Category Archives: Haiti

Final day in Haiti

The training at St Damien has come to a successful end. Below are some pictures from the last day. A very big thank you to the trainers, trainees, partners and friends for making this a success!

ISUOG Ultrasound Course on Obstetrics and Gynecology

ISUOG Ultrasound Course in Obstetrics and Gynecology

Last day of training

Last day of training

Graduates and trainers

Graduates and trainers

A gift from the trainees

A gift from the trainees

New friends Gitte and Ellen

New friends Gitte and Ellen

Father Rick and his driver visit Villa Francesca

Father Rick and his driver visit Villa Francesca

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Video

Videos from Haiti

We have received some video footage from the Outreach course in Haiti!

Dr Fouron gives a lecture:

Enrico guides a trainee in a scan:

Bettina and a trainee work on a scan:

Day 4: Nearly there

As the week in Haiti starts drawing to a close, we received various comments from different members of the team…

The ride to work

The ride to work

Gitte: “A new day with lots of hands on. Very eager trainees – we could have continued doing ultrasound examinations all night. Many of the trainees today totally understood nurse Gitte’s tip: follow the highway of the fetus, that is to say, follow the spine whichever orientation is needed. Gives a quick feeling of the position of the fetus and where to make biometrics.”

Dr Antonio from MSF demonstrates his ultrasound skills

Dr Antonio from MSF demonstrates his ultrasound skills

Ellen: “the four chamber view, the “five chamber view,” the pulmonary trunk and the three vessel view. That’s it for the transverse screening of the fetal heart. There isn’t anything more to it! And the Haitian pupils did understand that thanks to Dr Fouron. Some of them succeed in a better screening than some colleagues back home!”

Dr Fouron evaluates a cardiac screening scan

Dr Fouron evaluates a cardiac screening scan

Andrea: ” I am very happy to be back here after last years experience. I think the ISUOG team can be satisfied with their previous teaching because the trainees have grown in their skills with ultrasound in OBGYN. Even the new trainees, both MDs and NMWs, show promise as they work with their well trained colleagues. Great experience which is so satisfying because this is useful for our Haitian colleagues and friends, and ultimately useful for the Haitian women.”

Enrico guides a trainee with a scan

Enrico guides a trainee with a scan

Lisbet: “I am so thankful to Bettina, Gitte and Ellen for helping correct the pre and post tests! We will graph their results and review the results tomorrow with them. It has truly been such a pleasure working with this entire international ISUOG team and of course the hard working Trainees, who have leapfrogged forward with their ultrasound skills. I feel a little like a proud parent!”

Patients wait

Patients wait

Haiti Day 3: Triplets!

Today Ellen Roets has shared her experience of Day 3 at St Damien, with a triple surprise for one lucky mother:

A philosophical taxi in Port-au-Prince

A philosophical taxi in Port-au-Prince

“Today was again an astonishing day in every way it possibly could be.
Morning started with the Mass of father Rick, held in the hospital church, and burying again 4 adults and a child. Start of another day in Haiti. Singing ‘Noye noye, mwen pral bay nouvel la’ (bring us the novel), people are saying goodbye to their beloved ones – a captivating image.

Dr Fouron works with a a trainee

Dr Fouron works with a a trainee

We began the third day of ultrasound experience with a lecture on optimising the use of the ultrasound machine (Gitte Stoerup), a lecture on metastatic disease in gynaecologic malignancy (Dr Lisbet Hanson) and wíth finishing ‘the renal story’ by myself.

Obstetrics ward

Obstetrics ward

Some ultrasonographic cases made the course attendants reflect about pathology and gave a forum to Dr Fouron to share his knowledge on transposition of the great arteries, greatly appreciated by all!

Dr Fouron speaks to the trainees

Dr Fouron speaks to the trainees

But we were all eager to start with the hands-on training.

Scanning under Dr Fouron's guidance

Scanning under Dr Fouron’s guidance

One of the cases was a triplet pregnancy, consulting for the first time at 30 weeks of gestation. Bettina Hollwitz took this challenge under the eye of about ten Haitian ultrasonographers… to conclude that the weights of the three foetuses were about the same and the Doppler indices were normal. However, a shortened cervix urged an admission at the obstetric high care unit of St Damien.

Triplets!

Triplets!

We were having lunch atthe restaurant Fransisville, which we already know by now and highly appreciate for its Haitian cuisine.

Examining the triplets closely

Examining the triplets closely

A short afternoon (due to the very late lunch because no one wanted to stop scanning…) was filled with a visit to the maternity ward. Gitte had brought a lot of knitted caps for the curly heads of the newborns as they use to do in Denmark. (In fact, we use caps in Belgium too, but those are stockings for underneath plaster application who got a second life at the maternity…) All women were very excited about this and for now, newborn babies in Tabarre have the cutest capped little heads on this island!

A little warm head

A little warm head

Enrico closed the day with a lecture on doppler monitoring in case of intra-uterine growth restriction.

Dr Aupont helps trainees to find accurate measurements

Dr Aupont helps trainees to find accurate measurements

Back home at Villa Francesca, the guesthouse of the Rava foundation, Enrico followed the good tradition of preparing us a delicious Italian dish ! We were spoiled with pasta Norma, heavenly penne with tomatoes, basilic and eggplant.
Again a pretty exhausting but very rewarding day came to its end…

Dr Tocel reviews results with a patient

Dr Tocel reviews results with a patient

I realize now we only have two days left to finish the course and to try to share everything we still want to share with these wonderful people. It is amazing to see how eager they are to learn and to gain experience, to feel their enthusiasm, to laugh together with them and at the same time have a philosophical talk with them about their country and their future.

These are people willing to improve the health care and life standard in their country and my colleagues and I want very much to continue to help and support them as much as we can.”

Day 2 at St Damien: Diagnoses and progress

Today we hear from trainer Bettina Hollwitz on the encouraging developments of Day 2:

Bettina and trainees

Bettina and trainees

“Our second training day lies behind us, and everybody gets tired (and retires) quickly after dinner. Again, Enrico would insist on cooking dinner, especially since he discovered the Northern Europeans were not to be trusted when it came to pasta and vegetable preparing… So, we got treated to Italian delicacies once more! Lucky us as we did not take the opportunity to go shopping for groceries, because it became a really long day in the hospital today:

Andrea shows a trainee how to fill out a logbook

Andrea shows a trainee how to fill out a logbook

We continued our lectures in the morning, focusing on the crucial role of US in GYN cases (esp. ectopic) and diagnosis of threatened preterm delivery. Professor Nicolaides would have been proud of us emphasizing the superiority of US to traditional clinical practices: Enrico went as far as telling the Haitian colleagues they could possibly cut their right index finger off! Don’t tell: I don’t quite agree here, but we really had a point when in the afternoon a symptomless IV-Gravida at 31+ weeks who had lost three children soon after birth due to prematurity was found to have a cervical length of 13 mm with an impressive bulk of intra-amniotic sludge at routine scan! She got admitted for lung maturation, antibiotics and initiation of progesterone treatment, and we all will have an eye on what happens to her during the rest of the week and whether this baby finally will be the survivor.

Twins!

Twins!

Also we newly diagnosed two sets of twins today (we have to report, however, the mothers were not overly delighted), and also some more stunning findings (huge fibroids totally obscuring a tiny 5th week gestational sac in one corner, huge polyhydramnios to be dealt with immediately). Happy to say so, the students are clearly aware of the ever-growing importance of US in antenatal care, and the returning trainers are very excited how last year’s achievements have been sustained and even broadened by the trainee group, and how the word of the quality of the course has spread: A few new people including more midwives show great determination to catch up with their colleagues, and I personally find it a very encouraging step in empowerment of women how the dominantly male OBGYN doctors and the midwives and female general practitioners now share tasks, trainers, tools and time in order to accomplish better patient care together. Of course, some do better than others and to keep them patiently waiting for their slower peers, we had to offer bonus material: long after the presumed ending time, we showed the remaining cracks how to do uterine artery Doppler, and they did amazing. How great their astonishment and pride to hear from me that they now already can do a test that many specialists in practices in my rich home country have never really learned to perform!

Ellen demonstrates a scan

Ellen guides a trainee in a scan

For me on my return to Haiti three years after our earthquake relief efforts it’s quite obvious: These are strong young people we deal with, highly determined to build a better future for themselves and others. They didn’t lose the spirit, so we won’t either. Good night.”

First day of class

Today we hear from team leader Lisbet Hanson on the very first day of lectures at St Damien Hospital:

“A long day!

We have a great day reconnecting with old friends and making some new ones.

The church at St Damien

The church at St Damien

As previously, the lectures and discussions were stimulating and interesting. Lectures started at 8:30 AM after mass in the chapel with Fr Rick. (One stretcher before the alter held 5 small bodies wrapped in their funeral shrouds. As Gitte said, it was a reminder of why we are here; to help improve pregnancy outcomes.)

Trainees in class

Trainees in class

It was a day of OB lectures. This course is about applying ultrasound skills to clinical situations, i.e. now that they can get the measurements and make the diagnoses what do they do with that information?

Senior trainees Dr Davilmar, Dr Dupont and Dr Lemaire

Senior trainees Dr Davilmar, Dr Dupont and Dr Lemaire

Dr Lemaire gives a lecture on the basic ultrasound exam

Dr Lemaire gives a lecture on the basic ultrasound exam

Three of our Haitian colleagues gave excellent presentations as did Dr Fouron, Ellen and Bettina.

Trainees and their textbooks

Trainees and their textbooks

Lunch at Francisville

Lunch at Francisville

Because of the discussions and a late lunch at a local restaurant, we had to postpone two lectures until tomorrow.

Dr Fouron lectures on basic cardiac anatomy

Dr Fouron lectures on basic cardiac anatomy

Ellen gives a lecture

Ellen gives a lecture

Enrico again wowed us with his culinary skills at dinner. Our housing arrangements are definitely an upgrade this year – no tents and only 2 to a room instead of the dormitory style. There is a large crack under our door to the outdoors. Enrico says it is so the bugs can get out.

Nightfall over Port-au-Prince

Nightfall over Port-au-Prince

Now off to bed as the day starts early here!”

Safe arrival in Haiti

We are happy to report that the entire Outreach team arrived safely in Haiti on Sunday, and they were able to enjoy some time visiting the various social projects linked to the St Damien Hospital before enjoying a team dinner courtesy of Enrico Ferrazzi’s cooking expertise. Gitte Stoerup gives us an update:

“I am a volunteer for the first time with the ISUOG Outreach Project.
From the 18-23 February we visit St. Damien pediatric hospital to help the local doctors and midwifes optimise their skills in obstetric and gynecological ultrasound examinations. This visit will be the third in the project.

Gitte Stoerup after a long journey to St Damien from Denmark.

Gitte Stoerup after a long journey to St Damien from Denmark.

In the team we are Lisbet Hanson, teamleader, USA; Jean Claude Fouron, Canada; Ellen Roets, Belgium; Bettina Hollwitz, Germany and Gitte Størup, Denmark. In very close teamwork with Enrico Ferrazzi and Andrea Paganelli from the Italian Fondazione Francesca Rava.

Bettina Hollwitz relaxes after arrival.

Bettina Hollwitz relaxes after arrival.

The three of us are new in the Haitian project – Bettina, Ellen and I. Ellen and I travelled from Europe and met in New York, staying overnight together close to the airport, leaving for Port-au-Prince very early in the morning. Arriving in a very renewed airport we were met by a lot of eager taxi drivers. We understood  why we were told to only wait for the driver from the hospital.

Ellen Roets works on her cases.

Ellen Roets works on her cases.

We then drove with Lisbet the short way to our guesthouse, only a 10 minute walk from the hospital. Nice rooms and very kind and good service.

Roseline – our local “guide” in the project showed us around. Roseline took us by car to see an orphanage for small children up to 5 years of age and a “container” camp for children 5-15 years of age. Many of the children lost their parents during the earthquake in 2010. Others have poor parents who could not afford to feed them. And then again some children just dropped at the gate in a plastic bag.

Poor stories but amazing how the Fondazione are able take care of them in nice clean surroundings. A lot of the children made impression on us.

We finished the afternoon by seeing the St. Damien Hospital with all its facilities. Impressive how much they can do with the donations.

A meeting in the late afternoon regarding good practice in obstetrics finished the day at St. Damiens.

Enrico Ferrazzi shows off his Italian cooking skills.

Enrico Ferrazzi shows off his Italian cooking skills.

In the camp Enrico prepared a lovely evening dinner for all volunteers.

Dr Fouron slices cheese with surgical precision.

Dr Fouron slices cheese with surgical precision.

We made plans for tomorrow’s lectures and programs and we were all off to bed early.”

The team's first dinner together.

The team’s first dinner together.

Good luck for the fist day of class!

Return to Haiti

This weekend the ISUOG Outreach training team will begin their travels to Haiti for the third training course to take place at St Damien Hospital in Port-au-Prince, starting on Monday 18 February 2013. Our project leader Lisbet Hanson will guide Bettina Hollwitz, Ellen Roets, Gitte Stoerup, Enrico Ferrazzi, Jean-Claude Fouron and Andrea Paganelli in the week-long course that will train 31 practitioners from St Damien Hospital and local Medecins Sans Frontieres clinics in ultrasound in obstetrics and gynecology.

From left to right: Ellen Roets, Bettina Hollwitz, Enrico Ferrazzi, Lisbet Hanson, Jean-Claude Fouron, Gitte Stoerup and Andrea Paganelli

From left to right: Ellen Roets, Bettina Hollwitz, Enrico Ferrazzi, Lisbet Hanson, Jean-Claude Fouron, Gitte Stoerup and Andrea Paganelli.

Project partners Fondazione Francesca Rava NPH Italia have once again been great partners to the project, and we are sure we will see another successful week of ultrasound training.

We will be updating the blog as usual with stories from the ground so do check back regularly, or you can subscribe by entering your email address into the field on the right of this post (“Follow blog by email”).

We wish the team safe travels to Haiti and much luck to the trainees!

A fond farewell, à bientôt!

The Outreach training course in Haiti has sadly come to an end and our team have returned home safely. ISUOG is so proud and honoured  to have had such a dedicated team on this project. A big heartfelt thank you to Dr Lisbet Hanson, Dr Jean-Claude Fouron, Dr Enrico Ferrazzi, Dr Maria Small, Dr Andrea Paganelli, Dr Frank Sanderson and Dr Samir Khalife, and of course to all our friends at the Fondazione Francesca Rava – NPH Italia for being such wonderful partners to ISUOG, Dr Jean-Edgard Aupont and staff at St Damien Hospital for their unrivaled hospitality, and Physicians for Peace for their continued support in this and all of our Outreach activities. ISUOG is truly fortunate to be working with such great organisations.

We leave you now with some more photos from the final days of the course:

Dr Fouron explaining the heart

Dr Sanderson with a trainee

Dr Sandeson and Dr Hanson on a visit to a Fondazione Rava-sponsored children's home

ISUOG Certificates of Achievement for our trainees!

Dr Ferrazzi presents Dr Dupont with his Certificate of Achievement

Dr Khalife, Dr Ferrazzi, Dr Hanson, Dr Sanderson and Dr Paganelli are presented with commemorative gifts

Snapshots from the week at St Damien’s

A young 24 yo at 18 weeks with severe oligo probably due to PPROM. Her first pregnancy ended at 20 weeks after an accident involving abdominal trauma.

A woman with an 18 cm cervical myoma and several other large fundal myomas presents with abdominal pain at 34 weeks.

Severe IUGR, oligo, abnormal dopplers and a long closed cervix sends a woman we scan to L&D for delivery

Dr Small helps an OB-GYN patient carry out her first ever scan

The woman who could not lie down to have an ultrasound because of dyspnea is successfully managed and delivered. Both mother and baby are alive on post op day #2. The mother’s hgb stabilizes at 5.9.

Dr Fouron scanning a newborn delivered prematurely and finding Epstein’s anomaly. The mother dies post partum of complications related to eclampsia.

Dr Fouron and Dr Khalife with newborn

Being awakened at 4:30 in the morning by the call of the imam to morning prayers from the UN Compound next door to our tent hotel.

Lunch on the terrace with the hospital director, Dr Genevieve Arty . Goat stew with red sauce, pickly (spicy coleslaw), fresh potatoes, rice with dried mushrooms, and sliced tomatoes. A cake for dessert to celebrate the successful completion of the weeklong course.

Enjoying lunch

Afternoons spent scanning with the Trainees helping each other to get the best image. Reviewing reports and management plans.

Trainees scanning

The patient women waiting for their scans.

A case presentation of a maternal death by one of the Trainees as a test run for the SFMFM meeting in Dallas. The lively discussion following.

St Damien staff presenting a case

A visit to the University Hospital (HUEH).

The celebration and speeches at the opening of a renovated Maternity.

A visit to a children’s home where they live a dozen to each container and are thankful to have a bed of their own.

Dr Hanson and friends

Appreciating, admiring, respecting the Haitian art, music, food and especially Haiti’s people.

Congratulations!

— Dr Lisbet Hanson