Tag Archives: Maternal Mortality

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

Impressions from a first time volunteer in Papua New Guinea

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ISUOG  Outreach volunteer Alice Robinson (far right) in Papua New Guinea with one of the trainees (Image courtesy of Nayana Parange)

 

ISUOG Outreach and the Australasian Society of Ultrasound in Medicine (ASUM) conducted an Outreach mission in Port Morsby, Papua New Guinea in October 2016. As a first time volunteer for ISUOG Outreach and ASUM, Alice Robinson of Australia explains her experience in empowering other practitioners with ultrasound.

Flying into Port Moresby Airport, I found a hive of activity; many of the travellers were expats arriving back to Papua New Guinea (PNG) for a variety of reasons – leading fishing charters, managing a food distribution company, working in a local school, whilst others were visiting PNG for tourism, which extends to bird watching in the highlands and walking the Kokoda track. Brief interactions with these fellow travellers made me think I had underestimated the resources available to this small country, which lies just a hop, skip and jump from the northern tip of my own home country, Australia (150km to be more precise).

Papua New Guinea has a maternal mortality rate of 250 per 100,000, one of the highest in the Western Pacific region, and a high fertility rate of 3.8 births per woman, which is double that of Australia’s fertility rate. The role of ultrasound in the overall care of women and children in PNG needs to be put in the context of these staggering figures, and is certainly vastly different from the role of ultrasound in Australian medical practice.

Spending five days at Port Moresby General Hospital and teaching ultrasound to a dedicated group who had traveled far to attend the course made me realise I had overestimated the resources allocated to maternal health and safety. The doctors, midwives, and supporting healthcare staff who we had the privilege of meeting during the program provide an amazing service to the women of PNG despite limited supplies and challenging circumstances.

With all this in mind, my three colleagues and I (brought together by the Australian Society of Ultrasound in Medicine – ASUM – Outreach Committee), tailored a basic OB/GYN ultrasound course for the nine rural healthcare professionals we trained. Despite the four tutors originating from Australia, we come from different corners of the country and gained our medical, ultrasound, and teaching skills via varied pathways. It was such a pleasure to work with like-minded professionals who brought very different attributes and skills to the course, such as Nayana Parange (PNG Project leader) who’s prior experiences in PNG were particularly beneficial in understanding the local healthcare system and how our course could be most beneficial.

As we took the trainees through tutorials (two or three per day) and practical sessions (three-four hours per day), it became apparent that their enthusiasm and hunger for knowledge was not only due to their impending exams (to achieve a Diploma in Gynecology and Obstetrics), but also due to the direct applicability of new ultrasound skills to each of their clinical practices. The small group practical sessions were a highlight, with two to three trainees per tutor, and a long line of patients from the outpatient clinics and inpatient wards at the hospital. This gave us the opportunity not only to meet some delightful local women, but to see each of the trainees improve individually over the next four days.

The many stories that were told over the course of the program highlighted that ultrasound will be another useful tool at the disposal of these talented doctors. A perfect example is one participant who had recently undertaken carpentry and plumbing training, skills which seemed as vital as any medical technology in keeping his remote health centre running smoothly.

Looking to the future, we hope that this brief training course will give participants the ultrasound skills to save lives and improve management in women’s health. This will require ongoing support and feedback for the trainees, which we are planning to provide with online discussions, and refresher courses during subsequent visits.

I feel privileged to have been involved in the first joint ASUM/ISUOG ultrasound training course in PNG. The involvement of both organisations ensured a structured approach and collaboration between all parties to achieve a common goal. Our glimpse into PNG life was very educational, and I hope we were able to teach the trainees as much about ultrasound as they taught us about overcoming the difficulties of working in the country’s rural areas.

Alice Robinson
Australia

 

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Patients in waiting, Port Morsby – PNG (Image courtesy of Nayana Parange)

 

 

ISUOG Outreach off to Papua New Guinea!

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Training in Papua New Guinea
Image courtesy of Dr. Nayana Parange

Some exciting news – in partnership with the Australasian Society of Ultrasound in Medicine (ASUM ) on their first Outreach endeavor – ISUOG Outreach will be supporting a program in Port Moresby, Papua New Guinea from 23 October to 27 October. Led by ISUOG Outreach volunteer Dr. Nayana Parange, a team of three from Australia (Dr. Alice Robinson, Dr. Kris Barnden and Dr. Sujatha Thomas) will be training nine trainees from around the area in basic OB/GYN ultrasound at the Port Moresby General Hospital. While they will be working on the current two machines in place, GE Healthcare has partnered with the program to lend portable machines for this endeavor.

Of all the countries in the Asia/Pacific region, Papua New Guinea (PNG) has the highest levels of maternal mortality and has actually shown little (if any) progress on achieving the previous Millennium Development Goals (MDG’s) on reducing maternal mortality at a staggering 230 women dying for every 100,000 (according to HDR 2014 Report).  More statistics on PNG can be found here via the World Health Organization.

With the levels of women dying in the country due to preventable causes, providing basic training in OB/GYN ultrasound is vital to help identify issues in advance. Be sure to watch this space as we hear more from the field and provide more updates from the team!

 

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Village near Port Moresby
Image courtesy of Nayana Parange

On the road again – we’re returning to Ghana!

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(Image courtesy of Manna Kamio Badiella for ISUOG Outreach – Kumasi 2011)

They say two times is a charm – and boy they weren’t kidding! We’re excited to announce that ISUOG Outreach will be returning to Kumasi, Ghana on 16 November for the second phase of its development program in the region, in partnership with local NGO Women’s Health to Wealth and GE Healthcare. Led by Outreach Chair Dr. Anthony Johnson (USA), the team will consist of returning volunteer Dr. Janet Horenstein (USA) and first time volunteer Dr. Theodora Pepera-Hibbert (UK/Ghana) while empowering two local trainers, Dr. Buah Hamilton (Ghana) and Yusif Yacub (Ghana) as they progress to become local trainers in ultrasound in OB/GYN. Both Yusif and Hamilton have taken part as trainees in the past three training trips so we’re excited to see their progression to the next phase of this program, which goes to the heart of the ISUOG Outreach credo – sustainability and empowerment. ISUOG’s International Development Officer, Gesu Antonio Baez and GE Healthcare’s Tammy Lynn Anderson will also be joining the team as the program takes an exciting turn to teach the teachers and ensure long lasting impact in the region. Be sure to follow this space as we highlight the events throughout the week we’re there and to read more about our previous work in Ghana, click here.

ISUOG Outreach returns to Australia

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(image courtesy of Nayana Parange)

ISUOG Outreach is delighted to be supporting an Outreach workshop, in partnership with ASUM from 18-19 June in Whyalla, South Australia. The workshop, led by ISUOG Outreach volunteer Nayana Parange, will aim to train 14 midwives on basic ultrasound in OB/GYN. With high levels of maternal mortality within the aboriginal communities of Australia, these midwives are intended to work in these communities with their newly acquired skills to provide quality care locally. Stay tuned for more information post-event as the weeks progress!

WHO Meeting in London: maternal health in the post-2015 agenda

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ISUOG participated as an active observer during the WHO-PMNCH Board meeting in London, chaired by Graça Machel, former First Lady of South Africa and Mozambique.

As a member of WHO’s Partnership for Maternal and Newborn Child Health, ISUOG participated in their Annual Board Meeting on Monday 20 April 2015, at the RCOG headquarters in London.

Chaired by former South Africa/Mozambique First Lady, Graça Machel (who is also the widow of Nelson Mandela) the energy in the room was electric with discussions on strategies to improve women’s health and focused on identifying priorities for maternal and child health for the post-2015 Sustainable Development Goals (SDG) agenda. However, identifying these priorities became a real challenge for the board which tried to agree on what these should be and at the same time recognise the needs of all nations. This stems from the common issue of data and feedback monitoring which proved to be inconsistent over the years and there is now a lack of concrete and inconsistent reporting on what the main issues are in various countries.

ISUOG is a proud to partner with PMNCH and our presence at this meeting helped address the importance of providing doctors with quality education and training so that they can deliver effective obstetric and gynecological care to women all over the world.

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Amina Mahamad of Nigeria, UN’s Advisor to Maternal and Child Health for the Post-2015 agenda, responds to why educating doctors is crucial in saving the lives of countless women.

Highlighting the importance of ensuring all OB/GYN’s are empowered with quality education in training, Amina Mahamad of Nigeria, who serves as the UN’s Advisor to Maternal and Child Health for the Post-2015 agenda, shared her own experience as a mother. When giving birth to her four children in Nigeria, she was found subject to squalid conditions and dealt with doctors who were not sure exactly how to manage the childbirth. She highlighted that it is indeed time for countries to invest in education and resources for their health practitioners to help prevent maternal mortality. She mentioned as well her own cousin, who died of pre-eclampsia, which was not diagnosed until it was too late, despite having been to all her routine check-ups. Her message was clear; all mothers should be given the assurance and ease of mind that their doctor is fully capable of delivering their baby safely and this only comes through quality education for our doctors.

The agenda for the Sustainable Development goals aim to incorporate the needs of both the developing and developed world; and, it is clear that many more conversations will be needed to ensure that the goals fulfil the health requirements of women and children globally. ISUOG is very proud to be part of this process and looks forward to progress in the years to come.

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)