Tag Archives: Asia

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!


Visions of Burma – supporting training in Yangon


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!


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.

Group photo

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!



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

Making a difference in Papua New Guinea


Dr. Nayana Parange (at centre with scarf) with PNG team and trainees, displaying their certificates (image courtesy of Dr. N Parange for ISUOG Outreach/ASUM)

ISUOG Outreach Volunteer, Dr Nayana Parange has recently led the Papua New Guinea Outreach mission in October, conducted in partnership with the Australasian Society of Ultrasound in Medicine (ASUM). In this blog, she recounts her experience on the field and her impressions with the local dynamics.

Papua New Guinea – the land of striking natural beauty with fascinating tribal customs. It is also one of the toughest places in the world to become a mother.  With great excitement, I was coming back to Papua New Guinea (PNG) for my fifth annual visit for another intensive workshop, but this time with an enthusiastic team. The team comprised of Dr Sujatha Thomas from Darwin, Dr Kris Barnden from Tasmania, Dr Alice Robinson from Melbourne and I from Adelaide, and all of us arrived in Port Moresby on Saturday, 22nd October 2016.

Our intensive workshop commenced on Sunday morning, and Prof Glen Mola, an Australian-trained Obstetrician/Gynecologist, introduced us to the trainees, all of whom were doctors training in OB/GYN, as well as rural and remote emergency medicine. The trainees were eager to start training on a Sunday morning, full of hope and keen to learn basic techniques to use ultrasound to help their patients.

We started off the workshop with a quiz to establish the baseline knowledge of the cohort. This enabled us to plan and focus efforts on aspects of hands-on training, such as the ISUOG “six-step” method  of evaluation. As the workshop progressed, we also got several opportunities to interact with medical students, midwives and consultants, and we were able to conduct several presentations for the whole department as well.

It is hard to envisage the reality of pregnant women in PNG. Nearly 15,000 women deliver in Port Moresby General Hospital, and women able to find their way to the hospital are some of the more fortunate ones. Maternal and perinatal mortality is high with 88-98% of these deaths being preventable. Extreme poverty, remote geographic location, mountainous topography leading to inaccessibility of health services, sociocultural factors and most importantly, inaccessible and ill-equipped health centres with a shortage of skilled professionals have contributed to the poor maternal mortality rate in the country.

We came across a wide range of pathology and I was deeply moved by the stoicism displayed by the women, especially when given bad news. One such incident that has been indelibly imprinted in my memory, is where Sujatha and Alice scanned a lady at around 14-16 weeks of amenorrhoea, and diagnosed an abdominal ectopic pregnancy of nearly 16 weeks gestation. We then got to know later that she could be operated upon, in a timely manner, where although she lost three litres of blood, she recovered from the surgery. At least one life saved because of ultrasound!

Common causes of maternal death in PNG include sepsis, low lying placenta leading to postpartum haemorrhage, ectopic pregnancies leading to catastrophic bleeds. Fetal and neonatal deaths here are common because of growth restriction and prematurity. A vast majority of these problems can be recognised on ultrasound, and most often, interventions can be applied to prevent mortality and morbidity, but there is a shortage of skilled personnel to diagnose these problems to be able to manage them effectively.  The dedication of the health professionals though, often overworked and under resourced, is inspiring. Despite the insurmountable challenges, as Prof Glen Mola says, there are many people doing amazing things within the given constraints and making a difference in so many lives through sheer will and personality. “We can’t give up”, he often says.

I would be remiss if I didn’t mention the effort and dedication of the trainee doctors to master the content as much as possible within a short duration. All of them were quite proficient by the end of the training program, and were able to obtain anatomical landmarks and measurements correctly, and confidently perform the six step approach. Quiz scores improved from a 20 percent average to 90%!  A job well done!

Thank you ASUM, ISUOG and our wonderful outreach team! I feel very grateful and privileged to have been able to participate and play a role in PNG ultrasound outreach. We have a long road ahead of us, and the path is not easy, but onwards and upwards from here. Together, hopefully, we will be able to make a difference.


“Individually we are one drop. Together, we are an ocean” –  Ryonosuke Satoro.