EMPOWERING LOCAL STAFF
The feasibility study was successful and Nadimpalli returned to Aweil earlier this year for the second stage of implementation. “Now we are going back to basics: basic ultrasound skills, basic obstetrics, basic trauma, abscesses, and, for those with advanced skills, basic cardiac ultrasound,” said Mayronne. POCUS can help sharpen the diagnosis of basic trauma injuries too.
“The POCUS initiative is specifically focused on increasing clinicians’ ability to make bedside diagnoses,” said Mayronne. “We want to empower our local staff.” Four South Sudanese midwives will also receive training. Previously, ultrasounds were performed by the hospital’s ob-gyn or the midwife supervisor, positions typically held by international staff. “Now, South Sudanese midwives will also be able to utilize POCUS—a huge asset in a hospital that delivers 400 babies per month,” said Mayronne.
Continuing education will be an important component to the success of POCUS. “As we train our staff, we want to make sure they continue to develop their skills and that they are properly updated on new protocols,” said Nadimpalli. “We are promoting key people in each project who can be ultrasound leaders.” The project will also use telemedicine to stay connected with the team in South Sudan, help develop skills, and rapidly identify any deficiencies that may require additional training.
The use of POCUS in Aweil is already having an impact. “One of our maternity patients was admitted with shortness of breath,” said Nadimpalli. “We needed to send her ultrasound to telemedicine, where a cardiologist diagnosed her with mitral stenosis.” Mitral stenosis, a heart disease that is incredibly dangerous for women, has a mortality rate of 50 to 60 percent. That rate increases with each pregnancy.
After discussion with MSF obstetric and anesthesiology referents in Paris, it was determined that the patient should have a Caesarean section and a tubal ligation for permanent contraception. However, this was only her second pregnancy, and not being able to have more children is a difficult decision in South Sudan, where large families are the norm. “Because of the ultrasound, we could confidently discuss with the patient, her husband, and her father the need for surgery and contraception—explaining that she may not survive another pregnancy,” said Nadimpalli. “In this instance, the use of ultrasound was truly lifesaving.”
Based on the experiences and lessons learned in South Sudan, MSF hopes to rapidly expand the technology and training to other projects around the world.