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The Role of Sample Collection and Management during the Covid-19 pandemic

By: John Bosco Kamugisha, Msc, Emergency Care Practitioner, Masaka Program Coordinator

My role during the pandemic was sample collection and management for Masaka Hospital’s Coronavirus Response Team. This includes collection, packing, refrigeration, recording, and transporting samples.

In the beginning people feared to take samples, so I boldly accepted to be trained to do sample management. My two colleagues and I trained other regions on how to do sample management which helped to increase human resource capabilities, and reduce the staffing gaps in management of Covid-19. Being on the frontline as a sample manager, I used to pick follow up samples from the Covid-19 Treatment Unit which was a tough task in the beginning because no one wanted to be exposed. In the middle we faced a lot of stigma arising from colleagues who didn’t want us to be close to them.

The worst stigma was when I went to the market to buy food and the vendor said “you work in corona so I can’t touch your money” It affected me so much but later I improved. Even our colleagues used to call us Covid-19 and this increased stigma outside work place.

My role as a sample management officer is key in that I can collect appropriate sample and send it in time for early diagnosis then I follow up on contacts if one person turns positive. Contact tracing helps to reduce the transmission of the virus. Sample management is also key in that if results are positive or negative it helps to isolate those who are suspected to have the virus.

Life has changed since the President started to uplift the lock down. Many shops are open, markets stores, schools, and other institutions. People used to follow the guidelines but as time went on and no one was dying most Ugandans are no longer following guidelines.

Many people no longer put on masks, any soap or sanitizer at the work place. Many people believe that Covid-19 is a ‘hoax” and is being politicized. The campaigns for elections have made things worse because no one is now following any guidelines. We anticipate that there might be an influx of cases after elections.

Let’s stay safe, sanitize, wash our hands, wear masks correctly, and protect our families.

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Working as an ECP during COVID-19

By: Kansiime Glorious

Kansiime Glorious is an Emergency Care Provider working in a low-resource setting, hospital in Masaka, Uganda who is very passionate about her work.

How was your role critical in Uganda’s coronavirus response?
Being an Emergency Care Provider has taught me to attend to the pandemic as a community emergency. I started by orienting the fellow hospital staff about the proper use of personal protective equipment, hand hygiene, and the proper triaging of patients at the hospital gate, emergency department, and the outpatient department. Due to our capability shown in daily patient care, I was transferred, along with other ECPs, to the Covid-19 treatment unit by the hospital director as they expected very sick Covid-19 patients.

How has your role as an ECP changed since the pandemic began?
As the pandemic has gone viral in the community, very sick patients present to the emergency department. By applying the knowledge and skills of approaching very sick patients, we have improved patient care because not every patient with Covid-19-like symptoms has specifically Covid-19, and there is a likelihood of other respiratory infections.

How have things changed as the pandemic has evolved and the country has opened back up?
Being a regional referral hospital, the government provides personal protective equipment. Intensive care facilities are being put in place with equipment needed as the backup and continuous emphasis on maintaining standard operating procedures in daily work by the health sector. The country’s economy has suffered as many businesses, schools, and others that involve gatherings are still under lockdown. 

Glorious working in the Covid-19 Triage Unit at the hospital gate
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Working as an Emergency Care Practitioner

By: Teddy Kiire

“Big ideas come from forward thinking people and challenge the norm, think outside the box and invent the world they see inside than submitting to the limitations of current dilemmas”. – T.D Jakes

Teddy Kiire is my name. I’ve been working as an Emergency Care Practitioner for the past 10 years with Global Emergency Care, and that’s where my story started.

Years ago, I had no idea what it would feel like to be an ECP, but here I am to share with you what it feels like. It’s now my passion and I am very happy, and at the same time satisfied with my career choice. I encourage people to undertake emergency medicine because it comes with personal satisfaction of knowing one’s work directly to engage with patients.

WHY IS EMERGENCY MEDICINE A GREAT CAREER TO ME AS AN ECP

As an ECP, I initiate care for patients with urgent, higher acuity illness, traumas, and injuries to provide acute resuscitation and stabilization of patients with life threatening emergencies. To love this career, one must understand how to recognize and quickly manage complex patient needs. For the time I have practiced as an ECP, I have mastered the skills of multi-tasking, prioritization, and working with a care team.

The main summary reason That I love being an ECP is that it is both challenging and personally rewarding. You directly and quickly see the benefits and positive results of your diagnosis and treatment of patients with emergent conditions. You will have that satisfaction of knowing you have a big positive differences in patients’ lives and wellbeing. This aspect is what makes emergency medicine so interesting and stimulating.

Throughout my practice, Emergency medicine encompasses a nice mix of diagnostic medicine and performing diagnostic and therapeutic procedures like bedside ultrasound, incision and drainage, paracentesis etc.

CHALLENGES

The fact that emergency medicine is quite a new course here in Uganda is a challenge. There is still a lot to be done, but we can’t stop being positive.

So, I personally love the challenges that come with adopting to the ECP roles. Today’s challenge, as an ECP, is to be able to work in a very stressful environment with high volume of patients and limited resources.

It’s amazing how the ECP role has advanced since 2008. I am grateful for the advocacy that Global Emergency Care has provided nationally within different states to clarify our roles and scope of practice, while not forgetting my fellow ECPs because ours is not a one day dream.

To sum it all, emergency medicine is a great career that the national health care system should adopt to it. We shall not stop until we get there, “The struggle continues”!

To support Teddy, the ECPs, and the struggle, please consider a donation to GEC today:

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Ultrasound in Resource-Limited Settings: A Case Based, Open Access Text

Faculty at UC Davis Health in collaboration with the California Digital Library (CDL) and Blaisdell Medical Library are pleased to announce the release of Ultrasound in Resource-Limited Settings: A Case Based, Open Access Text. This new online resource aims to provide an open access clinical resource for radiologists and clinicians who practice ultrasound in low and limited resourced healthcare settings. The project was conceived of and developed by two UC Davis Health physicians: Michael Schick and Rebecca Stein-Wexler, with help from Aida Nasirishargh as the online editor. Drs. Schick and Stein-Wexler have been teaching and using ultrasound for many years in some of the least resourced healthcare settings in the world. In these regions, most people have no access to diagnostic imaging.  Ultrasound is particularly positioned to help fill this gap as the most portable, inexpensive, and versatile form of diagnostic imaging. 

“While caring for patients and teaching ultrasound in the most low resourced health settings in the world, we routinely diagnose illnesses such as rheumatic heart disease and extra-pulmonary tuberculosis,” said Dr. Schick. “Many conditions we encounter are considered ‘neglected’ and rare in high income countries, but are becoming increasingly relevant with global travel, migration, and population displacement. When we tried to learn more about the ultrasound diagnostics of these diseases and find high quality images and videos for teaching our global trainees, we noticed a lack of available resources. Standard texts offer ample education about diseases that are common throughout the world. However, they fall short in building the expertise that is needed by those who practice in limited-resourced and tropical regions.”

The team’s goal was to create an up-to-date and useful resource for those who use ultrasound to take care of vulnerable patients around the globe. Drs. Schick and Stein-Wexler envisioned a text that was concise and clinically relevant, with high quality images and discussion that could be easily accessed, shared and downloaded in areas with limited internet bandwidth — a living text that would be translated into multiple languages and continue to grow as future impactful cases were identified and new techniques were discovered.

The project is a collaborative effort by health care practitioners worldwide who use point-of-care and comprehensive ultrasound. Each chapter is authored by experts with case-based knowledge of both ultrasound and the highlighted disease. The chapters are 100% case based and provide important insight into how experts practice medicine and apply ultrasound in the limited resourced healthcare setting. As you scroll through chapters, high quality videos (in bandwidth-efficient GIF format) play automatically, and full-resolution video files are available for download and sharing.

When Drs. Schick and Stein-Wexler consulted with Blaisdell Medical Library about publishing options for this unique work, health sciences librarian Amy Studer saw the opportunity to connect them with CDL to investigate the possibility of hosting their work on an open access publishing platform. “This publication, by virtue of its intended audience and goals, is particularly concerned with issues of accessibility and discoverability, and CDL’s eScholarship Publishing program shares that commitment. We regard this publication as an important step forward in redesigning medical publications for the specific needs of users in the field,” says Studer.

Because of the large number of videos and images needed to illustrate the concepts in the text, CDL identified the Manifold platform as the best system for building and displaying the work. “Foundational to the Manifold platform is the ability to harness dynamic web content as an integral component of a publication, layering text and media alongside one another in an intuitive reader that encourages thoughtful engagement,” said Terence Smyre, Manifold Digital Projects Editor. “Manifold’s open-source, open-access ethos is also specifically aimed at the public good — values that align strongly with the goals of the project.”

This publication also represents the first project completed under the eScholarship Labs program at California Digital Library. “We launched the Scholarship Labs program in 2019 with the aim of fostering innovation in scholarly publishing by piloting new publishing technologies to support experimental forms of scholarship,” said Justin Gonder, Senior Product Manager, Publishing at CDL. “Manifold has now graduated from the Labs program and is available for use by any member of the University of California community who has a scholarly project in mind that requires deep integration of text and media.” For more information, visit the eScholarship Help Center.

In the coming months, Ultrasound in Resource-Limited Settings will be released in several different languages including Spanish and Farci, initially, with many others to follow. If you would like to contribute to additional translations of this resource, please contact the editors: mschick@ucdavis.edu and rsteinwexler@ucdavis.edu.

Ultrasound in Resource-Limited Settings: A Case Based, Open Access Text is available now at:
https://manifold.escholarship.org/projects/ultrasound-in-resource-limited-settings

Michael Schick DO, MA, DIMPH, FACEP
Associate Clinical Professor, Emergency Medicine
Director, International Ultrasound
Co-Director, Technology Enabled Active Learning
Director of Ultrasound, Global Emergency Care

Rebecca Stein-Wexler, M.D.
Professor of Radiology
Section Chief, Pediatric Radiology
Director, Global Radiology Education and Outreach
University of California, Davis Medical Center
and UC Davis Children’s Hospital

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Monthly Sustainers Week

The COVID-19 outbreak and the subsequent quarantine of communities has caused many challenges that have affected GEC’s bottom line. To combat this, we are doing two things:

  1. Celebrating our current Monthly Sustainers for their continued support
  2. Putting out a call for support to register at least 10 Monthly Sustainers per day at $10/ month for the week of Sept. 28th – Oct 4th.

Monthly Sustainers are our friends, colleagues, supporters, and donors who have decided to donate to GEC on a repeating basis, usually once a month. The donor picks the amount they want to give each period, and then the donation schedule is recorded in our system in order to complete the donation requests regularly.

​Why Become a Monthly Sustainer?

  • Mission Driven – Ensure GEC serves the communities where we work and continues to train more ECPs
  • Convenient – Guarantee uninterrupted GEC donor status with no renewal reminders. Your contribution will be automatically deducted, until you tell us to stop.
  • Cost Effective – More of your contribution goes to programming and lowers long-term fundraising costs, reducing administrative expenses.
  • Enduring – Spreading your support over time is easier on your budget while giving GEC the security of a steady, reliable stream of program support.

Our belief is that you will help us show strength through this time of adversity. By becoming a Monthly Sustainer, you will contribute a steady, reliable income to save lives in Uganda.

By joining, you will support our ongoing work and make giving easier.

In solidarity, Tom Neill

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Racism is a Public Health Crisis

The brutal murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and the countless others before them are a result of brutality that has been and still is perpetuated by a culture of white supremacy and racist violence towards Black people. These are not one-time incidents by rogue police officers or vigilantes, but rather the direct consequence of a structurally racist system that has treated Black lives as enemies.

The events of the past few weeks have caused us to reflect on ourselves as individuals, our privilege, our organization, our industry, and where we go from here. We acknowledge that racism is an ongoing public health crisis. It is a consequence of a structurally racist system that is failing people of color every day. This is readily apparent not only in the police brutality that disproportionately effects Black Americans, but also in the history of slavery and discrimination that can be seen today in many social determinants of health. While the COVID-19 pandemic has laid these inequities bare for all Americans to see, the underlying injustices have endured for generations.

As an organization, Global Emergency Care continues to be committed to strengthening the emergency care workforce capacity in Uganda and expanding the cadre of national clinical and research emergency medicine experts. We focus on local advocacy, and leveraging our privilege to amplify the Ugandan voice. Our vision is to be a part of building an emergency care system that is designed, implemented, and led by Ugandans for Ugandans. 

We continue to be committed to demonstrate reciprocity to support the work of the leading Ugandan institutions in the quest to build a sustainable emergency care system. We strive to be a catalyst to reduce the unequal power dynamics between the global north and south by trying to build capacity, lead from behind, and do our best to listen and learn. Moving forward, we commit to inclusivity and to be enablers of our Ugandan colleagues in capacity development, academic research, and advocacy. 

We work in Uganda where our staff on the ground is 100% Ugandan, but as global health practitioners, we recognize the enduring legacy of colonialism and structural racism in global health. We acknowledge the unequal power dynamics: racism, classism, and many of the residual exploitations of a terrible colonial past, while at the same time must commit to not engage in a neocolonial narrative. Today, we continue to commit to do our part to decolonize global health.

As Seye Ambimbola eloquently put it, “We can begin to truly decolonize global health by being aware of what we do not know, that people understand their own lives better than we could ever do, that they and only they can truly improve their own circumstances and that those of us who work in global health are only, at best, enablers.”

We have much work to do. In particular, those of us who are white must continually reckon with our privilege and take actions to enact a power shift. We need to have hard conversations, challenge our assumptions, cultivate empathy, and actively pursue an anti-racist, anti-colonialist agenda. 

We do not yet have the answers of how we will implement these changes, but we are committed to this work and will keep all of you – our friends, families, supporters, and partners – updated as we do the necessary work. Thank you for fighting for a more equitable world with us.

In humility, commitment, and solidarity,

Mark Bisanzo, MD, DTM&H, FACEP 
President of the Board of Directors

Heather Hammerstedt, MD, MPH, FACEP
Board of Directors

Stacey Chamberlain, MD, MPH
Board of Directors

Bradley Dreifuss, MD
Board of Directors

Tom Neill, MPH, MBA
Executive Director

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Fighting COVID-19 in the US and Uganda

The COVID-19 Treatment Team at Masaka Hospital

Patient volume in the ED – Fear of contracting COVID-19

In the US, Emergency Department (ED) patient volumes have been 40-50% lower than normal over the last month at University of Maryland Medical Center. Decreased travel and recreation have greatly reduced the number of injuries. Moreover, fear of contracting Coronavirus at the ED or hospital is also impacting patients seeking care even when they are ill. 

In Uganda, Emergency Care Practitioners (ECPs) working on the front lines of the COVID-19 response in Uganda are seeing a similar decrease in ED patient volume, but the patients coming to the ED are much sicker. Part of the Ugandan government’s COVID-19 response has been to restrict public transportation, especially by boda boda, motorcycle taxis that are prolific across Uganda, in an effort to decrease virus transmissions. Decreased traffic has reduced injuries from road traffic accidents seen in the ED, but there is concern seeing more patients presenting with injuries sustained in episodes of interpersonal violence, especially within the home. Similar to the US, our ECPs are worried about violence with families quarantining at home in a time of increased stress.

Furthermore, economic concerns stemming from the COVID-19 shutdown have increased poverty, further limiting patients’ resources for seeking healthcare. Charles: “Patients are not afraid to come to ED because of COVID-19, simply because we haven’t got any COVID-19 cases in western Uganda, but they are not coming simply because of the measures put in place by the government to stop the spread of the virus.”

Providing care during COVID-19 and effects on the quality of care

In the US, social distancing is an effort to “flatten the curve” and ensure that the healthcare system does not become overwhelmed. However, working in the ED in the US and following medical pieces in the popular literature, it is clear that COVID-19 is impacting care in many smaller ways like: provider concerns about contracting the virus through patient contacts; limited personal protective equipment leading to decreased face to face patient contacts; and delays related to COVID-19  testing and canceled non-essential appointments or surgeries.

In Uganda, the healthcare system is facing the same challenges compounded by baseline resource constraints. Charles Ndyamwijuka, GEC’s Operations Manager, expresses the concerns of those working on the front lines of the response Uganda, “with the department grappling with limited PPE and no testing, there is fear that ED staff is at risk of contracting COVID-19 since they are the face of the hospital.”

Benifer Niwagaba, an Emergency Care Practitioner based at Nyakibale Hospital said, “people are no longer working and businesses are closed. There is not enough money to care for their families and they can’t make it to hospital with no money. A few weeks back I treated a patient with a diabetic emergency who had spent two days in a low resource facility where they couldn’t diagnosis his condition due to lack of funds and transport.”

Charles adds, “now, many patients that come to the ED are very sick which is challenging for the ED staff. Patients are going to the nearest clinic, or self-medicating, because of both limited transport and limited financial resources to come to ED. In the era of COVID-19, patients exhaust all the other options and the ED becomes the last resort.”

Testing

In the US, limited testing, as well as concerns about test accuracy, has been a challenge in addressing the pandemic. In rural Uganda, our teams are providing care with virtually no access to testing, leading to concerns that they will not be able to identify patients with COVID-19 to provide high quality care, but also to keep themselves and other patients safe from the disease. The government is providing testing; however, it is offered at a site near the capital (Entebbe) hours from where GEC works. Confirmed cases are being cared for by the government referral hospitals so the ECPs are working hard to identify cases through symptoms. Still without testing the fear of missing cases is significant since the symptoms of COVID-19 are vague and can mimic many other diseases.

Protecting our families

Front line healthcare workers everywhere are concerned about bringing COVID-19  home to their families and are taking every precaution to reduce the risk to their loved ones. Our colleagues in Uganda are no different in their concerns: “I am staying somewhere else away from family, but even though I stay away from my family I know that everyone is a potential victim” (Charles). For those who are still living with their families the situation can be more difficult since they dispose of masks and wash their hands at the hospital, but go home in uniform. Changes of clothes and opportunities to do laundry are also more limited.

Overall, the COVID-19 pandemic is showing similarities around the globe. From health systems with many resources to those that are under-resourced, the commonalities bring us all closer together. Uganda has done an excellent job in its surveillance, contact tracing, and isolation leading to relatively few number of cases to date. Whereas, the US response has shown a clear lack of coordination, planning, and a fragmented execution. Unfortunately, front line health workers everywhere are putting their lives and sometimes their families’ lives on the line, to fight this global pandemic. We salute to courage and bravery of all front line health workers risking their lives to protect all of us.

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True Stories of Mothers Fighting COVID-19

As we appreciate and give thanks to our mothers around the globe, I want to take this opportunity to highlight some of the extraordinary mothers working on the front lines of this pandemic.

Life has been turned upside down for the mothers working in hospitals overwhelmed by COVID-19 patients. The days of coming home to hugs and kisses from their children are gone. In its place, is a strict regimen of changing clothes, sterilizing everything, and fearful hugs with the constant, nagging fear of infecting loved ones.

Fear for our families

Heather Hammerstedt, emergency physician and GEC co-founder working night shifts in an emergency department, said her worry is constant. 

“When I get home, I change and everything goes directly into the laundry and I shower again. Only then do I risk spending time with my children, but always in fear of getting them sick. I worry about myself getting sick and dying; about my husband getting sick from me and dying; about the effect of my stress on my children; about their education during this time.”

Our colleagues in Uganda echoed this sentiment. Elizabeth is an ECP working in the emergency department in Masaka. She has not received hospital-provided scrubs said worries constantly about getting her children sick.

“After work I make sure I disinfect my shoes, wash hands very well, remove clothes for laundry after reaching home. I do this in order to avoid putting my kids at risk.”

Stigma from the community

Another ECP, Teddy, says she has sent her son to stay with his grandma. Between the stigmatizing from the community, and her fears for his health, she felt it was the best thing for him.

“As a result of the pandemic we’re facing long shifts, since most staff are not willing to take care of positive COVID-19 patients due to the fear and the stigma in communities. It was difficult before because I didn’t know how to go about it too, I was scared of going back to meet my family and sometimes I would get home exhausted, worried, and emotionally drained due to the long hours. I would come home late in the night just to avoid anybody home seeing me because my neighbors had started isolating me and my family. Until I decided to send my son to my mom’s place because I was certain that he will be safe and happy. Currently, I have to keep self-isolated so that my family stays safe. I miss my son — he used to welcome me home with hugs, and realized I can’t stop him from hugging me.”

Despite these challenges, Teddy maintains an incredibly positive and fighting attitude.

“I’m glad I have the courage to treat positive patients because at first everyone was scared but I stood brave to join the team. I’m glad our patients are doing better and we will be discharging our first patient soon.”

Economic fears

While Elizabeth also worries most about the health of her family, she worries about her families’ finances as well. Supplies are much more difficult to come by.

“Its’ not easy managing family and work during this pandemic, first of all it’s expensive, and we sometimes run out of sanitizer and other supplies.”

But she concluded her remarks, as any mother would:

“But still we have to fight the battle, and together we shall win.”

Please Consider a Gift Today to GEC’s COVID-19 Emergency Action Fund

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LAUNCHING THE CONTINUING EDUCATION & LEADERSHIP PROGRAM

Emergency Medicine is a vast field, encompassing a knowledge base of essentially every other discipline in medicine and a wide array of procedural skills; practitioners need to constantly stay up to date. This can be a daunting task and one that requires significant support to be achievable.

To support our graduates after they finish their two-year Emergency Care Practitioner training, we are launching the Continuing Education & Leadership (exCEL) Program. The exCEL Program will provide graduates with continuing medical education opportunities to review higher level content, learn new skills, and receive additional mentorship after they graduate. Furthermore, it will enable ECPs to attend regional retreats and larger scale conferences, take emergency care training courses, and access online resources. Once back at their home hospitals, we’re working to set up visits to work with administration on integrating emergency care into their facilities and regular phone calls to support ECPs in their new environment.The need for continuing medical education

In the US, continuing medical education (CME) is required in every field of medicine in order to provide the highest possible level of patient care. Innovations impact how patients should be assessed, treated, and cared for. As a result, medical professionals have to continue their education and stay on top of these changes. Only by doing so can they confidently provide patients with the level of care they deserve. And while continuing medical education is ubiquitous in the US, no such infrastructure exists for emergency care practitioners in Uganda.

As GEC enters our 11th year training Emergency Care Providers, we’re concentrating on CME to achieve sustainability and maintain the excellent outcomes for patients cared for by the ECPs. We’re defining CME in the broadest terms possible—striving not to just maintain skills, but to continually build new skills as the practice of emergency medicine in Africa evolves. This will take creativity on our part, as the continuing education infrastructure for emergency medicine in Africa is in its most nascent stages.

Supporting our ECPs beyond the program

Since 2010, we’ve been funding ECPs to attend regional conferences. These conferences, while a high cost for us as an organization, are invaluable to trainees. ECPs use conferences to present GEC’s work and make connections with providers in other countries and benefit from the high-level continuing education offered at each conference.

Furthermore, ECPs serve as ambassadors of the ECP model, and the concept of non-physician emergency care providers is now recognized as a critical and successful component of emergency medicine development in Africa.

 

  “AFCEM inspired me to return home and continue moving emergency care forward in Uganda. It was very impactful to have our work, as ECPs in Uganda, acknowledged by important speakers from other African countries and to hear that, because of our success, similar programs are being started in other countries.”
—Kizza Hilary, GEC’s Nyakibale Program Coordinator & ECP
 

While these conferences are valuable, they’re relatively infrequent. Thus, we deploy emergency medicine volunteers to provide CME opportunities for ECPs to review higher level content, teach new skills, and provide additional mentorship. This has been a highly successful part of our approach, but is insufficient as a stand alone method of continuing education, especially since the ECPs face challenges in their practice that are unimaginable to most doctors practicing in high income countries.

​East African conferences on emergency medicine are being organized, large international organizations, such as the World Health Organization are offering training courses in aspects of emergency care, and more online resources are becoming available for ECPs.

All of this continuing medical education comes with a cost

Our extensive volunteer network continually enhances the education we offer our trainees, we want to emphasize how critical it is for us to be able to offer them additional resources to further their education and training.

The educational experiences we are providing the ECPs as they graduate and enter practice are building on the solid foundation we build over their two years of training.

Please support ECPs to walk the path of lifelong learning and provide truly amazing care to those vulnerable patients they care for every day by donating to GEC. Together, we can continue to make lifesaving emergency medical care available to all Ugandans.​

 

 

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ULTRASOUND CHRONICLES: GLOBAL POCUS IN UGANDA WITH GEC

“I realized that by spending a few extra minutes evaluating this patient with bedside ultrasound, Alfunsi may have saved this man’s arm.”

By Dr. Leigha Winters, GEC Volunteer

Reposted with permission from SONOSTUFF: Education and entertainment for the ultrasound enthusiast

​Having traveled and worked in under-resourced settings before, I thought I had some idea of the type of clinical situations I would be encountering while teaching in Masaka, Uganda with Global Emergency Care (GEC). However, during my three weeks at the Masaka Regional Referral Hospital, I was continually amazed by the breadth and acuity of conditions seen by the medical officers (MO’s) and Emergency Care Practitioners (ECPs) in the Accident & Emergency (A&E) department. They managed some of the sickest patients I have ever seen with foley catheters for chest tubes, only four oxygen wall regulators, one intermittently functioning defibrillator, and minimal IV medications. It was exciting to watch the ECPs utilize clinical and ultrasound knowledge acquired through their diploma program to direct and improve patient care.

Take, for example, the 20-year-old man who presented with proximal right forearm swelling. He had been stabbed in his forearm, just below the elbow, at the beginning of January (over two months ago). He had presented to the hospital immediately after the injury, and had the wound closed with stitches at that time. Sometime in the next two months, he started to notice right forearm swelling and pain. He had no fevers, and there was no obvious infection around the original wound. The swelling bothered him enough in late March for him to present for medical attention. The first medical officer to evaluate him was concerned that he had an abscess under his skin, so sent the patient to the A&E for them to cut open his forearm.

When first evaluated by one of the senior ECP graduates named Alfunsi, he recognized that something wasn’t right about this story. Alfunsi elected to put his ultrasound skills to use.

Picture

Upon placing the ultrasound probe on the patient’s forearm, he immediately realized this was not an abscess; the fluid collection didn’t look right. When color flow was placed on the large, round fluid collection, the fluid was pulsing! This was, in fact, either a pseudoaneurysm or aneurysm of the radial artery with a fistula between the cephalic vein and radial artery. In essence, the knife wound in January had poked a hole in the artery in the patient’s upper forearm and connected the artery to the nearby vein. Every time the artery pulsed, it had been pushing blood into the vein and the surrounding soft tissue. These ultrasound findings were reinforced by the fact that the patient had only a very faint pulse at his wrist near his right thumb (the distal radial artery), but a very strong pulse in his left wrist. If Alfunsi had cut open this wound, it would have bled all over the room, and the patient could even have lost his arm. Instead of antibiotics or cutting open the swelling with a scalpel, this patient needed a vascular surgeon to repair the artery and vein.

Alfunsi and the other ECPs took the initiative to call over the intern physician to explain the case. After reviewing the ultrasound findings with the ECPs, the intern agreed with them; this patient needed to be referred to a vascular surgeon. Since there are no vascular surgeons in Masaka (the hospital, in fact, does not even have a CT scanner, let alone sub-specialists), the patient was referred to a surgeon in Kampala. I realized that by spending a few extra minutes evaluating this patient with bedside ultrasound, Alfunsi may have saved this man’s arm.

This was one of many cases I witnessed in the Masaka A&E where ECP clinical knowledge and ultrasound skill greatly improved patient care and outcomes. It is incredibly powerful and fulfilling to watch expertise you have shared with ECP learners be directly translated into clinical care. In my experience, this information-exchange is the most impactful in incredibly under-resourced locations like Masaka, Uganda. Even small changes in knowledge base or imaging availability (i.e. having a bedside ultrasound available in the A&E for ECPs to use) has a huge impact on patient care, community health and system-wide practice. I am so grateful to the staff at the Masaka Regional Referral Hospital for sharing their enthusiasm and ingenuity with me during my time in Masaka, and so excited about the work that GEC is doing to help empower the medical community in Uganda.

Ultrasound Machine Fundraiser for GEC – 100% Match
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines. Can you help save lives with a contribution towards these new ultrasound machines?

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