Tag Archives: Simulation

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.

ISUOG Outreach: Interview with Australia Outreach project leaders, Nayana Parange, Sujatha Thomas and Karen Shand

In October 2014, ISUOG Outreach supported a workshop in Darwin (Northern Territory), Australia, in partnership with the Australasian Society of Ultrasound in Medicine (ASUM) to improve maternal health in aboriginal communities. The workshop trained local general practitioners and midwives on basic ultrasound in obstetrics and gynecology to support their practice in the remote aboriginal communities of Northern Territory. The project was led by Nayana Parange, Sujatha Thomas, and Karen Shand who happily shared their experience in the interview below:

 

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In a few words, tell us about the Outreach Workshop

The key purpose of the Outreach workshop was to provide ultrasound training to midwives and doctors working in the Northern Territory Outback regions to help their practices to meet the Australian national antenatal Care Guidelines. In doing so, we hope to support the development of a model for the training of health professionals in remote areas which would be relevant to the Australia, as well as to evaluate this model with regards to its suitability to be replicated in other regions across the country.

High-risk pregnancies are more prevalent in Aboriginal and Torres Strait Islander women that stretch the low-resourced community health centres. Due to a higher rate of preterm births and intrauterine growth restriction, predicting gestational age is particularly important so that these women can be referred to larger, better resourced centres for delivery. The high smoking rates, pre-existing medical conditions and socioeconomic disadvantages place additional burdens on these communities.

Training remote midwives and GP’s will enable them to deliver point-of care-services better, encouraging women to present early for a dating scan and antenatal booking. Families and partners would be able to attend this examination, improving bonding, positive family support and early health education. However, training and retention of the workforce in remote settings continues to be a challenge as midwives and GP’s relocate frequently to other isolated settings

 

What inspired you to bring ISUOG Outreach to Darwin?

The demographics of the region, as per the Aust Bureau of Statistics 2008, demonstrate that 54% of the population live in the town of Darwin, 14% live in Alice Springs and the remainderlive in the rural Northern Territory. A disproportionate number, 72%, of the aboriginal population live outside the two urban areas, in very remote communities. This has an adverse impact on health outcomes, at least partly as the most basic of services may not be available locally.

My involvement with the ISUOG Outreach training programmes overseas brought the realisation that we need to offer better ultrasound services amongst our own underserved communities. We thus sought the expertise of ISUOG, which was immediately forthcoming but as we also wanted to achieve a national standard for this training, we approached ASUM as well. We aimed to develop training and credentialing within a unified national framework encompassing these goals in a rural, remote and indigenous context. Recognising this need, ASUM also decided to introduce and implement a credentialing for midwives called the CAHPU (Certificate for Allied Health Performed Ultrasound (CAHPU) Midwife Specific) certification.

Dr Sujatha Thomas is an obstetrician in Darwin already involved in outreach work in obstetrics and was looking for ways to get better ultrasound services to remote areas, including achieving more accurate dating of pregnancies. Integrated Maternity Services from Northern Territory Health Darwin sought Sujatha’s support in identifying the appropriate training for midwives working in these areas. 20 midwives and 1 GP were selected to undergo training.

As ISUOG and ASUM had experience and resources to deliver training workshops, collaboration was formed in conjunction with the Northern Territory health services. Sujatha was then able to bring everyone together, including recruiting additional high calibre faculty such as Roger Weckert and Carol Brotherton – both senior tutor sonographers, Dr Russell Carter who is a procedural GP in obstetrics and Dr Martha Finn who is a senior obstetric and gynecological sonologist from Melbourne.

In addition to the support provided by Sonosite for portable machines, simulation vendors VIMEDIX and Synergies also generously offered use of their obstetric simulators for transabdominal and transvaginal training. This was very exciting for us, as we were able to incorporate simulator training along with hands-on training on real patients at the same time. We covered all the topics pertinent to basic level scanning in a ‘point of care’ situation.

A follow-up hands-on session has also been scheduled four months down the track, to reinforce the practical skills, review the performance and audit the images. This will give us a chance to establish where our training needs to head to achieve our aims.

 

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Trainees diligently learning at the workshop

 

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ISUOG Outreach Sujatha Thomas providing hands on training with live patient

Australia is classified as a developed nation. Do you therefore believe that ISUOG’s mission, to improve maternal mortality, is still relevant here and how do you think ISUOG Outreach, in particular, can help?

 The issues in remote Australia are unique. The Northern Territory (NT) is Australia’s third largest state, with 243,000 people living in an area of around 1,346,200 km². If the NT was a country all on its own, it would be the world’s 20th biggest in terms of land mass, just ahead of Peru. The UK could fit into the NT around 5 1/2 times and it is almost twice the size of Texas.

Sixty percent of the NT population live in “very remote” areas, scattered in small communities over very large distances. These communities experience the lack of immediate access to health services and many communities do not have resident midwives or GP’s or these services are only accessible by air. During the wet season the small airstrips may be flooded resulting in even greater isolation.

Women in remote regions are not able to access ultrasound examination in early pregnancy due to patient travel funding limitations, limited availability of adequate equipment, and lack of ultrasound training of local health professionals. Retention of the workforce continues to be a challenge and those that fly in are required to provide not only obstetric services but a broad range of medical care over all specialties.

These challenges represent only the tip of the iceberg. There are so many other complexities including socioeconomic, inadequate education, language barriers, racial prejudices, high risk and health related behaviours which contribute to the wide gap between Aboriginal health and the rest of Australia. Although Australia is a first world country, these challenges can be third world or even fourth world in some instances.

We believe that the ISUOG mission is therefore still relevant even in Australia, and our pilot endeavour has made an attempt to take a step forward in this direction, in terms of obstetric ultrasound services. We are very thankful to ISUOG, as it has generously assisted in addressing this aim to “Bridge the Gap” by sharing the existing training course material and their assistance in “tweaking” the training will be invaluable as it becomes clearer as to what we can expect to achieve successfully within our own rural and remote context here in Australia.

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Trainee using her skills on the field within the aboriginal communities

How has being a volunteer with ISUOG supported your desire to make a difference?

I have worked as an obstetrician-gynaecologist and a sonologist in a rural community in India for nearly 10 years. I am familiar with the problems faced by developing countries and have been exposed to the different challenges one faces as a health professional working with limited resources. During my time in India, I conducted ultrasound training workshops in remote regions to help train GPs and specialists. This prompted me to become a volunteer with ISUOG Outreach once I had migrated to Australia. The experience with the ISUOG Outreach team in Ghana gave me the opportunity to work in a team with high a calibre international faculty who were passionate about making a difference, and also taught me the ‘train the trainer’ approach which ISUOG does so efficiently.

The ISUOG Outreach experience in Ghana inspired and motivated me to keep working towards improving perinatal mortality with the help of ultrasound. In addition to working towards our ‘Close the ultrasound gap’ initiative in Australia, I have, for the last three years, also been involved in similar ultrasound outreach initiatives in Papua New Guinea as well as the remote East coast of Indonesia. I am very fortunate to have wonderful colleagues like Karen and Sujatha as well as many other experienced and qualified professionals who share the passion and vision, eager to make a difference.

Workshop faculty:

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From left to right:

Roger Weckert (NT,Darwin), Clare Whitehead (NT, Darwin) , Russel Carter (NT, Darwin) , Karen Shand ( South Australia, Adelaide) , Sujatha Thomas (NT, Darwin), Nayana Parange (Adelaide, SA) Martha Finn (Victoria, Melbourne), Amanda Grauze (Simulator educator and Director Medical Synergies, WA)