Above, photo by Charlie Forgham-Bailey, Save the Children
Mary* is weighed in order to check for malnutrition (a contributing factor to pneumonia) at the Centre de Santé et Maternité, Galilée, a health centre on the outskirts of Kinshasa, DRC.
A COMMENT FROM THE COORDINATOR
Innovation is a hot topic among health professionals, but its significance may become diluted through overuse, and sometimes has a limited scope focused mostly on new technologies. The World Health Organization (WHO) has a much broader definition of innovation and includes “…new or improved health policies, systems, products and technologies, and services and delivery methods that improve people’s health and wellbeing. Health innovation responds to unmet public health needs by creating new ways of thinking and working with a focus on the needs of vulnerable populations. It aims to add value in the form of improved efficiency, effectiveness, quality, sustainability, safety and/or affordability. Health innovation can be preventive, promotive, curative and rehabilitative and/or assistive care…” The Pneumonia Innovations Network is committed to accelerating innovations related to pneumonia diagnostics/prognostics, pulse oximeters and oxygen therapy, child-friendly antimicrobials, nutrition, and the reduction of household air pollution. Using this broad lens, in this newsletter, we will highlight two innovations that are aligned with our critical areas of innovation: pneumonia diagnostics/prognostics and child-friendly antimicrobials.
The WHO turns our attention to antimicrobial resistance, and rolls out a new tool to help governments work in coordinated action against the overuse of antimicrobials. The AWaRe tool categorizes antimicrobials into three groups – Access, Watch, and Reserve. As antimicrobials remain an important tool for the treatment of pneumonia, antimicrobial resistance continues to shape the future for innovations in pneumonia treatment, and the need for improved care including pneumonia diagnostics. This month’s blog features one of our members and innovators, Bridge to Health, who describe the use of point-of-care ultrasound to diagnose and treat childhood pneumonia in rural Uganda.
I would like to take this opportunity to thank Amy Ginsburg and Mari Couasnon for organizing the first three very informative and well-attended PIN webinars of 2019: Influenza and child pneumonia; Respiratory syncytial virus (RSV) and child pneumonia; and Pneumococcal conjugate vaccines (PCV) and PCV schedules. We are now passing the baton to Leith Greenslade and Ashley Johnson who will develop, organize, and lead the upcoming PIN webinars for the rest of 2019. Before passing this baton, please enjoy the last of Amy and Ashley’s PIN webinar series: Child pneumonia in high resource settings taking place on July 2nd at 10 AM EST. We anticipate hearing the latest in childhood pneumonia management from fellow PIN members who are also leading experts in the field.
DEEP BREATHES: BLOGS FROM PIN MEMBERS:
A new approach to pediatric pneumonia – Butterfly iQ used to train mid-level providers in point of care ultrasound in rural Uganda
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.
“Challenges & Opportunities in Diagnosing and Managing Pneumonia in High Resource Settings”
Webinar Event on Tuesday, July 2, 2019 at 10:00 AM EST / 14:00 GMT. Event will last approximately 1 hour.
Listen to talks by:
- Samir Shah, Cincinnati Children's Hospital Medical Center & University of Cincinnati College of Medicine
- Lilliam Ambroggio, University of Colorado & Children’s Hospital Colorado
- Todd Florin, Lurie Children’s Hospital of Chicago & Northwestern University Feinberg School of Medicine
PIN MEMBER NEWS:
Congratulations to PIN member, FREO2 for becoming a top 12 finalist for the Macquarie 50th Anniversary Award (“the Award”), an $A50 million philanthropic commitment that seeks to initiate or support projects that address an area of unmet social need. The finalists, selected from close to 1,000 applications, have entered the final stage of a selection process that is expected to identify five non-profit organisations to receive approximately $A10 million each and mark Macquarie Group’s 50th anniversary of operations. Winners will be announced in August 2019!
Their project focuses on saving the lives of children with pneumonia in remote areas of Africa through the deployment of technology that affordably produces, stores and distributes medical grade oxygen without the need of electricity.