ISUOG Outreach is committed to ensuring that every woman throughout the world has a quality ultrasound scan – and that is evidently assured via training and quality education. With such a mandate, it is with no surprise that the the World Health Organization (WHO) finds an ally in ISUOG Outreach, with whom it has been working as a close partner in the Partnership for Maternal Newborn and Child Health. Recently, the two organizations joined forces to support the WHO Action trails (a multi-site randomized trial of antenatal corticosteroid use for women at risk of imminent preterm birth in hospitals in low-resource countries ) where ISUOG Outreach recruited two of its volunteers to provide training accordingly. Reporting from the field are ISUOG Outreach Trainers Dr. Lynn Coppola (USA) and Dr. Sandhya Maranna (Australia) who share their experiences taking part in the Action Trails in multiple countries – from India to Kenya.
“The ISUOG Outreach is supporting the World Health Organization (WHO) for the ACTION Trails (Antenatal CorticosTeroids for Improving Outcomes in Preterm Newborns) which will be conducted in a total of 28 sites spanning 5 countries. The study is designed to address current concerns regarding the efficacy and safety of antenatal corticosteroid use in low-resource settings. Accurate gestational age assessment will be an important component of the study, and the WHO has thus provided an ultrasound machine for each of 28 sites. ISUOG Outreach trainers are providing the associated fetal biometry training. Thus far, training has been conducted in India, Bangladesh, Pakistan, and Kenya. Training in Nigeria is scheduled to occur in May. Here are some of the highlights!
India: Sandhya Maranna, an ISUOG Outreach Trainer with academic and clinical background in medicine, radiology and ultrasound, collaborated with WHO as a temporary adviser in the trials. She trained ten obstetricians and gynaecologists in a 2400-bed tertiary, referral research and teaching hospital in Belgaum in Southern India. ‘Train-the-trainer’ model was employed to standardise protocol with estimating gestational age or patient recruitment into the trials. She and Dr Lynn Coppola will be continuing their collaboration with the quality assurance of the ultrasound component of the project.
Dr. Sandhya Maranna observing training in India (Image courtesy of Dr. S. Maranna)
Teaching hospital in Belgaum, India (Image courtesy of Dr. S. Maranna)
Bangladesh: Training sessions (both didactic and practical) were conducted in both Dhaka and Sylhet, with approximately 10-12 trainees at each site. ISUOG training materials and Dr. Alfred Abuhamad’s eBook entitled Ultrasound in Obstetrics and Gynecology: A Practical Approach were the primary didactic materials used. As common with all sites, the trainees in Bangladesh had a wide range of prior experience with fetal ultrasound. Due to their excitement to participate in the study and to improve their personal ultrasound skills, it was fun and amazingly rewarding to facilitate their learning process. Their enthusiasm to work together as a group and to help each other was obvious. This picture is of Dr. Maritza Gonzalez (MFM fellow, University of Arizona Health Sciences Center) as she works with some of the trainees in Sylhet. In the other picture, you can see that the love for selfies shows no national boundaries! Dr. Saima Sultana and Dr. Salahuddin Ahmed were gracious and kind hosts.
Training in Bangladesh (Image courtesy of Dr. L. Coppola)
Dr. Lynn Coppola and the trainees in Bangladesh (Image courtesy of Dr. L. Coppola)
Pakistan: Approximately 10 trainees from 2 sites met at Aga Khan University in Karachi for the training. As evidenced by the fact that some trainees even travelled for 8 hours by overnight train, they showed great dedication to preparing their site for the ACTION trial. Some attendees were motivated enough to even attend the didactic sessions for a second time when conducted in Hyderabad! Although some of the trainees had prior ultrasound experience, this was the first time that others had ever received formal ultrasound training. The improvement in their skills, the evolution of their questions, and their expressions of appreciation were all a great reward. The group picture shows our Pakistan ultrasound trainees, accompanied by local ACTION trial leaders Dr. Shabina Arif, Dr. Farrukh Raza, and Dr. Sajid Soofi.
Dr. Coppola with the trainees in Pakistan (Image courtesy of Dr. L. Coppola)
Hands-on training in Pakistan (Image courtesy of Dr. L. Coppola)
Kenya: Training was conducted at the Reproductive Health Unit of Thika Level 5 Hospital and was attended by approximately 15 providers, representing 4 study sites. Local flooding from an unusually wet rainy season significantly delayed our arrival on the first day, but the weather subsequently improved. Again, the dedication of the trainees to the trial and to improving their personal ultrasound skills was readily apparent. The trainees were tireless in their desire to spend time on the ultrasound machines and to stretch the practical sessions for as long as possible. They additionally created a short list of extra questions for didactic review on the last day. Also on the last day, we had a small bit of excitement and practised “speed scanning” for one patient as she was apparently in active labor and we were not in physical proximity to the maternity ward. Dr. Joshua Vogel (WHO) and Dr. Zahida Qureshi (University of Nairobi) were in attendance to support the training process and to encourage the trainees to share their new skills with others when they return to their home study sites.
Group picture in Kenya (Image courtesy of Dr. L. Coppola)
Dr. Coppola going over a scan with trainees (Image courtesy of Dr. L. Coppola)
Trainees scanning in Kenya (Image courtesy of Dr. L. Coppola)
Participation in the ISUOG Outreach program has been an amazingly rewarding experience for me. While writing this blog and thinking about my most favorite memories, these are the benefits that I continue to treasure the most:
- Making a small contribution to an important international efficacy and safety trial
- Witnessing a clear international dedication to maternal and child health
- Strengthening obstetric ultrasound capacity at various sites by “training the trainers” (a benefit that will extend beyond the actual WHO ACTION trial)
- Meeting new friends and establishing opportunities for future collaborations
In gratitude to ISUOG Outreach (and to Sandhya Maranna for contribution of the India portion of this blog submission)
Lynn Coppola, MD, MPH
Assistant Professor OBGYN, Maternal-Fetal Medicine
University of Arizona College of Medicine