Tag Archives: Outreach

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.

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.

Supporting Outreach work in Yangon – round two!

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Dr. Philippe Jeanty and team in Yangon (from left to right: Dr Gwan Ju, Dr. Jeanty, Dr. Ya Chiao, Dr. David Berck and Dr. Federico Badano)

Last year, ISUOG Outreach supported the work of dedicated Outreach Committee Member and renown expert, Dr. Philippe Jeanty in launching a program in Yangon, Myanmar. Now returning for Trip II with his team (Federico Badano from Argentina, Gwan Ju of South Korea, Ya Chiao from Taiwan and David Berck from USA), Philippe reports from the field midweek to share with our followers some updates from training.

“The second course to Myanmar has started, with all the previous students minus four, delivery, maternity leave and two who were not able to get replacement (the obstetrician who came to the course had to be cross-covered by a surgeon for the emergency C-section section). One of the students, whom I like very much, is one of six obstetricians for a city of 4 million people!!

We had asked the students to fill a spreadsheet with all the findings they made during the year and they did a remarkable job at it: probably a first in ISUOG Outreach history!

I like how no one could find cardiac or skeletal dysplasia ( so not a defect on me 😊 )

This table is big, but it shows the constant efforts they did during the year.

Today, we started with the second set of lectures we were provided by from ISUOG, of which Federico enriched very substantially with many video clips. I added some cases related to the lectures and to insure participation, we got four students to come to the front of the class and answer each case. Nothing like being in the hot seat to focus attention! They did pretty well.

The afternoon and the end of the morning we actually did scan. We had not pre-selected the students and some were still fairly hesitant, so we redistribute them into basic, intermediate, advanced level so that the teaching could be more focused; that worked out to be better.

Most of the patients had not undergone ultrasound in pregnancy before.  Our cases included numerous twins, suspected growth restriction, and placenta accreta.

The more interesting case was a hydranencephaly with retinal detachment and it was their first time seeing retinal detachment (a nice case )

On the second and third day, we went on with the lectures. We had asked all the students ahead of time to prepare a 5-minute presentation and with the firm hand of Dr Yin Yin Soe and Dr. Khin Latt (our local contacts) they had all prepared one or several cases, including many ectopic pregnancies, ovarian masses and pre-eclampsia with IUGR. The 2 more striking cases were an abdominal pregnancy and a 38 weeks tubal pregnancy in which the location had not been correctly recognized. This was great way to re-emphasize the routine exam: after the first sweep always document the cervix, size, competence and vasa previa.

The students were very comfortable giving the presentations and very organized in doing so. Mostly their images were poor, often too gained, with depth too far, and captured with cell phone. To remedy this, we went over the depth setting, the gain, and Ya Chiao Hu gave them a short presentation on how to save images digitally on a memory stick!

Dr Gwan Jun Kim, who was with us last year and participated during all trips of the Outreach program in 3 Mongolia, gave the CNS and cardiac lectures with his usual brand of humor and animated descriptions. He is always popular!

Dr. Federico Badano also lectured with great calm and a ton of videos to the ISUOG.

Dr. David Berck, who is also a veteran from Mongolia, was with us as well. In the end, we ended up all adapting Gwan Jun technique of abundantly moving around, using the many dolls that Dr Khin Latt had prepared.

We had a very large supply of patients, and even an extra ultrasound machine. The course is sponsored by Mindray and the local distributor “Concordia” and Dr Than Win had really gone out to make sure we had all that we needed. The extra machine allowed the students to practice under less time constraint. Ever efficient Justin Liu was going from machine to machine making sure everyone was alright with the knobology. He was part of it group last year too but was much less shy this year and has remarkably improved his fluency in English. By the way, all the students speak perfect English but with a British flair (liquor.. for amniotic fluid) and an accent sometime difficult for my deficient ears.

The only really problem was that it is incredibly hot here and the Air Conditioning could not keep up with the 30 people in the room, plus the patients and six ultrasound machines. I was dripping over my students who would provide me wipes and water every three minutes. So sweet!

The students are very comfortable with us. Last year, being shy, I had asked them to write their questions on paper and leave the questions on our desk for us to answer. This year, there was no problems at all. I think that getting them to come answer the cases in front of everyone, although terrifying at first, gave them much more confidence. It helped that Thao and Ya rewarded the correct answers with a gold medal of chocolate. A old trick I used in Mongolia too.

On to the fun part where David was interested in the local dress that men wear here, called Longi. Dr Khin Latt generously gave one to each of us!! Resulting in a rather unique picture (as see at beginning of blog).

Tomorrow is it last day and we are already nostalgic about leaving our students for a year.”

Follow our blog for more stories from the field!

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.

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

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.