Category Archives: Haiti

Le dernier jour….the last day of Outreach in Haiti

 

After a jam packed week of training in the North Haitian city of Cap-Haitien, the Outreach “Dream” Team finally wrapped it up on Friday, 27 October 2017. In wonderful prose, ISUOG trainer Stephane Michel recounts the excitement of the last day and the passion shared by both trainers and trainees for ultrasound. They truly show how much they “#LoveUltrasound.

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ISUOG Outreach Trainer Dr. Stephane Michel giving a lecture (Photo by L. Hanson)

“The exhaustion after four loaded days was definitely felt waking up this morning. The tiredness was immediately replaced by the excitement of this last day. The journey to the Hôpital Justinien where the training has been taking place has now become a routine – one that always becomes an opportunity to enjoy the stark contrast of landscape of this city on the cape (hèlas, Cap-Haitien). The city is awoken: children are joyous as the march on to school, the morning rush-hour with motorbikes coming at us in all directions. It’s a lively and beautiful city; the streets, the bars, the music and the food bring back memories from the time I was here for my residency – a time I long thought lost.

I’m so energetic before delivering my last presentation and to guide once more these trainees who are so receptive and perpetually happy. They have the secret of the people of Northern Haiti – the secret to win over guests to their land. It’s such an adventure being here – one that I am so delighted to participate in. This ambitious project will have multiple medical impacts; for the residents and the doctors, this is a further skill. For the hospital, it’s an effort to reduce the maternal mortality rates linked to certain conditions. For the women, it’s the possibility to receive quality care. I just can’t help but say “Vive l’échographie !” (Long live Ultrasound!).

And then there’s jeopardy! That’s how we started the training in the first place. Dr. Hanson (our team lead) asked questions to the two competing teams, formed of the trainees, who didn’t make it easy for themselves. The score was tight but wasn’t predictable. Then the final question: “which heart chamber is closest to the spinal columns?”

We were so renewed by their desire to learn through fun. In the end, everyone won through knowledge and the fun, thanks to ultrasound.

Then came the moment to head to the practical session and into the scanning room. The ultrasound machine that preformed the best with the real quality images that surpassed the rest was without a doubt the Phillips cx30. One of the trainees brought his own ultrasound machine to use for the practical aspect as well and to take the opportunity to master imaging via his own machine. It was a complete pleasure to to help him.

GAIN…..TGC….FOCUS….DEPTH……whoops, not obvious. Doing this was also a way for me to learn about the knobology of his machine because – to be perfectly honest, dear followers – it was really hard to scan with the machine!

But hèlas, it not a farewell my friends! Yes, it was truly the end of an amazing week but the adventure will continue for the good of women and for a world where as we say in French “Où le son (ultrason) continuera à nous réunir la sonde à la main.”

For more information around our work in Haiti, be sure to visit our website. Stay tuned in the coming week as the Outreach team heads to Oman, Sudan and Ghana for more inspiration and education.

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Hot weather. Spicy food. Welcome to Outreach in Haiti

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ISUOG Trainer Gail Ghiretti (pictured centre) with fellow ISUOG trainer Dr. Stephane Michel (pictured left in blue) during the practical training session (Photo by L. Hanson)

It’s day three of ISUOG Outreach in Cap-Haitien and the trainees are showing more progress by the day! ISUOG Trainer Gail Ghiretti writes to us from the field in today’s featured blog:

“Hot as in weather and spicy as in food. 

Food is very spicy here and found in the most unusual things …like peanut butter. This is my first visit to Haiti and my first time volunteering with ISUOG. I have worked in various places around the world teaching ultrasound but I must say this group is the most enthusiastic I have seen in awhile. It’s Day 3 and they are still interested in our presentations! And they all participate in hands-on without becoming bored by watching others scan ; they help and encourage each other with a positive attitude.

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ISUOG Trainer Gail Ghitetti delivering a lecture (Photo by L. Hanson)

There’s lots of laughter in my scanning room but unfortunately, I am not sure what they are saying because everyone is speaking French to each other. My high school French teacher would be appalled since – believe it or not – I did get all A’s in class but that was a long time ago. I am learning new words and should be fluent by end of the week.

When someone asks a question, a great response for scanning instructions are responses like such as “gauche” and “droite”. Impressed ? Oui, n’est – ce pas ?

It has been a pleasure working with the trainees and I look forward to working with them in the future. À bientôt !”

Keep following our blog throughout the week for more live updates from Haiti. For more information around our work in Haiti, be sure to visit our website.

 

 

22 trainees and 90 degrees…..Outreach in Haiti continues!

Day Two of the ISUOG Outreach Program in Cap-Haitien continues again today. Reporting straight from the field is Project Led Dr. Lisbet Hanson who recounts the day’s success in today’s blog post:

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The ultrasound dream team (Left to right: Dr. Stephane Michel (Haiti), Dr. Vladimir Lemaire (Haiti), Gail Ghiretti (USA), and Dr. Lisbet Hanson (USA) – Photo by L. Hanson)

“22 Trainees; 4 Trainers; 5 ultrasounds (not always working); 90 degrees Fahrenheit

We hit the ground running early Monday after Opening Ceremonies with the playing of the Haitian National Anthem, a warm welcome from the Hôpital Universitaire Justinien Administrative Director and a benediction by Dr Cyril Leconte, Chef de Service d’OBGYN.

Stéphane, Vladimir and Gail’s excellent lectures have included a variety of basic introduction to ultrasound topics, including ultrasound physics, transducers, knobology, biometry, etc. We are using the standardised ISUOG lecture sets and adding videos and images when we want to emphasise a point. The trainees consist mostly of OBGYN and Family Medicine Residents, but also a few seasoned practitioners. They are not afraid to speak up when they have questions or to debate a point passionately. Some have never touched an ultrasound machine before. Most have had a little exposure in their residency. Dr. Leconte is clearly an impassioned educator. His vision is to develop and incorporate a formal ultrasound-training program into the three-year OBGYN Residency at HUJ.  I am really enjoying the opportunity to finally meet him and get to know the man who applied to ISUOG Outreach for this training opportunity a few years back.  That evening, he gave us a tour of the city and with a little history lesson on the way home; it was very interesting!

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Cap-Haitien (Photo by L. Hanson)

Our lecture hall is above the busy Maternity Ward where 300+ deliveries are performed monthly. The ward consists of six large open rooms with up to ten beds in each. Every single bed is occupied, not only by the patient but the family caring for her and her newborn; there is zero privacy. Those in labour can be seen walking the open halls, sitting on the front steps or crouching in the hallways. From time to time, one hears a labouring woman cry out.  Nurses in starched white uniforms, tights and shoes navigate the crowds to deliver medication, checks IV’s or get a blood pressure.

Our afternoons are spent scanning. Most of the patients have been obstetrical though we have had at least two that insisted they were pregnant but alas, no IUP was discovered.  It is very hard to convince these ladies that they are not pregnant. I am told this happens quite often here in Haiti.  The rooms for scanning are small but the enthusiasm high. The trainees critique each other:

“Slide, don’t rotate.” says one.

“Where is the stomach on the abdominal circumference?” says another.

The patients wait patiently for their scans. Most are more than 24 weeks GA and having their first scan. We practice our 6-Step-Approach and the four transducer moves. By the second day, the trainees are getting really getting good.

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Patients waiting patiently (Image by L. Hanson)

Around 5:30 PM, the ISUOG Team heads back to the hotel for a shower and dinner.  We talk about the day, call home to check on family, review the next day’s lectures and fall into bed.

After all, the rooster will wake us up in just a few hours….. “

Keep following our blog throughout the week for more live updates from Haiti. For more information around our work in Haiti, be sure to visit our website.

 

ISUOG Outreach returns to Haiti!

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Day 1 ISUOG Outreach in Cap-Haitien (Photo by V. Lemaire)

ISUOG Outreach returns to Haiti this week – this time, the Northern city of Cap-Haitien. Partnering with Hopital Universitaire Justinien (HUJ) and local NGO Zanmi Lasante, the lead – led by Dr. Lisbet Hanson, will be training a group of 18 doctors on basic ultrasound in Obstetrics and gynecology. For this endeavour, Philips has donated a machine for the project to the University Hospital. What makes this program so dynamic is that ISUOG Outreach is proud to site that one of its previous trainees from the ISUOG Haiti (St. Damien) program, Dr. Vladimir Lemaire, has now joined the team as an ISUOG Outreach Trainer! Catch his blog below as he explains how the day unfolded and the emotion it brought:

“After a very early morning breakfast, my heart was completely full as I walked back to the Hopital Universitaire Justinien (HUJ) here in Cap-Haitien where almost 13 years ago, I undertook my own residence. Inspired by the familiarity and with both great pride and humility, I returned but this time as a trainer.

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Dr. Vladimir Lemaire teaching with the donated Philips machine (Photo by L.Hanson)

During the time I was there for my residence, ultrasound training seemed to me at the time completely out of reach, But after ceremonial formalities and a brief introduction from Dr. Lisbet Hanson (USA – Haiti Team Leader), time was of the essence and we went rapidly into the subject. Dr. Stéphane Michel (Haiti), Ms. Gail Ghiretti (USA) and myself gave our presentations one by one, with the pre-test interwoven between the first and second talks.

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Trainees listening attentively to lecture (photo by V. Lemaire)

We were pleasantly surprised by the quality of the questions and case studies of the participants during the lectures and this feeling was reinforced during the practical lesson where they really showed a good level of skill.

The day ended with a debriefing with Dr. Hanson, during which she reemphasised the “points to improve on”, responding the last questions from the participants – it was an incredible day!”

Check out more about our previous work in Haiti by visiting out website and stay tuned for more blogs straight from the field during the week!

 

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

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!”