I have just returned to Vermont from Uganda – I was there as part of a team implementing an ultrasound project through Imaging the World (ITW), an organization that I helped to found. ITW has developed a medical outreach model designed to provide low-cost ultrasound machines to the most under-resourced areas of the world. As part of the model, nurse mid-wives in village health centers are taught to generate ultrasound images just based on the surface anatomy of a patient, by moving the ultrasound wand (transducer) from point A to point B and saving all of the information in between as a short video-clip, or cine loop. These video-clips are compressed to the size of a photo using special software loaded on a regular laptop computer and then are sent via a cell phone modem over the internet to a secure web server.
Ultrasound experts, both through the ITW network and in the country where we are locating the inexpensive ultrasound machines, can look at the basic ultrasound images and send an interpretation back to the nurse midwife in the field clinic using a text message on her cell phone. This short message on her cell phone helps her know how to triage the patient, and there is a longer report stored with the images on the web and available through an email link.
As a result of our visit, ultrasound images are being sent from Nawanyago, a small remote village in Uganda to the web, and the images are being seen from anywhere in the world that there is web access: Burlington, Vermont, Washington D.C., Vancouver, Belize, the U.K., China, and Kampala (the capitol of Uganda)!
The greatest utility for the ITW model in under-resourced areas is in maternal-fetal healthcare. In the part of Uganda where we have started this project, one out of every 20 women dies in childbirth. These deaths often result from complications that can be prevented by early diagnosis using ultrasound. For example, using ultrasound, a pregnant woman may be told early enough in her pregnancy that the placenta is too low and that when she goes into labor, she needs to labor near a larger hospital where she can get definitive treatment like c-section, if necessary to save her life. Even in the few weeks since implementing the project in Uganda, we have already identified and counseled several pregnant women with potential complications.
In addition to using available, affordable technology, ITW is founded in education, collaboration, and quality assurance. The ITW model is set up to provide a quality of care for patients that is at least equal to that provided at most hospitals in the developed world. The program is constantly assessed for potential quality improvements. The ITW team works with in-country local ultrasound experts and healthcare infrastructure to ensure sustainability. Nurse midwives and sonographers are given the opportunity to advance professionally by using ITW on-line training modules and local Ugandan educational resources to either become sonographers or get advanced training. One sonographer from the district where we are currently working recently graduated from a six month advanced ultrasound training program that she attended on an ITW scholarship.
The sustainability mission of ITW is to “teach to fish”…once there are enough trained professionals in rural areas to not only perform but interpret the ultrasounds, ITW can take the turn-key model to the next place. Uganda will then own this model of improved health care. Because the images are still sent to the web, ITW ultrasound experts (including in Uganda), can be asked at any time to help interpret images for second opinions or if volumes become heavy.
ITW is working closely with the Ugandan government and Ministry of Health, as well as regional and local healthcare institutions in the country. The ITW team is non-exclusive, in that anyone who has a passion to help is invited to participate – we are collaborating with a variety of industry and academic partners around the world. ITW takes a multidisciplinary approach, with volunteer ultrasound experts representing all facets of medicine: diagnostic sonography, radiology, maternal fetal medicine, emergency medicine, family medicine, etc.
Many UVM Medical Center employees have volunteered their time to be involved in the ITW project. Translational research of new ITW ultrasound protocols is on-going under the supervision of the IRB at the University of Vermont, with the Departments of Radiology, Emergency Medicine, Surgery, and Women’s Health all participating. A multidisciplinary team from the UVM Medical Center Breast Care Center is working together to develop a breast cancer program for Uganda using the ITW breast diagnostic ultrasound protocol. The Department of Family Medicine is discussing a research plan to use this model to provide ultrasound accessibility at rural health clinics right here in Vermont. The ITW trauma ultrasound protocols have huge potential for disaster relief and “battlefield” ultrasound. Five medical students (four from Larner College of Medicine at UVM), one UVM/UVM Medical Center radiology resident and one UVM Medical Center sonographer were part of the ITW team on the latest trip to Uganda last month, participating in the ITW proof of concept.
If you would like more information or would like to participate, please visit the web site at http://imagingtheworld.org or contact Dr. Kristen DeStigter at 802-847-3592.
Kristen Destigter, MD, is Vice-Chair of the Department of Radiology at the UVM Medical Center and co-founder of Imaging the World.