Sustain, Aid, Nurture, and Assist (SANA) with SonoSim in Lebanon

SANA (Sustain, Aid, Nurture, and Assist) is a Non-Governmental Organization (NGO) based in Lebanon that, in cooperation with the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), strives to train and educate caregivers and patients in local communities. Within their short five-year existence, SANA has made tremendous strides by conducting field research on ultrasonography, translating ISUOG Guidelines into Arabic, and providing sonographic training and ISUOG certification to physicians, OB-GYN residents, nurses, and midwives. Additionally, SANA has led the integration of ultrasound education and training into the midwifery curriculum at the Lebanese University, Tripoli Branch. SANA currently uses a fully-equipped mobile clinic to undertake clinical outreach missions that often provide treatment to Lebanese and Syrian refugees.

SANA, believing good prenatal care and gestational monitoring are key factors in the battle to reduce maternal morbidity and mortality rates, has a strong focus on improving local obstetric medical education and ultrasound training. Ultrasonography aids in gestational dating, fetal visualization, and diagnosis of placental abnormalities that might indicate a high-risk pregnancy. “Over the past 5 years, SANA has been involved in providing sonographic training to health care providers who have never held a probe nor scanned any patients,” states Dr. Reem S. Abu-Rustum, founder and President of SANA. “What is most unique and challenging when scanning the obstetrical patient is that the sonologist is constantly trying to obtain images of a moving target with an unstable lie. This requires significant adaptability and skill at probe manipulation.”

A core portion of SANA’s ultrasonography curriculum involves the ISUOG Six Step Approach, which prioritizes key windows of OB-GYN ultrasonography and simplifies the sonographic approach for the novice, particularly in the outreach setting. It requires determining fetal presentation, ascertaining fetal viability, number of fetuses, placental location, amniotic fluid index and obtaining fetal biometric measurements.

In March 2016, SANA received a SonoSim^® Edition through a grant from the Elmer and Mamdouha Bobst Foundation. The SonoSim^® Edition gave students access to SonoSim^® Modules comprised of didactic instruction, knowledge assessment questions, and virtual hands-on scanning cases from a library of normal and pathologic sonographic conditions. SANA program student Khawla Saada describes, “Working on the SonoSim simulator has enhanced my ability in applying the ISUOG Six Step Approach. The simulator has taught me to look at organs of the fetus according to its position in the womb. It also taught me how to obtain biometric measurements.” Participants in SANA’s supplemental education program are typically midwives, many in their senior year of midwifery school, with little to no experience scanning patients. Students take advantage of SANA’s offerings outside of their midwifery education by visiting the clinic to work on the simulator during their free time. They work in pairs to learn ultrasound image acquisition techniques and interpretation. “The [SonoSim] simulator helps us recognize anatomy and how it appears sonographically,” said student Jinan Hamoui. “When we are actually scanning a patient, after working on the simulator, we can immediately recognize what we are looking at.”

Since acquiring SonoSim, SANA’s midwifery trainees are now required to complete the relevant modules prior to their participation in outreach missions. Dr. Abu-Rustum notes, that as a result, “[Students showed] more confidence and ease in handling the real probe, had no difficulty with caliper placement, and…found scanning an actual patient easier… Trainees feel more secure in their abilities as they go out into the clinical arena.”

Student Lina El Morhabi attests, “The simulator gives us a lot of experience because it offers a huge number of sample images.”

Upon completion of their Midwifery and SANA programs, the graduates’ newfound ultrasonography proficiency and understanding of human anatomy sets them apart from their peers and positively impacts their clinical practice and enhances the level of care that they provide to the most needful patients: members of their local communities and refugees. Most graduates find careers in health dispensaries, in government hospitals, or in private midwife clinics.

Looking towards the future, SANA will benefit from additional content development from SonoSim, as well as incorporation of multi-language support. These advancements will allow for the SANA education program to continue to grow and deepen its impact within and beyond their local communities. Through hard work and dedication, and with the assistance of cutting-edge ultrasound education and training from SonoSim, SANA is successfully educating healthcare providers and working towards its goal of improving the overall health and wellbeing of Lebanese communities and Syrian refugees.