The long delayed, latest update from PURE

Hi Everyone,

My sincere apologies for a lack of contact for the past 5 months, I hope this email finds all of you well.  After submitting all of our applications for working in Rwanda and accreditation, there was a period of little news.  After the news started to come, it was at first somewhat trying, and only in the past 3 weeks or so have things been looking up again and we are still on target to launch this pilot program in September!

The hurdles we ran into relate to some changes to our programming requested by the Rwandan Ministry of Health, specifically that we deliver a diploma level course rather than a certificate.  For the past two months we have been discussing options with them, and we are now awaiting the formal decision of the Senate of the National University of Rwanda(NUR) regarding our proposed post-graduate certificate level training to start as a pilot this September.  Pending their approval, the Hon. Minister will review our plans and with luck will give us the formal go ahead to move forward with this pilot-certificate, and we will direct our energy towards development of diploma level programs in the future if this will better fulfill the needs of the Ministry of Health.  Though these discussion slowed our progress a bit, these events were not a true setback, as it has helped us to understand the needs and desires of Rwanda better, and illuminate a path towards future programming.  Additionally, we have achieved accreditation as Continuing Professional Development (CPD) providers in Rwanda by the Rwanda Medical Council (RMC), the Faculty of Medicine has approved our plans, and both the Rwandan National Ethics Committee and and Partners IRB have approved our research plans.  With all this in place, we believe that the NUR will approve our plans as well and the Hon. Minister will have everything in place that she needs to feel confident that this pilot-certificate program will serve Rwandan physicians well.

Now the even better news:
– Thanks for the generosity of The International Foundation we have won a $10,000 grant to complete our pilot project in ultrasound training!  Recall that our budget is around $50,000, so fundraising continues, through grant applications and individual donations, but this was fantastic news.  If you can help, or know someone who can, please consider making a donation to support PURE – http://ultrasound-rwanda.us4.list-manage1.com/track/click?u=62216daa85ee11971fbcfa0e8&id=2f6e269e50&e=d201712ed0 (through google checkout, we get free processing!) orhttp://ultrasound-rwanda.us4.list-manage1.com/track/click?u=62216daa85ee11971fbcfa0e8&id=e48df47d4a&e=d201712ed0 (if you don’t want to log in to google)

– We have created a calendar of time-periods during which we need ultrasound trainers to spend 2-3 weeks in Rwanda teaching our physician colleagues to use ultrasound at the bedside.  If you feel you are qualified to teach, and interested in the travel, please contact me (krebse@gmail.com) to get a link to the Doodle calendar.

– PURE welcomes two new board members, Dr. Damas Dunkundane (A Rwandan GP, currently working at the PIH/Rwandan district hospital Butaro, who has extensive experience in local development projects, international speaking engagements, and a strong interest in ultrasound) and Dr. Raja Rao (A radiologist from Oregon, currently retired, who has been working on ultrasound training at Rwandan district level hospitals (and some radiology training as well) for the past two years.).  Both have been invaluable to PURE so far and bring unique skills and experience to our board.

– Three talented Rwandese ultrasound technicians will be working with us while we are in country training physicians.  With their incredible image acquisition skills they will help us to give as much hands on training to our trainees as possible.

– Curriculum building is going great, with almost all lectures completed and the focus now turning to creation of a teaching guide to standardize our delivery of the material to trainees, learning adjuncts, development of written and practical examinations, and surveys.

Just 3 months until we launch this pilot!  Many of you were on this list from the very first emails back in Fall of 2010, so you can join me in thinking back to the humble beginnings of PURE (almost regrettably named PUER, French for ‘to stink’).  Without the dedication and and tireless work of people like Trish Henwood, a PURE co-founder, this never could have come together.  The door is always open for greater involvement amongst any of the rest of you, just let me know your interest.  Thanks!

Take care,
Liz and the PURE team

exciting developments in Rwanda…

HRH Program :: Rwanda.

The link above will take you to the site that details the plans for Rwanda’s ambitious Human Resources in Health (HRH) plan to improve medical education and, consequently, the quality of healthcare.  The gist of the HRH plan is that foreign educators will be brought in to begin trainings and as time passes knowledge will be transferred ultimately resulting in construction of a sustainable means for Rwanda to continue progressing independently.  A big rush of foreign trainers at the outset, and at the end a group of skilled Rwandese able to take over as trainers.  No need for me to explain the details here, the site is comprehensive and well organized and includes information for how to apply to get involved.  As PURE is an NGO, and multi-institutional effort(not a single university) we are not able to be formally affiliated with the HRH plan.  However, we are excited at the prospect of helping to incorporate ultrasound training into appropriate educational programs.

Trish’s last update

November 16, 2011

So I just arrived back in Boston this evening and figured you were all due for an update!  The time in Rwanda was very busy and very productive for PURE.  Since I checked in last, Emily Douglass, our priceless and incredibly helpful MGH ED Ultrasound Division intern joined me to help with the assessments and meetings at Kibagabaga, Ruhengeri and Gihundwe hospitals.  I never got used to her telling people I was her ‘boss,’ but I can tell you that we wouldn’t have gotten nearly so much done without her very hard work!  Overall, there were successful visits to all five provincial hospitals and meetings with hospital leadership and interested staff physicians at each respective site to continue to raise awareness, support, and interest in our proposed training program.  I re-investigated the ultrasound machines at each site to compare to findings from my March needs assessments and I’m happy to confirm that both Ruhengeri and Kabgayi have just been the recipients for two brand new Mindray ultrasound machines each!  These great machines came to them from the Ministry of Health (MoH), by way of a donation by the Global Fund, and this increase in machine capacity is great news for both of these busy hospitals!  Our three other sites all have functioning machines, however their ability for image storage for quality review is a challenge so we are currently discussing allocation of other donated machines with image storage capacity with the MoH.

I had very productive meetings and received good feedback from Dr. Patrick and Dr. Sanctus, the head deans at the Faculty of Medicine for the Rwandan National University.  We are now working with them as they review our strategic action plan and details of our curriculum.  Once we make any necessary amendments and get their official approval, we will again discuss CPD accreditation with the Rwandan Medical Council where we have a CPD provider application pending.

Damas and I presented to the Rwandan National Ethics Committee this past Saturday.  We discussed the background of PURE, our proposed training program and the research questions that were born out of this training program, in order that we should help further the limited evidence based with regards to the efficacy of this type of training program and its impact on patient management.  Our hope is that these outcomes data will help find the optimal approach for further scale-up of diagnostic ultrasound training programs in Rwanda.  We anticipate formal feedback from the RNEC by email this week and then Damas will help get the final version of the protocol submitted for approval.

From here, will we will continue to focus on our fundraising efforts.  I’m happy to report we just officially received of 501c3 status from the federal government in the US so we are setting up a payment system for direct donations through our website so stay tuned for more updates and please direct friends, family and colleagues to our website for donations!

- Trish Henwood

Trish’s first update

3 November 2011

Hello from Rwanda!  On behalf of PURE, I have gotten little sleep but have definitely have been off to a running start…firstly thanks go out to Dr. Damas Dukundane, PURE’s logistics coordinator, who has definitely helped me with a lot of logistics (especially as neither of my bags decided to join me in Rwanda initially) and to Jean Paul Iyamuremye, who I have dubbed the transportation director for PURE, who has been carting me all over the country!  Yesterday I travelled to Rwamagana district and had a great meeting with Dr. Jean Claude who is the hospital director there.  I am happy to report that we secured a glowing letter of support for PURE from he and the Rwamagana district mayor which will help us with our registration as an international NGO working in Rwanda.  I also had great meetings with several members of the clinical staff at the hospital who are interested in ultrasound and I got their input in a number of areas. 

Today I was invited to attend a conference put on by the Rwandan Medical Association and the Rwandan Medical Council (physician licensing body in the country) on  continuous professional development, otherwise known as the hot topic of ‘CPD’ in Rwanda.  The Honorable Dr. Agnes Bingawaho, the Rwandan Minister of Health, opened the meeting with her perspective on the importance of continuing education and training as well as academic productivity, especially encouraging Rwandan physicians to start publishing on the huge strides the health sector has been making in the last few years.  At the meeting I got to reconnect with Dr. Michael Miller, one of the Rwandan Family Medicine Residency faculty members from the University of Colorado, to hear more about the great work and growing program he and his colleagues have created.  

I had previously met with Dr. Eugene Ngoga of the Rwandan Medical Council (RMC) during my initial visit in March, and today we reconnected to discuss official accreditation for PURE by the RMC.  I will be completing the necessary documentation in the next few days and we are hopeful that PURE may become one of the earliest recognized CPD providers in Rwanda!

Tomorrow I will start my day with meetings at the Ministry of Health and then I will head to Kibagabaga hospital which is one of the provincial hospitals very close to downtown Kigali.  There I will meet with hospital leadership and interested physicians to discuss our training program in more detail and will reassess the ultrasound machine capacity at that site.  I am excited to report that I have heard through the grapevine (a reliable grapevine that is J) that there have been brand new ultrasound machines delivered within the last week to both Kabgayi and Ruhengeri hospitals.  I will be headed there next to week so investigate in person and will definitely keep you all updated on that!

- Trish Henwood

PURE and international radiology

Hey everyone, PURE had the great fortune to be presented at the third annual RAD-AID International conference yesterday.  Trish and I met so many fantastic people, all dedicated to bringing appropriate radiology to the developing world.  What I mean by appropriate is that the findings will serve a purpose in the context of the particular healthcare systems capacity, i.e. nobody needs mammography if there are no breast surgeons or oncologists to treat a positive finding.  Anyhow, the other ultrasound work that people and organizations are dedicated to is just awesome, and PURE can learn so much from their experiences.  Notably, Imaging the World and their unique approach to training healthworkers to do ultrasound sweeps that are then interpreted by radiologists and sonographers (sonographers in Uganda are trained to interpret ultrasounds) have achieved incredible things including being awarded a Gate’s Challenge Grant (http://imagingtheworld.org/).  Dr. Bill Marks has done ultrasound training all over the world, and will be publishing a book on his experiences and recommendations, I attached a PDF below of his.  Tarek S. El-Shayal, principal of the East Africa Aid foundation (http://www.eastafricaaidproject.org/) had a lot of great advice based on his experiences trying to bring equipment to the hospitals and clinics he partners with.  We can learn a lot from the experiences of Dr. Robert Nathan and his partners working on training midwives in focused high yield ultrasound, they too have impressive achievments in obtaining support from foundations and corporations (http://change.washington.edu/projects/mobile-midwives-ultrasound/).  As far as I know PURE represented the only non-radiology based efforts at ultrasound training at this conference, and it was great for us to network with these other groups we may not have had as much access to otherwise.  I also attached the ppt that was presented, in case anyone wants a quick and dirty overview of the project.

Trish leaves for Rwanda today!  Really excited about what she’s aiming to get done while there, and we’ll keep you all posted.

Rwanda IRB Application

The last week has been a whirlwind of PURE activity between all of us that make up our core group, busting our butts to get all of the paperwork together in order for Trish to meet with the Rwandan National Ethics Committee while she’s in country to get their approval of our research agenda.  I posted a PDF of the file for all those interested.  This is a rough sketch of our research plans, but I think it gets at the meat of what we’re trying to accomplish.  Next up is working on the American IRB and continuing to come up with important things to be addressed during the trip.  Please get in touch if you’re in Rwanda and would like to meet with Trish!

T-minus…

This is my formal commitment to all of you reading these updates that I will do better from here on out.  No excuses, just apologies and promises to do better.  Since the last post in July we’ve formed a fantastic working group up in Boston to finish up the curriculum design.  We’ve been lucky enough to draw the interest of Dr. Alice Murray, an MGH international emergency ultrasound fellow and experienced in Rwanda.  She’s been working with other new team members like Dr. Josh Rempell, a current EUS fellow at MGH, as well as Emily Douglass an intern from Northeaster University.  In addition to curriculum design they’re all working on American IRB approval of our research agendaTrish is doing her best to make a return trip to Rwanda happen next month in order get our MOU signed, submit all the INGO registration paperwork, and complete the Rwandan national IRB approval process.  My goal now is to work on publicity, fundraising, networking, and trainer recruitment.  As all these pieces come together we get closer and closer to a launch date.  I still can’t predict this exactly, but we’re shooting for early 2012.  Action items that YOU can help with:

– donate through our friends at Good/Works global
– subscribe to our twitter feed and spread the word
– like us on facebook
– subscribe to the e-mail list 
– reconnect if you previously were interested in getting involved but have lost touch
– if you’re ultrasound trained, and looking to travel, get in touch about becoming a trainer

Any help is good help, so please don’t hesitate to e-mail liz@pureultrasound.org if you want to get more involved, thanks!

Moving Right Along…

I can’t believe the last post here was over three months ago!  If anything, the paucity of posts is a reflection of how many other things are demanding my attention when it comes to PURE; we’ve made so much great progress in the past three months.  As I hope you were able to read in the latest e-mail update, we’ve settled on a specific plan for the pilot program based on direct requests of the Rwandan MoH.  The project description has been updated with the details of this action plan, so check it out if you didn’t have a chance to read the document attached with the last e-mail.  In order to execute this plan we’re doing everything we can to help connect the Rwandan government with potential sources of ultrasound equipment donations or low-cost purchasing options.  Provision of equipment by PURE is out of reach of our small, education focused organization, and we would prefer that the equipment be fully owned by Rwanda.  To support the costs of executing our training and thoroughly studying the outcomes we’ve projected financial needs of approximately $50,000.  Within the next couple weeks I hope we have a solid plan for accomplishing this goal.  There are lots of elements already at work (like the support of our friends at Good/Works Global, check it out!) but my goal is to have a list of many different means of raising these funds so we can divide and conquer in maximizing our efforts.  $50,000 is the minimum we need based on the current plan, but anything we can raise above that will ultimately just make this program stronger and give us more options for an intense longitudinal analysis and helping to support our trainees/hospitals over the long term.  We have obtained fiscal sponsorship from Good/Works, so all donations/support will be tax deductible for the donors/partners, but we are still working on our own 501c3 application.  We need to finish formal International NGO registration in Rwanda, obtain IRB approval both here and in Rwanda, and complete a formal write up of our curriculum to submit to the RMC for CPD approval.  There’s so much to do still, but we’re well on our way to getting it all done.  Get in touch if there’s something specific you want to get more involved in!

Successful Trip

Trish recently returned from her time in Rwanda making in person introductions of PURE and learning about the needs and current capacity of various district hospitals. She met with leadership in the MoH, the Rwandan Medical Association (a doctors and patients civil advocate group), and the Rwandan Medical Council (the government branch responsible for medical education).  In general our group and plans were very well received, the challenge now is to determine the best way to integrate our abilities with the needs we learned of through this trip.  More to details on this soon, there’s still a lot of information to synthesize.  We have formed a formal board of directors as posted on The Team section of this site.  This is necessary for decision making related to the incorporation process and other organization matters.  The law students are hard at work on the incorporation process, and the board is currently reviewing the bylaws for approval.  Once we have become an entity we will establish a fiscal sponsorship agreement with Goodworks Global while we work to obtain our own nonprofit status.  This will allow us to receive tax deductible donations as well as qualify us for many grants that require an NGO to have 501c3 nonprofit status.  Our group was recently featured in the EMRA “What’s Up in Emergency Medicine” publication, you can find the article here – http://www.emra.org/emra_articles.aspx?id=43551.

Lots of Progress!

There are three law students from the University of Pennsylvania that along with the help of a faculty member have volunteered to help us navigate the legal aspects of the incorporation process, I´ll be meeting with them later this week.  Additionally, there are several members of our group working on this process and finding sources of potential funding.  Finally, I´ll be presenting our organization as a social enterprise pitch at the 2011 Unite for Sight global development conference this April in New Haven, CT.

Dedicated to improving ultrasound education in the developing world