Tag Archives: Maternal Mortality

Day 4: Tireless efforts for Omani Women

It’s the second to last day of ISUOG Outreach in Oman as Week 2 slowly wraps up. As a returning trainer, Dr. Nimrah Abbasi from Canada shares her insight not just on the week but on the trainees and culture”.

 

“It’s hard to believe week two of the Phase 1 ISUOG Outreach program in Oman is already coming to an end.  Today was another busy day in the Outreach curriculum, covering aspects of common gynecological pathology with review of the International Ovarian Tumour Analysis (IOTA) classification, discussion of the use of Doppler in fetal medicine and high-risk pregnancies, fetal urinary tract abnormalities and finally an overview of critical aspects of documentation in ultrasound reporting. 

 

Hands-on training continues to be the most prized time for trainees, as this provides the opportunity to practice attaining the various 20+2 planes of foetal anatomy introduced at the start of the second week.  Trainees’ improvement in probe movements with smooth transition between planes is more apparent with every session.    In today’s workshop, learners are in awe as they perform Doppler assessment of the umbilical artery for the first time and appreciate the complexity of obtaining an adequate midsagittal plane for visualization of the lumbosacral spine.  This further motivates the trainees to learn to perfect probe motion and orientation. These sessions have also been instrumental in identifying the natural leaders and educators among the trainees, who are quick to recognize the less experienced scanners and provide them with guidance and direction during the practical sessions and online discussion groups.  These individuals represent potential future trainers for phase 2 of the ISUOG outreach program.  Means to further develop and nurture these skills over the upcoming months as well as potential ways for increasing scanning time for less-experienced trainees are outlined in regular discussions with Dr. Mouza, ISUOG’s Local Project Liaison.

 

What is particularly touching is the hospitality and appreciation expressed by the trainees as they continuously thank us for guiding them through the principles of women’s imaging.  We are particularly moved by the patients volunteering their time to provide opportunities for the trainees to scan, and their expression of gratitude to the ISUOG trainers for helping improve ultrasound quality and access for Omani women.

 

Despite the early morning starts and busy days of lectures, workshops and assessments, motivation and enthusiasm remain high among the trainees.  We are amazed by the distances so many of these women have travelled and the time they have taken from their busy family life and clinical practice to develop and improve their ultrasound skills.  As this week concludes, we are continually inspired by Dr. Mouza’s tireless efforts along with the enthusiasm of our trainees and the Ministry of Health to improve the quality of women’s healthcare in Oman, reinforcing our belief in the sustainability of this project long-term. “

Catch our posts this week as Week 2 Phase I of the Omani program comes to a close.

Check ISUOG Website for more information about ISUOG Outreach and to volunteer or donate.

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A sweet Omani end to the second day

It’s day two for ISUOG Outreach in Oman and keeping with the Arabian tradition of storytelling, we are inviting our trainers to tell their tales on the field to you all, highlighting the adventure to really make an impact on women’s health in the country. The following blog is from our trainer Pauline Schut from the Netherlands:

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Local Project Liaison Dr Mouza Al Salmani delivering a lecture to the Oman Trainees (Image courtesy of P. Schut for ISUOG Outreach)

“Day Two of the program went by very smoothly; the trainees were motivated to start early, the GE Voluson ultrasound machines were ready to use and several volunteer patients had arrived. We very much appreciate the fact that these women are willing to visit the hospital for this teaching purpose and it greatly improves the hands-on training sessions as we only need to concentrate on teaching and not on patient care simultaneously.

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Omani mahalabia (Image courtesy of P. Schut for ISUOG Outreach)

During the morning, we continued repeating the six-step approach to obstetric ultrasound. For the more skilled trainees, who were able to finish these steps quickly, assessment of the fetal brain, face and profile was added. In order to acquire these images, trainees need to understand how to move the probe to obtain the correct coronal and sagittal planes, which made this a challenging and very useful practice. After the lecture about the technical aspects of Doppler on the first day, trainees also got the chance to measure the Doppler of the umbilical artery and see what happened when they changed different settings. We were pleased to see the trainees were engaged and tried to help each other. This also gave us the opportunity to get an impression of their potential to become a trainer.

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Oman Trainees (Image courtesy of P. Schut for ISUOG Outreach)

 

 

 

 

 

 

 

 

 

 

 

 

The afternoon session covered fetal anatomy, including the 20+2 planes, longitudinal plane, assessment of the head and the face. We heard a lot of “ahh’s” and “ohh’s” from the trainees, showing the understood the messages in these lectures.

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Dr Nimrah Abbasi going over some unique applications of Voluson machines with trainees to customize their experience in scanning (Image courtesy of P. Schut for ISUOG Outreach)

After the debriefing of this satisfactory day, accompanied by our favorite Omani lemon-mint juices, we had a nice dinner to end the day with. Our new team members were introduced to a variety of tasteful Arabic specialties. Just like last time, we were impressed by the portions, especially of the delicious Omani version of Mohalabieh dessert. I have to disappoint the regular followers of this blog who might expect an Umm Ali-like story of its origin (see blog week 1), since the origins of this dessert remain unknown. Inspired by the WHO-quotes on the stairs of the Royal Hospital, trying to convince people to use the stairs, we took the stairs up to our rooms.”

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The ISUOG Team for Oman Phase I Trip II (Image courtesy of P. Schut for ISUOG Outreach)

Stay tuned for more stories from Oman throughout the week!

Under the Omani Sun – Outreach returns to Muscat

Under the warm Omani sun – as warm as the hospitality of the people of this gracious country, ISUOG Outreach returns to Muscat for Week 2 of Phase I of the program here. With the 28 trainees from all across the Sultanate having returned, it was a wonderful reunion for the ISUOG Outreach trainers to catch up with the trainees whom they’ve been engaging with for the past 6 months remotely as they hone in on their scanning technique.

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Dr Titia Cohen-Overbeek delivering a lecture to the Oman Trainees (Image courtesy of G.A Baez for ISUOG Outreach)

Reflecting on the day with optimism for the rest of the week is the Oman Project Lead, Dr. Titia Cohen-Overbeek who shares her experience on the blog:

“With great pleasure we returned after six months to the Royal Hospital of Sultan Qaboos for our second week of the ISUOG Outreach program for training in obstetric and gynecological ultrasound. In the past half year, the previous four trainers – Dr Nimrah Abbasi from Canada, Dr Valeria Angioni from Estonia, Pauline Schut and myself from the Netherlands – have kept weekly contact with our groups of seven trainees. Images concerning biometry, early pregnancy, twins and a variety of abnormal pregnancies were shared. This medium guaranteed that we were always available for questions and could reply swiftly but even more importantly the trainees kept contact among them selves. As some work in remote areas without easy access to other colleagues the digital connection provides a good opportunity for consulting and sharing knowledge.

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Oman Outreach (Image courtesy of G.A Baez for ISUOG Outreach)

This time, our team has expanded with new additions joining the team – Dr Divya Singh, radiologist from Chandigarh, India and Flora Mates ISUOG’s Project Development Assistant to both coordinate the data collection from the trainers but also to assist Gesu Antonio Baez, ISUOG’s International Development Coordinator on site. As women run solely obstetric and gynecological medicine in Oman, Flora will be in a more comfortable position to monitor the requirements in our ultrasound rooms. The addition of Divya to our team ensures that our trainee groups are now smaller to facilitate more hands-on teaching time for the trainees. Dr. Theodora Pepera, ISUOG’s Special Representative to Ghana also joined the team to observe the Omani program at first glance and learn from its successes in order to bring back to Ghana, following the end of the Ghana program back in December.

Our first day worked out to be great. First of all, the happy reunion with our trainees and especially with Dr Mousa who runs her department with 10.000 deliveries a year very effectively. Her ability to organise many meetings and courses, run a large department and keep smiling all the time while her phone is buzzing is an example for everybody.

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Oman Outreach trainees (Image courtesy of G.A Baez for ISUOG Outreach)

The lectures this week will cover a variety of subjects, from Doppler ultrasound to fetal anatomy and gynecological ultrasound. And as always, a pre- and post-theoretical test was administered to assess their retention of last week’s material.

Most particularly during the practical assessment, before we started the hands-on teaching session, we could easily see that those who had had weekly regular scanning time had greatly improved and were incorporating the systematic approach to scanning which was taught in the first week. After a full day starting at six in the morning and finishing with a debrief at seven in the evening, we detected a beach restaurant only 15 minutes away from our Omani base – The Platinum Hotel. The ambience was sublime with 37 C (98 F) in the evening much to the delight of those of us from colder Northern Europe and Canada. Feeling satisfied with the way training went today, we look forward to the next four days.”

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Oman Outreach (Image courtesy of G.A Baez for ISUOG Outreach)

Be sure to continue to follow our blog for more updates and stories from the team in Muscat throughout the week! And don’t forget to join ISUOG as it celebrates 10 years of ISUOG Outreach on Twitter with the hashtag #OutreachTurns10.

The perfect union: ISUOG and WHO partner for global women’s health

ISUOG Outreach is committed to ensuring that every woman throughout the world has a quality ultrasound scan – and that is evidently assured via training and quality education. With such a mandate, it is with no surprise that the the World Health Organization (WHO) finds an ally in ISUOG Outreach, with whom it has been working as a close partner in the Partnership for Maternal Newborn and Child Health. Recently, the two organizations joined forces to support the WHO Action trails (a multi-site randomized trial of antenatal corticosteroid use for women at risk of imminent preterm birth in hospitals in low-resource countries ) where ISUOG Outreach recruited two of its volunteers to provide training accordingly. Reporting from the field are ISUOG Outreach Trainers Dr. Lynn Coppola (USA) and Dr. Sandhya Maranna (Australia) who share their experiences taking part in the Action Trails in multiple countries – from India to Kenya.

“The ISUOG Outreach is supporting the World Health Organization (WHO) for the ACTION Trails (Antenatal CorticosTeroids for Improving Outcomes in Preterm Newborns) which will be conducted in a total of 28 sites spanning 5 countries.  The study is designed to address current concerns regarding the efficacy and safety of antenatal corticosteroid use in low-resource settings.  Accurate gestational age assessment will be an important component of the study, and the WHO has thus provided an ultrasound machine for each of 28 sites.  ISUOG Outreach trainers are providing the associated fetal biometry training.  Thus far, training has been conducted in India, Bangladesh, Pakistan, and Kenya.  Training in Nigeria is scheduled to occur in May.  Here are some of the highlights!

India:  Sandhya Maranna, an ISUOG Outreach Trainer with academic and clinical background in medicine, radiology and ultrasound, collaborated with WHO as a temporary adviser in the trials.  She trained ten obstetricians and gynaecologists in a 2400-bed tertiary, referral research and teaching hospital in Belgaum in Southern India. ‘Train-the-trainer’ model was employed to standardise protocol with estimating gestational age or patient recruitment into the trials. She and Dr Lynn Coppola will be continuing their collaboration with the quality assurance of the ultrasound component of the project.

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Dr. Sandhya Maranna observing training in India (Image courtesy of Dr. S. Maranna)

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Teaching hospital in Belgaum, India (Image courtesy of Dr. S. Maranna)

Bangladesh: Training sessions (both didactic and practical) were conducted in both Dhaka and Sylhet, with approximately 10-12 trainees at each site.  ISUOG training materials and Dr. Alfred Abuhamad’s eBook entitled Ultrasound in Obstetrics and Gynecology: A Practical Approach were the primary didactic materials used.  As common with all sites, the trainees in Bangladesh had a wide range of prior experience with fetal ultrasound.  Due to their excitement to participate in the study and to improve their personal ultrasound skills, it was fun and amazingly rewarding to facilitate their learning process. Their enthusiasm to work together as a group and to help each other was obvious.  This picture is of Dr. Maritza Gonzalez (MFM fellow, University of Arizona Health Sciences Center) as she works with some of the trainees in Sylhet.  In the other picture, you can see that the love for selfies shows no national boundaries!  Dr. Saima Sultana and Dr. Salahuddin Ahmed were gracious and kind hosts.

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Training in Bangladesh (Image courtesy of Dr. L. Coppola)

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Dr. Lynn Coppola and the trainees in Bangladesh (Image courtesy of Dr. L. Coppola)

Pakistan:  Approximately 10 trainees from 2 sites met at Aga Khan University in Karachi for the training.  As evidenced by the fact that some trainees even travelled for 8 hours by overnight train, they showed great dedication to preparing their site for the ACTION trial.  Some attendees were motivated enough to even attend the didactic sessions for a second time when conducted in Hyderabad!  Although some of the trainees had prior ultrasound experience, this was the first time that others had ever received formal ultrasound training.  The improvement in their skills, the evolution of their questions, and their expressions of appreciation were all a great reward.  The group picture shows our Pakistan ultrasound trainees, accompanied by local ACTION trial leaders Dr. Shabina Arif, Dr. Farrukh Raza, and Dr. Sajid Soofi.

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Dr. Coppola with the trainees in Pakistan (Image courtesy of Dr. L. Coppola)

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Hands-on training in Pakistan (Image courtesy of Dr. L. Coppola)

Kenya: Training was conducted at the Reproductive Health Unit of Thika Level 5 Hospital and was attended by approximately 15 providers, representing 4 study sites.   Local flooding from an unusually wet rainy season significantly delayed our arrival on the first day, but the weather subsequently improved.  Again, the dedication of the trainees to the trial and to improving their personal ultrasound skills was readily apparent.  The trainees were tireless in their desire to spend time on the ultrasound machines and to stretch the practical sessions for as long as possible.  They additionally created a short list of extra questions for didactic review on the last day.  Also on the last day, we had a small bit of excitement and practised “speed scanning” for one patient as she was apparently in active labor and we were not in physical proximity to the maternity ward.  Dr. Joshua Vogel (WHO) and Dr. Zahida Qureshi (University of Nairobi) were in attendance to support the training process and to encourage the trainees to share their new skills with others when they return to their home study sites.

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Group picture in Kenya (Image courtesy of Dr. L. Coppola)

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Dr. Coppola going over a scan with trainees (Image courtesy of Dr. L. Coppola)

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Trainees scanning in Kenya (Image courtesy of Dr. L. Coppola)

Participation in the ISUOG Outreach program has been an amazingly rewarding experience for me.  While writing this blog and thinking about my most favorite memories, these are the benefits that I continue to treasure the most:

  • Making a small contribution to an important international efficacy and safety trial
  • Witnessing a clear international dedication to maternal and child health
  • Strengthening obstetric ultrasound capacity at various sites by “training the trainers” (a benefit that will extend beyond the actual WHO ACTION trial)
  • Meeting new friends and establishing opportunities for future collaborations

 In gratitude to ISUOG Outreach (and to Sandhya Maranna for contribution of the India portion of this blog submission)

Lynn Coppola, MD, MPH
Assistant Professor OBGYN, Maternal-Fetal Medicine
University of Arizona College of Medicine

 

Outreach returns to Oman!

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Oman Outreach (Image courtesy of G.A Baez for ISUOG Outreach)

The Outreach Team will be returning to Muscat next week to carry out Phase I, Trip II of the Oman Program from 8-12 April 2018. Led once more by Dr. Titia Cohen-Overbeek (Netherlands), the team (Dr. Nimrah Abbasi of Canada, Dr. Valeria Angioni of Estonia, Ms. Pauline Schut of the Netherlands and Dr. Divya Singh of India) will be training 28 trainees from across the country in OB/GYN ultrasound so they can then take on their new roles as local trainers within the Sultanate of Oman. Joining them on the field will be both ISUOG’s International Development Coordinator (Mr. Gesu Antonio Baez) and Project Development Assistant (Ms. Flora Mates).

ISUOG Outreach is looking forward to partner again with the Omani Ministry of Health, Royal Hospital of Muscat, GE Healthcare and Medaphor in efforts to bring this program to life. Stay tuned for more updates from the field!

To learn more about our previous work in Oman, visit our website to read about our work during Phase I, Trip I this past November.

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.

 

ISUOG Outreach returns to Haiti!

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Day 1 ISUOG Outreach in Cap-Haitien (Photo by V. Lemaire)

ISUOG Outreach returns to Haiti this week – this time, the Northern city of Cap-Haitien. Partnering with Hopital Universitaire Justinien (HUJ) and local NGO Zanmi Lasante, the lead – led by Dr. Lisbet Hanson, will be training a group of 18 doctors on basic ultrasound in Obstetrics and gynecology. For this endeavour, Philips has donated a machine for the project to the University Hospital. What makes this program so dynamic is that ISUOG Outreach is proud to site that one of its previous trainees from the ISUOG Haiti (St. Damien) program, Dr. Vladimir Lemaire, has now joined the team as an ISUOG Outreach Trainer! Catch his blog below as he explains how the day unfolded and the emotion it brought:

“After a very early morning breakfast, my heart was completely full as I walked back to the Hopital Universitaire Justinien (HUJ) here in Cap-Haitien where almost 13 years ago, I undertook my own residence. Inspired by the familiarity and with both great pride and humility, I returned but this time as a trainer.

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Dr. Vladimir Lemaire teaching with the donated Philips machine (Photo by L.Hanson)

During the time I was there for my residence, ultrasound training seemed to me at the time completely out of reach, But after ceremonial formalities and a brief introduction from Dr. Lisbet Hanson (USA – Haiti Team Leader), time was of the essence and we went rapidly into the subject. Dr. Stéphane Michel (Haiti), Ms. Gail Ghiretti (USA) and myself gave our presentations one by one, with the pre-test interwoven between the first and second talks.

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Trainees listening attentively to lecture (photo by V. Lemaire)

We were pleasantly surprised by the quality of the questions and case studies of the participants during the lectures and this feeling was reinforced during the practical lesson where they really showed a good level of skill.

The day ended with a debriefing with Dr. Hanson, during which she reemphasised the “points to improve on”, responding the last questions from the participants – it was an incredible day!”

Check out more about our previous work in Haiti by visiting out website and stay tuned for more blogs straight from the field during the week!

 

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:

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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

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)