Tag Archives: International Development

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.

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!

 

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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

Humbled. Elated. Empowered.

Blog by ISUOG Ambassador and Trainer Reem S. Abu-Rustum

Humbling. Elating. Empowering. That is how I would describe my first Outreach mission with ISUOG to Sudan.

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Gesu Antonio Baez introducing ISUOG Outreach

From the moment our team of trainers met, it was obvious how compatible we all were with our different ethnic backgrounds and personal experiences. Under the watchful eye of ISUOG’s phenomenal Gesu Antonio Baez, and the leadership of insightful Dr. Mirghani, we knew that this was destined to be a most impactful mission for all involved.

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On the Lakeshore of Rahad

Humbling it was to be received by the warmest most genuine people of Sudan who welcomed us like royalty, and escorted us with pride all over Al Obeid and North Kordofan State. Despite the logistical challenges, they made sure we had the most comfortable accommodations and an organized clinic set up with all the necessities in place, not to mention the unforgettable “Jebana” coffee. The Minister of Health, his Excellency Dr. Abdullah Faki Omer, never left our team: from receiving us at the airport to escorting us as we departed. Dr. Khidir was the driving force behind our entire mission on the Obeid front: the true embodiment of commitment and dedication.

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Rahad Lake

Elating it was to have the privilege to participate in the sonographic education of 30 most dedicated Ob/Gyn and Radiology Physicians who had come from all over North Kordofan State to attend our 5 intense days. We had their undivided attention whether it was during the didactic or the hands-on sessions. They had such a hunger and eagerness to learn, and were so receptive to any instruction or criticism to help them improve their sonographic skills. The trainees were divided into 4 groups and rotated on a daily basis with the trainers. On the last day, each team of trainees ended up with their trainer from the first day. I had the “Red Team” and it was amazing to have them back with me on the last day: the progress they had made was unbelievable. They were secure and confident in utilizing the systematic 6 Steps Approach, were able to recognize key anatomical landmarks and were able to manipulate the probe to arrive at the required biometric planes.

Dr. Samira Demonstrating 6 Steps and the Red Team

Empowering it was to be able to play a role, albeit indirect and quite small, in the future of the mothers of Sudan. Visiting the labor ward at the Al Obeid new Maternity Hospital, a referral center for the area, offered us a glimpse of the challenging conditions faced by both physicians and patients. Though all the basic necessities are met, the patients have to secure and purchase key “material” for labor, and they are usually discharged 2 hours postpartum to make room for the other 15-20 daily parturients, not counting the cesarean deliveries. Nonetheless, there is an unshakable commitment from the Sudanese Government led by the Ministry of Health, and an army of health care providers dedicated to improving the maternal and neonatal mortality rates and their co-morbidities. It was most empowering for me, as a member of the ISUOG Outreach Team, to be a part of Sudan’s vision for a future where every woman has access to a properly performed sonographic examination in order to identify and safeguard against the major contributors to maternal morbidity and mortality.

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Our Entire Team

Humbled. Elated. Empowered. That is how I feel. That is what Sudan and its beautiful people have left me with. I feel honored and privileged and I eagerly look forward to our next mission amongst the most gracious Sudanese…

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Closing Ceremony 

 

Day 2 in Sudan: practical training

We’re on with day two with ISUOG Outreach in Sudan. The morning saw practical training for the most part, with trainees divided amongst the trainers. Each group had an average of six patients and the instructors focused on helping trainees understand how they will be assessed on ultrasound competency.

(ISUOG trainers in action; image courtesy of G.A Báez for ISUOG Outreach)

The trainees also conducted a pre-test in 1st and 2nd/3rd trimester ultrasound in order to measure and understand their current knowledge in OB/GYN ultrasound scanning. Lectures today focused on early pregnancy, 1st trimester and abnormal pregnancies. The team had the chance to hear a lecture on abnormal early pregnancy from Observer and Trainer, Dr Sami Mahmoud who is Secretary General of the African Federation of Obstetrics and Gynecology (AFOG).

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(Dr Sami Mahmoud with the team; image courtesy of G.A Báez for ISUOG Outreach)

The trainees are enthusiastic and very focused, with hands raised in eagerness to understand more. The team has only made a scratch in the Sudan program, but already progress can be seen. Stay tuned!!

Day 1 in Sudan and ready to learn

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(ISUOG Ambassador and Trainer Hisham Mirghani speaking to trainees; image courtesy of G.A Báez for ISUOG Outreach)

Sunday the 13th of November kicked off the ISUOG Outreach program in El Obeid, Sudan with 30 trainees eager to get started at the Planned Parenthood Headquarters in El Obeid. The morning began with an opening ceremony, presented by the Minister of Health, Dean of the University of Kordofan, along with ISUOG Ambassador Hisham Mirghani and ISUOG International Development Coordinator Gesu Antonio Báez. This was followed by a practical scanning session. And the sessions were big – up to 70 patients were in the waiting room ready to be scanned by the trainees who were also eager to learn.

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(Hands on training with ISUOG Trainer Yasmin Casmod; image courtesy of G.A Báez for ISUOG Outreach)

MindRay generously loaned two machines to the program to enhance the training experience. The rest were provided from local hospitals and were functioning in full form!

Each trainee was divided into groups based on their years of experience with ultrasound in order to provide a tailored approach to their learning. This also allowed them to get to know other trainees who came from afar – some travelled up to five hours from other parts of Sudan!

Dr Reem Abu-Rustum ended the day with theoretical training by going over the “Six Step Method”.  Prof Mirgani demonstrated how to properly handle the probe, Yasmin Casmod covered knoblology and Dr Angela Ranzini spoke about Fetal Biometry.

With day one already a success, the group looks forward to taking the scanning skills of the groups to next level. With hope, it will be a successful week to follow, or as they say in this part of the world “inshallah”.

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(ISUOG Trainer and Ambassador Reem Abu-Rustum with trainees; image courtesy of G.A Báez for ISUOG Outreach)

The purpose of the ISUOG Outreach project to Sudan is to provide ultrasound training to local OB/GYN practitioners with the intention that these trainees eventually become local trainers.

Phase I comprises of three week-long training programs, which will take place in a 12-18 month time frame with a space of 6 months between training. Between training, trainees will be mentored by designated trainers from the project team to provide guidance on scanning. By the end of Phase I, trainees will be competent in ultrasound scanning techniques and conduct quality scans in line with basic training outreach templates (SO2).

For more information on the goals and outputs on the program see http://www.isuog.org/Outreach/Projects/Sudan/Sudan+1.htm

Beyond 2015: the continued relevance of maternal mortality

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Image from ISUOG Outreach – Ghana 2010

Gesù Antonio Báez is ISUOG’s International Development Officer. He coordinates and is responsible for all development projects, in particular for the coordination of the ISUOG Outreach Program. He contributes regularly to the ISUOG Outreach Blog. To inquiry about Outreach, reach him at outreach@isuog.org

December 2015 will technically mark the end of the current Millennium Development Goals for 2015 and multiple organisations and NGO’s are running at frantic pace to continue to work towards fulfilling what those goals were set out to accomplish while governments are providing their last reports and findings to demonstrate whether they have met their goals for 2015 or not.

The Millennium Development Goals (or MDG’s as they are commonly called) were a list of eight specific goals designated and agreed to by the United Nations in 2000 that were aimed at cutting poverty and related factors in half by 2015. Among those eight goals were number four and five which primarily focused on the need to reduce levels of maternal and neonatal mortality rates in under development countries. But after 2015, should the topic on improving maternal and neonatal health come off the priority list?

At present, talks on the Post 2015 Sustainable Development Goals are underway with countless stakeholders and NGO representatives invited to the United Nations and relevant UN agencies to help identify them. A new initiative carried out by the NGO “Red Elephant” is underway in collaboration with the UN to carry out surveys in various regions to ask the global audience which items they should view as a top priority to begin working on- items such as adolescent rights, women’s empowerment, gender equality, and many more. And at ISUOG’s 25th World Congress which will take place in Montréal of this year, the topic of global maternal mortality will be a major focus. But will maternal mortality still be relevant for the new global goals going forward? Or will new priorities take precedence.

Clearly, there have been achievements, such as in China. According to the WHO, 97 women died per 100,000 live births in China in 1990. By 2013, the number reduced to 31 and this achievement was highlighted at ISUOG 10th International Symposium in Beijing last year.

India, however, is a different matter. At present, India is not anticipated to reach their goal for halving maternal mortality rates by 2015. Though significant progress has been made in certain Indian states, such as Kerala (which has also hosted a number of ISUOG Approved Courses), other states – particularly in the north such as Uttar Pradesh – have been improving at a slower rate. With this, it only carries more importance into why ISUOG is hosting its 11th International Symposium this year in New Delhi and stresses the importance of its presence in that particular region of the world.

Other countries such as Papua New Guinea have barely made any improvement since the MDG’s creation in 2000. In fact, it’s only doubled which makes it the worst place to give birth in the pacific region.

And in the wake of the current crises in Syria where refugees are giving birth within tents that are exposed to harsh environmental conditions, the need for maternal morality reduction is growing more urgent than ever before.  Maternal mortality must continue to always be a priority in all global agendas and ISUOG Outreach endeavors to ensure that it is through its education endeavors. Educating OB/GYN practitioners in ultrasound technology is vital for them to identify preventable causes of maternal mortality and in the long run, this can only help to reduce rates. But prioritizing maternal health globally is crucial for there to be reduction in the long term.

– Gesu Antonio Baez

 

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Infographic courtesy of the World Health Organization (WHO)

eBook for Outreach: a practical approach

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In dealing with the ISUOG Outreach Program, one of the main struggles for most countries in the developing world is to find proper resources to teach basic skills in ultrasound for obstetrics and gynecology. In many regions, such as in North Africa (most particularly in Egypt and Algeria), it’s not common to be offered training in gynecological ultrasound within a university context and if it is, it’s not sstandardizedbetween the institutions, rendering it difficult to keep up the consistency in quality.

Realizing this, ISUOG’s Outreach Committee Chair, Dr. Alfred Abuhamad and several other notable names in ISUOG (Prof. Rabhi Chaoui, Dr Philippe Jeanty and Prof. Dario Paladini) joined forced to produce the new eBook entitled Ultrasound in Obstetrics and Gynecology: a Practical Approach.

This eBook provides a thorough description of each trimester through multiple gestations as is intended to be used in both within outreach and in a basic developmental program settings.

Already, the eBook has been met with much success. After it was well received at the Outreach Workshop in Barcelona, Spain during ISUOG’s World Congress, it has been downloaded more than 4, 300 times to date and it has also been used for the first time used within an outreach setting when ISUOG supported an Outreach workshop in Darwin (Northern Territory), Australia. It is also currently being translated into multiple languages and has been adopted in Kiev (Ukraine) to provide basic training, thanks to the effort made by ISUOG’s Ambassador to Russia, Eastern Europe, and Central Asia – Dr. Fred Ushakov.

With the ISUOG Outreach program expanding, we’re looking forward to seeing where this eBook will lead in providing standardized ultrasound training.