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!
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.
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
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.
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
The intensive six-month follow-up for our pilot training program was successfully wrapped up in February by Anthony Dean and Bob Jones, and since the PURE Operation Group has been busy continuing with data entry and analysis with regards to the hard work that our trainees had been doing recording and uploading scans. We hope to be reporting on some of these numbers soon and will keep you updated about that.
Next weekend a group of us will head to Kigali for a wrap-up course and closing ceremony for the pilot program. I am very lucky to again be joined by Dr. David Mackenzie who is a member of the PURE Operation Group, Mass General Emergency Ultrasound faculty and one of our original intro course trainers, as well as by Dr. Gregory Bell, Emergency Ultrasound Director at the University of Iowa. We are also happy to announce that Dr. Hein Lamprecht, Director of the Clinician Performed Ultrasound Program and Fellowship at the University of Cape Town/Stellenbosch University in South Africa will join us and help with teaching ultrasound modules particularly targeting the burden of disease in Africa, including HIV and TB related applications. We will also have some of our Rwanda obstetric specialists joining our group to go over more advanced OB applications.
We will have a closing ceremony with all of our trainees, local PURE volunteers and invited officials from the Ministry of Health, National University of Rwanda and Rwandan Medical Council. We look forward to celebrating the achievements of our pilot program trainees and planning more with our Rwandan colleagues regarding future training programs.
We are hoping for a train-the-trainers program for our pilot trainees in the Fall of 2013 and an additional basic course at the same time. Please get in touch with us at firstname.lastname@example.org if you are interested in getting more involved with PURE or helping with future trainings.
More updates to come after this next training!
It was quite a busy year-end for PURE, and we are certainly off to an exciting start so far this year! Our penultimate group of pilot course trainers, Drs. Katie O’Brien and Chris Dorgan, just recently returned from Kigali. Their hard work and intensive training period was quite productive for our trainees, and also with identifying final areas of focus as the pilot comes to a close next month. We are excited to have some of our most experienced point-of-care ultrasound trainers, Dr. Bob Jones and PURE founding board member Dr. Anthony Dean, wrap up the pilot training for us with a final training session and exams in early February.
We currently have funding proposals submitted to a few different groups in hopes of pursing a train-the-trainers course for our outstanding trainees later in 2013. If you are interested in helping for future training sessions, grant writing, day-to-day organizational operations, research efforts, etc. please get in touch with me at email@example.com. PURE is always looking for donations, large or small, or specific grant opportunities you may know of so please feel free to get in touch about that as well.
On behalf of the PURE board and our entire organization, we would like to thank Dr. Liz Krebs for her contributions to the development of what PURE is today as well as her continued support of our efforts. We look forward to continued collaboration with her as she pursues other educational endeavors in Rwanda.
Stay tuned as we will have more updates to come as the pilot course wraps up in the next few weeks!
Tuesday Week 2: September 11
Tuesday morning, we started the day off again with hands on review,
since we’ve found that diving right in gets the day going with a good
level of energy and enthusiasm. That morning Trish and I went downtown to get the official PURE stamp made, which I have to say is pretty cool. This stamp definitively demands respect, purple ink and all, and I’ll admit it definitely makes things look official. In the morning Raja gave renal and spleen lectures in the, and then trainees spent some more time with hands on practice.
After lunch Megan gave brief knobology lecture to help the trainees
get more acquainted with the machines and a few of the more complex uses, such as M-mode, Doppler, and taking measurements.
The trainers took some time in the afternoon to do some more hands
on review and let the trainees get some more practice in any
application they felt needed more attention. Since the next day was
the last day of training at CHUK, and would include the assessments of the trainees’ progress and skills, we had them practice the process of performing an ultrasound from the beginning: approaching the patient and setting up the machine, to the execution, the identification of anatomic structures, image acquisition, exam interpretation, saving and storing clips, cleaning the patient and machine, and finishing up by properly communicating the results of their exam with the patient. The trainees rotated set stations to practice each of the applications that they have learned during the last 7 days of training.
Realizing that most of us only had a few days left in Kigali now
that the training was wrapping up, Megan, Dave, Trish and I went to
the market to shop for some Rwandan art and gifts to bring home with us. I don’t know about everyone else, but I definitely spent way too much. At dinner the team discussed how best to execute 17 OSCE’s, 17 image based tests, and 17 course evaluations in one day. We decided that no matter how the trainers pulled it off, a day like that would have to end with a cake!
Monday September 10, 2012- Week 2 Training at CHUK
We began the second week of training on Monday with some free scanning review to reinforce last weeks training and help shake of the cobwebs from the weekend. The trainees practiced musculoskeletal, abdominal, cardiac, IVC and OB scanning on each other for about an hour. I was glad to see they kept their new skills strong and were ready to dive right back in. We then had a quick concept review and had some time for the trainees to ask any questions they might have thought of while back at their hospitals. We were also curious to find out if any of our physicians had any cases over the weekend where they were able to use ultrasound, since most of them spent the weekend working shifts at home. One of our trainees reported that they performed a FAST exam on a trauma patient at their hospital. He saved the scans and brought them in to review with us, which was extremely proactive on his part and such a great example for how we plan to incorporate their own clinical practice into continued training over the next 5 months. The patient passed away from his injuries, which included severe internal bleeding shown with a positive FAST exam by our trainee, but he acknowledged that had he been able to scan the patient earlier, it would have changed their management plan and may have changed the patient’s outcome.
After practice, Sam gave a talk on the logistics of image acquisition,
saving scans and clips, uploading them to databases using USB drives
and using our awesome (and super convenient for all of us) online
Dropbox database. The didactics’ then continued with Raja’s expertise
in liver and gallbladder ultrasound. In our usual fashion we finished
up the afternoon by taking our new skills to the wards for some
This weekend gave the PURE team a chance to get a lot of work and
planning done, as well as a little free time for the trainers to
explore Kigali and see a bit of the lush countryside. The team took a
break from work for a few hours to visit the Kigali Genocide Memorial
Center on Saturday, and then Sunday a few of us took a morning trip
out to Volcano National Park for an intense and very muddy hike up
Volcan Bisoke to Crater Lake. The park includes the Virunga Mountains
that run through the boarders of Rwanda, Uganda and the DRC, and is
home to at least half of the world’s remaining mountain Gorillas and 6
volcanoes (3 of which are active). The lake is over 3000 meters high
on the top of the mountain, and although we brought some bruises and
plenty of mud back with us it was an gratifying trek and an impressive
site at the top. Sunday evening the PURE team was treated to a
delicious home cooked Indian dinner courtesy of Raja and his wonderful
local friends Randy and Diane, who have a lovely home in Kigali. Back to class tomorrow to kick off week 2!