Monday, June 13, 2016

Saying Goodbye Never Gets Easier

Saying Goodbye Never Gets Easier
Through the planning stages to execution to departure, the process of leaving new and old friends behind never gets easier.  I want to especially thank these outstanding individuals who made this trip memorable and productive.
The Faculty:
Rusty Brown, M.D.—The chair of past Radiology Education Days programs in Port-au-Prince, Rusty continues to provide the leadership, planning and execution necessary for success. His calm demeanor and professionalism throughout the experience makes it easy on both the faculty and staff to execute the program. 
Jennifer Nicholas, M.D.—Jennifer visited for the first time in 2013 and has become a mainstay working at both the University Hospital and St. Damien’s Hospital (where she and Lacy stayed and provided additional training). Jennifer has opened her home to Haiti radiology residents attending RSNA and has provided the enthusiasm, resources and outstanding teaching skills necessary to help improve the resident’s skills and development.
Ernst Garcon, M.D.—not only a talented teacher of cross-sectional imaging (primarily using CT), through his personal attachment with Haiti, Ernst has provided the necessary interpretation, cultural understanding and connections to assist in furtherance of both radiology and medicine in his homeland.  Ernst has proven to be an essential member of our team on this his 5th visit for the ACR and many others as an activist on behalf of improving care.
Julie Franz, M.D.—new to international outreach, Julie proved to be an inspiration to several residents who are seeking to build a women’s imaging program in the future. Her guidance and outstanding lectures were very well-received. Given the lack of
Lacy Gandor, RDMS--despite this being just her first visit to Haiti, Lacy proved a natural as she worked directly with the residents with hands-on ultrasound training. Working off the lectures of Drs. Franz, Nicholas and Brown, Lacy was able to provide outstanding hands-on examples as well as instruction for the proper use of ultrasound. We enjoyed her infectious enthusiasm throughout the trip.
Lauren Alfero—having planned multiple trips in the past and attended a former RED Days, Lauren continued to provide the support and expertise necessary for the effective delivery of the program to the residents. Lauren's ongoing commitment to international outreach have been integral to our ongoing programs.

Catherine Jones—handling much of the logistics for this meeting was Catherine Jones. Catherine’s attention to detail and logistical expertise kept us on task ensuring a very smooth meeting for faculty and residents.
Friends from Fujifilm/Sonosite
Special thanks go to Sarina Stow, Matt Combs and the team at Fujifilm/Sonosite Global Health Program for once again providing two loaner ultrasound machines that were well utilized by the radiology residents. These devices allow us to deliver critical hands-on training.  Sonosite has been with us from the beginning and we appreciate their years of dedicated assistance to our programs.     
Hospital Bernard Mevs and the Bitar Brothers
Special thanks to Hospital Bernard Mevs and the Bitar brothers. With one of only a handful of CT machines in the country, Hospital Bernard Mevs has become a critical site for the resident's training in cross-sectional imaging. Drs. Jerry and Marlon Bitar, two surgeons who also help run Hospital Bernard Mevs, provided us a lecture room and space to work on our hands-on ultrasound.  
Drs. Mainville, Telemaque and Michel
I want to specifically thank Drs. Mainville, Telemaque and Michel for their ongoing commitment to the radiology residents at the University Hospital. We look forward to continuing our work with you in the future.
Dr. Bijou
I want to thank our friends at Grace Children's Hospital and ICC for their warmth and ongoing relationship. Particular thanks go to Dr. Bijou, Chuck Phelps, M.D. and Jeannine Hatt, M.D.
Ongoing Efforts of Volunteers and Organizations

While the ACR Foundation has worked to help radiology in Port-au-Prince, Haiti since 2011, it takes a village to help sustain and grow these programs. We are grateful for the ongoing working relationship we have with Imaging4Change (Drs. Crenshaw, Zivin and Parikh) and RAD-AID International (Drs. Sydnor and Stein-Wexler). We have also established many connections through radiology volunteers that have been going to Haiti long before the earthquake of January 2010. Finally, while much of Haiti's population is centered around and near Port-au-Prince, efforts by organizations such as Partners in Health and individuals (such as Drs. Mendel and Harris) have assisted in improving radiology elsewhere in the country. There are too many to be listed here but to you all we say THANK YOU!

Existing Radiologists and Radiology Residents at HUEH

Finally, we pay homage to the radiologists and the radiology residents of Haiti who work so tirelessly to improve radiological care in Haiti. You inspire us all. You represent the future of radiological care in Haiti and we hope to assist you in fulfilling your goals in Haiti. 

Radiology residents from the University Hospital (seen here interspersed with our volunteer faculty) represent the future of radiology in Haiti. Your knowledge, dedication and professionalism are greatly appreciated and serve as an inspiration to us all.  

Thursday, June 9, 2016

More Intensive Educational Sessions, Hands-On Ultrasound and Meetings with Officials Mark Day Three

The third day of our visit provided intensive morning didactic/interactive sessions on ultrasound of the liver and gall bladder given by Rusty Brown, M.D. and pediatric orthopedic ultrasound provided by Jennifer Nicholas, M.D. The afternoon sessions were highlighted by orthopedic ultrasound hands-on ultrasound sessions led by Lacy Gandor, RDMS.

Rusty Brown, M.D. provides a lend lecture on ultrasound of the liver during the third day of trip.

Amused residents enjoy listening to lecture from Jennifer Nicholas, M.D. Dr. Nicholas provided an extensive lecture on the use of orthopedic ultrasound in children.

During the afternoon, Drs. Brown, Ernst Garcon, M.D. and Brad Short visited with officials from Grace Children’s Hospital and took a tour of their new educational facility as well as their radiology department. Former Health Minister and current Medical Director, Dr. Josette Bijou provided an update on the radiological needs of GCH and the future prospects for expansion. Additionally, Dr. Bijou discussed the ongoing efforts of GCH to provide public health outreach in Haiti.  The hospital was significantly damaged during the January 2010 earthquake.

During the late afternoon, the team met with Dr. Georges Michel, Interim Chair of Radiology at the University Hospital. Dr. Michel noted that the residents were greatly appreciative of the added instruction provided by the ACR Foundation and dedicated teams from Imaging4Change and RAD-International. He noted the short, medium and longer-term goals of the department as they pertain to the existing and future new facility. He was further appreciative of the individual efforts of US radiologists to bring the senior residents to the US as part of observership programs and attendance at various US radiological meetings including the ACR, RSNA and SPR meetings. Finally, he expressed his thanks for the learning materials provided to enhance their study and development. 
The team also met with Drs. Mainville and Telemaque of the University Hopsital. The two leaders provided some context for the future facility and overall planning goals for medicine and radiology in the country. They both expressed their sincere appreciation for the long-term support of the ACRF and discussed the ramp-up of new technologies and the specific needs that it will impose for radiologist and technologist training as well as referring physicians as they begin utilizing newer modalities and move to the use of electronic health records and PACS systems. The ACRF, along with other stakeholder groups, was asked to assist in the radiology department design and establish a proper timetable for the introduction of the new technology. Discussions ensued about the plans for a new radiologic technologist program, the need for maintenance training of individuals in Haiti to keep equipment operating, the need for medical physicists to ensure optimal image quality and lower radiation dose and the desire for facilities to work more closely together to ensure improved health outcomes for Haiti’s residents. The ACRF was and is honored to play a small role in this transitional process. 

Tuesday, June 7, 2016

2nd Day in Haiti Focuses on Breast Imaging

The second day of radiology resident training was focused on breast imaging, an area of great need in Haiti.  Residents were treated to a half-day didactic session given by Julie Franz, M.D. of Northwestern University in Chicago. Dr. Franz and Lacy Gandor, RDMS worked individually with the residents on proper technique, diagnostic identification, measurement and biopsy of artifacts provided in chicken breasts. This simulation is critical in helping prepare residents for scanning and diagnostic purposes.

Radiology residents at the University Hospital anxiously await a presentation by Julie Franz, M.D. Dr. Franz began an in-depth introduction to breast imaging for the residents on Day 2. While breast imaging currently is not available in the existing University Hospital (and there are just a couple of units in the country), plans for the new hospital include mammography. Students will need to become familiar with the technology. Dr. Franz noted that breast cancer is the second leading cause of cancer death among Haiti’s women. 

Dr. Franz provides didactic lectures on mammography to a very interested group of radiology residents. Some residents are hoping to establish women’s imaging in Haiti in the future.

Lacy Gandor, RDMS provides proper ultrasound technique for imaging the breast. Chicken breasts were pitted with artifacts (olives) for both identification and biopsy purposes during this hands-on session.

Dr. Franz provides proper use of the transducer for diagnostic purposes on chicken breasts.  The ultrasound devices were generously provided by Sonosite as part of its ongoing loaner program for teaching purposes in low resource countries.

Radiology residents from the University Hospital take their turn scanning chicken breasts simulating the use for ultrasound in breast imaging.

The highlight of the second day was the opportunity to identify and biopsy artifacts inserted into the chicken breasts.  The residents proved adept in their technique while the embedded olives were systematically removed via biopsy. 


Sunday, June 5, 2016

Productive Day One as Faculty Instructs Radiology Residents in Haiti

Sunday marked the first day of instruction as Ernst Garcon, M.D. and Rusty Brown, M.D. led didactic presentations and lively discussions on Emergency CT Imaging and Renal Doppler Ultrasound.

The group landed in Port-au-Prince in the early afternoon and quickly prepared for their sessions. Dr. Garcon and Dr. Brown provided outstanding lectures and were peppered with questions by the knowledge thirsty residents.

Members of the faculty ready to make trip to Port-au-Prince, Haiti. From left to right are Dr. Rusty Brown, Dr. Jennifer Nicholas, Ms. Lacy Gandor, RDMS, and Dr. Julie Franz (shown with husband).

Dr. Garcon turns to engage audience of radiology residents during didactic lecture on emergency CT imaging on Sunday.

Radiology residents actively engage presenters during didactic lecturers. 
Rusty Brown, M.D. provides an insightful discussion on renal Doppler ultrasound. The lectures and discussion led into Sunday evening. 

Saturday, June 4, 2016

Back to Port-au-Prince

We are on our way back to Port-au-Prince. We will be working to assist the radiology residents with more didactic lectures and hands-on training as they prepare to provide a broader array of imaging services in the near future. 

Joining us on this journey will be Drs. Douglas Rusty Brown, Ernst Garcon, Jennifer Nicholas, Julie Franz and Patricia Lacy Gandor, RDMS. We will be introducing breast imaging for the first time on this trip.

Last year several of our faculty returned to Haiti and were able to conduct an outstanding program for the residents despite some on-the-ground challenges. I am truly in awe of our volunteers. They work selflessly throughout the year to assist in building a radiology footprint in Haiti. I am also in awe of the young Haitian radiology residents whose thirst for knowledge and making a difference in their homeland are commendable. Finally I want to thank Sonosite which once again has provided loaner portable ultrasound machines for our trip. 

In just five years, Haiti is in the process of doubling the number of radiologists trained specifically to increase the expertise of imaging in the country. I want to thank our friends at Imaging4Change and Rad-Aid International for their contributions to this effort.

Finally, I want to thank my colleagues Lauren Alfero and Catherine Jones who made this trip possible. Your contributions to making this a reality are invaluable. We couldn't have put this together without you!

It is time to reacquaint with old friends and establish new relationships as we begin the next chapter in our journey. We hope it will be a successful trip.