Having arrived home safely, Nayana Parange provides us with a summary of the trip, starting from Day 2:
Day 2 was a day of evaluating the trainees’s baseline skills and knowledge, and consolidating basic biometry and ‘ ISUOG six step evaluation‘ in pregnancy, which included checking for fetal presentation/lie, fetal viability (heartbeat), number of fetuses, placental location, amniotic fluid and biometric measurements. This gave us an idea of the strengths and limitations in each trainee to consider the best strategy to ‘fast-track’ their learning.
Day 3 at work dawned and after the usual greeting “ Wo ho te sen?” meaning ‘how are you’ to a standard response of “ me ho ye” meaning ‘I’m good’, we got down to business.
The plan for the day was to get each trainee to perform 2 to 3 scans each for 30 to 40 minutes per scan. Each trainee was encouraged to get the basic ‘six step’ done quickly and then focus on fetal anatomy. We began with the relatively easy imaging of bladder before progressing to other structures. The joy on the faces of trainees when they were able to muster all fazes – when Emelia learnt to trace the spine completely in all the different views, or when Evelyn got the diaphragm views or when Jemima managed to identify all chambers in the four chamber heart as well as get the outflows—is indescribable. My vegan lunch today included traditional yam and tomato sauce-delicious!
Dr Hamilton was called away in between a few times while scanning – there were a few emergencies – including a caesarean section for fetal distress, as well as a ‘maternal death’ audit. When he got back, he let us know that this was a case where the woman had probably had malarial fever, obstructed labour and a ruptured uterus leading to haemorrhage and death. It is a sobering thought-Malaria still takes a lot of lives here in Kumasi and in most parts of Africa. Once we got back to the hotel, we compared notes as well as met up with trainees Evelyn, Erica and Yusif over a working dinner (Chinese food), where the trainees practiced their presentations for Friday, with individual as well as collective feedback provided to all.
Day 4 was spent doing more of the same, but today I decided to focus a bit on knobology of the machine as well -optimising controls, showing them changes in gain, TGC, dynamic range, transducer frequency, focal zones, sector width, depth, high resolution zoom etc can make a difference in image interpretation. Initially the trainees were a bit reluctant to use the controls as they were used to working with presets, but their confidence gradually grew and they felt more encouraged to play with the machine controls as we progressed along the day. After scans, we also managed to squeeze in a half hour trip to the cultural centre in Kumasi thanks to Evelyn and Erica. I was given a tour of the traditional handloom weaving of the tribal designs and patterns – very beautiful. I also bought my souvenir—a beautiful bronze mask depicting a Ghanian tribal woman.
Day 5 scans were basically a wrap up with final evaluations on their progress. It was a short scanning session as we had to truncate the scanning sessions by 11 am to be able to get to our final session with midwives and trainee presentations. It was African Union day, so the day was filled with celebrations across the city, the air with music and African drumming. Traffic was horrendous.
We eventually reached the centre, Kumasi South, where the midwives had gathered to listen to the trainees. Erica and Yusif did a great job. Eric stressed the importance of ultrasound in diagnosis of ectopic pregnancy and Yusif discussed amniotic fluid evaluation on ultrasound. They were both very interactive and the midwives enthusiastically participated as well. We were presented with a beautiful painting as well as traditional attire and we had a presentation ceremony, awarding certificates to trainees amidst lots of clapping and cheering. The last part of the evening was the post-tests which we conducted resplendent in our African attire. This was then followed by lots of photos. The trainees had developed a lot of confidence over the week, and assured us that they would keep up with their studies and case discussions.
Our last evening at Kumasi, we decided to visit an African restaurant, ‘Beauty Queen’. The lovely waitress Gladys managed to rustle up a tasty vegan African stew for me, with lots of vegetables.
Early next morning, we headed off back to Accra, and back at Novotel we finished marking the post-test papers and were quite impressed with the progress. All trainees showed marked improvement, many of them scoring above 80%, some of them above 90%. Reflecting on the work done, challenges and lessons learnt, we all acknowledged that although there was progress, our work was far from done and that continued, ongoing mentoring was required. After a quick tour through the city and sights, I headed off to the airport to head back home, feeling so overcome with indescribable emotions—so happy to have made new friends, so overwhelmed by the love and warm hospitality shown by our trainees, their eagerness and enthusiasm to learn, so gratifying to see them soak up knowledge like sponges—what an incredible journey this has been! I know what we have done is just a little drop in a vast ocean, but it really feels good to be part of this endeavour, and I so look forward to meeting all my ISUOG friends, Niki, Janet and Tony, and our lovely trainees, again. Thank you ISUOG!