January in Uganda

January saw the successful wrap-up of Phase 1 of the PURE/MGH point-of-care ultrasound project in southwestern Uganda at Mbarara University of Science and Technology (MUST). Project trainers included Drs. Adeline Boatin, Lisa Bebell, Trish Henwood, Vicki Noble, Katie O’Brien, Derek Harborne, Brooke Hensley, Nicola Baker and Julius Mugisha.

Prior to project kick-off in September 2014, a PURE-led needs assessment in early 2014 demonstrated that clinicians from the Obstetrics-Gynecology and Emergency wards could benefit most from immediate training and access to point-of-care ultrasound. To that end, clinicians were elected by local leadership from the surgical, medicine, pediatrics and ob-gyn departments. Clinicians learned to utilize bedside ultrasound to identify a variety of potential life-threatening conditions such as tubal pregnancies, high risk pregnancies, trauma injuries such as bleeding in the chest and abdomen, advanced heart failure, fluid in the lungs, abdomen and hearts of AIDS patients, and blood clots, to name a few.

Supervised practice makes perfect, so trainees then received ongoing 1:1 bedside scanning practice with expert PURE/MGH trainers every 6 weeks for the duration of the project. Input from trainers and structured assessments of skill retention – also done every 6 weeks-showed that our 18 clinician trainees are amazing! Despite tremendous clinical work loads, their ongoing commitment and enthusiasm to point of care ultrasound was inspiring!

They share stories already of patient lives saved because they used their new POC ultrasound skills. ‘Joseph’ is a 24 year old male with shortness of breath after a fall from a motorcycle. He came to the hospital critically ill. Clinicians were extremely concerned about his breathing status and, in particular, for perforated lungs. Time was of the essence and x-ray unavailable. Bedside ultrasound showed that both lungs were collapsed, a life threatening condition. A tube was placed in each lung and the patient survived and discharged home smiling one week later.

Another patient, ‘Peter’, is 38 years old with AIDS. He was admitted to the medicine team also unstable and unable to breathe well, the reason for which was unknown. The patient did not improve with typical management. A bedside ultrasound was done because the clinicians were perplexed. This ultrasound showed an enormous amount of fluid surrounding the patient’s heart: a life threatening condition for this patient. Because of this ultrasound finding the patient underwent removal of the fluid and survived. These are just two of the success stories rapidly accumulating since the PURE/MGH trainings began 6 months ago!

At the completion of the phase 1 course, along with enormous smiles and hugs from our new colleagues and trainee friends at MUST, 2 questions were repeatedly asked: “When are you coming back? And when can we learn even more?”

With the financial assistance from gracious donors world-wide we hope to return to MUST throughout 2015 and not only continue current training efforts with our initial group of clinicians, but also expand efforts to include more extensive ultrasound-in-trauma training and obstetric training, and a train-the-trainers course for our sono-stars of course!

An enormous thank you to everyone who made this initial effort a huge success AND to those who may contribute in the near future!