Tag Archives: Education

ISUOG Outreach is off to Oman!

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ISUOG Outreach is excited to announce that it will be launching Phase I Trip I of its Outreach Program in Muscat, Oman starting Sunday, 5 November. Led by ISUOG Outreach Committee Member, Dr. Titia Cohen-Overbeek and supported of ISUOG Ambassador to the Middle East, Prof. Hisham Mirghani, the team consists of an international group such as Dr. Nimrah Abbasi of Canada, Dr. Valeria Angioni of Estonia and Ms. Pauline Schut from the Netherlands, with ISUOG’s International Development Coordinator Gesu Antonio Baez joining the team to deliver the program. The team will be teaching a group of 30 trainees from across the country in basic ultrasound in obstetrics and gynecology. With the backing and official partnership of the Omani Ministry of Health and GE Healthcare in supporting machines on loan, the ultimate goal of the program is to train key doctors from vital regions of the country to spread ultrasound knowledge and training in order to foster a sustainable environment in OG/GYN ultrasound education. Stay tuned on our blog for updates on the field as they happen! For more information about our program, visit our website for more details.

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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.

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.

 

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

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

ISUOG returns to Ghana!

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Women in waiting – Kumasi, Ghana 2015
Photo by G.A Baez for ISUOG Outreach

 

Following a successful Outreach Program back in November 2015, the ISUOG Outreach team is returning to Kumasi, Ghana for Phase II Trip II on 13 March 2017! Led by Outreach Chair and Project Lead Dr. Anthony Johnson (USA), the team will consist of Dr. Janet Horenstein (USA) and Dr. Theodora Pepera-Hibbert (UK/Ghana) once more. ISUOG’s International Development Coordinator, Mr. Gesu Antonio Baez, will also be joining the team in Kumasi. ISUOG Outreach is proud to be working with local NGO partner Women’s Health to Wealth (WHW) in supporting the team and program mission, as well as GE Healthcare who previously donated 3 Voluson machines for this project. The team is looking forward to getting back on the ground and help the trainees hone in on their skills and build their confidence to train locally in line with ISUOG’s “Teaching the Teacher’s” concept. For more information on our work in Ghana, visit our website for more details.

Stay tuned for more stories from the field as they happen – subscribe to our quarterly newsletter!

Making a difference in Papua New Guinea

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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.

Milestones: ISUOG’s role is to become the bridge in education

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(Image courtesy of ISUOG Outreach – Somaliland)

Paulina Stachnik is ISUOG’s Events and Education Assistant. Passionate about delivering high quality educational resources, she has worked as a teacher on three continents and completed her MSc in International Development in 2014 at the University of Edinburgh. She believes that comprehensive education and skills building are the key to long-term and sustainable growth around the world. As a result, she’s chosen to share how her passion and education mix in with ISUOG’s overall mission.

 

Milestones are a unique occasion for pause and reflection. While ISUOG has done little in terms of slowing down, with a growing list of 13,300 members, 25 years marks a significant chapter in the journey of an organization with humble origins and mindful values: quality, innovation, leadership, and learning.

Milestones are also an opportunity to come full circle and to gauge our progress, not only by how far we have come from the starting line, but also by how true we have remained to the ideas that have sparked ISUOG’s conception. As new initiatives continue to take form, ISUOG remains mindful of the most valuable—and renewable—resource it offers: education.

Picture this: one doctor in Ghana region attends a course on prenatal genetics via live streaming. She shares the knowledge with ten colleagues at her hospital; each doctor scans fifteen women every day—two spot an anomaly they would have otherwise not known about.

One Chinese trainee’s newly acquired knowledge of a Doppler technique shifts the direction of a fetus’ development, significantly increasing the chance of the recommended treatment’s success.

A case study presented by a young Turkish researcher starts a conversation between two doctors who come to a conclusion about an unresolved diagnosis.

ISUOG’s role is to become that bridge—for sharing knowledge, progressing research, encouraging discussion, redefining expertise—and after a quarter of a century, that bridge links a community of medical professionals in 126 countries. Momentum continues to build—ISUOG’s online CME platform makes learning a click away, as easily accessed from a suburb of Doha as a home office in London; translated guidelines make critical information clearly understood in native tongues; over 730 scientific abstracts for the 2015 World Congress in Montreal arrived from every continent.

Soon, it’ll be time for a birthday cake and birthday wishes. Though 25 candles may not be needed, as ISUOG’s ultimate goal of making comprehensive education and training for all professionals, anywhere in the world, is becoming a reality.

And we’re just getting started.

SANA’s Spring Reflections from the Lebanese Outreach

Reem Abu-Rustum, MD FACOG is the founder and President of SANA Medical NGO (an ISUOG partner), dedicated to outreach obstetrical care in Lebanon. She is also ISUOG’s Ambassador to Lebanon and the Middle East, being actively involved in the integration of ultrasound in medical education. SANA celebrated 4 years of success this past May and in this post, Reem graciously shares her insight on not just outreach in the under deserved communities in Lebanon, but also accommodating new disadvantaged communities coming in from neighboring Syria as well.


Spring, earth’s time of rebirth and regeneration.

It brings with it endless hope and promise. This spring, it marked a most special time for SANA Medical NGO during which it celebrated its 4th birthday on 19 May 2015 and renewed its commitment to its mission.

It has been an amazing four years during which SANA had to evolve and adapt to the changing needs within the Lebanese Outreach. So many missions, lessons and stories have had a lifelong impact and have been forever etched within SANA’s memory; the endless images of stoic expectant mothers wearing appreciative smiles of reassurance and the bright faces of SANA’s trainees empowered by their new skill and knowledge. There lies the driving force behind SANA, infusing it with such a sense of purpose.

On its 4th birthday, SANA reflects back on its teachers, trainees, patients and supporters who have all been an endless well of inspiration.

Without its teachers, who served as the ultimate role model, SANA would not have come into existence. The incredible work that was being accomplished all over the globe by Alfred and Sharon Abuhamad, Titia Cohen-Overbeek, Jean-Claude Fauron, Lisbet Hansen, Philippe Jeanty, Anthony Johnson, Dario Paladini, Ann Tabor and the ISUOG Outreach volunteers is what led to the birth of SANA. It was founded in loving memory of Dr. Sana Elias with the goal of carrying out ISUOG Outreach’s work in ‘our own Lebanese backyard’. To its teachers, SANA is forever grateful.

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Over the past 4 years, SANA has been blessed in being able to partake in the sonographic education of over 30 deeply committed and motivated trainees of various ages and qualifications. The training is ongoing at different phases to the diverse groups. Regardless of their background, whether or not they could read or write, they held the probe with contagious excitement and dedication soon after putting their newly acquired sonogaphic skills to tremendous use. Nothing is as gratifying as watching SANA’s trainees positively impact the medical care being provided to the underserved expectant mothers in the Lebanese Outreach, which now comprises of both native Lebanese mothers and Syrian refugees. SANA is proud of its first group of nine midwives and nurses who have completed the basic training and received ISUOG certificates. They are now undergoing continuous advanced training. In addition, one of SANA’s star trainees, Midwife Loulou, has lectured to the newest group of 16 midwifery students igniting their interest and capturing their attention. Today, SANA is as committed as ever to making available proper sonographic training to all interested probe-handlers.
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As SANA reflects back, it becomes quite apparent that perhaps the most powerful images are those of its patients. SANA was established with a primary goal of providing high standard quality care to underserved Lebanese mothers. Little was it known back in 2011 that over one third of SANA’s patients would be Syrian refugees. SANA had to adapt to mounting needs where, in addition to the pre-existing suboptimal conditions in the Lebanese Outreach, it was faced with the additional challenges of a growing number of patients who had witnessed the atrocities of war in all its forms, due largely to the current conflict in Syria. But these patients were combatting death by bringing in life and as such, SANA has managed to take care of several patients now in their second and third pregnancies during their displacement in Lebanon. These patients tended to be either much younger or grand multiparas with higher rates of prior home births and prior cesarean births when compared to their Lebanese counterparts. SANA is indebted to its able partners who have facilitated its mission in delivering quality prenatal care to over 1000 patients. Most importantly now, it is through the actions of SANA’s trainees, who have been most gracious in providing quality prenatal care to underserved Lebanese and Syrian refugees, that SANA’s existence is validated.

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And how could SANA have ever succeeded in any of its activities had it not been for its volunteers? They have been giving consistently and selflessly, serving as a key to SANA’s sustenance.

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As SANA’s reflections come to a close, it looks forward to a most promising future fueled by unwavering passion and acquired wisdom, aided by its donors and supporters. Today, SANA renews its vows to carrying on with its mission thanking each and every one who has accompanied it on this most unforgettable journey in the glorious Lebanese Outreach.

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