Category Archives: Ghana

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

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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.

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Day 4: Putting theory into practice at South Kumasi Hospital

Outreach continues for its 4th day of training in Kumasi, Ghana. Today, we’re following the group to South Kumasi Hospital where an exceptionally large amount of gynecology cases were presented today – which came in handy as the group has just learned tips and tricks for conducting a transvaginal scan! Local ISUOG Trainer Buah Hamilton showed, the benefits for identifying both gynecological and obstetrical issues were numerous.Ghana4

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Guided by both ISUOG trainer Buah Hamilton and GE Healthcare’s Tammy Anderson, the group identified cyst growths in patients and a peculiar case of an infantile uterus in a 15-year-old patient, resulting in discussion amongst the group on what the follow up and next procedure should be.Ghana3

There was also a “lunch lecture” by Buah Hamilton over scanning the Gyne patient which helped put a lot of the hands on training into focus theoretically.

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The trainees have been demonstrating so much enthusiasm and really putting their newly acquired skill into practice. With tomorrow being the last day, it will be impressive to see what they’ve learned throughout the week and get a feel on how they plan to hone their skills in going forward.

ISUOG Outreach in Ghana: Kicking off day two!

Each of the trainees spread out to different regional hospitals this time to take a group of 8 trainees with them for hands-on work.Ghana4

Today, we’ll be focusing on Old Tafo Hospital located in a predominantly Muslim neighborhood of Kumasi. Droves of patients waited for the ISUOG team near the manicured courtyard of the hospital, dressed in their colorful garments that reflected the tradition of the Ashanti region. The trainees were as excited as Janet Horenstein and Tammy Anderson and guided the group on using the new GE Voluson P8 machine, which was donated to the hospital. “These trainees are both enthusiastic and passionate about scanning and making a difference in the lives of women,” says Gesù Antonio Báez, ISUOG’s International Development Officer who’s reporting from Kumasi. “It’s inspirational and promising for the future”.Ghana7

The training session also helped reveal a heart defect in a 3rd trimester patient, prompting the trainees to take action in advising an emergency C-Section and careful monitoring once the baby is born.

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“I’m loving this new machine,” says Adams Abekah who is based in Old Tafo, “but I’m excited to learn more and [perfect the techniques.] That is my dream.”

Stay tuned as we visit the trainees in the other hospitals in the Kumasi Metro region!

Day One – Return to Ghana!

And we’re up and running! ISUOG kicked off the first part of Phase II of our Outreach program in Kumasi, Ghana. The day started strong with Project Leader  and Outreach Committee Chair Anthony Johnson (USA) introducing the Outreach Volunteers to the 25 trainees at Kumasi South Hospital.

This time round, 15 of the trainees were basic with no previous ultrasound experience while 10 were advanced, having previously participated in the last program.

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If there was a key word for the program this time, it would be empowerment. Two of our strongest trainees from our last trip – Yusif Yacub and Buah Hamilton – are joining the ISUOG team and are teaching the trainees themselves, tackling topics such as ectopic pregnancy and second trimester scanning. It must be said, Yusif stole the show with his charismatic presentation skills and stories from the scanning room.Ghana15

GE Healthcare’s Tammy Anderson explained to the group how to use the new machines – three brand new beautiful voluson ultrasound machines – which was the cause of much excitement once the group to the chance to scan during the first live scan session, led by Tammy and Janet Horenstein (USA). It was a really special moment too as one of the patients being scanned had not had an ultrasound until that day and was overjoyed by the image of her unborn son.

Ghana17Theodora Pepera-Hibbert (Ghana/UK) focused her talks on using ultrasound for Gynecology cases and, despite the projector breaking down half way through during her presentation, her passion for scanning radiated in her engagement with the group and helpful insight on proper scanning practices, such as speaking to the patient and communicating with her about the procedure.

Day one was rewarding and jam packed, but only a taster of how the rest of the week will be – stay tuned!

On the road again – we’re returning to Ghana!

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(Image courtesy of Manna Kamio Badiella for ISUOG Outreach – Kumasi 2011)

They say two times is a charm – and boy they weren’t kidding! We’re excited to announce that ISUOG Outreach will be returning to Kumasi, Ghana on 16 November for the second phase of its development program in the region, in partnership with local NGO Women’s Health to Wealth and GE Healthcare. Led by Outreach Chair Dr. Anthony Johnson (USA), the team will consist of returning volunteer Dr. Janet Horenstein (USA) and first time volunteer Dr. Theodora Pepera-Hibbert (UK/Ghana) while empowering two local trainers, Dr. Buah Hamilton (Ghana) and Yusif Yacub (Ghana) as they progress to become local trainers in ultrasound in OB/GYN. Both Yusif and Hamilton have taken part as trainees in the past three training trips so we’re excited to see their progression to the next phase of this program, which goes to the heart of the ISUOG Outreach credo – sustainability and empowerment. ISUOG’s International Development Officer, Gesu Antonio Baez and GE Healthcare’s Tammy Lynn Anderson will also be joining the team as the program takes an exciting turn to teach the teachers and ensure long lasting impact in the region. Be sure to follow this space as we highlight the events throughout the week we’re there and to read more about our previous work in Ghana, click here.

Suntreso experience continued – A summary of the week

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!

Final thoughts and wishes for the future

The Ghana trip comes to an end with presentations and presents. Niki Harding gives us a final update:

“On my third day at MCHH Tony joined us for the day. We have been having a lot of debate about how to assist the trainees to show ISUOG progress in their scanning, and monitoring and auditing of their work. Tony has been trying to find out whether we can download data electronically from the machines. Unfortunately there does not seem to be an on-going service arrangement and the local engineer was proving hard to contact. There were issues we would like to have sorted out while we were there, especially with the Manhyia machine which locks up if asked to do anything interesting (Doppler!)

Scanning Ghana style.

At MCHH we tried to advance into these areas of practice but with the newer students, establishing systematic and comprehensive LS and TS scanning to assess the pregnancy was still proving taxing. Descriptions of anatomy or planes became answered with requests to “draw it for us Niki!” As my students back home know, I think in pictures – the examination gloves box will have to be filed for reference, it was covered with diagrams by the end of the week!

Dr Imrana was our newest trainee and was keen for any advice having had extremely limited hands-on. Cecelia, Zenabu and Dinah, our three midwives, were taking in all the little scanning manoeuvres and tips I threw at them; head to femur TS views of fetus making FL measurement a little easier. Zenabu had only had one ISUOG week previously but had a good eye and showed great promise as well as having the greatest laugh which I wish I had on tape! Dinah had to leave us early to take a Public Health exam at a town 4 hours away. With Dr Annie and Yusif we looked at hearts in some of the 3rd trimester ladies where the anatomy was easier to demonstrate. In fact, in review of our patients, we have had a couple of 16/17 weeks but no other 2nd trimester patients.
The women in Kumasi are not committed to following through their care in any one clinic. Many of the ladies we scanned had had scans elsewhere and had more than one EDD given. We discussed, and I stressed the need to stick to the first scan EDD given and carry that forward.

Dr. Annie and Niki Harding with orphaned twins. Dr. Annie sponsors an orphan home and feeding programme.

Between sonograms Drs Annie and Imrana had patients appearing in the clinic with a variety of complaints, resulting from the local conditions and other treatments:
– A Pregnant lady with a nasty eye infection – needing general infection screen and anti-biotics. Baby looked fine.
– A Para 2 teenage mum abandoned by partner whose eldest daughter was suffering the effects of malnutrition. The whole family was being cared for on the paediatrics ward and were also given baby clothes and food money from donations.
– Incomplete surgical abortion with RPC’s – referred to surgeons.
– Our teratoma lady who has been referred to Oncology for assessment.
– A lady with a 4 year old son with developmental delay (and possibly microcephally). Dr Imrana described a possible scenario of infection such as CMV leading to PROM and subsequent problems of prematurity. Again a feeding program be will used to try and kick start residual brain function.

A very interesting discussion developed over lunch about the sequalae of malnutrition and the start up feeding program local staff have developed with local food resources.

Manhyia Mamas and Papa Hamilton (at the back!) lead by Nayana Parange.

Our final day with the trainees also involved an extended seminar to include local midwives. The aim was to introduce the other local midwives to how ultrasound can help them in their practice. This involved our trainees getting on the podium. Lectures were given by Tony, on behalf of poor Evelyn who had lost her voice, on 6 scanning steps, by Erica on ectopics, by Yusif on Oligo/poly -hydramnios and Tony again on twins. The trainees also had post-course tests to do and Abenaa, MCI Representative, attended for the presentation of certificates. Our local speakers were a big hit again. They spoke extremely well and we hope they will carry the banner forward.

Team MCHH lead by Niki Harding.

Suntreso Swingers lead by Janet Horenstein.

There was a general air of merriment starting from when Tony was asked to slow down his rapid Texas via West Virginia patois! As time ran out we had a general forum/ discussion of gynae issues. Presents were presented – flowing Ghanaian robes for all – Tony will be a dream in the OR in his beautifully printed smock! Nayana and Janet had tunics and trousers and I have a full length robe usually seen on stately ladies of “traditional build”. We girls had matching head scarves. Our thanks to Dr Annie et al for these.

Dr. Johnson – man about the OR?

Other personal gifts were exchanged or given and the star item was a beautiful painting of three ladies in the bloom of pregnancy, one carrying her baby traditionally on her back. We thank Abenaa for that gift. I have carried it carefully home from Ghana to Manchester and hope to deliver it safely to Outreach headquarters so it can hang in the ISUOG office. Before going our separate ways we went to visit trainee Doris who had been admitted to Kumasi South with cholecystitis. We wish her well.

Abenaa’s beautiful gift

The Four Musketeers finished off the trip with a lay-over in Accra. We procured the services of a very knowledgeable local guide called Moses who drove us round the highlights of Accra. I am much more in tune with Ghana and its place in the world now. I know my companions will agree when I say it has been a very special week. I have greatly enjoyed the company of all my new friends. The warm feedback and hospitality I received from “my” songraphers was wonderful. We hope our feedback to ISUOG shows that this is a project that can continue to develop and that this shouldn’t be the end of our involvement in Kumasi. There is still so much we would like to do and I thank ISUOG for allowing me to be a part of it.”

Last few days in Ghana

Janet Horenstein updates us on progress in Ghana:

“Thursday at Manyia hospital went well with more fine tuning measurements and adding some Doppler in the umbilical artery. Another long and rewarding day. That evening there was a lovely dinner with the head trainees, Abeena and representative from MCI. Friday was a short scanning day. In all we scanned 76 patients during the 3 1/2 days.

That afternoon two trainees , Yusuf and Erica, gave lectures along with Dr. Johnson. Of course the best and most memorable part was the presentations of the certificates to all the trainees. They all were so proud and appreciative. Throughout the week there was continued expression that they would like
to have us return and spend more time in Kumasi. One would think they would be glad to see us go since we had them work so hard and a few even have other responsibilities.

Saturday was uneventful with a return to Accra. We had a tour of some of the city sites—independence square, (Niki and Janet of course had to get their feet wet in the ocean), first presidents memorial and an art gallery. Nayana had to depart first in the afternoon–the rest to London and beyond in the evening.”

Second day at Maternal and Child Health Hospital (MCHH)

Niki Harding shares her experiences at the Maternal and Child Health Hospital (MCHH) with trainees Dr Annie, Yusif and their team.

“Massive culture shock on Day 1 – The hospital is very basic. It has a number of low buildings all surrounded by open drains or ditches to carry the rainwater. These are a foot or more deep and you wouldn’t want to fall down one. We have no running water in the hospital – it needs a new well and pump. Water everywhere is from tanks or small plastic bags – even on the labour ward. Highlights today – Dr Annie and her orphans. They came today to be weighed and measured and given food parcels; Newborn being scrubbed clean in the labour room sink. Janet went one better when a patient arrived in pain. The lady had already delivered the baby’s head while staff were discussing where she should be, and shortly delivered the rest of her baby. We are so precious of our patient’s dignity at home. We had a lady on the couch prepped for a TV scan and staff were at the open door shouting across the corridor for her notes to be brought.

But the dedication the staff have is incredible.

My scanning experience here was a baptism of fire as Yusif – lead Sonographer had brought back a number of patients for review by the “US Doctors”. So we commenced with an anencephalic at 26 weeks – subsequently referred to Nayana’s team – an encaphalocele, an ovarian terratoma and some pregnancies complicated by multiple large myomas, a twins case at 36 weeks with twins overlying one another in a cross. A difficult lie in which to assess anything.

This was all a bit of a challenge. Our second day fortunately has been a little more straight forward. But the Government target of an early and midtrimester scan still seems a far off target as many women are third trimester before they have their first scan.

Tony is a stalwart in keeping the programme on track. We met with the lead Sonographers this evening and got their views on what follow-up of outcomes they felt was achievable. They will be delivering lectures on Friday to boost local training initiatives. The good thing is that at my place the midwives are interested – expressing interest in getting involved with Ultrasound.

The clinic may be basic but I think I struck gold with Doctor Annie. Nothing is so bad if you can go shopping after! She has been lovely in showing me the city on our journeys between hotel and Hospital and I am stocking up on souvenirs too.

Having an amazing time!