RFS Voices: Uganda

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I am overjoyed that I could participate in the recent Imaging the World trip to Uganda as a radiology resident and videographer.

Imaging the World introduces ultrasound technology to rural clinics in Uganda with innovative, simple protocols that allow providers at the point-of-care to complete studies and send them electronically to be peer-reviewed by an expert located in an urban center in real time. Prior to this adventure, I took ultrasound technology for granted and this trip emphasized its impact beyond simple medical diagnostics for both the rural population and the country as a whole.

thumb IMG 8783 1024Uganda is a landlocked nation with Sudan to the North, the Democratic Republic of the Congo to the West, Rwanda and Tanzania to the South and Kenya to the East. The capital city is Kampala; with over 2 million people, it is an urban center with both private and public hospitals. Although many people receive care in the cities, most of the population lives more rurally. On the day after we arrived we traveled to Nawanyago Province in Kamuli District, to visit our first clinic site. The health center here has four main buildings, one of which was just completed prior to our arrival. It is the main health center for the region, and is supported by the Catholic church. Every important project has its leader — Nawanyago’s is Sister Angela. She runs the clinic and not only understands the anatomy and technology of ultrasound as a sonographer, but is also a trusted member of the community working tirelessly for their benefit.

During my time here, Sister Angela was integral to my project, which was to create a teaching video of ultrasound basics. Sister Angela, who is both a midwife and a certified sonographer, not only helped coordinate filming, but she also edited the scripts to ensure they were in the proper local dialect. In order to make my video applicable to the local students I filmed during the busy days of ultrasound scanning at the clinic with permission from women coming for their care.

speaking with local women about stickers

In Uganda there is a high rate of teen pregnancy, which has serious consequences as girls cannot continue their education once they have a baby. The country also has a 5 percent rate of rheumatic heart disease. ITW focuses on these issues with several projects: the Ultrasound Lab, the Village Health Team (VHT) rheumatic heart disease project, and a “sticker project” which uses illustrated stickers to inform women about fetal/placental positioning.

The Ultrasound Lab is an education project spearheaded by Mary Streeter, ITW’s director of education and research, which gives American high school students the opportunity to present about ultrasound to local Ugandan peers, after which everyone can watch Sister Angela scan. This sounded simple, but I was completely astonished, when six high school and two college students from Burlington, Vermont stood in front of twenty Ugandan high school students and began to teach with confidence and clarity about the statistics of local teen pregnancy, the physiology of pregnancy, all forms of birth control methods, and the technology and use of ultrasound imaging during pregnancy, including its safety and efficacy.

thumb IMG 8781 1024Both groups were entirely engaged and after the presentation the local students asked insightful questions and discussed their own barriers to care, including the inability to afford birth control methods (many types are free through a grant to the local clinic now). I was struck by the richness of the information and interaction between the two peer groups coming from two starkly different cultures and countries. It is one of the most impressive and valuable interactions I have ever had the pleasure of witnessing and was the epitome of appropriate cultural exchange in an environment of mutual respect and understanding. I believe this will have a lasting impact on both sets of teenagers.

The Village Health Team (VHT) rheumatic heart disease (RHD) project is being spearheaded by two pediatric cardiologists, Dr. Andrea Beaton and Dr. Craig Sable from the Children’s National Medical Center in Washington D.C. as well as an incredible public health worker, Amy Scheel, who has been living in Uganda for the past two years. This is an NIH funded project, with ITW as a subcontractor, examining the prevalence of RHD in pregnant women as well as the impact of the disease on maternal mortality.

Currently, all women having a prenatal ultrasound examination at the clinic also receive an echocardiogram looking for signs of RHD. In order to address the cause of RHD at its root, Naiim Ali, MD, one of my co-residents, led a project working with local village health teams to educate the community about the disease, its treatment, and its consequences.

During our time in Nawanyago, Naiim met with about ten of the village health teams (VHT) and taught them about RHD, strep throat, and ultrasound. After his presentation, we headed into the community with two VHTs to speak with local women about their recent births and care at the center. Naiim asked each woman what she understood about strep throat and RHD, and the response was remarkable. The women had a solid understanding of the danger of a sore throat, the need for treatment with medications, and the risk of RHD associated with death in pregnancy. They each credited their VHT with their knowledge. Hopefully, as this information spreads, the rate of RHD may be lowered in these communities.

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The final project I want to highlight is the prenatal scan sticker program which creates a pictorial representation of fetal and placental positioning, spearheaded by the engaging psychiatrist, Magdalena Naylor, MD, and my artistically talented, focused, and remarkable co-resident Anjuli Cherukuri, MD. Anjuli’s drawings-turned-stickers are absolutely charming and help both parents understand the specific risk and need for follow up care in the clinic or hospital setting. Each sticker has an illustration of the fetus and placental position along with a symbol to indicate recommended follow up level of care. If there are multiple gestations, or a dangerous fetal presentation or placenta previa there is a symbol on the image to warn them and any healthcare providers they may encounter in the community.

The information was always verbally communicated to patients, but now with the stickers, they can better understand the information and have an easier time explaining it to others because it gives a tangible representation. It also was a wonderful way of engaging the fathers and when interviewed they were able to refer to the sticker to accurately describe fetal positioning. This unique form of communicating ultrasound findings and recommendations is a very simple way of saving the lives of many women and their children and would not be possible without the ultrasound program.

Imaging the World is a vibrant, dynamic program that addresses the needs of the communities it serves in a holistic manner. The simple utilization of ultrasound technology has a huge impact; literally saving lives, changing how the community perceives and interacts with local healthcare providers, attempting to lower the prevalence of RHD through community engagement and education, creating an inclusive environment for mothers and fathers, and helping better define the needs of the communities it serves. I hope to return to continue this valuable work and I am glad my first trip to Africa took me to beautiful Uganda with ITW.

By Lucy Lane, MD, resident at the University of Vermont

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