Above, photo provided by Bridge to Health.
Michelle helping our local Ugandan coordinator, Nangoli Andrew, to scan
In the winter of 2014, Bridge to Health, working with our Ugandan partners, realized the power of portable ultrasound. We discovered its broad practicality for rural and remote settings, as well as its unique ability to incentivize patients to engage in the healthcare system who might otherwise seek traditional healers. Starting with antenatal care, we demonstrated a six-fold increase in uptake of services when ultrasound was advertised versus when it was not. From there, we empowered our community partners in Uganda with devices, and asked our colleagues who were Ugandan mid-level health care providers, what they would most like to use ultrasound for if given the opportunity. Initially, they described obstetric ultrasound and their desire to learn that technique. We wondered though, “do they know the full extent for how ultrasound can be used?” So, we changed the survey, this time we gave a menu of options and asked that they select their top choices. Now, topics like breast masses and pediatric pneumonia rose to the top. With that in mind, our team began to put together a group of world-leading experts to design curriculum, engage local partners and find the devices necessary for the program.
The question? Could we train mid-level providers in a rural / remote region to use POCUS to diagnose pediatric pneumonia. After reviewing available devices, our team happened to meet a representative from Butterfly Network. We engaged in discussions and quickly realized that this device offered exceptional opportunities to sync a cloud-based server with our rural populations such that experienced providers in North America could easily review images taken from a mountainside in rural Uganda.
The training process utilized multiple modalities – including flipped-classroom, in-person didactic sessions and hands-on practice, mentored scans and continued remote quality assurance of acquired scans. Currently, we have more than 160 scans on our cloud, a team of seven trainees working their way through the program, and a vision for launching this as a platform for education and training in partnership with Ministries of Health and Academic centers around the world. Ideally, this program will be able to help our partners feel more confident with their management of patients in rural regions by giving them a tool that can enhance their clinical assessments. Specifically, improving the triaging process by more accurately identifying patients with complex pathology and improving the transfer to centers with a higher level of care, as well as allowing identification of children who likely have a viral illness and can be safely discharged home with no medications.
About the authors:
Dr. William Cherniak MD, MPH, CCFP(EM) is an academic emergency physician with training in family medicine, public health and cancer research from the Johns Hopkins Bloomberg School of Public Health and the NIH/NCI, Center for Global Health. He cofounded and is the Board Chair of Bridge to Health Medical and Dental, a Canadian humanitarian organization working in sub-Saharan East Africa and cofounded and is the Board Chair and CEO of Bridge to Health USA, based in Washington, DC. He is a Faculty at the University of Toronto and Northwestern University.
Dr. Michelle Lee is an academic clinician in the division of pediatric emergency medicine (PEM) at the Hospital for Sick Children. She completed her medical training at the McGill University and pediatric residency at McMaster University. She completed both of her Pediatric emergency medicine fellowship (as chief fellow), and pediatric point-of-care ultrasound (POCUS) fellowship at the Hospital for Sick Children. Her academic focus is in the dissemination of PEM and POCUS amongst other innovative technologies to low-resource settings for improving child health.