Tuesday, April 1, 2014

Leaving/Thanking Old Friends and New

On Wednesday morning we awoke to clear skies and warm temperatures.  We ate a quick meal, settled up with the hotel and met our friends from ICC to take us to the airport.  Some members of our trip stayed in Haiti to assist in other endeavors. 

The trip seemed so quick yet a lot was accomplished in a short time.  A capacity of 100 Haitian physicians participated in an outstanding two-days of lectures and hands-on training The faculty presented 8 didactic lectures on pediatric imaging, concluding with multiple pediatric radiology case discussions and the hands-on application of pediatric ultrasound on the kidney, gastrointestinal, liver, gallbladder, cranial/spine, appendix and pylorus. 

On the second day, the faculty presented a total of 9 didactic lectures on musculoskeletal ultrasound followed by a competitive round of ultrasound clinical case review and five ultrasound stations focusing on musculoskeletal ultrasound including specific focus on shoulders, wrists, hands, ankles and feet. 

The two-day sessions also included a separate track for radiographers.  Once again a capacity of 40 radiographers attended didactic and interactive sessions focused on basic patient care and safety, radiation protection principles, occupational safety, radiographic pathology (including respiratory and skeletal), film processing, exposure factors and manipulation, pediatric radiographic considerations and developing exposure charts.  The session concluded with an excellent questions and answers exchange. 

We also used the opportunity to travel to Grace Children's Hospital to see new construction at that facility. We met with Dr. Josette Bijou and Billy Brandt, Chair, ICC Haiti to discuss developments for the ICC/Grace Children's Hospital which will be built in two phases.  We also had the opportunity to look at the donated Siemens hybrid portable x-ray machine that we donated to investigate its digital use in the near term. 

We met with Dr. Maurice Fils Mainville, Executive Director of the University General Hospital, and Dr. Carine Cleophat, Director of the University General Hospital's  Radiology Department.  We were elated by the news of the second class of radiology residents (a total of 10) now in training.  Should all 10 matriculate through the program, it would increase the total number of radiologists in the country from 19 to 29 (an over 50% increase).  We signed a Memorandum of Understanding to assist the hospital with its training program and prepare them for the new radiology modalities planned for the new hospital to be built by the end of 2016. 

We also met with leaders from the medical school to discuss a four-year radiographer program and with contacts from other institutions about possible collaborations moving forward.

The most difficult part of the trip is saying goodbye (or until we meet again) to our friends from Haiti and our impressive team (in action below).   

Kimberly E. Applegate, M.D., FACR, ACR Speaker (seated) discussing ultrasound on an infant. 
Former ACR Chair, ACR Board of Chancellors and Chair, ACR Foundation International Outreach Committee discussing ultrasound findings with Haitian doctor. 
Tammy Stearns, MS, RDMS, RVT, RT(R) works with group to illustrate the use of the transducer and ultrasound machine in Haiti. 

Jennifer Nicholas, M.D. (seated) discussing ultrasound on an infant. 

Dorothy Bulas, M.D., FACR provides a didactic lecture on Monday, March 24. 

Robert Harris, M.D., MPH, FACR provides ultrasound advice as Haitian physicians (and the patient) observe the machine.  Dr. Marie Excellent (far right) translates in Haitian Creole for attendees.  Dr. Excellent has provided outstanding assistance as a translator during all three courses of Radiology Education Days in Haiti. 

Amy Hoffman, MBA, RT(R), (CT), RDMS, CRA provides a lecture to an engaged radiographer class as part of Haiti Radiology Education Days. 

Sung Kim, M.D. delivers a presentation on musculoskeletal imaging

Veronica Hernandez, RDMS, RMSK works with group on MSK ultrasound. 
Ron Adler, M.D., Ph.D., works with attendees to review and assist with the use of MSK ultrasound. 
Paul H. Ellenbogen, M.D., FACR, Chair, ACR Board of Chancellors opens meeting by reviewing the ACR's efforts in Haiti. 
Terry Konn, Ph.D., LRT leads discussion in the radiographer courses during Radiology Education Days in Haiti. 

Ernst Garcon, M.D., from Columbia University and a native Haitian let's the faculty and attendees know how much their work is making a difference in Haiti.  Dr. Garcon has served as the major translator of all materials including slides as well as the primary translator during didactic sessions and clinical case review at each conference. 
Douglas "Rusty" Brown, M.D. (right) listens to the progress made at Grace Children's Hospital.  Dr. Brown is the current Chair, ACR Foundation International Outreach Committee and was program chair for the first two Radiology Education Days in Port-au-Prince. 
Chuck Phelps, M.D. and Jeannine Hatt, M.D. (far left and far right respectively) introduced the ACR to ICC and Grace Children's Hospital immediately after the earthquake.  The two have been volunteering at Grace Children's Hospital for over 15 years. 
Lauren Alfero has been an integral member of the team planning both the team's activities and coordinating on-site logistics for the program.  Lauren also assisted with the presentations during the conference. 

Preferring to stay out of the pictures, I am accompanied in this shot by Dr. Carine Cleophat, Chair, Department of Radiology at the University General Hospital.  I have had the great fortune to be associated with the ACR's ongoing program over the past four years. 

Our team from left to right (front row):  Terry Konn, Ph.D., LRT, Paul H. Ellenbogen, M.D., Lauren Alfero, Rusty Brown, M.D., Veronica Hernandez, (back row) Brad Short, Kimberly Applegate, M.D., Dorothy Bulas, M.D., Robert Harris, M.D., Jim Borgstede, M.D., Ernst Garcon, M.D., Ron Adler, M.D., and Amy Hoffman, MBA, RT(R), (CT), RDMS, CRA.  Not pictured are Sung Kim, M.D., Jennifer Nicholas, M.D., Chuck Phelps, M.D., Jeannine Hatt, M.D. and Tammy Stearns, MS, RDMS, RVT, RT(R).

Time for Thanks!!!

To our Organizational Friends:  We thank our friends from Sonosite and GE for assisting us with loaner devices for the ultrasound sessions.  Their assistance was critical to apply the knowledge gained during the lectures. 

We especially thank the following organizations for their co-sponsorship of the program, commitment to Haiti and to the improvement of radiological care:

American College of Radiology
Society of Radiologists in Ultrasound
American Society of Radiologic Technologists
Society of Diagnostic Medical Sonography
Society for Pediatric Radiology
World Federation of Pediatric Imaging

We thank our friends from ICC/Grace: To Emma Arana and Rosa Voltaire Damas, you were both gems helping coordinate the program, assisting with on-ground logistics and registration both before and during the conference.  Thank you both so much.  Keith Mumma and Michael Palmer--thanks for all you do to make ICC and Grace Children's Hospital a working reality.  We could not enjoy the relationship we have had without your support.  To Drs. Chuck Phelps and Jeannine Hatt--thanks cannot adequately express our sense of gratitude and indebtedness.  Thanks for letting us see the need and be a part of this outstanding effort.  We look forward to continuing our relationship.  To Billy Brandt and Dr. Bijou--thanks for your leadership and stewardship of the hospital. To Robenson Lucceus--you are the man!  Thanks for getting everything done on the ground while you juggled two conferences. To Dr. Gina Joachim--thanks for your ongoing commitment to radiology and your presentation during the conference.  To Mary Gomez and our new friends at Lurie Children's Hospital and the Chicago Consortium--thanks for making "lemonade" and making the total conference more than the sum of its parts.  To Mrs. Sharon Nicholas--thanks for your contributions before and after the conference and for raising such an amazing pediatric radiologist.  Finally to the Boards of ICC in both Haiti and the U.S.--thanks for your continued support and all you have done to envision better patient care to the children of Haiti. 
We thank our friends from the University General Hospital --To the radiology residents and Chief Resident Dr. Fabienne Joseph--thanks for your passion, commitment and collaboration in representing the future of radiology in Haiti.  To Dr. Carine Cleophat and Dr. Georges Michel--we thank you for your commitment to radiology and look forward to working with you and the residents to continue to get ready for the changes ahead at HUEH.  To Dr. Collimon--thanks for your support of our last two programs and your commitment as a pediatrician to your patients.  To Dr. Maurice Fils Mainville, we look forward to fulfilling our part of the Memorandum of Understanding. 

We thank the attendees of the program--To all of you who took the time to learn more about pediatric and musculoskeletal radiology, who came from us far as 5 hours away, we thank you for your passion and commitment to improving patient care in Haiti. 

Finally, we thank our team--Drs. Adler, Applegate, Borgstede, Brown, Bulas, Ellenbogen, Garcon, Harris, Hatt, Kim, Konn, Nicholas and Phelps and Ms. Hofmann, Hernandez, Konn and Stearns--thanks for taking the time and sharing your knowledge with the physicians and radiographers of Haiti.  Your efforts were greatly appreciated by all the attendees and your ongoing commitment and contributions to improving radiology in Haiti will serve the population for years to come.  We also honor your institutions for supporting your work while you were gone. 

Leaving Haiti for now 

Haiti is truly making progress but there are still many challenges ahead.  New building is occurring at Grace Children's Hospital and the University Hospital with more significant construction to come.  The radiology residency program, which was non-existent just two years ago, now has 10 active radiologists.  Roads are better paved and the clutter from the earthquake is largely gone.  Fewer tent cities are apparent as we drive the streets of Port-au-Prince.  We are cautiously optimistic that progress will continue and that radiology will become an integral part of the diagnostic capability of the Haitian health system but much more work will be needed to make it happen and keep it sustainable for the distant future.  We look forward to our ongoing contributions to a better day for Haiti and its people. 
While still present, fewer tent cities line the streets of Port-au-Prince since the earthquake devastated the area in January 2010. 
Representing the future of Haiti, school children are busily making their way to class as the clutter of street debris and rubble from the earthquake are no longer as prevalent. 
Representing the future of radiology, an impressive 10 radiology residents are now enrolled in a training program at the University General Hospital. 

Despite a recent drought, Haiti is still a tropical Caribbean island with beautiful flowers and trees.  A land of contrasts, the perseverance and resilience of its beautiful people are what set Haiti apart and provide optimism for a brighter future. 


Tuesday, March 25, 2014

All in a Day

As snow fell on the east coast of the U.S., the sun shone brightly on Port-au-Prince.  A day full of didactic sessions for physicians and radiographer, hands-on ultrasound and a competitive battle of "name that diagnosis" ensued as part of the clinical case review.  In addition, the ACR and University Hospital signed a MOU to assist in the training of the 10 radiology residents currently enrolled there. 

The day started with several outstanding presentations given by Bob Harris, M.D., (Co-Program Chair), Sung Kim, M.D. and Ron Adler, M.D. on musculoskeletal imaging.  Dr. Adler provided the basics and physics of MSK ultrasound along with lectures of the upper and lower extremities and a well-received talk on MSK ultrasound procedures.  Dr. Kim provided a talk on axial skeletal trauma, appendicular skeletal trauma and CT of the axial/appendicular skeletal trauma.  Dr. Harris provided a presentation entitled "Ultrasound of Superficial Lumps and Bumps".  The session concluded with Dr. Gina Joachim, a Haitian radiologist who presented on musculoskeletal ultrasound in Haiti. 

The afternoon ultrasound sessions included our two diagnostic medical sonographers, Tammy Stearns and Veronica Hernandez as well as Drs. Ron Adler, Rusty Brown, Bob Harris and Dorothy Bulas.  The Clinical Case Review led by Dr. Jim Borgstede and ably translated by Dr. Ernst Garcon became a battle royale of name that ailment on the ultrasound pitting on side of the room against the other.  The competitive juices were flowing as each side shouted out the condition or diagnosis on the screen.  The engaging session left many in the room laughing with no clear winner determined (although that is under review). 

While the morning sessions were going on, a leadership team comprised of Dr. Ellenbogen, Applegate, Brown and Borgstede travelled to the University General Hospital to meet with the Chief Medical Officer and the Executive Director.  Discussions ensued about plans for the new hospital and the training of the ten radiology residents.  Significant progress had been made to buildings damaged by the earthquake on the hospital's campus.  The new hospital is scheduled to open in December 2016 with the radiology department gaining new radiological equipment.  We took a tour of the radiology department and met with personnel on the ground.  We also toured the pediatric and emergency facilities as well as the nursing school that devastated during the earthquake. 

In the evening we toasted the end of a productive two-day conference with pizza and Prestige (a Haitian beer).  We met with colleagues from Chicago who were there to put on a program in pediatrics as well as representatives from Grace Children's Hospital, ICC, the University General Hospital and Hospital Bernard Mevs.  Enjoy the pictures below that highlighted a very busy day!

Approximately 100 physicians participated in the second of two Radiology Education Days in Haiti.  Here the audience is captivated by a presentation by Ron Adler, M.D. on Ultrasound of the Upper Extremity. 

Ron Adler, M.D. provides lectures, translated and interpreted in French by Ernst Garcon, M.D., to the audience on musculoskeletal ultrasound. 

Robert Harris, M.D. and Sung Kim, M.D. have an opportunity to discuss the morning's sessions prior to beginning afternoon didactic lectures and hands-on ultrasound.
The ACR leadership delegation toured the grounds at the University General Hospital including the pediatric unit where this small baby rested quietly. 

Patients wait outside the radiology department at the University General Hospital in Port-au-Prince

Child at the University General Hospital in Haiti. 

ACR Speaker Kimberly Applegate watches the University General Hospital's Executive Director, Dr. Maurice Fils Mainville, sign a Memorandum of Understanding for the organizations to work together to supplement the radiology resident's training.  The radiology resident program has increased from 0 to 10 in the past two years. 

Veronica Hernandez performs MSK ultrasound on a patient as physicians participating in the program watch.  Each physician had the opportunity to try their hand at the transducer to enhance their ultrasound imaging skills. 
Tammy Stearns helps guide a physician on a pediatric abdominal ultrasound procedure.  The ultrasound devices were generously loaned by Sonosite and GE.
Local radiologists and physicians take turns providing ultrasound to an infant during Radiology Education Days in Haiti. 
 Terry Konn, Ph.D. provides interactive session to a room full of radiographers at Radiology Education Days in Haiti
 Amy Hoffman lectures to radiographers at Radiology Education Days. 
 Jim Borgstede, M.D. and Ernst Garcon, M.D. engaged the room in a competition of "name that ailment on the ultrasound".  The highly enjoyed event was very engaging, illuminating and showed the physician community in Haiti to be both knowledgeable and quite competitive indeed. 
The faculty was fully engaged.  Here, Dr. Adler works with a physician as they ultrasound the foot and ankle of Dr. Kim, standing in as a patient during the musculoskeletal ultrasound session. 
Dr. Adler and local physicians collaborate over a finding during the ultrasound session. 
Patients enjoying some free coloring books and crayons as a reward for their patience and great behavior. 
After a long, but successful day, and after enjoying some pizza and Prestige, Dr. Paul Ellenbogen, Chair, ACR Board of Chancellors, thanked the volunteers, organizations, patients, staff and representatives that made the event possible.  He ended his remarks with a great joke. 

Monday, March 24, 2014

Successful Day in Port-au-Prince

Approximately 140 physicians and radiologic technicians (radiographers) attended didactic lectures, hands-on ultrasound sessions and clinical case review as part of Radiology Education Days. 

After Paul Ellenbogen, M.D., Chair, ACR Board of Chancellors and Josette Bijou, M.D., Medical Director of Grace Children's Hospital welcomed the attendees the sessions began in earnest.  The physician participants received outstanding presentations on pediatric imaging from Dorothy Bulas, M.D. (Program Co-Chair--WFPI), Kimberly Applegate, M.D. (ACR Speaker) and Jennifer Nicholas, M.D., (WFPI).  The faculty presented on pediatric chest, pediatric skeleton, radiographic imaging of the vomiting infant, child presenting with abdominal pain, pediatric cranial ultrasound, pediatric renal ultrasound, pediatric gynecological emergencies--radiographic evaluation, and the importance of ALARA.  These same participants were then provided an opportunity to test their knowledge with hands-on ultrasound studies on pediatric patients in the afternoon.  Ultrasound instructors included representatives from the SDMS (Tammy Stearns and Veronica Rodriguez) as well as Drs. Douglas "Rusty" Brown, Paul Ellenbogen, Robert Harris, James Borgstede, Dorothy Bulas, Kimberly Applegate and Jennifer Nicholas.  Drs. Bulas and Applegate moderated the Clinical Case Review and Ernst Garcon, M.D., a native of Haiti and professor at Columbia University provided interpretive services. 

Amy Hoffman and Terry Konn, Ph.D. provided an outstanding radiographer all-day didactic session on basic patient care and safety, radiation protection principles, occupational safety and radiographic pathology. 

The engaged participants stayed to the end of the course and looked forward to learning more tomorrow as the program switches from primary pediatric imaging to musculoskeletal imaging.  The entire team looks forward to further engagement tomorrow.  

Dr. Kimberly Applegate presents in front of a capacity crowd of 100 physicians as part of Radiology Education Days. 

Amy Hoffman presents on the topic of Occupational Safety to radiographers during Radiology Education Days. 

Radiology residents outside of Radiology Education Days.  The University Hospital radiology residency program started last year with a group of four residents.  There are now 10 radiology residents in training at the hospital. 
Applying knowledge gained during the didactic lectures, Tammy Stearns (SDMS) trains physicians on ultrasound techniques of a small child during Radiology Education Days in Haiti. 


Sunday, March 23, 2014

Arriving in Port-au-Prince

We arrived today in Port-au-Prince.  Our delegation had the opportunity to take a brief tour of Grace Children's Hospital.  Some exciting news is occurring at Grace.  New construction has begun providing expanding administrative and training capacity.  This is great news and I'm sure will be part of our discussion with ICC/Grace's leadership tomorrow.  We also drove through the city to see some of its highlights (and challenges).  A country of contrasts, much has begun to improve since the post-earthquake days and much remains to be done. 

It was great seeing old friends today.  The staff at ICC/Grace could not be more impressive serving as an outstanding host for our conference.  We start early tomorrow with roughly 140 health personnel expected.  After months of preparation, we can't wait to get started. 

Luggage including donated supplies and ultrasound equipment is brought on board a transport bus from the airport in Port-au-Prince. 

New construction begins at Grace Children's Hospital increasing their administrative and training facilities. 

Program faculty tours waiting areas leading to exam rooms at Grace Children's Hospital in Port-au-Prince. 

Saturday, March 22, 2014

Getting to Know You

One of the things I have truly enjoyed on our previous trips has been the instant camaraderie that develops among our faculty.  This evening was no different.  Arriving from as far away as North Dakota, we came from different places but sharing a common desire to assist medical personnel in Haiti. 

Tonight was for breaking bread, telling good stories and sharing experiences.  Tomorrow morning we head out for Port-au-Prince as we get ready to assist over 140 Haitian medical personnel with pediatric and musculoskeletal imaging, radiographer training, hands-on ultrasound and clinical case review.  We look forward to our journey. 

Wednesday, March 19, 2014

Getting Close

We received four ultrasound loaner units from our friends at Sonosite today.  Also, our great PR Team has begun getting information out about our trip.  You can access the press release at http://www.acr.org/About-Us/Media-Center/Press-Releases/2014-Press-Releases/20140319-Radiology-Experts-Return-to-Haiti-to-Educate-Local-Radiologists-and-Technologists.  Our registration continues to grow for the trip with over 100 attendees already signed up for the event.  We are excited to be staying close to the University Hospital and look forward to our trip to HUEH and Grace Children's Hospital.  Mostly, we look forward to working with the dedicated health care workers of Haiti who selflessly dedicate themselves to serving their fellow citizens.  Finally, after 8 inches of snow on Monday, I am personally looking forward to the warm weather.  The anticipation is definitely growing. 

Friday, March 14, 2014

Back to Haiti

The American College of Radiology Foundation is sponsoring a trip to Port-au-Prince, Haiti to assist physicians and radiographers with educational content and hands-on learning in diagnostic imaging.  The two-day program (March 24 and 25) chaired by Dorothy Bulas, M.D., FACR and Robert Harris, M.D., FACR will feature didactic sessions on pediatric imaging and musculoskeletal imaging.  Morning didactic lectures will be followed by afternoon ultrasound sessions.  The program will also feature interesting case review.  In addition to the physician training, the American Society of Radiologic Technologists will be featuring sessions both days for radiographers. 
The trip is a collaborative effort that includes participation from the following organizations:  the World Federation of Pediatric Imaging; the Society of Diagnostic Medical Sonography, the Society for Pediatric Radiology, the Society of Radiologists in Ultrasound, and the American Society of Radiologic Technologists.  Grace Children’s Hospital (of Port-au-Prince) and International Child Care are also sponsoring the event.  Sonosite and GE have provided loaner ultrasound machines in support of the program. 

In addition to the program, ACR leaders including Paul H. Ellenbogen, M.D., FACR, Chair, ACR Board of Chancellors and Kimberly E. Applegate, M.D., FACR, ACR Council Speaker will join former and current ACR Foundation International Outreach Committee chairs James P. Borgstede, M.D., FACR and Douglas “Rusty” Brown, M.D. respectively to meet with officials from multiple hospitals.   The ACR Foundation has been working with Grace Children’s Hospital and the University Hospital since its fact finding mission in early 2011.  The 700 bed University Hospital has recently started a radiology residency program and is planning to rebuild the facility featuring new radiology modalities.  The ACR Foundation, along with several other charitable organizations, are working with the radiology residents to assist with training on these newer modalities. 

This is the third broad-based educational program that the ACRF has sponsored in Haiti since the earthquake in 2010.  The previous programs, which have reached capacity in attendance, have been very well received.  This year’s meeting, to be held at the Plaza Hotel close to the University Hospital, is expected to reach capacity as well and will build on the learning to date. 
We are all very excited about the trip and to see our friends again in Port-au-Prince.