Last day of Outreach in Ghana, Friday Sep 9, 2010

What an awesome day! (borrowing Sharon's favorite word, but it just fits so well!) The entire class showed up for the last day even though it's a national Ghanaian holiday. That speaks for itself I think.

We started with Post Tests of First and Second Trimester and Gynecology. The tests were in actuality the same as the Pretests and included multiple choice as well as ultrasound images. Ann graded them and presented the fantastic results later in the day: a significant improvement on all 3 tests across the board!The class was delighted as were we. There were a lot of cheers and applause.

But before we got to that I gave a short review of adnexal masses, benign vs malignant and then after a short break of donuts and Fanta the scanning began. Some of the NMWs were so good they could complete the entire OB exam in < 15 minutes. Remember, some of them had never seen an ultrasound before! That is remarkable. Truly!

Today we actually saw a normal uterus without fibroids (myomas). It was a bit comical at first because the Trainees were so used to easily identifying the uterus because of the high prevalence of fibroids. This one tilted to the right and was slightly retroverted so the Trainee struggled to find it; an experienced ultrasonographer would have also. The patient had had surgery several years ago but she wasn't sure what procedure she had had done. Her complaint was primary infertility and absence of menses at the age of 36. It was a mystery that needed solving. Dario helped locate the uterus and ovaries which were small and inactive in appearance. The most likely diagnosis was premature menopause, unfortunately for the patient. Soon thereafter we scanned a patient with acute abdominal pain and a moderate amount of fluid in her pelvis. Having just had the lecture on ovarian masses the Trainee successfully demonstrated the "ring of fire" in the left ovary representing the vascular flow around the corpus luteum formed after ovulation. Talk about great timing! Fortunately this patient had a good prognosis- her pain was related to ovulation and would not require surgical intervention.  We scanned many others and saw twins again. The Trainees have had plenty of practice learning how to assign measurements to the appropriate twin durng an ultrasound scan. I think all in all we scanned 20 patients.

Lunch break was late around 1:30 PM. Dario, Barbara and I enjoyed "fufu with light soup." Fufu is a soft doughy substance of plantain and cassava pounded and mixed together. One eats with one hands here in Ghana so washing of the hands before the meal is a  must. Then one grabs a little bit of the fufu and dips it into the soup which is spicy and contains either vegetables alone or fish, chicken or meat. It is quite filling and delicious. Another Ghanaian food I have enjoyed is "red red" - a spicy mixture of fried plantains and rice.

 At 3 PM Abeena, the coordinator with MCI arrived and the scanning stopped. The room was cleaned and set up for the closing ceremony. Abeena demanded the group to be on their best behavior. Before the official ceremony started ISUOG Course Instructors were given an opportunity to say a little something to the participants, thanking them for the opportunity to be with them, complimenting them on their dedication and enthusiasm and expressing thanks to the Partners including MCI, Physicians for Peace and Siemans.

Several physicians from the Ministry of Health and the Press arrived at 3:30. The official Closing Ceramonies started with a prayer, proceeded with introduction of the Master of Ceremony and then all the Officials including the Chairman, the Ghanaian course leaders, ISUOG's Outreach leader and several others spoke. The diplomas were handed out with a handshake and photo session and gifts were presented. We received some beautiful Ghanaian clothes that had been carefully chosen to fit the individual in size and personality. It was quite touching. Because our schedules had been so full I had not been able to purchase any fabrics which is what this area is known for so I was delighted with these very thoughtful gifts as were the others. Ann and Alfred presented Abeena and Dr Apoko-Adusei with our gifts - a lovely glass bowl from Copenhagen and a handsome mantele clock with an inscription. Then it was time for the official handing over of the 3 Sequoia ultrasound machines to the MOH by Barbara. Channel 3 News recorded it all. There were a lot of shaking of hands (Ghanaians love to shake hands!) and posing for photos galore, exchange of contact information, hugs all around and laughter. A great day indeed!