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Supporting Outreach work in Yangon – round two!



Dr. Philippe Jeanty and team in Yangon (from left to right: Dr Gwan Ju, Dr. Jeanty, Dr. Ya Chiao, Dr. David Berck and Dr. Federico Badano)

Last year, ISUOG Outreach supported the work of dedicated Outreach Committee Member and renown expert, Dr. Philippe Jeanty in launching a program in Yangon, Myanmar. Now returning for Trip II with his team (Federico Badano from Argentina, Gwan Ju of South Korea, Ya Chiao from Taiwan and David Berck from USA), Philippe reports from the field midweek to share with our followers some updates from training.

“The second course to Myanmar has started, with all the previous students minus four, delivery, maternity leave and two who were not able to get replacement (the obstetrician who came to the course had to be cross-covered by a surgeon for the emergency C-section section). One of the students, whom I like very much, is one of six obstetricians for a city of 4 million people!!

We had asked the students to fill a spreadsheet with all the findings they made during the year and they did a remarkable job at it: probably a first in ISUOG Outreach history!

I like how no one could find cardiac or skeletal dysplasia ( so not a defect on me 😊 )

This table is big, but it shows the constant efforts they did during the year.

Today, we started with the second set of lectures we were provided by from ISUOG, of which Federico enriched very substantially with many video clips. I added some cases related to the lectures and to insure participation, we got four students to come to the front of the class and answer each case. Nothing like being in the hot seat to focus attention! They did pretty well.

The afternoon and the end of the morning we actually did scan. We had not pre-selected the students and some were still fairly hesitant, so we redistribute them into basic, intermediate, advanced level so that the teaching could be more focused; that worked out to be better.

Most of the patients had not undergone ultrasound in pregnancy before.  Our cases included numerous twins, suspected growth restriction, and placenta accreta.

The more interesting case was a hydranencephaly with retinal detachment and it was their first time seeing retinal detachment (a nice case )

On the second and third day, we went on with the lectures. We had asked all the students ahead of time to prepare a 5-minute presentation and with the firm hand of Dr Yin Yin Soe and Dr. Khin Latt (our local contacts) they had all prepared one or several cases, including many ectopic pregnancies, ovarian masses and pre-eclampsia with IUGR. The 2 more striking cases were an abdominal pregnancy and a 38 weeks tubal pregnancy in which the location had not been correctly recognized. This was great way to re-emphasize the routine exam: after the first sweep always document the cervix, size, competence and vasa previa.

The students were very comfortable giving the presentations and very organized in doing so. Mostly their images were poor, often too gained, with depth too far, and captured with cell phone. To remedy this, we went over the depth setting, the gain, and Ya Chiao Hu gave them a short presentation on how to save images digitally on a memory stick!

Dr Gwan Jun Kim, who was with us last year and participated during all trips of the Outreach program in 3 Mongolia, gave the CNS and cardiac lectures with his usual brand of humor and animated descriptions. He is always popular!

Dr. Federico Badano also lectured with great calm and a ton of videos to the ISUOG.

Dr. David Berck, who is also a veteran from Mongolia, was with us as well. In the end, we ended up all adapting Gwan Jun technique of abundantly moving around, using the many dolls that Dr Khin Latt had prepared.

We had a very large supply of patients, and even an extra ultrasound machine. The course is sponsored by Mindray and the local distributor “Concordia” and Dr Than Win had really gone out to make sure we had all that we needed. The extra machine allowed the students to practice under less time constraint. Ever efficient Justin Liu was going from machine to machine making sure everyone was alright with the knobology. He was part of it group last year too but was much less shy this year and has remarkably improved his fluency in English. By the way, all the students speak perfect English but with a British flair (liquor.. for amniotic fluid) and an accent sometime difficult for my deficient ears.

The only really problem was that it is incredibly hot here and the Air Conditioning could not keep up with the 30 people in the room, plus the patients and six ultrasound machines. I was dripping over my students who would provide me wipes and water every three minutes. So sweet!

The students are very comfortable with us. Last year, being shy, I had asked them to write their questions on paper and leave the questions on our desk for us to answer. This year, there was no problems at all. I think that getting them to come answer the cases in front of everyone, although terrifying at first, gave them much more confidence. It helped that Thao and Ya rewarded the correct answers with a gold medal of chocolate. A old trick I used in Mongolia too.

On to the fun part where David was interested in the local dress that men wear here, called Longi. Dr Khin Latt generously gave one to each of us!! Resulting in a rather unique picture (as see at beginning of blog).

Tomorrow is it last day and we are already nostalgic about leaving our students for a year.”

Follow our blog for more stories from the field!


Final stages of ISUOG’s training mission in Ghana

Outreach continues in Kumasi today and we’re following the group in Old Tafo as local trainee to become Trainer, Abekkah Adam Jonah, leads the lectures this morning under the supervision of ISUOG Trainer Dr Janet Horenstein.

Abekkah Adam Jonah giving a lecture under watchful eye of Dr Janet Horenstein

Abekkah Adam Jonah giving a lecture under watchful eye of Dr Janet Horenstein

The morning was full of lectures on fetal anomalies, with multiple ectopic pregnancies identified and referred.  Scanning resumed for the majority of day as usual, but as the second phase of the funeral ceremonies were taking place in the evening with a required curfew imposed at 6:00 PM, the day ended early at 2:30 PM in order to facilitate the trainees’ long return home.

Tomorrow will mark the end of the Ghana Program and a handover to local actors. Stay tuned for this final chapter in ISUOG Outreach in Kumasi in the coming blog!

GesĂš Antonio BĂĄez
International Development Coordinator

Rising stars in ultrasound training: Day 3 of Outreach in Ghana

It’s Day 3 of ISUOG Outreach in Kumasi. To change up the scenario a bit and given the large group numbers, six of our trainees conducted training with Local Trainer Dr Buah Hamilton in Manhyia Hospital, which sits right beside the official residence of the Ashanti King, Manhyia Palace (where the team visited early on the week).

If one word could describe this group of trainees, then it’s ownership. Many of the Trainers (both local and international) were very impressed at the ongoing desire to learn from the trainees and the newfound confidence of the new trainers. Some trainees, such as Anita from the Kumasi South group, felt confident enough to even guide the trainees in scanning alongside local Trainer Prince Owusu.


Trainee Anita feeling confident to coach trainees on scanning – clearly a rising star!

Theoretical lectures proceeded practical training, but it was perfect timing for as the Multiple Pregnancy lecture at Kumasi South was given, a twin pregnancy was then detected, heightening excitement among trainees.

As this is the last trip of the ISUOG Ghana Program, it goes without saying the extreme gratitude of both the ISUOG Trainers and trainees have on the presence of GE Healthcare, both with the three donated Voluson machines and the presence of GE Healthcare reps (Ms Tammy Anderson from Trip 1 and 3 and Ms Sarah Stephens from Trip 2). The passion they bring for the technology is apparent and has made such a difference in training.


Images from Kumasi

Stay tuned for more journeys on the field. 

-ISUOG’s International Development Coordinator, GesĂš Antonio BĂĄez

New trainees becoming future trainers in Kumasi

ISUOG’s International Development Coordinator, GesĂš Antonio BĂĄez, is proud to see new trainees already learning to teach others the skills they’ve acquired through ISUOG ultrasound training – a promising sign for the future of ultrasound training in Kumasi.

“It’s day two of Outreach in Kumasi. The team divided into the key three hospitals – Suntreso, Old Tafo and Kumasi South Regional Hospital. While the morning had a rocky start, the trainees were eager to get in to hands-on training. With morning lectures on ectopic pregnancies, fetal biometry and informed consent by the new local trainers, they continued with scanning during the rest of the day. Real stars included Bernice Nsobilla over at Suntreso and Prince Owusu at Kumasi South. The group at Kumasi South has even already set up a WhatsApp account with their trainers Prince Owusu and Albert Adu as they shared an ultrasound picture for the day for them to discuss on.

Stay tuned for more from the field as Outreach in Kumasi continues.”

-GesĂš Antonio BĂĄez


First day of training in Kumasi with a promising week ahead

With both excitement and melancholy, the ISUOG Outreach Team arrived in Kumasi over the weekend for Phase II, Trip III – the last trip of the Ghana Outreach Program.

The team arrived in Kumasi, which was in full swing as it commemorated the late mother of the Ashanti King – one of the most powerful men in Ghana. With regalia and ceremonies taking place in the streets, the team was invited to Manhyia Palace to pay homage to the king and their respects to the royal family. The team was received graciously by the King’s wife, Lady Julia, who took complete delight as ISUOG Outreach Trainer Dr Theodora Pepera-Hibbert explained to her about the program ISUOG has been implementing in Kumasi since 2011.

After a memorable night, the team kicked off the program by meeting with the trainees who are being empowered as Local Trainers (Abekah Adam Jonah, Bernice Nsobilla, Osei Bonsu Sarpong, Albert Adu, Prine Owusu, Yusuf Yacub and Buah Hamilton). Thirty-four trainers from across the Ashanti Region were present at Kumasi South Hospital for the first day, with lectures given by both the local trainers and ISUOG team members. The introductory slides were given by Dr Pepera who – following the end of the program – will serve as Special Representative for ISUOG Outreach in Ghana following program’s end, with subsequent talks from Project Lead Dr Anthony Johnson, ISUOG Volunteer Dr Janet Horenstein and GE Healthcare’s representative Tammy Anderson.

The day consisted of a full day lecture with the aim of the ISUOG group to observe and understand how the local trainees engage. They were pleasantly surprised with how naturally Adam Abekkah and Bernice Nsobilla gave their respective lectures (Fetal Biometry and the Six Step Approach) with such ease, confidence and a good dose of charisma. Prince Owusu was particularly wonderful during the live scan with the donated GE Voluson S6 (which GE Donated back in 2015) and the natural skill he exhibited in teaching.

It was a long day for the trainers, but with a promising week ahead, the reward in seeing the new trainees so empowered and confident will be the real motivator for the rest of the week.

Coming to full circle: Outreach returns to Ghana for its last trip



Local Ghana Trainer Osei Bonsu explaining a lecture to the trainees

As the year comes close to an end, so does ISUOG’s Outreach Program in Ghana as the team heads over to Kumasi this weekend for the last of six trips made to the Ashanti region over the years since 2011. Led by Dr. Anthony Johnson (Chair of the Outreach Committee), the trainers (Dr. Theodora Pepera-Hibbert of Ghana/UK and Dr. Janet Horenstein of the United States) will be passing over the baton to the key trainees who have now been identified as local trainers to train a new batch of trainees from all over the Ashanti region. Both ISUOG’s International Development Coordinator, Gesu Antonio Baez, and GE Healthcare’s Tammy Anderson will also be in Ghana to support this last effort in Kumasi in partnership with Kumasi Metro Health Services and local NGO partner Women’s Health to Wealth. Follow our blog all next week as we share more inspiration from the field. To find out more of what we’ve done in Ghana, visit our website.

Breaking the Glass Ceiling…

…Slowly. Surely. Securely. Facilitated by vision, unification and dedication…

Indeed, this summarizes my experience as an ISUOG Outreach trainer, returning to Sudan exactly a year after our first trip in November 2016. Over the course of this tumultuous year, and as our world has sadly become more and more divided, our extended Sudan team has become more and more united.

The Government of North Kordofan State with ISUOG trainers and trainees.

Vision is what got us here: ISUOG’s vision that every woman should have access to ultrasound performed by a competent provider that impacts her outcome, and the vision of the Government of the North Kordofan State in Sudan in the fight against maternal mortality and morbidity where it instituted the training to 30 Ob/Gyn and Radiology physicians who provide the care to the women of North Kordofan. We had the honor of meeting the Deputy Governor of North Kordofan State with his Ministers where he addressed us in our closing ceremony. He shared with us his government’s bold glass ceiling-breaking steps: female circumcision has been banned, marriage to a minor has been banned, prenatal care is to be made available to all women free of charge, and 14% of the State’s budget shall be dedicated to healthcare. This has been with the support of Her Excellency Maria Al-Amine, Minister of Finance and Economy at the Government of North Kordofan State, the only female Minister in the State, an awe-inspiring persona to say the least.

Closing ceremony where Her Excellency Maria Al Amine presented me with the honorary plaque that was given to all trainers. Deputy Governor of North Kordofan addressed us (top right) as did our own trainer, Angela Ranzini, who spoke about the future role of ultrasound (lower right).

Unification has been fueling our whole mission: our trainers and trainees, in addition to all the representatives we have from the Government of North Kordofan State, the University of Kordofan, ISUOG, Salamat NGO and Mindray’s local dealer “Tabasheer”. We represent humans from all walks of life, all races and ethnic backgrounds, numerous religions and countless spoken languages. All are focused on winning the fight for equal access to education and all have been unified by the probe with its inherent ability to protect maternal health and optimize fetal outcome. In this mission, the team has come together as a true force ready to take on any challenge and leave an impact thereby exemplifying the extent of the power of a united front and how it can securely break the glass ceiling.

Unified under the Sudan sun at Lake Rahad drinking Jabana coffee.

Dedication has been the hallmark of this mission: that of the Government with the endless support it is providing, the trainers who put all their commitments on hold and traveled from across the globe, and our trainees who came long distances using unpaved roads leaving their patients and families behind in order to attend this training despite losing their daily clinic income. All were tireless in their commitment, adapting to all challenges as they arose, making the most out of every opportunity to implement the necessary change. When faced with no electricity and no ability to use the ultrasound machines, the SonoSim simulator was utilized in order to maximize the scanning experience for the trainees in every possible format.

Stopping at nothing: multi scanning stations with live patients (top right) and using the SonoSim Simulator (left) with His Excellency the Minister of Health assessing the scene (lower right).

With vision, unity and dedication, all geopolitical boundaries were eradicated, and with the union between human willpower and manpower the trainees were empowered, the trainers gratified and maternal well-being prioritized. May the essence of my experience in Sudan, with the gracious Sudanese people and every single member of our team, prevail all over our world. With vision, unity and dedication, we shall unequivocally shatter the glass ceiling…

The team with Salamat NGO President on day 1 (top). The team with the trainees on day 5.

By Dr. Reem Abu-Rustum, ISUOG Ambassador to Outreach in Lebanon and Middle East

Incense, smiles and jabanah: ISUOG Outreach in Sudan

Incense, smiles and jabanah….three distinct words which describe Sudan. Describing the essence of the country and program is Prof Hisham Mirgani Mubarak, who is both ISUOG’s Ambassador to the Middle East and Project Lead for Sudan. He is contributing to today’s blog to give more details on a country hardly known by the world:

“As we sat in the plane taking us from Khartoum, the capital of Sudan, to El Obeid, 400 km away for our second Outreach visit, I looked at the faces of the ISUOG Outreach team Gesu, Reem, Angela, and Yasmin sitting on my left. On my right was Sami, Sudanese obstetrician, and Sohaib from the local NGO facilitating our logistic. They were all full of excitement, eager to go back to El Obeid and build on last year’s success. What a team!

We came down the plane to find smiling, welcoming faces of friends we made during our first visit. There was Dr. Faki, the Minister of Health together with the Dean of the medical College. Just behind them was Dr. Khidir, the driving force for El Obeid Outreach program, receiving me with a big hug and tapping strongly on my back, which is how Sudanese welcome their friends. As we drove to the hotel we could see the tall large Adansonia trees, known to the locals as Al Tabaldi trees, guarding the entrance of El Obeid. No wonder it is the emblem of the city.


Adansonia tree, also know as Al Tabaldi tree in El Obeid

We spent the afternoon and evening discussing and preparing for our first day, which we were all looking forward to. The first day is always exciting meeting all the trainees. Everything was in place and ready. The rooms cleaned and ready, the ultrasound machines ready to function, and Hala, the director of the training site welcomed us with tea and coffee.

I was impressed to see Mohamed Khair, an obstetrician posted at the town Al Mijlad, who drove about 450 km on unpaved roads to join the second training week, excited and eager to develop his ultrasound skills and knowledge. His hospital caters for women from a wide catchment area including Darfur and some patients cross the borders from the neighboring newly founded country of South Sudan seeking care at his facility. His only referral hospital is in El Obeid, 500 km away! I was able to see the excitement in his eyes as he was telling me how the number of prenatal diagnoses of placenta previa has improved after the first ISUOG week of training.


Prof Hisham Mirgani Mubarak and Dr Mohamed Khair

All trainees were engaged and motivated. It was inspiring to see how they were learning and helping each other. Mastora is a mother of three that had to travel for two hours to have her first ultrasound examination during her fourth pregnancy. She was found to be at her 30th week. The glance at her baby’s heart beating and movements lit her eyes. Fortunately, no abnormalities were noted.

Hospitality here is always great! We were invited to attend a football match between the host “Al Hilal” team and a guest team from Khartoum. Fortunately, El Obeid team won!


The Minister of Health also invited the ISUOG team and all trainees to dinner at the side of “Al Rahad” lake a 45 minutes drive from El Obeid. The view of the sunset was just incredible! Everyone enjoyed drinking “Al Jabanah” the traditional Sudanese coffee.

Tomorrow is our last day for the second visit. Each time we visit El Obeid we feel we make a difference to the healthcare of women in this region. What a feeling!”

Prof Hisham Mirghani Mubarak

Enthusiasm for training and a trip to Lake Rahad on day 3 in Sudan

It’s day three of ISUOG Outreach in Sudan and days filled with lectures, hands-on training and famed jabana coffee are underway! Blogging on her experience is ISUOG Outreach Volunteer, Ms. Yasmin Casmod from South Africa, who writes:

“Today is the third day of the Outreach training program in Sudan.

As day three begins, we are halfway through the training and discuss the logistics for the day over breakfast. The day kicked off with a lecture by the team leader Prof Hisham Mirghani, followed by a lecture by Dr Sami Mahmoud, one of Sudan’s own.

Each group had an average of seven trainees and the practical sessions began with a specific focus on the intracranial anatomy, along with a revision of what has been covered thus far. Trainees are eager and enthusiastic to learn. It is certainly an honor and privilege to share knowledge and skills with professionals that are so motivated.


Dr Sami Mahmoud teaching trainees

After the lunch break, practical sessions continued and the day ended off with a lecture on distinguishing between normal and abnormal appearances of the urinary tract.

We finished the day with a trip to the beautiful Lake Rahad and a delicious meal as well as the famous Jabanah coffee on the banks of lake.


Trip to Lake Rahad

It is certainly rewarding to see tremendous growth and eagerness from all of the trainees and we look forward to continuous engagement and education.

-Ms. Yasmin Casmod

Trainees eager for more hands-on training! Day 2 in Sudan

Sabah al khair min El Obeid! Good Morning from El Obeid! The Outreach Team carries on with Day II of the program here in Sudan. Sharing her experience on the ground is Outreach Trainer Dr Angela Ranzini who describes her experience:

“Greetings from El Obeid! Today is Day 2 of our week in the Sudan. Once again, the week seems to be just flying by.

Our day today actually began on Sunday! One of the first things we did on day 1 was to ask for feedback from the trainees, and found that they are hungry for more “hands-on” training. Yesterday evening we compiled the results of the initial “hands-on” 6-step evaluation and reshuffled the trainees into new groups for today.

As sometimes happens, the best made plans change, and as trainers, we adapted. Last year, we had planned to have lectures in the morning and “hands-on” scanning in the afternoon, but when we got to El Obeid, we found out that the patients typically come to the clinic early in the morning, so we reversed the schedule to have “hands-on” scanning early in the morning and lectures after lunch.

This year, we found that patients typically come earlier in the week rather than later. So, given the trainees desire to have as much “hands-on” as possible, we adjusted the schedule. After an initial lecture on normal and abnormal heart (planes 7, 8, 9, 10) by Dr. Reem Abu-Rustum, the day was mostly spent doing directed scanning with the new groups, breaking for prayer and lunch, which was kindly provided by the International Planned Parenthood facility we are using for the training.

I have been consistently impressed with the trainees here in the Sudan. We have 28 trainees and lost only 2 over the past year (one relocated out of the country, and one was on her honeymoon) which I think shows an amazing dedication to the program. The eagerness to learn is palpable. The other thing that impresses me, is how hard these men and women work. All of the trainees are Ob/Gyn or Radiology physicians with their own practices here in the city or in the surrounding state. After class ends, many of them see patients in their offices until all hours of the night and some of them even into the morning. Despite being very busy and probably sleep deprived, they pay attention, don’t fall asleep and don’t get out their cell phones during lectures! During the lunch break, some did pull out their cell phones – to get second opinion consults for complicated anomalies that they recently identified in their patients.

Attentive and hard-working trainees in El Obeid

My “hands-on” scanning group consists of both Ob/Gyn’s and Radiologists. Today we scanned one patient each ½ hour or so, and rotated trainees, so all people scanned at least one patient and some two. We used a portable Medison machine, which has quite a nice image and is equipped with color and pulsed wave Doppler, which proved useful in patients with small babies. Most of the trainees stuck around before and after their scan time to assist in offering scanning suggestions to the trainee.

The trainees are very supportive of each other and not shy about asking questions. After performing the “6 steps” with each patient, we progressed to doing axial “sweeps” of the fetus from bladder through the three vessel view, noticing all of the structures in between. We had good conversations about technique and management of some abnormalities.

Hands-on ultrasound training 

Most of the patients present were there for their first ultrasound between 26 and 34 weeks, although we did have one scan at 20 weeks. They are not hard to scan since they typically have normal BMI’s. They are eager to have an ultrasound, despite having 8 people in the room watching, and like women everywhere, want to know the gender of the child. Fortunately for the patients, we didn’t see any anomalies today in my group.


Patients waiting to be scanned 

After the training session was over, the team relaxed with a Diet Coke and warm French Fries (chips) back at the hotel and traded observations about the day.

In the evening, we were invited to watch a football match by the Government. El Obeid played Khartoum and won 2-1. As the Government’s guest, we were escorted up the red carpet to our really comfortable red covered chairs at midfield. We were greeted by Dr. Abdullah, the Minister of Health, just after his arrival. What a treat!

The stadium was all lit up and colored flags ringed the upper wall. Two bands, one for each team competed for our attention with horns, drumming, dancing, flag waving and periodically, tongues of fire to celebrate a goal. Behind the stadium, two minarets were lit up with white and coloured lights as if to celebrate the game, and at half time, we were treated to jebena, a delicious spiced coffee served sweetened, in small glass cups. The heat of the day had dissipated and a bit of a breeze filled the stadium, making it a perfect evening to finish the day.


El Obeid vs Khartoum soccer game

It is a privilege to be teaching ultrasound in the Sudan with such a dedicated partnership: ISUOG, The Minister of Health, International Planned Parenthood and Salamat NGO, all dedicated to improving pregnancy outcomes for the women of the Sudan and creating a sustainable ultrasound teaching program.”

-Dr Angela Ranzini