Tag Archives: #ISUOGOutreach

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.

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Anomaly scans and ready hands: Day 3 in Sudan

Day Three of the Outreach Program in Sudan had an exciting start! After a lecture on placental assessment by Prof. Hisham Mirghani, the trainees broke off into their teams. Outreach Trainer Yasmin Casmod’s group identified two anomaly scans (one which was oligohydramnios with abnormally large eyes and heart), which had to be immediately consulted over to Dr Sami Mahmoud to oversee and recommend follow up accordingly.

(Attentive trainees, Dr Angela Ranzini explaining fetal anatomy in 2nd and 3rd trimester and Dr Sami Mahmoud explaining a scan; images courtesy of G.A Báez for ISUOG Outreach)

The trainees in Dr Reem Abu-Rustum’s group today were completely enthusiastic on scanning and encouraged her to show them new techniques even beyond the practical session.

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(Dr Reem Abu-Rustum explaining Fetal Biometry; image courtesy of G.A Báez for ISUOG Outreach)

Lectures continued the following morning on practical sessions, covering topics such as Fetal Growth, Fetal Anatomy and Amniotic fluid index.

Stay tuned as the ISUOG Outreach program in Sudan continues!

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

ISUOG Outreach is off to Sudan!

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(From left to right: The Sudan Outreach Team – Prof. Hisham Mirghani, Dr. Reem Abu-Rustum, Dr. Angela Ranzini, Ms. Yasmin Casmod and Mr. Gesu Antonio Baez – ISUOG’s International Development Coordinator)

We’ve got more news and we’re excited to share with you!

ISUOG Outreach is proud to announce its first program taking place in El Obeid, Sudan from 13-17 November 2017. Led by ISUOG Ambassador to UAE and the Middle East, Prof. Hisham Mirghani (UAE/Sudan), the team comprises of Ms. Yasmin Casmod (South Africa), Dr. Angela Ranzini (USA) and ISUOG’s Ambassador to Outreach in Lebanon and the Middle East, Dr. Reem Abu-Rustum (Lebanon). ISUOG’s International Development Coordinator, Gesu Antonio Baez, will also be joining the team in coordinating the project and working with key stakeholders on the ground.

The team will be training 28 trainees from North Khordofan State with the aim to have them become future trainers in OB/GYN ultrasound locally over time. ISUOG Outreach is very grateful to partner with Salamat Doctors Charity, the University of Kordofan and the Sudanese Ministry of Health on this endeavor.

Watch this space as more updates come up as the project develops. For more information on the project, please visit our website.

ISUOG Outreach in Ghana: Kicking off day two!

Each of the trainees spread out to different regional hospitals this time to take a group of 8 trainees with them for hands-on work.Ghana4

Today, we’ll be focusing on Old Tafo Hospital located in a predominantly Muslim neighborhood of Kumasi. Droves of patients waited for the ISUOG team near the manicured courtyard of the hospital, dressed in their colorful garments that reflected the tradition of the Ashanti region. The trainees were as excited as Janet Horenstein and Tammy Anderson and guided the group on using the new GE Voluson P8 machine, which was donated to the hospital. “These trainees are both enthusiastic and passionate about scanning and making a difference in the lives of women,” says Gesù Antonio Báez, ISUOG’s International Development Officer who’s reporting from Kumasi. “It’s inspirational and promising for the future”.Ghana7

The training session also helped reveal a heart defect in a 3rd trimester patient, prompting the trainees to take action in advising an emergency C-Section and careful monitoring once the baby is born.

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“I’m loving this new machine,” says Adams Abekah who is based in Old Tafo, “but I’m excited to learn more and [perfect the techniques.] That is my dream.”

Stay tuned as we visit the trainees in the other hospitals in the Kumasi Metro region!