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2017-03-07  Myanmar Travel - 2017  © Philippe Jeanty  wwwTheFetus.net

Myanmar Outreach course- 2017



First day!

So this is the first outreach course we do in Yangon, Myanmar. The first day was rest and recovery from long trips! Federico Badano was the longest distance flyer: 29 hours from Argentina, followed by Franti Grochal: 26 hours from Slovakia. Ya Chiao Hu from Taiwan, and Gwang Jun Kim from Korea had an easier time but still long trip.
We did some light visiting taking a local train to sight see.


From left to right: Franti, Philippe, Ya and Fede in the Central Women´s Hospital, in Yangon City, Myanmar.

Interestingly, we crossed the tracks a few time to get from platform to platform. Very surprising to me. The train was full of colorful people. They use some ground up stone for makeup and sunscreen. In the train there was a panel with 3 interdictions: can't smoke or litter, but more surprisingly, you cannot kiss on the train! The train was really packed and vendors circulate with all manners of food drinks and trinkets. They sell betel leaves that people keep in their check, a little like the coca leaves in the Andes, and similar bad effects on teeth! We chatted with some people who were very friendly and quite interested in us. Actually mostly interested in Ya Chiao and we learned later that Korean movies are very popular here and they thought she was a Korean actress!!

Franti, Philippe and Justin from Concordia crossing the tracks. Don´t do it at home!


A little boy with his father. He has the tipical Thanaka in his face, it is a yellowish-white cosmetic paste made from ground bark. It is a distinctive feature of the culture of Myanmar.


The whole team in the ¨circular train¨ in Yangon.

We visited a pagoda with an immense Buddha made of a single block of marble imported (if I am correct) so the way from Nepal! 
Food is very varied and influenced by Chinese and Indian food.
Today was the first day of the course and we meet Dr Yin Yin Soe who organized the course.
We have 30 students and they come from all over Myanmar! Very nice distribution. Incredibly many come from hospital with only 1 obstetrician so it was apparently difficult to get government permission for them to attend the course and a surgeon had to cover their absence. Many traveled by train the night before. Compared to previous outreach courses, they are much less intimidate which makes the contact easier.
We had class room the morning and workshop the afternoon.
It is very very hot! 37C, 99F, but the students are really eager to learn!


From left to right: Dr. Kim from South Korea, Philippe, Ya, Frantisek and Federico.



The whole course! 45 physicians all over the country (only 35 in this picture) 


The team visiting the Shwedagon Pagoda




The team visiting the Shwedagon Pagoda




Second day!

Since I am so hard of hearing I got in the habit of asking people to write their questions on paper and drop them on the desk! This is also a great technique for shy students and women who otherwise would not ask questions. Well, we were inundated, and the questions reflected a very good knowledge. This is an interesting situation with knowledgeable students who just have very little hand on practice. So I worry that our lectures were too basic.

Ya Chiao made her very first ever presentation, and even behind her impassible Asian face, she was clearly nervous! Sonographers don't often teach physicians in Asia. She did a very good job!

Gwang Jun had the second presentation and talked about CNS anatomy and the  views and as expected he had great presentation and his unique style of teaching, for instance a way to remember the ventricular system by folding the fingers, was a refreshing approach to the usual topic!

Federico then did his presentation with the ease of someone who has spend years doing that. He had greatly improved the stock ISUOG lectures.

Franti too could not live with just the isuog presentation and did some radical improvements with much better images. I think we need to put him in charge of ISUOG lectures!

Ya has already finished her first lecture in english. She did it very well!!





In the classroom. From left to right: Frantisek, Philippe, Federico, Ya and Kim. 


The afternoon we had tons of patients with anomalies, including large cephalocele, missed AB, triplets, ... Some patients needed TV examination which we rarely do in courses like this and Concordia rapidly got us a TV transducer and we did several scans. It helps that women here are accepting nicely and that almost all the students are women.

They know what they need to look for but need help in coordinating  what they see on screen which the movement of the transducer. So I hold their hand and show the movement. And invariably they look at my hand moving theirs instead of looking at the screen! So finally I took a patient chart as a “blind” to force them to just look at the screen!

The machines we have are uneven resolution. The 3 top end machines as fantastic but the low end one makes you realize what it is to scan in a country that has a hard time affording to machines: we are very spoiled! Average daily salary in Myanmar is just $3! It app specialist, Summer, is REALLY good and can explain all the menus in no time!! Great support!


Philippe in the hands on workshop




Frantisek in the hands on workshop




Ya in the hands on workshop




Federico in the hands on workshop





Safety first, of course (but.....shhhh, don´t say anything about the guys behind, they are climbing : ))


Third day

Today we started with another long question and answer session which is fun here because everyone speaks English, so no issue of translating question then waiting for translation of answers!

Federico gave the tests and questions and then Franti again dazzled everyone with his pictures. Lunch is in a nearby restaurant with good seafood. Very convenient Hotel, Hospital and food all within a block !

In the afternoon we had a fair amount of pathology, many twins, 2 previa, ovarian cyst, large hydronephrosis,… Ya had an accreta on a patient with 3 previous C-section (the topic i gave in the morning), and it was good to show doctors that a sonographer could make those diagnoses. We had a great number of patients and the room was hot ! They don’t seemed bothered and they even turn the fan off !


Philippe in the hands on workshop



Kim in the hands on workshop



Franti in the hands on workshop




Federico in the hands on workshop




Yu in the hands on workshop




Day 4 and 5

The last 2 days we finished the lectures. Dr Yu Shi from Peking university in Shenzhen joined us and gave a presentation on twins, Franti talked about ultrasound in the peripartum and gynecological issue in pregnancy and Fede about the web site. We also add some presentation on the 4 chamber view.

 

The workshop were very well attended with many patient, I was surprised to get a very small patient because I usually do not do pediatrics!

But actually she was 18 year-old complaining of primary amenorrhea! So good opportunity to review what an infantile uterus looks like, as well as hydrometrocolpos and Mullerian agenesis. 


There were simpler cases of dermoid, mucinous adenoma, renal obstruction. A great many twins. Apparently twining is very common in Myanmar. There was also a beautiful case of acrania at 26 weeks, a clear example that anencephaly is not the “end stage dissolution of the brain from acrania” as often reported, but an different entity.


Some student start to manipulate the transducer properly, but they feel a little overwhelmed with the amount of things to do.. find the image, freeze the image, lift the transducer, navigate the menus, measure the finding, review the report… explain to the patient the findings…

It will be interesting to see the progress by next year.


Dt Yin Yin Soe, the Director of the OB Gyn Dept is a perfect coordinator, reinforcing the information taught,


At the conclusion of the course we gave them a lot of homework to do: read the book of Alfred and Rabih, study the lectures on their cd, on the web answer case of the week.


We also prepared a spreadsheet on line where each one has her or his own tab to fill how many cases they have seen in the past month. The front spreadsheet will tabulate all the data.


Finally each has been assigned to make a 5 min presentation next year of either an interesting case, a difficult case they struggled with or a case in which they made a mistake, so we can all learn from it.


This was a very nice group of students and I am very thankful to the faculty, to Concordia (the local ultrasound machine distributor) and Mindray for they great support and sponsoring of the event.

Cheers from Chinatown in Myanmar! From left to right: Summer, Ya, Franti, Kim, Justin, Fede and Philippe



One of our student with hers long long hair, almost touching the floor!







Philippe and Federico eating scorpion in Chinatown.



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