Blog

Making Things Happen

Second and third year medical students at the University of Vermont are contributing to the development and training of our trauma ultrasound protocol (eFAST). Peter Cooch, Ashley Atiyeh (both seen in this photo) and Amanda Miller took photos for the ITW training poster. These students have also contributed to the research we are conducting in the Emergency Department at Fletcher Allen Health Care on trauma patients to test our trauma protocol. They are really making things happen!

– Mary Streeter

ITW Sponsors Student from South Sudan

Thanks to Gail Rouillard, ITW Training Group Leader and generous donor, ITW will sponsor a student from the South Sudan for ultrasound training through ECUREI (Ernest Cook Ultrasound Research and Education Institute). Abraham Kuol Manyror is an employee of the John Dau Foundation and has sixteen years experience working for international NGOs.

Abraham is a 2007 graduate of Yei Medical Training School and a certified nurse midwife. He also attended Clinical Medicine Training at Lobone Rural Hospital in Eastern Equatoria in 2001.

Integrated Community Outreach, Nawanyago

In Fall 2011, a community outreach project took place at Magogo Kisadhaki Primary School in Nawanyago, in the Kamuli District of southeastern Uganda. Our team included the drama group from St. Joseph’s Vocational Training Centre, Sister Angela from Nawanyago Health Center, and Monica from Kamuli Mission Hospital. The day started with a lot of rain – it followed us all the way from Kamuli and we were worried it would keep people from coming to the program the drama team had worked so hard to create. When we reached the center, to our dismay practically no one had come to see us, apart from the schoolchildren who peeped through the windows to see what was happening.

Straight away the team unloaded tents, chairs and the sound system, setting them up while hoping that the rain would stop. By noon, everything was set. The drama team entered the village singing and dancing to some local tunes, hoping to attract people to the function. The news began to spread across the village and at 12:30, the children were invited to work with our counselor to come for a voluntary HIV/AIDS test and immunizations. The drama group did great job, communicating essential information in a very entertaining way. Sr. Monica explained the advantages of ultrasound machines in diagnosing general ailments, including those specific to pregnant mothers, and encouraged all to go for the services at Nawanyago Health Centre. Despite the rain, the day turned into a great success – 174 HIV/AIDS tests were handed out and 612 inoculations were given including de-worming, polio, DPT and measles.

Special thanks goes to ITW, for the support given to this project – it is really making an impact in the rural community of Kamuli district. Last but not least, thanks too for the young adults from the drama group at St. Joseph’s Vocational Training Centre. Their good work is helping to improve the lives of the rural communities through music and drama.

– Br. John Njuguna

Ginger Merry presents ITW breast project at UCSF

Ginger Merry gave a talk today at University of California, San Francisco, titled “Uganda Breast Project for Earlier Detection of Breast Cancer”.

Ginger Merry, MD, a fourth-year UCSF Diagnostic Radiology Resident, presented information on breast cancer in Uganda and her experiences teaching and pilot testing the breast cancer diagnosis algorithm at Kamuli Mission Hospital, a rural hospital. Merry worked closely with Dr. Kristen DeStigter (radiologist and program director at University of Vermont) and physicians in Uganda to develop a breast health care algorithm for rural Uganda incorporating the breast ultrasound volume based protocols.

Merry also volunteered in Kampala, where she gave lectures for the radiology residents at Makerere University (the only radiology training program in the country) and for the sonography students at ECUREI (Ernest Cook Ultrasound Research and Education Institute), lecturing on breast imaging and ultrasound, ultrasound guided procedures, and pelvic ultrasound.

Merry was the recipient of the American College of Radiology Goldberg-Reeder Resident Travel Grant. This grant, which encourages international volunteer service among radiology residents, helped Merry travel to Uganda with Imaging the World.

Sharing

This was a week of sharing. The week began with Sister Angela (one of the nurses at Nawanyago Health Center) inviting me into her home to live with her for several days; we shared daily activities (going to church, eating meals, sleeping next to the labor room, delivering babies, treating patients) and she shared her life stories, full of adventures and dreams. I saw the love and passion that she has for life, God, her patients, and those that come in and out of her life. I am thankful for the kindness shared by Sister Angela and everyone at Nawanyago who made me feel right at home.

I then traveled back to Kampala to prepare for two days of lectures at Mulago Hospital for the radiology residents and at Mengo Hospital (ECUREI) for ultrasound students. I lectured on breast cancer, breast imaging, ultrasound-guided breast interventions and pelvic ultrasound. I received such a warm welcome and appreciation! Everyone seemed especially excited about the hands-on practice of ultrasound-guided breast procedures using breast phantoms – it was a rare opportunity to practice skills on a model. I felt very lucky to be the one sharing these lectures with such a bright group of motivated students – the excitement for knowledge was palpable!

– Ginger Merry

ITW Volunteer Receives ACR grant

Ginger Merry, a fourth year radiology resident at UCSF, is honored and grateful to receive the American College of Radiology Goldberg-Reeder Resident Travel Grant. This grant, which encourages international volunteer service among radiology residents, has helped Ginger travel to Uganda with Imaging the World. Ginger has been working closely with Dr. Kristen DeStigter and physicians in Uganda to develop a breast health care algorithm for rural Uganda which incorporates the breast ultrasound volume based protocols. Ginger and Kristen are currently in Uganda, along with Mary Streeter, and have had a successful start to the project.

Congratulations Ginger!

From Ginger: “I am grateful of the support from the American College of Radiology in pursuing my interests in global health care. I feel passionately that people across the world, no matter where they live, are entitled to adequate healthcare and the support of ACR is helping me be involved in a project that we hope will improve survival from breast cancer for women who live in rural Uganda.”

Stakeholders Meeting Report

Breast cancer is the second leading cause in cancer incidence and mortality for women in Uganda, but what is striking is that studies have shown Ugandan (and African and African-American) women develop cancer at a very young age (peak age group of 30-39 according to a study from Mulago Hospital, Kampala). Women have also been shown to present late for care with advanced stage cancers. The goal of this project is to detect breast cancer at earlier stages when there are more effective treatment options. Breast cancer guidelines for Uganda emphasize the importance of education on breast health care and self-breast examination. The guidelines also emphasize the importance of ultrasound in the diagnostic work-up given that it is the most readily available breast-imaging tool in Uganda.

Our project objectives were well received by the stakeholders and we had a lively discussion that generated great ideas for improving the project, which Mary is going to share. Briefly, the project objectives include: introduce a breast health care algorithm and referral system for women who present with a breast mass in the rural setting, introduce and establish volume-based breast ultrasound scan protocols to be performed at the rural clinics, train district or regional hospital doctors to perform ultrasound guided fine needle aspiration (FNA) and core biopsies, educate the community about breast health care and available resources, identify community barriers to utilizing or accessing breast health care and collaborate with inter-disciplinary teams in Uganda to publish the results.

– Ginger Merry

Active Collaboration Wins Every Time

Stakeholders Meeting
Kampala, Uganda

The stakeholders meeting was a success on many levels. Having such a diverse group of individuals come together to discuss the ITW breast-imaging project in Uganda provided an opportunity for discussion that allowed a variety of issues to unfold as the day progressed. There were many obstacles and opportunities that were presented by Dr. Destigter, Dr. Merry, Dr. Michael Kawooya, Dr. Alphonsus and Dr. Moses Galukande during the meeting. Many factors had already been identified but others came to surface as a result of the discussion portion of the meeting. The project is multi-faceted and there are many details to work out, but the energy and collaboration in the room gave a clear indication that individuals are willing to break down barriers that may exist to find a common ground to move the project forward. The support was palpable.

One key issue that came out of the meeting was the underlying fear that many women from the rural villages have when they need to seek care in a large city like Kampala at Makerere Hospital. Clearly there are affordability issues, but we also found that many women have not been outside of their villages and thoughts of having to take a taxi to the city, navigating their way to the hospital, and finding out where they need to go, are terrifying. Some cannot overcome this fear and never seek the care they need. Dr. Moses Galukande from Makerere Hospital informed us that currently the breast clinic is only held on Wednesdays. Quite commonly many of the women that find the courage to overcome their fear will make the journey to the clinic discover to discover that they have arrived on the wrong day. Or they may arrive on the correct day but not receive any services because approximately 50 other women have come to the Wednesday clinic seeking services and the clinic cannot support this volume in one day. Many women are lost to follow up at this point; they feel frustrated and defeated, accept their situation and do not seek diagnosis or treatment. It is clear that a more efficient streamlined system needs to be put into place to overcome some of these underlying obstacles to access. The idea of creating a “breast care coordinator” was discussed. There was clear agreement that this will be a key position to the success of the breast-imaging algorithm. This person would be the link between the clinic in Nawanyago and the Makerere hospital, arranging all services needed at the hospital and communicating this back to the rural clinic so the patient is informed prior to her arrival of regarding all aspects of her visit and individual concerns can be addressed prospectively. This personalized care would decrease miscommunications, unclog the current system and improve patient care. Creating an algorithm for this role will be one of our next steps; it will lay the foundation to a successful implementation of this project in rural Uganda.

– Mary Streeter

An Incredible Day

Today began with Dr. Alphonsus at Kamuli Mission Hospital. He took us on his morning rounds where we were able to see a variety of patients and diagnoses. For me this was a powerful experience; not only do I have a deep appreciation for the challenges that exist in the Uganda healthcare system, I am also impressed with the skills that Alphonsus has as a physician and his level of compassion and patience. After rounds we did some training on performing ultrasound guided breast biopsies. Just to give you an idea of how great this need is, we arrived at Nawanyago the day before to train Sister Angela. Four women from local villages came because they had heard word that we were going to doing ITW breast scans. One of these women had a suspicious lesion and she was able to get transportation to Kamuli the next morning so that Kristen and Dr. Alphonsus could perform an ultrasound guided breast biopsy. By doing these we are able to work through the steps and equipment needed to create a pathway for this process. People are overwhelmingly appreciative of the opportunity.

Later in the afternoon we went back to Nawanyago for the antenatal clinic. Monika, one of the sonographers from Kumuli Mission Hospital, was performing routine obstetric ultrasounds followed by Sister Angela performing the ITW protocol. Sixteen women received ultrasounds! Five woman delivered babies today at the clinic also. All of these women had received the ITW obstetric scans and all had successful deliveries at the clinic. I had the extreme honor of being there with Sister Angela for one of the deliveries. Kristen termed this the “miracle delivery” because the baby had the umbilical cord wrapped around his neck and was blue and floppy. The nurse midwives quickly cut the cord, however the baby needed some reviving and Sister Angela performed a miraculous resuscitation. This baby was “hungry to eat” Sister said, by the time we left for the day. Aside from this miraculous event, four other women arrived today to have breast ultrasounds. “If you build it, they will come” fits the situation here! Our day ended with an after dark trip from Nawanyago to Kamuli…night travels by car in Uganda are not for the weak at heart and I am glad Picho has such refined driving skills, because we all arrived back in Kamuli safely! This was an incredible day! I wonder what tomorrow will bring…

– Mary Streeter

Training at Nawanyago

We arrived at Nawanyago after a bumpy journey and were greeted by Sister Angela at Nawanyago Health Center III. After a warm reception, we received a tour of the clinic and spent time sharing stories about recent patient visits, including three recent ectopic pregnancies that were detected by ITW ultrasound. Each patient was immediately sent to Kamuli Mission Hospital for treatment. After our time catching up with Sister Angela, we began the breast ultrasound scan protocol training. After a short presentation going over the protocol and basic breast anatomy, four women with breast masses consented to breast ultrasounds for further evaluation. Sister Angela has already been trained in all the other ITW scan protocols and quickly demonstrated not only her proficiency in the breast ultrasound protocol, but also her depth of knowledge and deep compassion for her patients. The day was a success and tomorrow we will continue the training at Kamuli Mission Hospital!

–Ginger Merry