USIG/International Project Summary
Location: Mwanza, Tanzania
Duration of trip: 4 weeks
Please provide names and contact information for the following.
Student Travelers: Brad Jacobsen, Yuating (Allison) Zha, Michello Zhou, Bianca Rivas, Gabby Ventura, Anjali Hari and Neha Mitragotri
Faculty Advisor: Dr. Maguire, Dr. Fox and Dr. Boughton
International Organization/University: Tandabui Institute of Health Sciences and Technology
Description of Project:
Over three weeks, the students at Tandabui Institute of Health Sciences Technology were taught about seven ultrasound modules: Introductory Ultrasound/Knobology, Cardiac, Pulmonary, Abdominal, FAST, Musculoskeletal, and Female Pelvic ultrasound. Each module was taught on a separate day (as described in the “Schedule”), which included a lecture component and a time for students to receive hands-on training in the ultrasound module.
At the start of each class, every student received a printed copy of a study guide and a checklist for the ultrasound module taught that day. The study guide is a condensed outline of the lecture for the day, as well as of its corresponding video. The study guide also addressed topics that were not discussed during the lecture. These topics were solely for the students’ own interest, and they were not tested on this extra material. The checklist provided to the students is a modified list of items that they practiced finding on the ultrasound machines during the “hands-on” component of class.
Each class was taught by one of seven UCI students, with one hour of lecture at the beginning of class followed by two hours of “hands-on” time. The lecture consisted of a PowerPoint presentation projected on large screens to the students. The PowerPoint presentation consisted of the basic anatomy and physiology related to the ultrasound module, descriptions of the various ultrasound views and images, and some information about clinical correlates related to the module. The presentation also consisted of questions about the various topics addressed so that the lecturer could assess students’ understanding, and the students could test their own understanding of the topics presented.
After the lecture, students were divided into 6 groups of approximately 10 students each to practice ultrasound on one of the six machines available. Each group had a model on whom to practice ultrasound. This model was either another American medical student, or a student from Tandabui. Each group was led by a UCI student who briefly introduced the topic and showed the students how to find each item on the checklist provided to them. They were then allowed “stick time”, when they could each hold the probe and attempt to find the checklist items on the model, with guidance from the UCI student. During almost every class, each student had the opportunity to practice all items on the checklist. The students switched groups after one hour of practice so that they could attempt finding the structures on a different model and to also practice on different machines. Each class provided the students approximately 1.5-2 hours of practice with an ultrasound machine.
On Fridays, students were administered a quiz which consisted of a written and a practical component. The written quiz consisted of 5 questions from each of the two modules taught during the week for a total of 10 questions. Each question was worth 1 point, and the written portion of the quizzes were typically out of 10 points. The students first took the written component of the test and then waited their turn for the practical. The practical was a condensed version of the checklists for the two modules taught that week. There were approximately 6 stations for the quizzes, with the instructor serving as the model. 4 stations were “testing stations” and 2 stations were “practice stations”. Each student entered the station, and was asked to scan 6 different structures or views. If they were unable to find a certain item on the quiz, they were directed to the “practice stations” where the instructors reviewed their incorrect items and showed them the correct views. The students then had a second opportunity to find the missed items at their original testing station. The students received 2 points for every item they could find on the first attempt, and 1 point for every missed item that they then found on the second attempt. If they were still unable to find a structure/view on their second attempt, they received no credit for their answer. The practical portion of the quizzes were therefore out of a total of 12 points (2 points possible for 6 questions).
The final also consisted of a written and practical portion. The final was cumulative, and covered material from all modules/subjects. The written portion of the quiz was the same test given at the beginning of the class (the “Pre-Test”), with 2 questions from each of the seven modules, for a total of 14 questions. The practical portion of the final consisted of 1 question from each module for a total of 7 questions. Students who passed both portions of the final exam with a total passing score of 70% received a Letter of Completion to signify that they attended and passed the ultrasound course. Those students who did not pass the exam were given special consideration if they performed well on the weekly quizzes and attended lectures. These students were then also eligible to receive the Letter of Completion.
This introductory ultrasound course was taught over 3 weeks, which the UCI students deemed an insufficient amount of time to allow for diagnosis through ultrasound. The Tandabui students, therefore, have been taught normal ultrasound in this course, and are not yet qualified to use ultrasound for diagnostic purposes.
We also conducted an ultrasound research study on patients suffering from malaria. Our team rotated through different hospitals such as the Mwananchi Hospital, Buzuruga District Hospital and the Nyamagana District Hospital where we were allowed to scan malaria patients for hepatoslepomegaly and take measurements of their optic nerve diameter for our research study. At the Buzuruga Clinic, we scanned pregnant patients to assess fetal heart rate and biparietal diameter to determine fetal age. At Mwananchi Hospital we aided lab technicians with blood draws, blood smears, rapid diagnostic tests for malaria and microscopy. We also shadowed local physicians on rounds where we were exposed to the local patient population and their unique healthcare needs.
To prepare for our trip, we had numerous meetings over Skype with Dr. Kavit, the director of Tandabui Institute of Health Sciences Technology. We informed him of the curricular plans and coordinated enrolling students in the ultrasound course. In addition, each team member was in charge of teaching an ultrasound lesson and created a powerpoint lecture, a detailed study guide and checklists. The powerpoint presentation consisted of the basic anatomy and physiology related to the ultrasound module, descriptions of the various ultrasound views and images, and some information about clinical correlates related to the module. The presentation also consisted of questions about the various topics addressed so that the lecturer could assess students’ understanding, and the students could test their own understanding of the topics presented. Finally, we also created a pre-test, quizzes for each module, and a post-test to administer to the students in order to assess their understanding and the efficacy of our teaching. In order to prepare for each class, every team member underwent extra training sessions on evenings and weekends with trained ultrasound technicians in order to be proficient in teaching the material.
Outlook for Summer 2014:
Please describe how you foresee the next group of medical students continuing your project during the Summer of 2014. Include what you learned this summer (any barriers or obstacles your overcame) and what the next class of international travelers can do to make the project sustainable. 500 words of less.
Our work in Mwanza exceeded our expectations. The students, doctors and other health professionals responded very well to our ultrasound course and expressed interest in establishing future courses at Tandabui Institute. We wish to teach the same course to new students, while expanding the course to include more medical professionals. Also, we would like to create an ultrasound pathology course that builds off of the ‘Introduction to Ultrasound’ course. While teaching during the summer the team took note of those students who performed exceptionally well in the ‘Introduction to Ultrasound’ course, and we hope to offer the pathology course to them. Lastly, after assessing the need in Mwanza we realized that an ultrasound with Doppler would be extremely helpful to the community. With the help of the current first year medical school students, we hope to raise funds and donate an ultrasound with Doppler capabilities next summer.
These are a few of the problems/limitations we encountered:
- Our class was 140 students, which was reasonable number, however, the course should not exceed 140 students unless more than 6 UCI students participate.
- It is important to take attendance every class. We had students coming to class on days that they were not assigned. This made it logistically difficult to divide the class evenly.
- Unfortunately, Dr. Fox’s ultrasound podcast were not made available. However, some sort of pre-reading/youtube assignment should be made available. This is an intense 3-week course and any type of preparation could help the students tremendously.
- The national language in Tanzania is Kiswahili, but students who are at university level should speak english. We came to find out that Tanzanians speak very different english than we did. This is why it’s very important to include many words on the powerpoints. This allows the students to take notes during lecture even if they do not fully understand what the lecturer is talking about.
- Plan for printing costs. With many lectures and a large amount of students printing costs for the study guides, quizzes etc can become expensive.
- On the optional ultrasound session days (Saturdays and Sundays) make sure to take attendance. This will make it easier at the end of the course when submitting final grades.
- Make sure to have a laser pointer for the presentations and small towels to wipe off ultrasound gel.
- Scrubs are appropriate for teaching. There is no need for CF attire while teaching.
- Bring a flash drive with all the course information loaded on it.
10. Bring 3-pronged European converter in order to charge ultrasound machines effectively.
11. Better system for testing days:
- We need to also test on Saturdays and take into consideration Muslims and 7th day Adventists
- 7th day Adventists need to be done on Friday before 6 pm and Muslims end their fast at 6:30 pm during Ramadan
- Maybe religious students and health professionals can do their test first on Friday and the rest can do Friday night and Saturday
- Let’s move the tests to Monday’s so that it avoids religious conflicts?
12. Practical portion of the test should not exceed 4 questions.
13. Ensure that all team members stay the full length of the course.
As we have mentioned above, the students and faculty at Tandabui Institute are very excited to invite UC Irvine students back next summer. Now that the curriculum has been established not as much work is needed to prepare for the trip. However, it is important that each student who attends modifies any part of the course that they believe needs to be changed. Meetings with past UC Irvine students along with our contacts in Mwanza (Erick Oguta and Dr. Kavit) are necessary. Also, with the hope of donating a color doppler ultrasound machine fundraisers and networking are important. We also hope to continue and modify our research component, which will need IRB approval.
Please discuss which ultrasound machines you took and how many. Also list any other necessary supplies.
5 Sonosite Nanomaxx portable ultrasound machines that included curvilinear (C60X), phased array (P21), linear (L25) probes all provided by the UCI School of Medicine, an HKB ultrasound machine that included a linear, curvilinear, and an endocavity probe, converters and iPads. We also learned how to make our own ultrasound gel, which required Guar gum (bought of Amazon).
Breakdown of budget/travel expenses:
Please outline the cost of your trip.
Cost per student
Round Trip Ticket to Kilamanjaro International Airport: $1,600
Round Trip bus ride from Arusha to Mwanza: $60
Housing ($20/day for 20 days): $400
Transportation (from housing to hospital; $10/day): $200
Meals ($20/day): $400
Please describe any travel advice or tips you have for the next group. This can include travel logistics (airports, buses), fun activities to do before or after the project etc.
– The motto in Tanzania is ‘Hamna Shida,’ which translates to ‘no worries.’ What this means is that there is no schedule in Tanzania. Be prepared to have a complete blast while in Tanzania, but know that promptness and scheduling works very differently in Tanzania
– Be prepared to ride a lot of buses, and yes those buses do break down. However, this just gives you more opportunities to explore around the surroundings.
– The best airport to land in coming from the U.S. is Kilimanjaro. From there you could do what we did and take a 10-hour bus ride to Mwanza, which cost $30 or take a plane to the local airport in Mwanza, which was about $130. I think bus trips allow the opportunity of observing the scenery, however, if time is limited flying is probably the best option.
-While we were in Mwanza, we hired a private “Dala dala”, which is a taxi van. This worked out really well, since we all had to go to different hospitals and other locations each day. We also hired the dala dala on the weekends, just to make it easier to get around the town. You could also walk to the main road and just hail a dala dala, which is what the locals do. However, the house where we stayed was a bit far from the main road, and with the ultrasound machines we had, this would’ve taken quite a bit of time. For 4 weeks, the dala dala cost $
– After/during the trip everyone went on different adventures, here are some of the trips:
1. Gorilla trekking in Rwanda
2. Visit the Genocide Memorial Center in Kigali, Rwanda
3. Climb Mt. Kilimanjaro in Tanzania
4. Visit Lake Kivu in Rwanda
5. Visit the island of Zanzibar (off the coast of Tanzania)
6. Scuba/snorkel in some of the most amazing waters in Zanzibar
7. Bun-jee jump off Victoria Falls in Livingstone, Zambia
8. Microlight Flight over Victoria Falls in Livingstone, Zambia
9. 3, 4, 5 day safari to visit the Serengeti National Park and Ngorongoro Crater in Tanzania
10. Explore the shores of Lake Victoria
11. Hang out with elephants and go for an elephant ride in Livingstone, Zambia