in the quality of mothers lives in the region and the accuracy of diagnosis thanks to the ultrasound training skills. Needless to say, such mention surely made the team beam with pride!

Training gynecological scan techniques
Image courtesy of G.A Baez for ISUOG Outreach

Follow us as we continue to report from the forks.

Improving practical scanning skills in Ghana

GE Healthcare’s Sarah Stephens teaching machine optimizing and practical sessions at South Kumasi Hospital
Image courtesy of G.A Baez for ISUOG Outreach

Day two of Phase II Trip 2 in Kumasi, Ghana kicked off and we’re now following the training group in Kumasi South Hospital for another day of ultrasound training. GE Healthcare’s Sarah Stephens met with the group today to give a lecture to better optimize their skills on the GE Voluson machines that were donated to the program a year ago. Some tips or “pearls” she shared with the team included how to make the image blacker or whiter in order to achieve a sharper image when scanning.

Most of the patients seen were in their third trimester and there was even one with multiple pregnancy with fetuses that moved constantly making it difficult for the scanners (but good practice!). The team was stronger today, measuring femur length quickly and confidently with sonographer Prince Owusu even leading on training other trainees on a few scanning skills.

Meanwhile in the other sites, some highlights included the Suntreso group with Dr Theodora Pepera-Hibbert leading the group in recognizing ectopic pregnancies and scanning more than 23 patients in one go.

“The trainees have been very ready and very attentive.” said Dr Janet Horenstein, who worked with Project Lead Dr Anthony Johnson at Old Tafo Hospital. “They are still not at level they should be, but hopefully with more scanning they’ll get there soon.”

Sonographer and trainee Prince Owusu scanning with new skills thanks to guidance of Sarah Stephens
Image courtesy of G.A Baez for ISUOG Outreach

Stay tuned for more updates from the field as we report from Ghana!

Successful start to training in Ghana

Picture above are ISUOG trainers Dr Tony Johnson, Sarah Stephens, Dr Theodora Pepera-Hibbert Dr Janet Horenstein and ISUOG International Development Coordinator Gesù Antonio Báez
Image courtesy of G.A Baez for ISUOG Outreach

We’re back on the ground in Ghana. The ISUOG training team, led by Outreach Chair Dr Anthony Johnson (USA), immediately hit the ground running for Phase II Trip II as if no time had past since the last time we worked in Kumasi back in 2015.

The training team is currently working in each of our key hospitals for the project: Old Tafo, Kumasi South and Suntreso. The 18 Ghanaian trainees were divided between each of the hospitals to work with each different trainer including Dr Janet Horenstein (USA), Dr Theodora Pepera-Hibbert (Ghana/UK) and local trainer Dr Bush Hamilton (Ghana). GE Healthcare Sarah Stephens also joined the team to give an overview of the three GE Voluson machines donated last time.

Hands-on training in session
Image courtesy of G.A Baez for ISUOG Outreach

It was remarkable to note how eager the sonographers were not only scan, but also to help train other trainees (such as the midwives).  It really left an impression on the trainers who noticed little by little the “teach the teachers mission” slowly unfold for them.

The main part of the day was focused on review of lectures, especially going over the key “6 step approach” and providing more hands-on training to really hone in on their skills from last time. And they definitely did get practice with the team at Old Tafo, scanning well into 5:30 PM – after training ended at 4:00 PM.

Stay tuned for more stories from our project on the ground in Ghana and follow our blog for more Outreach journeys.

Visions of Burma – supporting training in Yangon

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Outreach team (from left to right: Franti Grochal from Slovakia, Dr. Philippe Jeanty from USA, Ya Chiao Hu from Taiwan and Federico Badano from Argentina).
Image courtesy of Dr. Philippe Jeanty of TheFetus.Net

On 7 March 2017, Outreach Committee Member and Founder of TheFetus.net Dr. Philippe Jeanty (USA), led a group of trainers in Yangon, Myanmar to train 30 trainees from across the country in basic OB/GYN ultrasound. ISUOG Outreach supported this mission and below, Dr. Jeanty provides his first impressions of Yangon from early this week.

“First day:

This is the first Outreach course we’de done in Yangon, Myanmar. The first day was rest and recovery from very long trips! Federico Badano was the longest distance flyer (29 hours from Argentina), followed by Franti Grochal (26 hours from Slovakia). Ya Chiao Hu from Taiwan and Gwang Jun Kim from South Korea had an easier time but still pretty long trips!
We did some light visiting, taking a local train to site see. Interestingly, we crossed the tracks a few time to get from platform to platform. Very surprising to me!  The train was full of colorful people. They use some ground up stone for makeup and sunscreen. In the train there was a panel with 3 warnings: you can’t smoke or litter, but more surprisingly, you cannot kiss on the train!

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Yangon train
Image courtesy of Dr. Philippe Jeanty of TheFetus.Net

The train was really packed and vendors circulating with all types of food, drinks and trinkets. They even sell betel leaves that people keep in their checks, a little like the coca leaves in the Andes with similar bad effects on teeth! We chatted with some people who were very friendly and quite interested in us. Actually mostly interested in Ya Chiao and we learned later that Korean movies are very popular here and they thought she was a Korean actress!!
We visited a pagoda with an immense Buddha statue made of a single block of marble imported (if I am correct)  from Nepal.
The food is very varied and influenced by Chinese and Indian cuisine.
Today was the first day of the course and we met with our local contact, Dr Yin Yin Soe, who organized the course.
We had 30 students and they come from all over Myanmar! It was incredible that many had come from hospitals with only one obstetrician so it was apparently difficult to get government permission for them to attend the course and have surgeon cover their absence. Many travelled by train the night before. Compared to previous Outreach courses, they are much less intimidated which makes the contact easier.
We had class room in the morning and workshop the afternoon.
It is very very hot! 37 C/99 F, but the students were really eager to learn!

Second day:

Ya Chiao scanning

Yao Chiao scanning with a trainee
Image courtesy of Dr. Philippe Jeanty of TheFetus.net

Since I am so hard at hearing, I got in the habit of asking people to write their questions on paper and drop them on the desk. This is also a great technique for shy students and women who otherwise would not ask questions. Well, we were inundated and the questions reflected a very good level of knowledge. This is an interesting situation with knowledgeable students who just have very little hand-on practice. So I worry that our lectures were too basic.
For Ya Chiao, this was her very first ever presentation in front of a class and even behind her impassible stoic face, she was clearly nervous! Sonographers don’t often teach physicians in Asia but she did a very good job!
Gwang Jun had the second presentation and talked about CNS anatomy and the views. As expected, he had a great presentation and has a unique style of teaching, for instance a way to remember the ventricular system by folding the fingers was a refreshing approach to the usual topic!
Federico and Franti then did their presentation with the ease of someone who has spent years doing them.

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Trainers with trainees
Image courtesy of Dr. Philippe Jeanty of TheFetus.net

The afternoon we had tons of patients with anomalies, including large cephalocele, missed AB, triplets and so on. Some patients needed TV examination which we rarely do in courses like this and Concordia rapidly got us a TV probe and we did several scans. It helps that women here are accepting and that almost all the students are women.
They know what they need to look for but needed help in coordinating what they see on screen with the movement of the transducer. So I hold their hand and show the movement. And invariably they look at my hand moving theirs instead of looking at the screen! So finally I took a patient chart as a “blind” to force them to just look at the screen!
The machines we have are uneven resolution. The three top end machines are fantastic but the low end one makes you realize what it is to scan in a country that has a hard time affording to machines: we are very spoiled!”

Stay tuned for more stories from Myanmar and next week, as we report from Ghana!

 

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Outreach team (from left to right: Franti Grochal from Slovakia, Dr. Philippe Jeanty from USA, Federico Badano from Argentina, Ya Chiao Hu from Taiwan and Dr. Gwang Jun Kim from South Korea)
Image courtesy of Dr. Philippe Jeanty of TheFetus.net

ISUOG returns to Ghana!

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Women in waiting – Kumasi, Ghana 2015
Photo by G.A Baez for ISUOG Outreach

 

Following a successful Outreach Program back in November 2015, the ISUOG Outreach team is returning to Kumasi, Ghana for Phase II Trip II on 13 March 2017! Led by Outreach Chair and Project Lead Dr. Anthony Johnson (USA), the team will consist of Dr. Janet Horenstein (USA) and Dr. Theodora Pepera-Hibbert (UK/Ghana) once more. ISUOG’s International Development Coordinator, Mr. Gesu Antonio Baez, will also be joining the team in Kumasi. ISUOG Outreach is proud to be working with local NGO partner Women’s Health to Wealth (WHW) in supporting the team and program mission, as well as GE Healthcare who previously donated 3 Voluson machines for this project. The team is looking forward to getting back on the ground and help the trainees hone in on their skills and build their confidence to train locally in line with ISUOG’s “Teaching the Teacher’s” concept. For more information on our work in Ghana, visit our website for more details.

Stay tuned for more stories from the field as they happen – subscribe to our quarterly newsletter!

Making a difference in Papua New Guinea

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Dr. Nayana Parange (at centre with scarf) with PNG team and trainees, displaying their certificates (image courtesy of Dr. N Parange for ISUOG Outreach/ASUM)

ISUOG Outreach Volunteer, Dr Nayana Parange has recently led the Papua New Guinea Outreach mission in October, conducted in partnership with the Australasian Society of Ultrasound in Medicine (ASUM). In this blog, she recounts her experience on the field and her impressions with the local dynamics.

Papua New Guinea – the land of striking natural beauty with fascinating tribal customs. It is also one of the toughest places in the world to become a mother.  With great excitement, I was coming back to Papua New Guinea (PNG) for my fifth annual visit for another intensive workshop, but this time with an enthusiastic team. The team comprised of Dr Sujatha Thomas from Darwin, Dr Kris Barnden from Tasmania, Dr Alice Robinson from Melbourne and I from Adelaide, and all of us arrived in Port Moresby on Saturday, 22nd October 2016.

Our intensive workshop commenced on Sunday morning, and Prof Glen Mola, an Australian-trained Obstetrician/Gynecologist, introduced us to the trainees, all of whom were doctors training in OB/GYN, as well as rural and remote emergency medicine. The trainees were eager to start training on a Sunday morning, full of hope and keen to learn basic techniques to use ultrasound to help their patients.

We started off the workshop with a quiz to establish the baseline knowledge of the cohort. This enabled us to plan and focus efforts on aspects of hands-on training, such as the ISUOG “six-step” method  of evaluation. As the workshop progressed, we also got several opportunities to interact with medical students, midwives and consultants, and we were able to conduct several presentations for the whole department as well.

It is hard to envisage the reality of pregnant women in PNG. Nearly 15,000 women deliver in Port Moresby General Hospital, and women able to find their way to the hospital are some of the more fortunate ones. Maternal and perinatal mortality is high with 88-98% of these deaths being preventable. Extreme poverty, remote geographic location, mountainous topography leading to inaccessibility of health services, sociocultural factors and most importantly, inaccessible and ill-equipped health centres with a shortage of skilled professionals have contributed to the poor maternal mortality rate in the country.

We came across a wide range of pathology and I was deeply moved by the stoicism displayed by the women, especially when given bad news. One such incident that has been indelibly imprinted in my memory, is where Sujatha and Alice scanned a lady at around 14-16 weeks of amenorrhoea, and diagnosed an abdominal ectopic pregnancy of nearly 16 weeks gestation. We then got to know later that she could be operated upon, in a timely manner, where although she lost three litres of blood, she recovered from the surgery. At least one life saved because of ultrasound!

Common causes of maternal death in PNG include sepsis, low lying placenta leading to postpartum haemorrhage, ectopic pregnancies leading to catastrophic bleeds. Fetal and neonatal deaths here are common because of growth restriction and prematurity. A vast majority of these problems can be recognised on ultrasound, and most often, interventions can be applied to prevent mortality and morbidity, but there is a shortage of skilled personnel to diagnose these problems to be able to manage them effectively.  The dedication of the health professionals though, often overworked and under resourced, is inspiring. Despite the insurmountable challenges, as Prof Glen Mola says, there are many people doing amazing things within the given constraints and making a difference in so many lives through sheer will and personality. “We can’t give up”, he often says.

I would be remiss if I didn’t mention the effort and dedication of the trainee doctors to master the content as much as possible within a short duration. All of them were quite proficient by the end of the training program, and were able to obtain anatomical landmarks and measurements correctly, and confidently perform the six step approach. Quiz scores improved from a 20 percent average to 90%!  A job well done!

Thank you ASUM, ISUOG and our wonderful outreach team! I feel very grateful and privileged to have been able to participate and play a role in PNG ultrasound outreach. We have a long road ahead of us, and the path is not easy, but onwards and upwards from here. Together, hopefully, we will be able to make a difference.

 

“Individually we are one drop. Together, we are an ocean” –  Ryonosuke Satoro.

Impressions from a first time volunteer in Papua New Guinea

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ISUOG  Outreach volunteer Alice Robinson (far right) in Papua New Guinea with one of the trainees (Image courtesy of Nayana Parange)

 

ISUOG Outreach and the Australasian Society of Ultrasound in Medicine (ASUM) conducted an Outreach mission in Port Morsby, Papua New Guinea in October 2016. As a first time volunteer for ISUOG Outreach and ASUM, Alice Robinson of Australia explains her experience in empowering other practitioners with ultrasound.

Flying into Port Moresby Airport, I found a hive of activity; many of the travellers were expats arriving back to Papua New Guinea (PNG) for a variety of reasons – leading fishing charters, managing a food distribution company, working in a local school, whilst others were visiting PNG for tourism, which extends to bird watching in the highlands and walking the Kokoda track. Brief interactions with these fellow travellers made me think I had underestimated the resources available to this small country, which lies just a hop, skip and jump from the northern tip of my own home country, Australia (150km to be more precise).

Papua New Guinea has a maternal mortality rate of 250 per 100,000, one of the highest in the Western Pacific region, and a high fertility rate of 3.8 births per woman, which is double that of Australia’s fertility rate. The role of ultrasound in the overall care of women and children in PNG needs to be put in the context of these staggering figures, and is certainly vastly different from the role of ultrasound in Australian medical practice.

Spending five days at Port Moresby General Hospital and teaching ultrasound to a dedicated group who had traveled far to attend the course made me realise I had overestimated the resources allocated to maternal health and safety. The doctors, midwives, and supporting healthcare staff who we had the privilege of meeting during the program provide an amazing service to the women of PNG despite limited supplies and challenging circumstances.

With all this in mind, my three colleagues and I (brought together by the Australian Society of Ultrasound in Medicine – ASUM – Outreach Committee), tailored a basic OB/GYN ultrasound course for the nine rural healthcare professionals we trained. Despite the four tutors originating from Australia, we come from different corners of the country and gained our medical, ultrasound, and teaching skills via varied pathways. It was such a pleasure to work with like-minded professionals who brought very different attributes and skills to the course, such as Nayana Parange (PNG Project leader) who’s prior experiences in PNG were particularly beneficial in understanding the local healthcare system and how our course could be most beneficial.

As we took the trainees through tutorials (two or three per day) and practical sessions (three-four hours per day), it became apparent that their enthusiasm and hunger for knowledge was not only due to their impending exams (to achieve a Diploma in Gynecology and Obstetrics), but also due to the direct applicability of new ultrasound skills to each of their clinical practices. The small group practical sessions were a highlight, with two to three trainees per tutor, and a long line of patients from the outpatient clinics and inpatient wards at the hospital. This gave us the opportunity not only to meet some delightful local women, but to see each of the trainees improve individually over the next four days.

The many stories that were told over the course of the program highlighted that ultrasound will be another useful tool at the disposal of these talented doctors. A perfect example is one participant who had recently undertaken carpentry and plumbing training, skills which seemed as vital as any medical technology in keeping his remote health centre running smoothly.

Looking to the future, we hope that this brief training course will give participants the ultrasound skills to save lives and improve management in women’s health. This will require ongoing support and feedback for the trainees, which we are planning to provide with online discussions, and refresher courses during subsequent visits.

I feel privileged to have been involved in the first joint ASUM/ISUOG ultrasound training course in PNG. The involvement of both organisations ensured a structured approach and collaboration between all parties to achieve a common goal. Our glimpse into PNG life was very educational, and I hope we were able to teach the trainees as much about ultrasound as they taught us about overcoming the difficulties of working in the country’s rural areas.

Alice Robinson
Australia

 

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Patients in waiting, Port Morsby – PNG (Image courtesy of Nayana Parange)

 

 

Humbled. Elated. Empowered.

Blog by ISUOG Ambassador and Trainer Reem S. Abu-Rustum

Humbling. Elating. Empowering. That is how I would describe my first Outreach mission with ISUOG to Sudan.

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Gesu Antonio Baez introducing ISUOG Outreach

From the moment our team of trainers met, it was obvious how compatible we all were with our different ethnic backgrounds and personal experiences. Under the watchful eye of ISUOG’s phenomenal Gesu Antonio Baez, and the leadership of insightful Dr. Mirghani, we knew that this was destined to be a most impactful mission for all involved.

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On the Lakeshore of Rahad

Humbling it was to be received by the warmest most genuine people of Sudan who welcomed us like royalty, and escorted us with pride all over Al Obeid and North Kordofan State. Despite the logistical challenges, they made sure we had the most comfortable accommodations and an organized clinic set up with all the necessities in place, not to mention the unforgettable “Jebana” coffee. The Minister of Health, his Excellency Dr. Abdullah Faki Omer, never left our team: from receiving us at the airport to escorting us as we departed. Dr. Khidir was the driving force behind our entire mission on the Obeid front: the true embodiment of commitment and dedication.

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Rahad Lake

Elating it was to have the privilege to participate in the sonographic education of 30 most dedicated Ob/Gyn and Radiology Physicians who had come from all over North Kordofan State to attend our 5 intense days. We had their undivided attention whether it was during the didactic or the hands-on sessions. They had such a hunger and eagerness to learn, and were so receptive to any instruction or criticism to help them improve their sonographic skills. The trainees were divided into 4 groups and rotated on a daily basis with the trainers. On the last day, each team of trainees ended up with their trainer from the first day. I had the “Red Team” and it was amazing to have them back with me on the last day: the progress they had made was unbelievable. They were secure and confident in utilizing the systematic 6 Steps Approach, were able to recognize key anatomical landmarks and were able to manipulate the probe to arrive at the required biometric planes.

Dr. Samira Demonstrating 6 Steps and the Red Team

Empowering it was to be able to play a role, albeit indirect and quite small, in the future of the mothers of Sudan. Visiting the labor ward at the Al Obeid new Maternity Hospital, a referral center for the area, offered us a glimpse of the challenging conditions faced by both physicians and patients. Though all the basic necessities are met, the patients have to secure and purchase key “material” for labor, and they are usually discharged 2 hours postpartum to make room for the other 15-20 daily parturients, not counting the cesarean deliveries. Nonetheless, there is an unshakable commitment from the Sudanese Government led by the Ministry of Health, and an army of health care providers dedicated to improving the maternal and neonatal mortality rates and their co-morbidities. It was most empowering for me, as a member of the ISUOG Outreach Team, to be a part of Sudan’s vision for a future where every woman has access to a properly performed sonographic examination in order to identify and safeguard against the major contributors to maternal morbidity and mortality.

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Our Entire Team

Humbled. Elated. Empowered. That is how I feel. That is what Sudan and its beautiful people have left me with. I feel honored and privileged and I eagerly look forward to our next mission amongst the most gracious Sudanese…

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Closing Ceremony 

 

Anomaly scans and ready hands: Day 3 in Sudan

Day Three of the Outreach Program in Sudan had an exciting start! After a lecture on placental assessment by Prof. Hisham Mirghani, the trainees broke off into their teams. Outreach Trainer Yasmin Casmod’s group identified two anomaly scans (one which was oligohydramnios with abnormally large eyes and heart), which had to be immediately consulted over to Dr Sami Mahmoud to oversee and recommend follow up accordingly.

(Attentive trainees, Dr Angela Ranzini explaining fetal anatomy in 2nd and 3rd trimester and Dr Sami Mahmoud explaining a scan; images courtesy of G.A Báez for ISUOG Outreach)

The trainees in Dr Reem Abu-Rustum’s group today were completely enthusiastic on scanning and encouraged her to show them new techniques even beyond the practical session.

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(Dr Reem Abu-Rustum explaining Fetal Biometry; image courtesy of G.A Báez for ISUOG Outreach)

Lectures continued the following morning on practical sessions, covering topics such as Fetal Growth, Fetal Anatomy and Amniotic fluid index.

Stay tuned as the ISUOG Outreach program in Sudan continues!