I am so grateful to have had the opportunity to join the PURE Team here in Rwanda and thank the Center of Expertise in Global and Humanitarian Health for making it happen. PURE stands for Point-of -Care Ultrasound in Resource limited Environments and was created by a rock star former Harvard Emergency Medicine resident Dr. Henwood. When Dr. Henwood gave a presentation on the impact of Ultrasound in resource limited settings her senior year, I knew that I wanted to not only perfect my ultrasound skills, but to also provide a useful skill to the practitioner abroad who sometimes may feel helpless when CT or Xray is not readily available.
I survived a long trip to Kigali, Rwanda. The view from the plane was amazing. The landscape reminded me of my days as a child living in Swaziland. I was picked up from the airport by one of the team members and given a short tour of the city before going home and crashing. The people were wonderful and I even learnt a few greetings in the local language.
Day 2 We packed up the rental car to go to a district hospital about 2.5 hours away to give a training on Cardiac ultrasounds, FAST, and DVT ultrasound. We drove up a windy road on a mountain ( mountains are very common here) where my heart literally wanted to jump out of my chest. The view was amazing.
Okay finally work!! We arrived at the University teaching hospital of Kigali at 8 am. Our work is performed in the emergency and accident ward mostly, but other internal medicine, surgical and pediatric wards have requested to have scanning sessions for their residents.
This day was busy, but apparently it gets more busy than this. We had a number of scans in the morning. For example, we performed an ultrasound on pt who had known cardiomyopathy who presented to the hospital with shortness of breath.
We also had a trauma come in from the scene with GCS of 3. One of the stellar training Emergency residents, ran the trauma. A-B-C's initiated. Pt airway was secured with ETT, He had a flail chest and decreased Breath sounds on the right and had a chest tube placed, and he was hypotensive and bradycardic. His Pelvis was unstable. The Emergency resident immediately called out for the US. This was not typical in the past as part of the initial trauma evaluation, but the residents who are so excited about ultrasound have been incorporating it in most trauma pt's. The FAST was positive excellent...now lets go to the OR?? or not...pt pressures were still in the 60s even with resuscitation. Blood was not readily available. Typically this would result in immediate OR intervention in the US, but the team felt that his head injury was too severe, and his quality of life would have been poor...watching resuscitation efforts/interventions stopped in this pt was a bit unsettling.
Until next time...
~Phindile Erika Chowa,MD
Emergency Medicine Resident, BWH/MGH