UVM Medical Student receives travel award.
Imaging the World is lucky to have had Tamar Goldberg, 2nd year UVM medical student as an obstetric protocol trainer on the latest trip to Uganda, where 4 new ITW clinics were launched. Here is some of her thoughts on the preparation for the trip and some insights on her arrival, meeting the Ugandan ITW team, and being a trainer for an ITW clinic rollout.
From Tamar: "Travel awards from UVM College of Medicine and ITW have enabled me to pursue this incredible opportunity. With their support, I am in a position to develop a better understanding of what is involved in implementing low cost sustainable models for health care. I see this Uganda experience as an opportunity to foster my professional development as a physician and as an individual committed to working with underserved populations. My involvement will allow me to expand my research and clinical experience and broaden my cultural awareness; it will give me the chance to join the team of UVM representatives already committed to an important healthcare initiative.
When trained sonographers capture ultrasound images, using their knowledge of internal anatomy and background in ultrasound image interpretation, they move the transducer around the region of the body being scanned until they see what they want to take a picture of, and then record. Imaging the World trains nurses and midwives from rural health clinics in an ITW Obstetric ultrasound protocol through which they learn to record ultrasound scans based solely on external landmarks of the pregnant mother. They are trained to record video clips of the fetus using 6 specific sweeps across the abdomen, without looking at the ultrasound image on the screen.
Images are compressed and emailed to ITW radiologists and sonographers in larger hospitals in Uganda and to the ITW staff in the U.S. who interpret the files, and within 2 hours, send an email response to the nurse with their diagnosis and interpretation of the scan, and recommendations for referral if necessary. Most importantly they will tell the nurse if it is safe for the mother to give birth at home, or if she needs to go to the hospital to deliver. The nurses will not scan all pregnant women everytime they come to the clinics. They routinely scan mothers in the first and fourth trimester and if there is an emergency. They will use their training as nurses and midwives to determine the value of an ultrasound image for each individual woman. The ITW scans should be performed if the mother presents with pain or bleeding and also to confirm the gestational age of the baby, the fetal position, the amount of amniotic fluid, the location of the placenta, suspected fetal demise, and that the embryo is developing in the uterus, not in the fallopian tubes.
Sister Angela at the Nawanyago clinic was trained last year and has been using the ITW protocol as a component of prenatal care since then. As a result, more mothers have been coming for prenatal visits, they are learning to keep more accurate medical records, the community has come to understand the importance of ultrasound and through education, there is less stigma associated with imaging and families are less fearful. Fathers are being encouraged to attend prenatal visits and are excited to be more involved in the pregnancy. The ITW scanning has allowed for detection of potential clinical complications like breech presentation, placenta previa (placenta is attached to the wall of the uterus, covering the cervix and obstructed birth), poly- and oligohydraminios (excess or deficiency in amniotic fluid) and multiple births.
By training locals and making ultrasound scanning more readily available in rural villages, ITW has created a sustainable model for not only improving mother and baby prenatal care, but for saving lives. Sister Angela is now a trainer for the program, and over time ITW will achieve their ultimate goal of, as Kristen calls it, “putting itself out of business.”
It is amazing what we are able to accomplish with such limited resources, minimal power, and simple training programs. Participating in the implementation of the program “in the field” and learning about health care here has been both educational and inspiring. People are so warm and friendly here, and eager to learn and partner with us as we work toward a common goal of improving global health. "