Myanmar - Second year

The second course to Myanmar has started, with all the previous students minus 4, delivery, maternity leave and 2 who were not able to get replacement (the ob who come to the course have to be cross covered by a surgeon for the emergency C-section section). One of the student, I like very much, is one of six obstetricians for a city of 4 million people!!

We had asked the students to fill a spreadsheet with all the findings they made during the year and they did a remarkable job at it: probably a first in the Outreach history. This was a Google spreadsheet and each student had her or his own tab, with a front sheet doing the addition of all the student tabs.

I like no one find cardiac or skeletal dysplasia ( so not a defect on me

So today we started with the second set of lectures, which are a little basic, but Federico enriched very substantially with many video clips. Philippe added some cases related to the lectures, and to insure participation we got 4 students to come to the front of the class and answer each case. Nothing like being in the hot seat to focus attention. They did pretty well.

The afternoon and the end of the morning we did scan. We had not preselected the students and some were still fairly hesitant, so we redistribute then into basic, intermediate, advanced level so that the teaching could be more focused. That worked out better.

Most of the patients had not undergone ultrasound in pregnancy before.  Our cases included numerous twins, suspected growth restriction, and placenta accreta.

The more interesting case was a hydranencephaly with retinal detachment.

The second and third day, we went on with the lectures. We had asked all the students ahead of time to prepare a 5 minutes presentation and with the firm hand of Dr Yin Yin Soe, and Dr. Khin Latt, they had all prepared one or several cases, including many ectopic pregnancies, ovarian masses and pre eclampsia with IUGR. The 2 more striking cases were an abdominal pregnancy and a 38 weeks tubal pregnancy in which the location had not been correctly recognized. This was great way to re-emphasize the routine exam: after the first sweep always document the cervix, size, competence and vasa previa.

( 38 weeks tubal pregnancy

Dr. Federico Badano also lectured with great calm and a ton of add on video to the isuog lectures making them much more attractive.

Dr. David Berck, who is also a veteran from Mongolia also had presentation, and we ended up all adapting Gwan Jun technique of abundantly moving around, using the many dolls that Dr Khin Latt had prepared.

We had a very large supply of patients, and even an extra ultrasound machine. The course is sponsored by Mindray and the local distributor “Concordia” and Dr Than Win had really gone out to make sure we had all we need. The extra machine allowed the students to practice under less time constraint. Ever efficient Justin Liu was going from machine to machine making sure everyone was ok with the knobology. He was part of it group last year too but was much less shy this year and has remarkably improved his fluency in English. By the way all the students speak perfect English but with a British flavor (liquor.. for amniotic fluid) and an accent sometime difficult for my deficient ears.

The only really problem was that is incredibly hot here and the AC could not keep up with 30 people plus patients plus 6 ultrasound machines. I was dripping over my students who would provide me wipes and water every free minutes. So sweet!

The students are very comfortable with us. Last year, being shy, I had asked them to write their questions on paper and leave the questions on our desk for us to answer. This year there was no problems at all. I think that getting them to come answer the cases in front of everyone, although terrifying at first, gave them much more confidence. It helped that Thao or Ya rewarded the correct answers with a gold medal of chocolate. A old trick I used in Mongolia too.

( follow up of student very very important .l like it )

On the fun part, David was interested in the dress that men wear here, called Longi. Dr Khin Latt generously gave one to each of us!! Resulting in a rather unique picture, with from left to right: Gwan Jun, PJ, Ya Chiao, Dave and Federico!!

Tomorrow is it last day and we are already nostalgic about leaving our students for a year.