P RELIMINARY R ESULTS
“W OLISSO U LTRASOUND ” P ROJECT
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
This project came true thanks to the support of the “XIII Convegno Nazionale di Ecocardiografia Transesofagea, Teramo 2008” participants and “Kumba Project” medical students.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
ABOUT US
SISM - Segretariato Italiano Studenti in Medicina (www.sism.org)
The Italian Secretariate of Medical Students (SISM) was officially founded in 1970 but it had already been present in some Italian universities already since 1944. It is a member of IFMSA (International Federation of Medical Students' Association) that is an international forum of medical students officially in connection with World Health Organization. SISM intends to provide a qualifying contribution to the academic formation of the students, to the increasing of their awareness of ethical and social aspects of the medical profession, to the intellectual, professional and deontological growth of the new medical class; this all to be achieved encouraging active relations among Italian universities, between national and foreign universities, among medical students of all nationalities, between students and the civil society; furthermore it carries out activities in the fields of general and specialist medical instruction, of social and medical formation and scientific research of particular interest. Il Gruppo Finalizzato “Wolisso Project” (www.wolissoproject.org)
The Section in Udine of Italian Secretariat of Medical Students began a collaboration with Wolisso St. Luke Catholic Hospital and College of Nursing in April 2005, with the following planned activities: · Four-weeks apprenticeships at Saint Luke Hospital for medical students attending the fifth or sixth year of Medicine Course, following physicians in their duties; · Support activities for St. Luke Hospital, and awarness-increasing activities for medical students and population. Since 2009 Wolisso Project has become a National Association, and has signed an official partnership with Doctors with Africa CUAMM to carry out all its activities in Italy and in Africa.
Medici con l’Africa CUAMM (www.mediciconlafrica.org)
The first non-governmental organisation (NGO) in the field of healthcare to be officially recognised in Italy, CUAMM is the largest Italian body working to improve and safeguard the health of African populations. The organisation’s projects have long-term goals, even when facing emergency situations, providing quality healthcare services which are open to everyone. It is committed to training and to spreading scientific knowledge through its technical contributions to healthcare projects. Among the public institutions involved and the general public, it extols the value of solidarity and cooperation between populations.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
THE PROJECT
The “Wolisso Ultrasound” Project, initiated at the beginning of 2009, had the general purpose to enhance Wolisso St.Luke Hospital diagnostic imaging service, through implementing the use of clinical ultrasound by local physicians and by their education and training in this field. Thanks to a portable ultrasound machine (Sonosite 180plus) donated by an Italian medical congress (“XIII Convegno Nazionale di Ecocardiografia Transesofagea, Teramo 2008”), during this year it has been possible to involve Wolisso Hospital physicians, Italian clinical ultrasound instructors and medical students in this project. Students, in particular, sustained project organization and on field monitoring, and are supposed to revise and analyze data from the ultrasound exams registry. The following report has to be considered preliminary, but the exposed data are sufficient to draw some general consideration on the project progress after twelve months.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
OBJECTIVES ACTIVITIES, RESULTS
In this section we all the performed activities shall be enlisted, according to the specific objectives and indicators foreseen by the project plan,and approved at the end of 2008 by Wolisso Project Staff. Objective 1
Making the portable US machine available and operational at the Wolisso St.Luke Catholic Hospital
Activity 1
Bringing the US machine to Wolisso, defining its use and training modality. Portable US unit has been operational at St.Luke Hospital since December 24th, 2009, thanks to a mission of two physicians and one student, members of WP staff. During the first three weeks they - assessed the real clinical directions for a correct use of the portable unit; - motivated the local physicians to join the planned training program in clinical US and to use the technique; - defined an agreement with Hospital Director and Medical Staff for clinical US courses and machine use; - identified a person in charge for the US unit handling and ordinary maintenance (Dr.Claudio Blè, CUAMM doctor). The participants’ feedback to the project was enthusiastic right from the beginning, and after the training courses in February and April 09, two Ethiopian internists, one Ethiopian gynaecologist and one Italian infectivologist became independent in performing clinical ultrasound. Contacts and updating about the project have been constantly mantained constantly during this year by the Project manager, Dr Parlamento in Italy, and Dr. Blè in Wolisso, by e-mail and phone. The ultrasound machine was extensively used in General Medicine ward, Paediatrics, Gynaecology and Out-Patients Department, both bed-side and in a dedicated ultrasound room.
Indicator 1
Number of performed exams; report on ordinary and extra-ordinary maintenance Available data about the number of exams are affected by a non-optimal recording especially concerning bed-side US examinations. This is because the registry book didn’t follow the US unit in the wards, and the machine SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
has not a specific software for exams registration. We estimate that around 20 percent of US examination were performed bed-side. The US operators registered about 100 examinations per week, that is, considering a period from April 15th to November 31st 2009, a total estimated (though rounded down) number of 3000 examinations, shared out as follows:
As regards US machine maintenance, we had a single problem concerning the display, at the beginning of December 2009. The unit was immediately brought back to Italy by a CUAMM doctor, where the Technical Support Division of SONOSITE-ITALY, in Milan, addressed the problem very quickly, substituting some display connectors: this occurred according to the maintenance agreement signed by Wolisso Project and Sonosite, and the unit has been operational again in Wolisso since January 6th, 2010.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
Objective 2 Activity 2
Making local physicians operational and self-sufficient in US use Carrying out training courses in clinical ultrasound As mentioned above, the training courses were conducted by two expert operators: dr. Roberto Copetti, Director of Tolmezzo Hospital Emergency Dept, and Dr. Paolo Agostinis, from Internal Medicine Ward of the same hospital. Wolisso Project took care of the organization and the expenses of the instructors’ missions, in February and April 2009. The training followed Americans and Italians most up-to-date guidelines on emergency ultrasound, obviously adapted to a developing country background. Three Ethiopian and one Italian Physician attended these courses, in their theoretical and practical aspects. In fact the two integrated courses were conducted through brief frontal lessons followed by bed-side exercise under the instructors supervision. A the end of each course, participants had a final test, in order to check their learning process and the courses’ goals achievement. A the end of these learning experience, participants formally espressed their satisfaction and thankfulness to St.Luke Hospital Director.
Indicator 2
Number of participants, including Wolisso Project students and doctors; number of courses’ hours As already said, three Ethiopian doctors (two internists, and one gynecologist) and one Italian infectivologist, attended the courses. Also four Italian Wolisso Project students and some St.Luke Hospital Health Officer followed US training. The courses had a 20 hours’ lenght concerning theoretical aspects, and about 100 hours of practical bed-side exercise.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
Objective 3 Activity 3
Making an evaluation report of the project available for the public Creating a clinical data-base of ultrasound examinations performed; analyzing data and defining possible study protocols; writing an evaluation report to share. An US performed examinations paper registry was filled in by trained US operators trained. Wolisso Project medical students are expected to review the registry and transfer all the data to a digital form. We are considering to use the general data analysis and the clinical impact assessment, to create a possible scientific publication. E’ inoltre partito un protocollo di studio sul ruolo dell’ecografia nella diagnosi di tubercolosi che sarà a breve inviato per eventuale pubblicazione su rivista scientifica. Furthermore we created a study protocol concerning the possible role of ultrasound for the Tuberculosis diagnosis, that in a short time will be sent for a possible publication.. The present paper is the first evaluation documentation of the project. A Final Report will follow, to be shared it between all the subjects involved in the project, and to be published on the Wolisso Project web page.
Indicator 3
Valuational report produced; study protocols created US examinations general registry; TB diagnosis study; possible study on US clinical impact in a low resources context; preliminary results report; power point presentation (available for the download from WP web site). The Final Report and a video to be presented to the International Federation of Medical Students’ Associations (IFMSA) General Assembly in March 2010, arebeing prepared.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
Objective 4
Promoting the results’ diffusion, in order to increase medical students and doctors’ awareness regarding developing countries problems.
Activity 4
Project presentations in Wolisso Project promotional activities, in involving Medical Schools in particular.
The “Wolisso Ultrasound” Project, as every other activity conducted by Wolisso Project was presented at the national SISM congresses (Chieti, March 09 and Messina, November 09), and at Firenze, Varese and Udine Medical Schools, as well as in several meetings on International Cooperation in Tolmezzo, Udine, and many other towns in Friuli Venezia Giulia. A presentation at the IFMSA March Meeting is planned in Bangkok, Thailand (http://www.thailandmm2010.org/), in March 2010.
Indicator 4
Number of students, doctors and citizens, reached by these initiatives National SISM Congresses are usually attended by 150 to 200 medical students; every Medical School Meeting involves about 50 to 80 persons, while initiatives involving other associations and common citizens have an average of 250 people each. 350-400 medical students are expected to join the Thailand March Meeting.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
ADMINISTRATION
In the following table the final balance of the project is presented. The “real service contribution” is a monetary conversion of material, goods or people’s work contribution.
*Cost covered by St.Luke Hospital
As already specified, the “Sonosite 180plus” US portable machine, as specified before, is a donation to Wolisso Project by Kumba Project, thanks to the “XIII Convegno Nazionale di Ecocardiografia Transesofagea”. The costs of the performed US exam are integrated in the St.Luke Hospital general budget.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
CONCLUSIONS
The overall number of performed US examinations and the wide US machine use among wards, is indicative of an optimal integration of the project in the hospital activity. In the second half of 2009, X-Ray machine was out of service due to technical problems, and in this period became evident to all the Wolisso hospital doctors, that clinical ultrasound can have a crucial role in basic diagnostic imaging. We found a high appreciation of our courses both from attendants and instructors, even beyond our expectations. This is also proved also by another meaningful fact reported from Ethiopia: every morning in St.Luke Hospital there is a sort of real challenge among US operators to use the US portable machine. The so far analyzed data are not sufficient yet to draw scientific conclusions about the impact of clinical US on hospital activity, or patient outcome. But if we consider the immediate and extensive use of the technique and the enthusiasm of the physicians involved in the project, we are allowed to be optimist concerning the success of the project, waiting for more detailed assessment. Concerning this point, general registry analysis and the studies we structured, will have a key role in determining the future use of clinical US in this context, and the organization of further training courses. The diffusion of the Project and its first results medical students, doctors and general population, were consistent with the general aims of Wolisso Project, that to awaken public opinion and to enhance general awareness about International Cooperation and Global Health. In conclusion it can be said that “Ultrasound Wolisso” Project has fulfilled all his targets after 12 months, and above all, it has had a good integration in the St.Luke Hospital policy to enhance primary care health system, in order to support a true development in an extreme poverty context
The“Wolisso Ultrasound” Project Manager (Dr.Stefano Parlamento)
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org
ACKNOWLEDGMENTS
Special thanks to Dr.Saro Paparoni and all the participants in “XIII Convegno Nazionale di Ecocardiografia Transesofagea, Teramo 2008”, for their generosity in supporting SISM projects. We have a particular gratitude for the helpfulness and collaboration of “Kumba Project” staff, and of the SISM Past-President, Dr.Cristiano Alicino. The achievement of this project was possible only owing to the medical and paramedical staff of the Wolisso Hospital: we have no words to explain what binds us to these extraordinary people and the honor they give us in joining our projects. We want to thanks, on behalf of all, Claudio and Lucia Blè and Gaetano Azzimonti, together with our ultrasound masters, Roberto Copetti and Paolo Agostinis. Finally, many thanks to Doctors with Africa CUAMM and all the students and young doctors supporting Wolisso Project.
SISM Gruppo Finalizzato Wolisso Project , Piazzale Kolbe n 2; 33100 UDINE www.wolissoproject.org, info@wolissoproject.org