A brief weekend break!

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!

Emily’s report on training day 5

Friday September 7 – One week down!

After an intensive first week of being saturated with ultrasound knowledge and practice, the PURE team was once again satisfied to see all of our trainees in attendance for Friday’s course. The focus of the day was to practice scanning and case review to reinforce all the information the trainees had covered this week, as well as to cover the logistics of the upcoming months. The trainees practiced documenting their scans with the data collection sheets using cases presented by Josh. We also got very positive feedback and from their suggestions, our CHUK trainees will help us establish a patient “line-up” to allow more time for actual scanning and decrease time identifying and consenting patients for participation.

In terms of logistics, the trainees all report daily access to free internet at their home hospitals, and like our idea of using an online database for storage of their scans for interval quality assurance review and for urgent consultation when needed between the PURE team when remote and the trainees as they continue to develop their ultrasound skills and practice over the next few months.

All of our trainees stuck it out through the morning and afternoon session,  despite most of the physicians having to work all weekend to make up for being away from their hospitals this week for the training. It is so great to have such a dedicated group to work with.  The week ended on a great note, and so far I can report very pleasing progress from the course!


PURE Training Day 4

Thursday September 5, 2012 – PURE Training Day 4

Today we started day number 4 of training with review of the last few
days using case review scenarios that incorporate the material we have
covered so far. The first case, for example, involves a case of a
young male in a MVA, in which bedside US of his RUQ shows free fluid
in morison’s pouch as well as below the liver and surrounding the
kidney. The LUQ showed free fluid in the splenorenal recess, but the
subphrenic space was not fully visualized up to the diaphram. The
trainees were given the case background and shown the clips, and then
asked to identify the presence of pathology and to suggest their plan
of management including ultrasound. It was great to again see their
continued progress and steady level of participation in the course
with this exercise.

We were also able to bring the trainees some more good news today that
the introductory course secured some CPD (Rwanda’s Continuing
Professional Development program, equivalent to CME in the U.S.)
funding which will in part support their expenses related to
participating in the course.  This is an added benefit for the
trainees and we appreciate the support it provides for our program.

The rest of the day proceeded to focus on Obstetric ultrasound,
starting with lectures from Josh Rempell, and continuing into the
Maternity ward for scanning. The trainees got lots of practice
scanning for gestational age using femur length and performed echos on
pregnant patients. It was great to have Dr. Muzungu, one of our CHUK
Trainees that specializes in OB/GYN, with us to help facilitate.
Although not directly relevant to today’s training topics, the
trainees also diagnosed a DVT. We clearly have some great sonographers
in the making!!


Emily’s day 3 update!

Day 3 began with the news from Dr. Stephen Rulisa that PURE’s training program was approved yesterday as a certificate program from the National University of Rwanda! The trainees were happy to hear this as we got the training for the day underway with image based review in the library, “pass the pointer” style. This was a great way to get all the trainees active and engaged right off the bat, and we were pleased to see how quickly they are catching on. After review, Dr. Emmanuel from the Rwanda Society for Ultrasound joined us for Dave Mackenzie’s absorbing presentation on lung ultrasound. From there we moved into the conference room to start scanning away on each other to looking for (hopefully the absence of) pneumothoraces, pleural effusions or consolidations. We were happy to find that our trainees lungs were all in good shape, as are there growing ultrasound skills. We were very pleased to have Dr. Vincent from the MoH join us for a visit this afternoon during Megan Leo’s lecture on soft tissue and bone applications. After the last lecture of the day, we moved to the wards for scanning. We found plenty of pathology and wrapped up the afternoon with the entire group back together reviewing the images the various teams collected on the wards for more learning. We found multiple pericardial effusions, pneumonias, liver disease and ascites, an atrial thrombus, and plenty of B-lines. The trainees even diagnosed their first core pulmonale with a very large right ventricle, after just one Echo lecture with Dr. Leo. All are looking forward to our OB sessions tomorrow!

Emily’s intro course day 2 update…

Tuesday September 2, 2012- PURE Training Day 2: Focus on IVC and Volume Status, and Echocardiography.

Today we began the second day of training with a hands-on scan review of FAST, which we taught and practiced with the trainees yesterday. This type of review seemed to be really useful for the trainees, their general attitude (as well as ours) is the more practice time they can get, the better. Considering how much information they were presented in one day, the trainees showed they had a pretty good grasp of the concepts and techniques, they were concentrated and engaged and they couldn’t get enough of it. Megan Leo presented a great Echo lecture, which was followed up again by small group practice focused on acquiring the different views and getting comfortable with the orientation. In the afternoon, we brought the portable machines into the wards in small trainee/trainer groups and scanned patients. We were excited to find lots of relevant pathology in the ER, Internal Medicine and Maternity wards- a few positive FAST exams, a pericardial effusion with severely depressed cardiac function, and a case of bilateral hydronephrosis. Scanning on patients definitely helped solidify the concepts for the trainees, and allow them to compare the normal images from practice to abnormal findings in the wards. To finish out the day, the PURE team had a nice family dinner – we know we have been working hard as two of us actually feel asleep at the table!




Updates from the intro course!

Emily Douglass has been a HUGE asset to PURE over the past year or so, and we’re lucky to have her on the ground in Rwanda for these next couple weeks.  She is documenting her impressions of the intro course here

Monday September 3, 2012 – PURE Training Day 1

The PURE training team arrived to CHUK early Monday morning, to set up the lecture room in the Research Building that will serve as the PURE teaching headquarters for the length of the initial 2 week intensive training course. Six high quality ultrasound machines, generously donated for use by PURE for the duration of the training course, will be set up and used for hands-on education and practice throughout the training. The machines include 5 compact portable Mindrays; two DP-10, and three DP-50s, along with 5 curvilinear transducers, and 2 linear transducers provided by AfriChem. One non-portable Phillips machine was also provided for teaching, which has a curvilinear, linear, intracavitary and also a cardiac probe. The machines are brand new, in great condition, and their portability is excellent for the means of this course.

At 9 am the trainees arrived, and after coffee and after an introduction by Dr. Stephen Rulisa, head of research at CHUK, Dr. Henwood began by welcoming the physicians to the course and introducing the team of PURE trainers, Dr. Megan Leo, Dr. Josh Rempell, Dr. Raja Rao, Dr. David Mackenzie, and Dr. Sam Vallincourt, as well as the other members of the team involved in the program development: Dr. Damas Dukundane, Emily Douglass, and Benjamin Kabagambe.  After Dr. Henwood’s introduction to the course and the schedule for the program in entirety, the physicians completed a two part baseline assessment, beginning with a questionnaire to assess their current level of experience with ultrasound prior to the training, as well as in what areas of training they have specific interest. The second part of the baseline assessment was a pre-training image based assessment, during which the trainees were shown a series of image based questions and asked to choose the answer based on their previous knowledge of the use of ultrasound.

After the baseline assessment, Dr. Rempell began the teaching with a lecture on Introduction to Point-of-Care Ultrasound, speaking a bit about Ultrasound use in emergency medicine and the role of bedside ultrasound in clinical practice. When asked about their prior training and ultrasound experience, the physicians indicated that they had received some training in medical school, and many of the physicians stated that they did currently use some applications of ultrasound in their practice. However, the trainees indicated a strong desire for more formal training in multiple applications. Dr. Rempell spoke about the importance of recognizing the strengths and limitations of POC ultrasound.

The next didactic session was given by our interventional radiologist, Dr. Raja Rao. He gave a great lecture on the physics and instrumentation of ultrasound. After a short lunch break, the application specific training kicked off with Dr. Rempell’s lecture on FAST protocol (Focused Assessment with Sonography in Trauma), which seeks to assess for the presence of abnormal collections of fluid within the abdomen.  After the FAST didactic session, the trainees were put into small groups at practice stations each led by a trainer. The trainees then spent the remainder of the day practicing the FAST applications and getting comfortable with the machines and scanning techniques. The trainees showed excellent initiative and interest in learning and practicing the applications taught, and at the conclusion of the first day of the course the PURE team was impressed, and looking forward to continuing to work with such a capable and enthusiastic group of physicians.

July update!

Hello from Kigali Everyone!

I hope this newsletter finds you all well, things are going great here in Rwanda.  I have been here now for a bit more than 2 weeks and while there have been ups and downs I can say without hesitation that we are making great progress towards making sure that things go as smoothly as possible after we launch the training on September 3rd.

Thank you to all of you wonderful folks who have volunteered your time and are generously supporting the cost of your own airfare!  I sincerely hope that we find additional funds to pay everyone back, but for now this solution is letting us move forward.  However, we can still use more trainers, especially during the months of October and November!   PURE is covering in country transportation and lodging, and we will coordinate the details of your trip.  Please reply to this email if you’re ultrasound trained and you’re interested in spending a couple weeks in beautiful Rwanda teaching your colleagues.

News wise, we ran into a problem in that the consideration we were to have from the Senate of the National University of Rwanda(NUR) didn’t happen as planned as they deferred any consideration of new programs due to a very full meeting agenda.  We will be considered on August 5th.  However, awaiting that decision will make it too late for us to plan properly for the training.  Our solution is that we are running this training to launch in September as a Continuing Professional Development (CPD) course, and will upgrade the status to a course to qualify for an academic certificate from the NUR once that approval is complete.  The general structure and content of the training will not change, nor will our research agenda, but doing this as CPD simplifies several factors.

While here in Rwanda we connected with leaders from the Kigali Health Institutes (KHI, trains allied health professions like ultrasound techs), the Rwandan Radiologic Society, and the Society for Ultrasound in Rwanda.  As we are all institutions dedicated to ultrasound education, we thought to work together through the formation of a consortium or organizations all working on the same common goal.  This will directly benefit PURE through greater local radiologist involvement for supervision and guidance as well as sharing of the responsibility for creation of a diploma in ultrasound for physicians as KHI has been assigned the same task.  We also all thought that our cooperation would decrease duplication of efforts and provide a direct means for sharing resources and accessing funding opportunities we each individually may not have been eligible for.  Most importantly, combining our efforts will better serve Rwandan healthcare practitioners and patients.

In the next couple weeks I hope to add some great detail to our website regarding the training curriculum, the agenda for trainers, info on lodging and transportation in Rwanda, and a map of our district hospitals with lots of other great details.

Any Rotarians on this list?  This Wednesday evening I will be presenting PURE to the Kigali chapter of the Rotary.  Their grants system is in the middle of some big changes, so I’m having a bit of trouble understanding where a grant to PURE would fall, but it would be great to make a connection between international chapters both interested in the same issue!

Thanks everyone, hope to hear from many of you soon,

Take care,

Dedicated to improving ultrasound education in the developing world