Medical check-ups

We strongly advise you to get a medical check-up with your doctor before you leave. A check-up will also give you the chance to discuss with the doctor the various vaccinations and prophylaxis needed for your trip.

Don’t forget to go to the dentist before you leave. Toothache in the field is generally bad news!

You may be going to a country with problematic health and sanitation conditions, so wide vaccination coverage is recommended. You need to find out which vaccinations and boosters you require. International medical centres offer websites covering vaccination needs for all countries. EG:

  • Centers for Disease Control and Prevention, USA (http://wwwnc.cdc.gov/travel/
  • London School of Hygiene & Tropical Medicine (http://www.lshtm.ac.uk/aboutus/contact/medadvice.html)
  • Pasteur Institute (France) (http://www.pasteur.fr/ip/easysite/pasteur/fr/sante/centre-medical/vaccinations-internationales-medecine-des-voyages)

 

 

 

 © Brax


 

Vaccination card

If you think you may make further trips for the WFPI/other, keep your International Vaccination Card up-to-date.

Caution your vaccination card may be required by the authorities to enter the country or issue your visa.

You should bear in mind that certain vaccinations take time to become active, and some are not available everywhere ex : vaccination against meningitis.

Blood group

We recommend that you find out your blood group before leaving (in the event of blood transfusions, etc.). To avoid any unnecessary examinations, remember to take your blood group card with you.

Visas

You may need a visa for your location, and possibly visas for neighbouring countries too in case of extended transit/evacuation. Check on the internet for the visa requirements for your nationality and submit your application in plenty of time – the visa issue process can be a lengthy one!

Driving licence

You should not need to drive around during WFPI outreach trips. However, if you intend to undertake personal travel afterwards, international driving licences can be obtained from the relevant driving licence authorities in your home country. You will need a national driving licence and passport-size photos for your application.

Malaria, TB

Malaria
Some WFPI outreach projects  are located in areas where mosquitoes are rife. The recommended pro- phylactic treatments vary from one country to another and should also be individually adapted according to your medical history. Your doctor/international travel centre will advise you on the possible options.
Prophylactics will not offer you 100% protection against malaria; they do however minimise the risk of complications (cerebral malaria, coma, etc.). But you must still use the mosquito nets and repellents as a precaution. We cannot insist enough on this. Take all these preventive measures, including prophylactics, seriously! They are vital to ensure your good health. Even if they seem heavy-going, do not relax your vigilance on this issue.

Tuberculosis
In some projects you may be in contact with tuberculosis patients. You will therefore need to undergo a specific medical check-up prior to departure with your doctor/international travel center.

Experience from Haiti

What to bring
  • bug repellent
  • tea bags
  • oatmeal packets or power bars (actually bite size payday candy bars are the best in my opinion)
  • small sanitizer bottles
  • extra pens
  • business cards
  • antibiotics / pepto bismol for tummy issues
  • advil, just in case of whatever
  • no shorts or short skirts
  • comfortable shoes!
  • warm jacket or cardigan - evenings might get chilly or the AC might be turned way up
  • tiny flashlight (Brookstone, USA, has a great one)
  • rubber flip flops for shower/bath areas to avoid going barefoot
  • small plastic container with tissues (multiple uses - especially emergency toilet paper)
  • small denomination bills for buying things from vendors - 1's and 5's.
  • black-out fabric or paper (and a way to hang it) so you will be able to see what you're ultrasounding.
Keep on your email account (and/or smart phone) PDF's of the following, in case you need or lose them:
  • copy of your passport
  • copy of travel itinerary / travel visa
  • copy of your medical license (at least one of them)

What worked
Practical teaching points, with repetition
  
What did not work
Audience feedback / participation worked this time Haiti, but does not work well with all groups - especially in more traditional cultures, expect that a lecture structured around audience participation might or might not work

Best ideas for sustainable impact

Cheap thumb drives to hand out, with your lectures on them

 

Feedback from Rebecca Stein-Wexler's teaching trips, ACR-Haiti March 2013 (Port-au-Prince) and UCLA Haiti Initiative, November 2013 (Port-au-Prince)

My advice for that is to keep things basic, and not to try to cover too much. Repeat yourself, to help overcome any language barriers. Although there might be full-fledged radiologists in the audience, most people have much less experience with imaging. The radiology residency programs can be young, and although later on these residents will be exposed to CT and Mammo in private practice rotations, they spend their first year with radiographs and US (no MRI). . Similarly, pediatricians mostly see radiographs. Include CT or MRI to help explain imaging findings on US or radiographs, or for limited correlation, but emphasize radiographs/US.

I recommend two lectures: one would show chest radiographs with CT correlation, clearly showing the anatomic explanation for what we see on radiographs (that would involve limited introduction to/explanation of CT also). Also, a similar lecture for abdomen. Try to make the two-dimensional become three-dimensional. I think that could have lasting impact. But avoiding too many technical details.

If you have sessions scanning real patients, try to arrange for communication of the findings to the clinicians.

Hands-on US: I transported a refurbished sonosite to the pediatricians, and spent some time (but not enough) showing them how to use it. The most important thing you could do is bring along an ultrasonographer to spend a lot of time with a few pediatricians, really teaching them how to use it. Those pediatricians would not attend the lectures but instead dedicate themselves to becoming proficient with the US machine. They could then educate others.

As far as the US sessions: Based on my experience, I'd say that limiting them to people who have access to an US machine is a good idea. The radiology residents would benefit. They can be fairly proficient with US, but their knowledge base is limited - they learn from attendings during readout sessions but otherwise learn on their own and from lectures they prepare for each other. The pediatricians who now have access to the sonsosite would also benefit (though a few would hopefully have more intensive training sessions with an ultrasonographer). Otherwise it's a somewhat meaningless show and tell, where people are exposed to equipment they will not have the opportunity to use. And yes, certainly those sessions should be small, allowing people the opportunity to scan.

Teaching the teachers is definitely the way to go. The audience will probably be more enthusiastic than any you've ever seen. The ACR program offers an incredibly rewarding opportunity to make a difference in a country that's been repeatedly brutally traumatized and help rebuild a deeply damaged medical system.

A last point: work with the local radiologists!! They are eager to be involved and should neve be underminded by external support for imaging. 

Onsite training tips in lower resource settings

From Savvas Andronikou, head of WFPI outreach

I often find that doctors have to interpret the radiographs themselves. So  I normally aim for:
Systematic interpretation of a chest radiograph in a child
Diagnosing pneumonia and TB [ these are the commonest indications for imaging and the commonest cause of morbidity and mortality]
Approach to abdominal radiographs in children
Diagnosis of high obstruction / low obstruction
Approach to imaging abdominal masses -  i.e look if its hydronephrosis with US and work from there
Interpretation of trauma radiographs [cervical spine /  common fractures]
A talk on radiation prevention in children's imaging [what not to image - e.g. sinuses]

I would spend some one-on-one time with the radiologist seeing where you could input most usefully: radiation and CT /  pediatric fluroscopy procedures and limiting radiation / uys techniques for children  [e.g. head US]
youre going to also have to play it by ear


From Dorothy Bulas, head of WFPI education

Hands-on is so helpful
Go from top to bottom
Head US, neck US, chest US, abdomen, renal, bowel (AP/intus/PS)  hips, spine gyn testicular
Then xr chest, abdomen
Fluoro ugi, obstruction intus
A little CT/ MR for path correlation
Case based is very helpful
It is a good review for pathology even if radiology knowledge is more limited
I would recommend breaking up the days to manage fatgigue.1 -2 hours in the morning then afternoon of lectures, then hands-on if possible.