September 9, 2014

So far this week has been packed full of ultrasound!  Monday we hit the road to Rwamagana and were well received by a large group of nurses.  After a beautiful drive through the countryside we are reminded why Rwanda is called ‘the land of a thousand hills.’  These nurses are undergoing an accelerated training program on non-communicable diseases and they will soon be leaders in their 10 district hospitals.   They were excited to learn the basics of ultrasound and were especially interested in the heart.  In order to keep things lively the nurses even treated us to a beautiful energetic song midway through the day (see clapping photo below!).  Tuesday we worked through plans to credential all the emergency medicine post-graduates with the EM faculty.  We then spent some time in the ED, where Drs. Paul, Laura and Colleen will be working later in the week with the emergency medicine trainees refining their skills.  We were running low on ultrasound gel and had some xanthan gum that we sent from the US by medical student Matt Smith – thanks Matt!  Last night we made a batch of ultrasound gel by mixing 2tsp xanthan gum with 1tsp salt then quickly stirring it into 2c boiling water.  After stirring until it all dissolves let it cool and thicken.  While we were in cooking mode, we wanted to challenge the surgeons who will be joining us this week with some homemade phantoms.  We created two phantoms using Jell-O and penne pasta to simulate a vessel lumen.  Stay tuned to see how the surgeons performed using our Jello-O phantoms!

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September 5, 2014

Week one of this round of intensive ultrasound trainings in Kigali has come to a close as we end the day with a large group from internal medicine. Mid-week we challenged the emergency medicine post-graduate trainees to an observed clinical skills exam in cardiac and thoracic applications as well as the FAST exam for free fluid. We then had 7 of those trainees for a follow-up didactic and practical session on the E-FAST exam. Overall these sessions helped the EM faculty identify exam where we will focus our skills training while PURE team member, Dr. Paul Pageau, remains here for continuity teaching over the next few months.

Thursday we had a large group of very enthusiastic pediatric residents who were eager to learn, and quick to pick up, the basics of ultrasound. Five team members were here to provide lectures on the basics of ultrasound physics, FAST exam, procedural skills, lung ultrasound and an amazing pediatric GI lecture by our radiologist, Dr. Raja Rao. Future PURE team member and 8-year-old son of Dr. Pageau was even willing to have the keen pediatricians ultrasound him to get some smaller sized scanning experience. The week came to a very rainy end today as we were joined in the Simulation and Skills Center by about 18 residents and several of the internal medicine faculty. The largest group of the week was packed with many of the regular lectures and practical sessions, with a highlight being a great cardiac exam and ultrasound lecture by cardiologist and HRH faculty, Dr. Gene Bukhman, in addition to a good review of liver ultrasound by Raja. The PURE team is looking forward to a brief break tomorrow before we begin traveling and gearing up for our training efforts next week.

LD teaching DVTprocedural US in RLS in a baglots of learning happening herehappy IM scannersTH teaching the subxiphoid

September 3rd 2014

PURE is back in Rwanda for more busy weeks of ultrasound training for all of the Masters of Medicine and Post-Graduate medical training programs as the academic year transitions. So far this week is off to a great start! Monday was busy teaching OB/GYN residents point-of-care ultrasound exams in a variety of abdominal applications and DVT, after a morning review of ultrasound physics. Yesterday and today we had the pleasure of teaching the anesthesia residents. This very attentive group got exposure to the FAST exam, cardiac and lung ultrasound, ultrasound-guided peripheral and central access, and nerve blocks with a mix of didactic and lots of hands-on practice. This afternoon we will be working with the emergency medicine post-graduates and then onto large groups from pediatrics on Thursday and internal medicine on Friday. All of our trainings this week are taking place on a cadre of Sonosite M-Turbo ultrasound machines that are dedicated for training purposes in the Simulation and Skills Center at CHUK, the University Teaching Hospital of Kigali.

PURE’s President & Co-Founder, Dr. Trish Henwood, is leading the current trainer team. First, we have Dr. Paul Pageau, an ultrasound-trained emergency medicine specialist from the University of Ottawa in Canada. We are excited to have Paul, along with his family, here in Rwanda over the next 3 months to provide ongoing ultrasound teaching and follow-up on behalf of PURE. Dr. Laura Diegelmann from the University of Maryland returns for a second time to assist with the didactic and practical sessions over the next few weeks. Dr. Helen Ouyang, also emergency medicine trained, from Columbia University just arrived to Rwanda for the first time to share her expertise in ultrasound and passion for working in resource-limited environments. Dr. Raja Rao, a member of the PURE Board of Directors, hails from Oregon in the USA and is recently retired from his interventional radiology practice there. Raja has significant experience teaching ultrasound in resource-limited settings and returns to Kigali with us to add his perspective and expertise to the practical applications of ultrasound. Later this week we are happy to have Dr. Colleen Holley, an emergency ultrasound fellow from the University of Maryland, joining the team through late September.

Overall the trainings are off to a great start and we are excited to continue working with our colleagues in the Rwandan Ministry of Health and Faculty of Medicine on a variety of training programs to help further increase ultrasound capacity in Rwanda.

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March 2014

On Tuesday March 11th the PURE team took a trip to the Rwanda Military Hospital to meet with the Clinical Director, Dr. Eugene Ngoga, to discuss plans for training more students, interns, resident physicians and general practitioners in clinical ultrasound.
In addition to time spent in the ED and ICU, we visited the OB wards where Dr. Ngoga works and teaches. We were lucky enough to come across a group of medical students working with the ScanTrainer, a transvaginal ultrasound simulator used for medical education. We got great feedback from the students on this teaching tool and they are enjoying the afternoon times Dr. Ngoga has put aside for this learning modality during their OB-GYN rotation.
A special thanks to Dr. Ngoga for his focus on medical education and continued support of PURE’s efforts, and to MedaPhor for the loan of this great product!

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March 2014 – Internal Medicine Training

On March 7th, PURE members Drs. Trish Henwood, Laura Diegelmann and Cindy Hsu, working in conjunction with some of Rwanda’s Internal Medicine residency leaders Drs. Tim Walker, Gene Bukhman and Yuki Aoyagi conducted a full-day ultrasound session for 15 internal medicine residents at the Centre Hospitalier Universitarie de Kigali’s (CHUK) Simulation Center. The team lectured on introduction to ultrasound physics, cardiac ultrasound, DVT evaluation, and abdominal ultrasound (focusing on FAST, with a brief overview of biliary, renal/bladder). The didactics were interspersed with practical sessions for the trainees to familiarize themselves with knobology as well as perform the aforementioned exams on each other. The trainees asked plenty excellent questions throughout the day, picked up the techniques quickly and left eager to work with their attendings in applying their newly acquired skills during their future clinical encounters.

Stay tuned for updates on PURE’s upcoming training sessions and
clinical scanning shifts with the CHUK emergency physicians in the
weeks to come!

March 2014 – Internal Medicine Training

We have been on the ground here in Rwanda for several days preparing for the IM training that will take place tomorrow.  The classroom is ready to go and we have 18 eager participants who will learn the basics of the cardiac, abdomen and DVT ultrasound exams.  The past few days have been busy preparing and meeting with key stakeholders to collaborate on and move forward with the future trainings and assessments.  Leaders in the Faculty of Medicine, Ministry of Health and current training programs have been very supportive of PURE’s efforts and encouraging as we discuss shared goals and training focuses.  We have also met with past PURE trainees and gotten their suggestions for expanding the project into district hospitals, and we plan to do some additional site visits next week.  Two new Emergency Medicine instructors have joined PURE’s efforts and hopefully will participate in future training sessions in addition to helping to support internal medicine and emergency medicine trainees over the next few weeks.

Laura Diegelmann, MD RDMS is from the University of Maryland where she completed an Ultrasound Fellowship.  She most recently lived in Cape Town, South Africa working on an ultrasound research project in one of their district hospitals located in the township of Khayelitsha.  Cindy Hsu, MD is from the University of Pennsylvania where she is currently chief resident.  She has a strong interest in Ultrasound and will be joining the team at Shock Trauma in Maryland for a critical care fellowship in July.  Both have added significantly to planning for future projects so far and we are looking forward to trainings to begin tomorrow!

October 2013 Training Day 7

Yesterday, we completed our 7th and last day of training. With the great work of our ultrasound instructors and good support from HRH and the Ministries of Health and Education, we provided training to just over 150 clinicians and medical students. We offered instruction in rapid ultrasound assessment of the abdomen and heart to all final year medical students. They will be heading to district hospitals as interns in less than a year taking on great clinical responsibilities. What we learned from last year’s trainees highlighted the power of basic ultrasound skills to save lives. We also trained last year’s first cohort of PURE trainees to the level of instructors and we are looking forward to continue to work with this motivated and talented group of physicians to advance point-of-care ultrasound education in Rwanda. We want to thank Dr. Joe Novik, of HRH Rwanda, for a great collaboration, and give a nod to our team of instructors:

  • Dr. Nick Avitabile, St. Luke’s-Roosevelt Hospital Center
  • Dr. Kristin Dwyer, Boston Medical Center
  • Dr. Trish Henwood, Brigham and Women’s Hospital
  • Dr. Nicole Kaban, St. Luke’s-Roosevelt Hospital Center
  • Dr. Megan Leo, Boston Medical Center
  • Dr. Resa Lewiss, St. Luke’s-Roosevelt Hospital Center
  • Dr. Raja Rao
  • Dr. Josh Rempell, Brigham and Women’s Hospital
  • Dr. Sam Vaillancourt, St. Michael’s Hospital

This project was made possible thanks to financial support from Philips Healthcare, and product support from Sonosite and Medaphor.

October 2013 – Training Day 2 – Internal Medicine and Medical Student Training

Day 2 of the PURE training. Working closely with the HRH project. PURE deployed two teams of ultrasound instructors.

Four instructors for PURE joined Joe Novik, of HRH, to train 25 Internal Medicine residents at the Centre Hospitalier Universitaire de Kigali (CHUK). Residents learned through a series of lectures and intensive hands on experience the basics of detection of free fluid in the abdomen and the pericardium, along with point-of-care echocardiography and detection of deep vein thrombosis. The team of instructors were impressed by the talent, dedication, and professionalism of the residents.

Meanwhile, PURE sent another group of instructors to train a cohort of medical students in Butare. Impressive results for a busy day of work in Rwanda.

- Sam Vaillancourt

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October 2013 Training Day 1 -Anesthesia Resident Training

Day #1 of PURE Training. Great team of ultrasound instructors from PURE, working in close collaboration with HRH ultrasound leadership begins October training.

On day 1, PURE team completed a one day training on point-of-care echocardiography and basics of regional anesthesia with the HRH cohort of anesthesia residents. A great day with small groups of leaners, many instructors, and great access to new ultrsound machines.

Greg’s perspective: pilot training closing session

Last month we completed the final addition to PURE’s pilot ultrasound training course.  It was my first trip to Rwanda, and having been to a few limited resource hospitals in Africa, I excited to see what benefit the training was having.  The entire team was anxious to see that these physicians are using their training, that their skills are developing and mostly, that ultrasound is assisting with making some otherwise difficult calls.

 

These guys have demanding jobs.  The Rwandan Ministry of Health is dedicated to improving quality of healthcare including to school more physicians, to assist them with better skills, and to provide them with more equipment and with improved support.  They have been fully supportive of the PURE project because this training group of doctors are often the primary and secondary docs for any presenting problems.

 

Understandably they are looking for reliable tools, and are anxious to learn.  Philips Healthcare lent us some great ultrasound machines to facilitate the training session and CHUK provided the venue.  Trish Henwood and I from the States joined Hein Lamprecht, Director of Emergency Ultrasound at University of Cape Town and Stellenbosch University in South Africa as well as Stephen Rulisa (OB/Gyn), Head of Clinical Research at Kigali University Teaching Hospital (CHUK), and Eugene Ngoga, President of the Rwandan Medical Council and OB/Gyn consultant from King Faisal Hospital.  The trainees wanted further instruction in early and late OB presentations, which our Rwandan leaders provided.  I did some resuscitation, procedural and DVT instruction and Hein presented some fascinating work to diagnose HIV and TB co-infection with high reliability.  The afternoon of his presentation, Hein scanned a hospital patient in extremis from cardiac tamponade likely due to extrapulmonary TB – she had virtually nothing left of a RV with a RR of 50+ and HR of 150.  Hein assisted the local team in a real-time life sustaining paracardiocentesis to buy the patient time needed to respond to anti-TB treatment.  How often do we get to do that?

 

Trish’s focus for the week was on ensuring that these guys are becoming good ultrasonographers.  She debriefed them on when they should consider using their new skills, how they may assist colleagues within their hospitals, and how to improve on ongoing quality assurance measures.  Trish set up an entire day for our team to perform observed structured clinical exams for different ultrasound applications. Joe Novik, an emergency physician with a background in emergency ultrasound who is working at CHUK for the year was of great assistance with these assessments.  We had plenty of time with each trainee to comment on their imaging technique, knowledge and interpretations.

 

These clinican ultrasonographers are good and highly motivated.  We celebrated their accomplishments over a formal dinner where Drs. Ngoga and Rulisa and Dr. Vincent Rusanganwa from the Ministry of Health offered some closing remarks and spoke in appreciation and support of PURE.  The future of PURE is bright.  Among the pilot trainees there is universal interest in becoming a trainer to other physicians.  Looking forward to that course and another introductory course that are in the works for this fall!

 

Greg Bell, MD

Emergency Ultrasound Director

University of Iowa Hospital

 

Dedicated to improving ultrasound education in the developing world