Category Archives: Mongolia

Day 5: another successful trip, thank you to everyone involved!

The Mongolia 3rd level training has now come to a close with the last morning of lectures having taken place earlier today. Dr. Philippe Jeanty, the trip leader, shares some of his thoughts:

“Everything went well! The trainees did a great job, so much so that their post-test scores almost doubled. The KSUOG team were excellent and a delight to be with; the local team, led by Tsedmaa Bataar, made every effort to take care of us volunteers and facilitated great scanning days. We had a ton of patients for the hands on scanning, mostly obstetrics (about 80% I would guess) with a lot of abnormal cases including some cardiac anomalies. One was an absent PV, which the trainees were able to successfully diagnose having seen it during one of the lectures earlier. There were two main translators on site who helped a great deal. I do see language to be a barrier for the future as many speak little English although many are fluent in Russian which might be another avenue for them to get reading material. All in all I think the program was a success!”

Kwang Jun Kim (KSUOG) guides a trainee during scanning

Kwang Jun Kim (KSUOG) guides a trainee during scanning

ISUOG would like to take this opportunity to thank all its volunteers for their tremendous work and efforts, Philippe Jeanty especially, who has served as project lead for all three trips of this program. We also wish to acknowledge the invaluable support of our partners: the KSUOG whose volunteers lent their considerable expertise to the training for each trip, Dr. Tsedmaa Bataar and the team at the UNFPA who provided excellent onsite logistical support and went above and beyond to help translate and facilitate communications on site, and Samsung Medison, whose generous donation made this training possible.

Thank you to our wonderful volunteers!

Thank you to our wonderful volunteers!

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Day 4: meet the trainees!

We are nearing the end of the training week and the volunteers have taken this opportunity to get to know some of the trainees a bit better, many of whom have completed all three stages of the training program and have become familiar faces.

There are 18 trainees in total all coming from a range of backgrounds and regions within Mongolia and representing hospitals from nine different provinces. Around half of the trainees work in more remote clinics, using the hospitals in Ulaanbaatar as their main referral centres.

Hye Sung Wong (KSUOG volunteer) with the trainees during an afternoon scanning session

Hye Sung Wong (KSUOG volunteer) with the trainees during an afternoon scanning session

Those working in more rural settings are all based in clinics that are connected to the main hospitals in the capital and use telemedicine facilities to review the more difficult cases. This means that most patients are managed locally with only the necessary cases transferred to the main hospitals.

David Berck (ISUOG volunteer) presents on using ultrasound in obstetric emergencies

David Berck (ISUOG volunteer) presents on using ultrasound in obstetric emergencies

Student presentations today included some interesting cases: cephaloceles, diastrophic dysplasia, thanatophoric dysplasia and ectopic pregnancies.

Philippe Jeanty (ISUOG volunteer) illustrates his presentation

Philippe Jeanty (ISUOG volunteer) illustrates his presentation

Tomorrow will be the final day of lectures. Dr. Jeanty, who has led all three trips to Mongolia, has seen the trainees steadily grow and feels certain that the majority will be competent, confident scanners by the end the week with the ability and enthusiasm to grow their skills independently. Providing teaching methods that are sustainable in the long term is a key goal for ISUOG’s Outreach program.

The volunteers meet with the local Ministry of Health (from left to right: NCMCH representatives, Dr. Bataar, Dr. Jeanty (ISUOG trip leader), Prof. Kim (KSUOG President), Dr. Bolormaa (Ministry of Health representative), Dr. Berck (ISUOG volunteer)

The volunteers meet with the local Ministry of Health (from left to right: NCMCH representatives, Dr. Bataar, Dr. Jeanty (ISUOG trip leader), Prof. Kim (KSUOG President), Dr. Bolormaa (Ministry of Health representative), Dr. Berck (ISUOG volunteer))

Day 3: the universal language of images

It’s the third day of the Outreach training program and scanning continues.

The differing knowledge levels amongst the trainees are starting to present themselves through the student’s case presentations, which are a reflection of the scanning experience to date. Some trainees have had few opportunities to scan patients as part of their own training, largely due to minimal access to machines, while others have completed up to 7000 scans since their last trip in September! In terms of their presentations, this means some have very few cases to present while others are able to draw on a large range of example.

The volunteers with Dr. Tsedmaa Bataar (second from left), the onsite coordinator

The volunteers with Dr. Tsedmaa Bataar (second from left), the onsite coordinator

Language continues to be an issue for some of the trainees with many not speaking a lot of English. Despite this, one trainee went above and beyond and made an effort to translate her slides into English and present in English, much to the delight of the volunteers! The trainees are in general encouraged to take up a second language by the chief of the hospital, which we all support, and in the meantime the onsite coordinator, Tsedmaa continues to very kindly simultaneously translate all the presentations on site.

Today’s presentation topics included the role of ultrasound in emergency obstetrics and delivery and the scanning focus was on how to do a simple test for possible tracheoesophageal fistula and the significance of echogenic fluid. A small group of trainees also looked at the E A V waves, isovolumic relaxation and contraction and Tei index – lots of discovery and great engagement from the students!

Moon Young Kim presenting her lecture on IUGR with dual projection in Mongolian for the trainees

Moon Young Kim presenting her lecture on IUGR with dual projection in Mongolian for the trainees

All in all the students’ skills and knowledge are quickly improving and they will no doubt continue to do so throughout the week! The group have demonstrated a lot of interest in Doppler scanning, which is a new topic introduced in the third level Outreach training.

Dr. Philippe Jeanty guides a trainee through scanning using the phantom  he developed

Dr. Philippe Jeanty guides a trainee through scanning using the phantom he developed

The volunteers have also had a chance to get to know each other better over large quantities of food – a great way to spend and evening!

Happy volunteers enjoying some food at the end of a long day!

Happy volunteers enjoying some food at the end of a long day!

 

Day 2: Trainees enjoy a day of interactive teaching and live scanning

The second day of ISUOG Outreach training combined lectures and case presentations, delivered in the morning, followed by an afternoon of hands on scanning.

Morning lectures covered topics from abdominal renal genital placental and fluid anomalies, amnionicity, chorionicity and associated zygoxity.  New volunteers for this trip, Hyun Sun Ko and Hye Sung Won, both had an opportunity to participate in the program and share their knowledge with the local trainees.

Trainees were also given an opportunity to participate and direct the discussion, as they presented their own cases. These had been prepared in advance of the trip, as the trainees were asked to bring some case examples they had come across in their scanning thus far. The first students presented their cases in the morning with student presentations due to continue throughout the week.

Teacher for a day  - the trainees present their cases!

Teacher for a day – the trainees present their cases!

In the afternoon, the trainees had a chance to put their theoretical knowledge into action, with some hands on scanning on patients at the hospital. Following the pre-training scan tests from day 1, the trainees were split in to four different groups according to their competency, in order to develop their skills in real-life situations. The volunteers each took a group and guided their trainees through the examinations. One of the groups detected quite a few anomalies including aortic stenosis, Dextrocardia, sacrococcygela teratoma and a diaphragmatic hernia!

Day 1 of Mongolia Stage 3 Training: introducing the phantom

It’s the first day of ISUOG’s level 3 Outreach training in Mongolia! 18 trainees from across the country are gathered at the National Centre for Maternal and Child Health in Ulaanbaatar to build on the skills they acquired in the previous two Outreach trips.

Our seven volunteer teachers, led by Dr. Philippe Jeanty, have arrived safely and are all set to pass on essential skills in ultrasound in obstetrics and gynecology to the local trainees.

The first day kicked off with a recap of the lessons learned in the last two trips, after which the trainees were required to carry out a pre-training scanning to assess the ability and learning requirements of each trainee.

New to this course (and to the Outreach program in general) is the use of a Phantom ultrasound machine to allow the trainees to re-familiarise themselves with the technology.  Using a phantom created by Dr. Philippe Jeanty, the trainees were able practise their scanning skills, carrying out repeat scans until they felt comfortable with the technology. By the end of the session most students could put a needle in a 10mm target at 10cm depth using ultrasound to guide them, with some getting down to a 3mm target!

Phantom scan trainee 1

Check out our custom-made phantom ultrasound that the trainees are using for their scan practice! A clever creation created by Dr. Jeanty and local doctors.

Phantom scan trainee 2

Phantom scan image

An image from one of the practice scans using the created phantom ultrasound

We will follow the volunteers and trainees over the next few days so stay tuned for more updates!

We’re back! ISUOG Outreach returns to Mongolia

Сайн мэдээ! – or “Good News” as they say in Mongolia!

It’s to the Central Asian steppes once more as ISUOG returns to Mongolia for phase three of its Outreach program starting on Monday 2 June.

Our Outreach volunteers will build on the successes of the previous two trips, led by Dr. Philippe Jeanty in partnership with KSUOG.

The team will again conduct their training at the National Center for Maternal and Child Health (NCMCH) in the capital city of UIaanbaatar, using the MySono U6 ultrasound technology generously donated by Samsung Medison.

During the last trip, the team conducted theoretical training on the basics of ultrasound for OB/GYN which was also simultaneously translated into Mongolian for the local practitioners by Dr. Tsedmaa Bataar. Interesting topics such as Doppler and cardiac views were introduced towards the end of the training, once the trainees were confident to deliver scans independently.

Follow our trails next week as we uncover new successes and stories to come.

Final days of training in Mongolia

The second level training trip in Mongolia is now coming to a close after a full 5 days of didactic teaching and hands on scanning. Dr. Philippe Jeanty shares his thoughts on the final days:

“Today we finished the 5th day of the course. Now the students clearly are in the routine mode, and things that were a struggle during the first trip are totally second nature (entering patient, cleaning transducers, biometry, making reports, what to obtain for the various types of examinations…). This makes the training more fun because we can concentrate on more interesting things such as Doppler, and cardiac views.

A 3D dissection presented by Prof. Kwang Jun Kim

A 3D dissection presented by Prof. Kwang Jun Kim

From 1 to 4:30 pm we scan patients and there are MANY of them. The students are at a level that we don’t need to tell them what to obtain, just nudge a little correction here and there, a few pearls (power Doppler to distinguish cord from fluid in late 3rd trimester) or challenge them to get views, in particular cardiac views.

Prof Ja Young Kwon helping out in the hands on session

Prof Ja Young Kwon helping out in the hands on session

We had quite a few pathologies over the course of the week, including a DC-DA twin with AEDV, previas, Dandy Walker cyst, Ebstein and more.  Today one of my students had trouble getting a good 3-vessel-trachea view, and as guiding her hand did not get us a better view I took over the scan, but still no luck. Ja Young was asked to take a look and found a pulmonary stenosis. This was a great demonstration 1) that if you can’t find a normal section, dig in or ask help, don’t skip; 2) of the thought process: a thin pulmonary artery along side a large aorta, what should you consider and how do you prove it ? (in this case PW showed high velocities in the PA); and 3) how to counsel the patient and explain what is happening.

Prof Moon Young Kim with her hands on scanning team

Prof Moon Young Kim with her hands on scanning team

All of us faculty very often call on each other to help with scans and diagnoses. This teaches the students that there is no shame in not knowing everything and asking for a second opinion is the right thing to do.”

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The volunteers are making their way back home now with the aim to return in another 8-12 months to complete the final level of training. ISUOG sends out a very big thank you to the trainers, the trainees, Dr. Bataar and the staff at the NCMCH, and our partners for their time and dedication and making this another successful trip! 

Mongolia Day 3: building partnerships and making friends

Training continues in Mongolia at the National Maternity Hospital in Ulaan Baatar. The trainees taking part this year have come from all over Mongolia and represent a wide range of regional health centres located across the country.

Outreach volunteer Dr. David Berck with a team of trainees

Outreach volunteer Dr. David Berck with a team of trainees

A key aim of all ISUOG Outreach projects is to build long term relationships with the trainees and partner sites so there can be continuous communication and feedback provided even between training trips.

The full team of volunteers (from left to right): Prof. Kwang Jun Kim, Dr. David Berck, Prof. Ja Young Kwon, Prof. Moon Young Kim, and Dr. Philippe Jeanty

The full team of volunteers (from left to right): Prof. Kwang Jun Kim, Dr. David Berck, Prof. Ja Young Kwon, Prof. Moon Young Kim, and Dr. Philippe Jeanty

The volunteer team have also been spending time getting to know the Mongolian culture better, including visiting local sights and trying their hand at Mongolian hobbies!

Dr. Philippe Jeanty shows off his skills!

Dr. Philippe Jeanty shows off his skills!

Back at the hospital the trainees have experienced first hand some of the challenging cases that arise when working in obstetrics and gynecology. Patients so far have included monochorionic twins with preeclampsia and weight discordance, severe hydronephrosis, threatened preterm labour, and a variety of gynecological pathology.

Check back tomorrow for more updates!

Training starts! Mongolia Day 1 and 2

Following long flights and considerable jet lag for some, the volunteers are now in place and have already been teaching and scanning for two days.

All doctors who took part in training last September have returned with most of them having done between 700 and 3,500 scans in the interval which means their skills have already greatly improved!

The team leader, Dr. Philippe Jeanty, shares his pictures from the first few days:

Dr. David Berck gives a lecture. The students can look at the slides either in English (left) or in Mongolian (right).

Dr. David Berck gives his first lecture of the day. The students can look at the slides either in English (left) or in Mongolian (right).

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“The fluid in front of the chest is 2 cell phones deep”

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Prof. Kwang Jun Kim from KSUOG showing how to get the ovary

Below: Philippe showing how to jump from one section to another by visualizing the fetal position, a skill quite baffling to some.

Tsedmaa, the chief of the Mongolian team, does all the translation with remarkable energy and stamina.

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“Very tiny” in Korean and universal sign language

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Now it is the turn of the students to answers quiz cases! Sugar (her real name) and Jack (a much shortened version of his real name) are puzzling over a case.

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Dr. David Berck during one of the hands on scanning sessions

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Prof. Moon Young Kim from KSUOG doing some scanning

Dr. Tsedmaa Bataar, from the NCMCH, with Dr. Philippe Jeanty. She has tirelessly been doing all of the translations, organised for patients to be available for hands on scanning, and provided logistical support throughout.

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To the steppes once more! ISUOG’s Mongolia Outreach Project, Level II

Good news; ISUOG will be returning to Mongolia for the second level of its Outreach program from the 2nd to the 6th of September!

The success of last year’s program has allowed Dr. Philippe Jeanty to return to this intriguing nation, nestled in the continent between China and Russia.

ISUOG will be working in partnership with the Korean Society of Ultrasound in Obstetrics and Gynecology, whose volunteers also took part in the first trip last year, to deliver this second level training. The five day program will include both didactic teaching sessions as well as hands on practical training in the afternoons.

The volunteers will be revisiting the National Centre for Maternal and Child Health, located in the capital Ulaanbaatar, where the first training took place this time last year. Samsung Medison generously donated three MySono U6 systems to the program in 2012, which have since remained in Mongolia and will be used again this year.

The first level of training was a great success for both the trainees, who managed to detect a high-risk placenta accreta in one patient early on in the training, but also for the volunteers, who were able to provide help and support to the local team throughout the week.

Stay tuned to see what this next trip brings and to meet the volunteers and local medics!