For those of us who travel, teach, and spread the gospel of ‘sound – we look for resources that may help in knowing the conversation for this topic. AIUM has a page that could help in your needs, as well as see photos of trips that their physicians have undertaken for ultrasound teaching and advancement.
Ive posted on other groups that have gone all over the world, in addition to my own experiences – including TO-theWorld who enhanced maternal education and minimizing MTFT of HIV.
For other resources, that are free for ultrasound in global health:
Here’e a video that discusses ultrasound in global health, with a cameo photo of our own Dr. Jessica Ngo using it during Stanford’s emergency response to Haiti after the disaster with our SEMPER team.
A friend of mine, William Cherniak – a family medicine resident in Canada at the University of Toronto- has been working on a project. Not just any project, but a global impact project with the help of KIHEFO (Kigezi Healthcare Foundation) and his own group that he created called TO-the World. What is this project, you ask? Well, it was to show how minimizing maternal to child transmission (MTCT) of HIV can be helped by simply having and letting the women know in the region that a portable ultrasound has arrived. This project will be presented at Global Health 2013
The project in brief: “In alignment with the WHO 2010 guidelines for MTCT elimination and the Ugandan government’s adoption of plan B+; KIHEFO, in collaboration with TO – the WORLD, designed a structured maternal health camp [sMHC] centered on providing expectant mothers in rural Uganda with a free obstetric ultrasound [OBU]. The four‐pronged approach of MTCT elimination was followed in the design of the sMHC. In one day, 45 women rotated through registration, pre‐test counseling, testing for HIV and Syphilis, family planning, obstetric ultrasound and, for the women identified as being high risk by triage, dental and/or medical services. Each woman received fansidar, multivitamins, folic acid and filled in a pre‐ designed questionnaire. In total, 10 women identified themselves as being HIV+ at registration, surprisingly only half were currently being treated with ARVs. An additional two women were diagnosed as being HIV+ during the health camp. All women received counseling and were started on ARVs for life. Only 7 women had ever previously had an OBU, and all 45 women verbally identified that the reason for attending the antenatal health camp was to receive a free OBU.” – Now that is just amazing. The power of what a portable ultrasound can have on a community in fighting MTCT of HIV. Bring the ultrasound, and they will come – that is your way to start the healthcare and assessment they need.
They continue to state how they hope to solve the problem of high maternal death and high infant death rates: ” Solving the Problem – Ultrasound and Outreach to Reduce Maternal Mortality. As stated above, the leading causes of maternal mortality include hemorrhage, eclampsia, obstructed labor, infections, and birth defects. Studies have shown that obstetric ultrasound imaging can prevent most outcomes by providing early diagnosis and intervention. By providing useful information such as whether or not the mother is carrying twins, has an ectopic pregnancy or otherwise a mother and her partner can make an informed decision about whether or not to deliver at home with untrained professionals, or a health center where they can receive life‐saving treatment. Furthermore, the World Health Organization (2003) recognizes ultrasound technology as ideally suited to low and middle income countries, as it is relatively low‐cost, low input, and easily maintained and transported. Additionally, studies conducted on the use of ultrasound technology in two rural hospitals in Rwanda have indicated that after an initial training period, an ultrasound program led by local health care providers can be sustainable and lead to accurate diagnoses. Ultrasound imaging is beneficial to rural populations as it is a simple a nd non‐invasive procedure. This helps to reduce levels of fear from women who have previously maintained their cultural preferences for receiving treatment and giving birth with untrained birth attendants in their local villages.
Sustainability: Various studies on obstetric ultrasound imaging as a sustainable and appropriate technology to developing nations, and its capacity to reduce rates of maternal mortality, have been conducted in rural regions of Rwanda, Botswana and Tanzania. In northern Tanzania, a study conducted amongst women who were
receiving ultrasound imaging for the first time indicated that the majority of women were satisfied with the information provided from the procedure, despite not initially understanding its purpose. The ultrasound procedure provided women with the ability to see fetal positioning, fetal sex, and to recognize any potential pregnancy complications. Information, particularly the latter, resulted in guiding treatment for the woman’s particular birth – helping her make an informed decision as to where and how she would deliver. This particular study in Tanzania concluded that the ultrasound imaging was useful in reducing the risk of maternal mortality, although the treatment should be accompanied by a thorough education campaign and consent program.”
The future? “Currently, TO – the WORLD is in the process of raising funds to purchase two portable ultrasound machines. These machines will be purchased locally in Uganda to ensure sustainability in maintenance and economic stimulus for the communities in which they serve. Multiple outreach camps will be conducted in 2014 with the previously designed model based on the WHO four‐pronged approach to MTCT elimination of HIV.
Here is the video William made to support his cause:
1. Report of a WHO Technical Consultation. Towards the elimination of mother‐to‐child transmission of
HIV. Accessed March, 2013 at http://www.who.int/hiv/pub/mtct/elimination_report/en/index.html
2. IRIN Humanitarian News and Analysis –A service of the UN office for the coordination of human
affairs. Accessed March, 2013 at http://www.irinnews.org/Report/96308/UGANDA‐Government‐
adopts‐new‐PMTCT‐strategy
3. WHO Executive Summary, April 2012. Use of Antiretroviral Drugs for Treating Pregnant Women and
Preventing HIV Infections in Infants. Accessed March, 2013 at
4. World Health Organization. Statistics on Maternal Mortality in Uganda, accessed March, 2013 at http://www.who.int/healthinfo/statistics/indmaternalmortality/en/index.html
5. Kigezi Healthcare Foundation website, accessed March, 2012 at www.kihefo.org
6. Maternal Health: Investing in the Lifeline of Healthy Societies and Economies. Africa Progress Panel
Position Piece. September 2010.
7. Yaw A.W., Alexander T.O., and Edward T.D. The Role of Obstetric Ultrasound in Reducing Maternal
and Perinatal Mortality, Ultrasound Imaging ‐ Medical Applications, InTech, Accessed March, 2013.
Available from: http://www.intechopen.com/books/ultrasound‐imagingmedical‐applications/the‐
role‐of‐obstetric‐ultrasound‐in‐reducing‐maternal‐and‐perinatal‐mortality.
8. Shah S.P., Epino H., Bukhman G., Umulisa I., Dushimiyimana J.M., Reichman A., Noble V.E. Impact of
the introduction of ultrasound services in a limited resource setting: rural Rwanda. BMC
InternationalHealth Human Rights. 2009;27:9‐4
9. Firth E.R., Mlay P.,Walker R., Sill P.R. Pregnant women’s beliefs, expectations and experiences of
antenatal ultrasound in Northern Tanzania.African Journal of Reproductive Health. 2011; 15(2):91‐
107
I saw an interesting blog post, sent to me by my ultrasound uncle, Dr. Chris Fox, that was on the: “Why Is American Healthcare so Expensive?” site entitled “How to Make Ultrasound gel: which is also sterile and edible and environmentally friendly” by Dr.Janice Boughton. Not only did the title catch my eye, but the content drew me even closer. If you are in need of gel – whether that’s because you are doing global health, disaster relief, or healthcare at any resource-limited area – there are ways to make it. Ive heard of a couple alternatives – and here is a way to make your own – that is also sterile, edible, and environmentally friendly. 🙂
As the blog post states: “Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glycerine, perfume, dyes, phenoxyethanol or carbapol R 940 polymer along with lots of water.” – not easy to find, and ot so cheap either. So, she set out and tried six different recipes – yup, that’s right – SIX! …and made the below gel (see pic) from guar gum (found in the flour section of stores), salt and water:
“Guar gum is available in the flour section of many grocery stores and costs about $10 for a 220 gram bag. It is purported to be good for diarrhea, constipation, diabetes and lowering cholesterol.” – how cool is that?!
1. Mix 2 teaspoons of guar gum with 1-2 teaspoons of salt. (The amount of salt isn’t vitally important since it is just added to keep the guar gum from clumping. Using slightly less than a teaspoon of salt per 2 cups makes a gel with which is isotonic, which would be ideal for use near eyes or other mucus membranes or on open wounds).
2. Boil two cups of water.
3. Slowly sprinkle the guar gum/salt mixture into the boiling water while stirring vigorously with a fork or whisk.
4. Boil for about 1-2 minutes until thick and well mixed.
5. Cool before using. Save lives.
To read more about her plight – click here. Thanks Janice!
World Humanitarian Day is August 19th. Travelling to a third world country is what all healthcare providers should experience, as it will make a difference (to either your perspective on life and happiness or to the people who you treat). I have met some amazing people along the way, none who affect me more than those who live there (and the great way they define happiness) and those who go around the world to try to make it a better place. I have travelled to the Middle East, India, Guatemala, Honduras, Mexico, and Nepal with groups of people who have done far more than I could ever do, and the inspiration I get from them is amazing (Stanford International EM facebook page and the Rwanda PURE initiative). The stories I’ve heard, the experiences I went through, and the humbling that comes from it all are what keep me going. But, Ive realized something: there are two ways of thinking about global health and our aid efforts: Continue reading →
SonoSpot: Topics in Bedside Ultrasound 