Hello! So many great things have happened in the last couple of weeks. Last week we had a delicious lunch at a beautiful historical building at the University of Istanbul with Associate Dean Dr. Fatis Altindas. It was very exciting to hear from the Dean that the students are really enjoying the course. Some other highlights of our lunch included the delicious dessert and Turkish coffee reading by one of our new friends.
Once back at Cerrahpasa, we prepared for our next challenge. The students’ positive feedback made some residents and attendings interested in our course, so we prepared a four-hour intensive course. While we only expected a dozen participants, we had an amazing turn out of 35. Not only did we get to meet so many individuals from the Cerrahpasa medical team, but we also got invited to shadow at their ICU!
This week we had the second session with a new group of Cerrahpasa medical students. It was very rewarding to see them learn so much in just a few days. Even though our team members started getting sick one by one, we had a very successful session. We will probably not miss walking every morning carrying the machines up that hill, but we will miss our students and the incredible hospitality of everyone at Cerrahpasa.
Reporting from Istanbul,
We sailed for three hours through Lake Victoria, on board a boat with 2 people and .5 chickens per seat, to Ukerewe island. Ukerewe island is a not so small island of 350,000 people in the middle of Lake Victoria where Schistosomiasis, a waterborne pathogen present in Lake Victoria, is endemic. Ukerewe has one hospital, in which the entire small staff of doctors is trained to perform surgeries. From the beach at our hotel every night we saw masses of people bathing and women washing clothes in Lake Victoria, the oasis for Schistosomiasis. For a week our team has worked at the hospital at Ukerewe with Dr.Majula, an expert in neglected tropical diseases. After Dr. Majula made an announcement to the community about our research, people lined up to be scanned, curious to see if years of schistosomiasis exposure had an impact on their organs. Almost everyone tested had either current Schistosomiasis or had the infection at some point in their life, most multiple times. What we saw on ultrasound was surprising, massive distended bowel, not outlined in the WHO procedure that our protocol was modeled after. What also surprised us are things we didn’t detect on ultrasound, significant liver and bladder pathology. We were also lucky enough to work with the lab at the hospital that provides free Schistosomiasis testing. The lab is modern and open 24hrs a day, unless the water is out, which can shut the lab for several days. When there was a lull in interested study subjects, we were also lucky enough to shadow in the wards. We observed an unplanned c-section and performed requested ultrasound scans with Dr. Boughton on inpatients.
Our experience at Ukerewe was not only an incredible opportunity for research but also a great chance to see unique pathology, which is usually dispersed among all the hospitals in Mwanza. As excited as we are about a potential use for ultrasound in areas with chronic Schistosomiasis, it is clear that there needs to be environmental changes to reduce the rates and problems caused by Schistosomiasis in the Lake Victoria regions.
Masha, Lauren, Megan, Kevin, Kate and Mikey
Masha and Lauren at the Lab
Megan and Mikey with Dr. Majula
We have had a busy week here in Armidale. This week we have embarked on our second study which is a retrospective chart review examining the potential benefits of implementing POC US into the ED at the Rural Referral Hospital in Armidale. It has been a tedious process going through hundreds of paper charts, but hopefully the results will provide valuable insight to see how US can help the patient population of this rural hospital. We have also been able to witness the inner workings of a rural ED, and the unique challenges that they face compared to more urban hospitals. Here in Armidale, the radiology department is only open until 6 pm so the doctors often have to be resourceful and rely on their clinical skills (and POC ultrasound) after hours!
We’ve enjoyed our stay in Armidale and we are making friends with a lot of the students. We are jealous though, because the students are our age or younger, but are already in their last year of medical school. Medical School is combined with undergrad here so you can become a doctor by 22 if you want!
Cheers from Australia!
This past week we took advantage of a few extra hours off to master a few of our favorite places like Taksim and Eminonu. The excitement and enthusiasm from our students in the first session spread and we caught the attention of the residents, attendings and associate dean! They came for an accelerated session this past Thursday. Despite us planning for about 10 doctors to show up, we ended up scrambling to teach 35 doctors with 3 machines everything we know within 3 hours. There will be more on that later this week as we gather our pictures!
I’ve included some pictures of our furry chaperones we’ve named: “Dog,” “Friend,” and “Loud” in Turkish. I think our names for them are spreading around the neighborhood as they follow us every where. As you can see, the cats and dogs have made the library their home as it has become ours.
I had my first steps in Asia when we crossed the Bosphorus to devour the delicious mountains that have a waffle hidden somewhere within. Luckily we ran into one of our students to show us how to make (and eat) them the right way.
The first day of our second session went as smooth as it could have and we are happy to get to know an entire new batch of students.
Until next time,
We said goodbye to Bangalore after a week full of adventures, delicious “Veg and Non-veg food”, and after seeing our anatomy textbooks come alive in the operating room.
On our way to Gudalur, which is located in the Nilgiris hills of Tamil Nadu, we stopped for a short visit in Mysore a city of palaces at the border of state Karnataka. This was our place to unwind and walk around palaces full of history and Hindu mythology, spice and fruit markets and far away gardens. It was here where we also met Lisa, the last member of our team and where we welcomed the holy month of Ramazan. Once our bags were packed and ready to go, we took a jeep to go across the border of the state of Karnataka into Tamil Nadu by wondering through their magical wildlife sanctuaries. We finally arrived in Gudalur where a homecooked south India dinner and the friendly staff from the Adivasi Hospital welcomed us.
It’s literally snowing. Our fearless leader and expert Australian climatologist, Eric Gray, informed us that quote, “The winter in Armidale is like the winter on the Newport peninsula,” so simply bringing a pull-over sweater and a pair of rainbows was not a wise decision. The snow however, has not deterred the progress of the US workshop here at the UNE rural health clinic in Armidale. A group of 35 medical students of varying age and year (year 3 to year 5 students) have undergone a rigorous crash course in everything from the physics of US, placement of central and peripheral lines, to live diagnostic demonstrations of US for patients in their 3rd trimester of pregnancy. For many of the students, particularly the year 5 students, this is the first time they have used ultrasound and we are extremely impressed with how they use their anatomical knowledge for probe placement and orientation of the correct view. It’s crazy to imagine that at the average age of 21 they will soon become physicians. Eric, Neema, and I have been teaching the basics of knobology, the RUSH and FAST protocol, and how much bowel gas an American can generate after drinking real Australian milk and a well-done kangaburger. In fact, one of the GP physicians showed us that you can simply wiggle the probe and the bowel gas will diffuse away. The course is also taking place in the 14 million dollar brand new Tablelands teaching facility, equipped with myriad of digital “SMART” white boards, an echocardiogram, and a brand new SonoSite X-PORTE generating beautiful images. Most importantly, our teaching and the expert demonstrations in the workshop have been an extremely valuable learning experience for the three of us. I think we all can agree that this experience will prepare us for the coming MS2 year when US will be used in pathology.
Here’s a picture of some of our students showing what they’ve learnt:
We finished our first week at Cerrahpasa University School of Medicine in Istanbul. It was such a great week!! We taught around 60 medical students cardiac, GI, pulmonary and FAST ultrasound exams.
Cerrahpasa students are really smart students and pick things up very quickly. In the end, when we compare the test results before and after our teaching, it is awesome to see that students learnt a lot, which means
that we did a great job. Also, we were so happy to hear from the students that they really love the program and want us to come back.
Now this week, in addition to teaching students extra ultrasound sessions, we have another challenge to overcome. We are going to teach ultrasound to the anesthesiology residents, attendings and associate deans. We are aware that this is a harder task but we know that we can do it!!
Besides the academic stuff, we are also having a lot of fun in istanbul. We went to all of the historical places like Hagia Sofia, Blue Mosque, Basilica cistern on the weekend as well as did the Bosphorus tour. Last night, we went to Eminonu and ate famous fish and bread with a gorgeous Bosphorus view, and then ate world-famous Turkish baklava.
So, life is awesome here in Istanbul for us!! Stay tuned for our next adventures!!!
Here is a photo of us from a clinic in Cerro Brujo. I wanted to take a moment to thank all the friends and family who have supported us on our journey. This is a short list, there are many, many more. Thank you so much!
Shout out to:
Carol A. Simonson
Drew S Grimes
Nancy E Vaughan
Verna M Vaughan
William J. Baker
David M. Daly
Lynne W. Saunders
Dan M. Cooper
Whitney A Miner
Richard B Ossias
Karen E. Miner
Vincent R Miner
Kevin D Martin
Verna M Vaughan
michael l abney
Nancy E Vaughan
Eliza C Williams
Erlinda A Moore
Elisabeth A Percival
Jennifer A. Punt
Landy E Barber
Barbara L. Earnest
Karen Carlson Des Prez
Laurie W Basile
Laura A Heely
Donna S. Tsuma
Michael C Yang
James R Percival
Asma Haji Datoo
Time has been moving very quickly for us here in Porto Alegre. With only one more week left, we are not looking forward to saying goodbye to the city and its people who have made us feel so welcome during our stay here. There is still a lot of work to be done though as we wrap up our course and administer exams to all the residents who participated in our study. It seems the world cup ended at just the right time!
Last week was a very exciting one for us, since we had the opportunity to shadow the residents as they made their rounds after we finished our instruction each day. With the permission of the patients and supervision of Dra. Ana Tonelli, we were allowed to scan a number of patients and diagnose a range of pathologies from pleural effusion to papilledema. It was an amazing experience to be able to apply our ultrasound skills outside the classroom and see firsthand how powerful of a diagnostic tool it can be. During our rounds, we were also able to see the placement of an ultrasound-guided central line in the femoral vein – a technique that we had taught the residents just a few days earlier!
Next weekend, after the completion of our course, we leave Porto Alegre and head to Iguazu Falls to explore one of the most beautiful sites in all of South America. Until then, there is still much work to be done and many more churrascos to be enjoyed.
As always, check out http://ecoamos.tumblr.com/ for pictures and updates of our progress.
Oh, and parabéns, Alemanha.
Today was very productive. We began our research project with Dr. Brasilins at the Armidale Rural Health Clinic. We started gathering data on patients in order to assess if Ultrasound could be a beneficial tool to expedite diagnoses. Armidale is much like a college town, there is a younger population and a quaint small-town feel. The hospital in Armidale has 99 beds and serves patients within approximately a 350km radius. Many of these patients are rural farmers or retirees and quite often the doctors of UNE have to travel via small plane or conduct consults via teleconference in order to assess their patients’ health status. The incidence of skin cancer within the population seen at UNE is one of the highest in the world. Often, the treatment of these skin cancers requires concurrent treatment of “a microbiological theme park” that infects the lesion created by the cancer, as stated by one of the Armidale ID physicians. We are greatly looking forward to learning more from the wonderful physicians at UNE!
Neema, Eric, & Danny