ITW Pilot Success!!!
"Hope is like a road in the country; there was never a road, but when many people walk on it, the road comes into existence." -- Lin Yutang
We are very pleased to announce that ITW completed our pilot trip successfully. The ITW team (26 strong, 14 from traveling from the USA) endured weeks of long days in very rugged conditions with sporadic water and electricity, multiple delays and unexpected problems. Despite hardships, the team was successful in completing the short-term objectives of the two-part proof-of-concept implementation against the odds. Suffice it to say, the team members that participated developed a real world appreciation and understanding of the term "low-resource", and we learned much about how we can adapt the ITW model to function well with unpredictable resources and circumstances.
The ITW pilot project consists of an IRB approved (with ECUREI) two part research project. Phase I, the Image Quality Study, began with a train-the-trainer session on the first day, led by Gail Rouillard. Data was acquired for Repeatability and Reproducibility analysis designed to show that the ITW protocols can be used reliably to produce scans of diagnostic quality. This study has already been performed in Belize and Vermont by ITW, but we repeated the study to show that it can be done in a very low-resource environment. We completed Phase I of the study only one day late which was amazing given all of the problems we encountered. The members of the team came together and worked extraordinarily hard under very difficult conditions. The results of this study will be published.
The Phase II part of the project was initiated, starting with the implementation of the ITW model at a low-resourced Health Center III in Nawanyago in the Kamuli District. This phase is designed to show observer agreement, comparing the results generated by a nurse midwife at Nawanyago and sent to the webserver for interpretation by ITW to the "gold standard" interpretation of the on-site ECUREI sonographer. The ITW team trained Sister Angela, a nurse/midwife at Nawanyago. She attended our ITW Foundational Training Course taught by Frank Miele and Cheryl Vance, learning knobology, basic computer skills, ultrasound ethics, basic physics and elementary anatomy. It did not take her long to learn how to generate images using the ITW protocols. She also was a quick study picking up the process for outcomes data collection workflow process. She was a very dedicated student, and her aptitude matched her passion to learn. Over the next six months, ITW will be collecting data to analyze to show the efficacy of the ITW model.
One of the most seemingly insurmountable challenges of the trip was an unanticipated internet connectivity problem at Nawanyago. The ITW Uganda team had tested the site for connectivity prior to our arrival, but when we arrived to begin set-up, we realized that the network connection had very slow upload speeds for data. After purchasing multiple modems and erecting an antenna on top of a large pole (tree trunk - see picture) there was still suboptimal signal stability. Frank Miele bought and carried a cell booster from the USA and once installed, this solved the problem.
Early on in the pilot, two medical students were invited to observe and assist in a c-section for obstructed labor at Kamuli Mission Hospital. The mother-to-be had been in labor for four days, and by the time she was brought to the hospital, she was too weak for a c-section, and she died. Hearing the students relay the details made everything that we were doing seem worth it - our ITW model could have saved her - we doubled our ambition to be successful and our troubles were diminished in relation to the reality of life there.
Since returning to the US we've experienced glitches with cineloop transmission, but as of Tuesday this week, images have been coming through regularly. The transmission problems were related to myriad problems including a network outage the affected all of Uganda.
We are so proud and appreciate and admire the teamwork and dedication of all of our volunteers (those who came to Uganda as well as those who stayed) that contributed so valiantly to the success of this trip. There are too many people to thank individually in this summary, but each of you have provided critical pieces in this massive and ambitious project - realization of the vision of ITW has begun! Congratulations to all of you!
--Andrea, Kristen and Brian