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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Another busy 14+ hour long day of ISUOG Outreach

Project lead Dr Lisbet Hanson describes another busy day of teaching and scanning as trainees discover the relevance of ultrasound in Haiti.

We started with a 6 AM petite déjeuner in lush surroundings. By 8 AM our driver, Sebastian, had delivered us to the hospital, expertly dodging what can only be described as a sea of humanity: pedestrians, motorcycles, 3-wheeled tap taps (taxis) and cars weaving through the busy streets to their destinations. An 18-mile ride takes 45 minutes. The hospital is downtown and surrounded by city noises with blaring horns, shopkeepers hawking their wares and children on the way to school. Even the sound of music from a funeral procession filters into our conference room.

 

Team debrief over breakfast and street life in Cap-Haitien

Today there were lectures on ectopic pregnancy, multiple pregnancy, ultrasound in labor and postpartum, as well as a lecture on GYN issues in pregnancy. Dr. Lemaire and Dr. Michel gave a case presentation of a woman who developed early onset pre-eclampsia and IUGR. It was a dramatic story of the challenges women in the developing world encounter accessing appropriate care.

 

ISUOG Trainer Dr Stéphane Michel lecturing and trainees with their youngest visitor!

After lunch we did hands-on scanning and trainee evaluations. We had patients ranging in age from 16 to 87. We scanned non-stop until 6:30 PM. Four machines were operational, two had vaginal probes and everyone was intent on having an opportunity to do scans.

Earlier in the week we had been challenged by one of the trainees with the question, “What relevance does ultrasound have in Haiti today?” And after four days of scanning, the question had been laid to rest.

Despite the extended hours of scanning, we could not accommodate all the patients and had to ask a dozen to come back the next day. Over dinner at our hotel we came up with questions for a game of “Ultrasound Jeopardy” that we plan to play with the trainees tomorrow, our last day.

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ISUOG Trainer and Project Lead Dr Lisbet Hanson (centre) with trainees.

This week has been both exhilarating and exhausting – another ISUOG Outreach experience I’ll remember fondly. I look forward to returning soon again!

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!

 

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

Gratitude for ISUOG ultrasound training

Trainee Adam Abekkah and selfie with Sarah Stephens and the training midwives in Old Tafo
Image courtesy of G.A Baez for ISUOG Outreach

For day 3 we’re following Dr Janet Horenstein and Dr Theodora Pepera-Hibbert training the group at Old Tafo.  Dr Pepera started the day with a review of gynecological scan techniques which carried on into conducting transvaginal scans during a good portion of the day. The strongest of the group, Adams Abekkah, even began training the other trainees (under the watchful eye of Dr Horenstein). The Old Tafo clinic was lined with patients. About 20 were scanned today, which gave plenty of opportunity to practice for the group!

Midway through the training, the chief clinical director paid a visit to the team and expressed his gratitude to ISUOG and the training being given in Kumasi. He explained seeing a notable difference in the quality of mothers lives in the region and the accuracy of diagnosis thanks to the ultrasound training skills. Needless to say, such mention surely made the team beam with pride!

Training gynecological scan techniques
Image courtesy of G.A Baez for ISUOG Outreach

Follow us as we continue to report from the forks.

Improving practical scanning skills in Ghana

GE Healthcare’s Sarah Stephens teaching machine optimizing and practical sessions at South Kumasi Hospital
Image courtesy of G.A Baez for ISUOG Outreach

Day two of Phase II Trip 2 in Kumasi, Ghana kicked off and we’re now following the training group in Kumasi South Hospital for another day of ultrasound training. GE Healthcare’s Sarah Stephens met with the group today to give a lecture to better optimize their skills on the GE Voluson machines that were donated to the program a year ago. Some tips or “pearls” she shared with the team included how to make the image blacker or whiter in order to achieve a sharper image when scanning.

Most of the patients seen were in their third trimester and there was even one with multiple pregnancy with fetuses that moved constantly making it difficult for the scanners (but good practice!). The team was stronger today, measuring femur length quickly and confidently with sonographer Prince Owusu even leading on training other trainees on a few scanning skills.

Meanwhile in the other sites, some highlights included the Suntreso group with Dr Theodora Pepera-Hibbert leading the group in recognizing ectopic pregnancies and scanning more than 23 patients in one go.

“The trainees have been very ready and very attentive.” said Dr Janet Horenstein, who worked with Project Lead Dr Anthony Johnson at Old Tafo Hospital. “They are still not at level they should be, but hopefully with more scanning they’ll get there soon.”

Sonographer and trainee Prince Owusu scanning with new skills thanks to guidance of Sarah Stephens
Image courtesy of G.A Baez for ISUOG Outreach

Stay tuned for more updates from the field as we report from Ghana!

Successful start to training in Ghana

Picture above are ISUOG trainers Dr Tony Johnson, Sarah Stephens, Dr Theodora Pepera-Hibbert Dr Janet Horenstein and ISUOG International Development Coordinator Gesù Antonio Báez
Image courtesy of G.A Baez for ISUOG Outreach

We’re back on the ground in Ghana. The ISUOG training team, led by Outreach Chair Dr Anthony Johnson (USA), immediately hit the ground running for Phase II Trip II as if no time had past since the last time we worked in Kumasi back in 2015.

The training team is currently working in each of our key hospitals for the project: Old Tafo, Kumasi South and Suntreso. The 18 Ghanaian trainees were divided between each of the hospitals to work with each different trainer including Dr Janet Horenstein (USA), Dr Theodora Pepera-Hibbert (Ghana/UK) and local trainer Dr Bush Hamilton (Ghana). GE Healthcare Sarah Stephens also joined the team to give an overview of the three GE Voluson machines donated last time.

Hands-on training in session
Image courtesy of G.A Baez for ISUOG Outreach

It was remarkable to note how eager the sonographers were not only scan, but also to help train other trainees (such as the midwives).  It really left an impression on the trainers who noticed little by little the “teach the teachers mission” slowly unfold for them.

The main part of the day was focused on review of lectures, especially going over the key “6 step approach” and providing more hands-on training to really hone in on their skills from last time. And they definitely did get practice with the team at Old Tafo, scanning well into 5:30 PM – after training ended at 4:00 PM.

Stay tuned for more stories from our project on the ground in Ghana and follow our blog for more Outreach journeys.

Visions of Burma – supporting training in Yangon

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Outreach team (from left to right: Franti Grochal from Slovakia, Dr. Philippe Jeanty from USA, Ya Chiao Hu from Taiwan and Federico Badano from Argentina).
Image courtesy of Dr. Philippe Jeanty of TheFetus.Net

On 7 March 2017, Outreach Committee Member and Founder of TheFetus.net Dr. Philippe Jeanty (USA), led a group of trainers in Yangon, Myanmar to train 30 trainees from across the country in basic OB/GYN ultrasound. ISUOG Outreach supported this mission and below, Dr. Jeanty provides his first impressions of Yangon from early this week.

“First day:

This is the first Outreach course we’de done in Yangon, Myanmar. The first day was rest and recovery from very long trips! Federico Badano was the longest distance flyer (29 hours from Argentina), followed by Franti Grochal (26 hours from Slovakia). Ya Chiao Hu from Taiwan and Gwang Jun Kim from South Korea had an easier time but still pretty long trips!
We did some light visiting, taking a local train to site see. Interestingly, we crossed the tracks a few time to get from platform to platform. Very surprising to me!  The train was full of colorful people. They use some ground up stone for makeup and sunscreen. In the train there was a panel with 3 warnings: you can’t smoke or litter, but more surprisingly, you cannot kiss on the train!

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Yangon train
Image courtesy of Dr. Philippe Jeanty of TheFetus.Net

The train was really packed and vendors circulating with all types of food, drinks and trinkets. They even sell betel leaves that people keep in their checks, a little like the coca leaves in the Andes with similar bad effects on teeth! We chatted with some people who were very friendly and quite interested in us. Actually mostly interested in Ya Chiao and we learned later that Korean movies are very popular here and they thought she was a Korean actress!!
We visited a pagoda with an immense Buddha statue made of a single block of marble imported (if I am correct)  from Nepal.
The food is very varied and influenced by Chinese and Indian cuisine.
Today was the first day of the course and we met with our local contact, Dr Yin Yin Soe, who organized the course.
We had 30 students and they come from all over Myanmar! It was incredible that many had come from hospitals with only one obstetrician so it was apparently difficult to get government permission for them to attend the course and have surgeon cover their absence. Many travelled by train the night before. Compared to previous Outreach courses, they are much less intimidated which makes the contact easier.
We had class room in the morning and workshop the afternoon.
It is very very hot! 37 C/99 F, but the students were really eager to learn!

Second day:

Ya Chiao scanning

Yao Chiao scanning with a trainee
Image courtesy of Dr. Philippe Jeanty of TheFetus.net

Since I am so hard at hearing, I got in the habit of asking people to write their questions on paper and drop them on the desk. This is also a great technique for shy students and women who otherwise would not ask questions. Well, we were inundated and the questions reflected a very good level of knowledge. This is an interesting situation with knowledgeable students who just have very little hand-on practice. So I worry that our lectures were too basic.
For Ya Chiao, this was her very first ever presentation in front of a class and even behind her impassible stoic face, she was clearly nervous! Sonographers don’t often teach physicians in Asia but she did a very good job!
Gwang Jun had the second presentation and talked about CNS anatomy and the views. As expected, he had a great presentation and has a unique style of teaching, for instance a way to remember the ventricular system by folding the fingers was a refreshing approach to the usual topic!
Federico and Franti then did their presentation with the ease of someone who has spent years doing them.

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Trainers with trainees
Image courtesy of Dr. Philippe Jeanty of TheFetus.net

The afternoon we had tons of patients with anomalies, including large cephalocele, missed AB, triplets and so on. Some patients needed TV examination which we rarely do in courses like this and Concordia rapidly got us a TV probe and we did several scans. It helps that women here are accepting and that almost all the students are women.
They know what they need to look for but needed help in coordinating what they see on screen with the movement of the transducer. So I hold their hand and show the movement. And invariably they look at my hand moving theirs instead of looking at the screen! So finally I took a patient chart as a “blind” to force them to just look at the screen!
The machines we have are uneven resolution. The three top end machines are fantastic but the low end one makes you realize what it is to scan in a country that has a hard time affording to machines: we are very spoiled!”

Stay tuned for more stories from Myanmar and next week, as we report from Ghana!

 

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Outreach team (from left to right: Franti Grochal from Slovakia, Dr. Philippe Jeanty from USA, Federico Badano from Argentina, Ya Chiao Hu from Taiwan and Dr. Gwang Jun Kim from South Korea)
Image courtesy of Dr. Philippe Jeanty of TheFetus.net