Wednesday, March 30, 2016

Emergency Medicine Bedside Ultrasound Training CHUK hospital in Kigali, Rwanda



Kristin Dwyer, MD, MPH
Fellow in Emergency Ultrasound, BWH
PGY 6


 I am currently in Rwanda, where I have returned to work in the University Central Hospital of Kigali (CHUK) hospital. It is a public hospital in Kigali, and is an academic referral and teaching center. There are many other hospitals in town, including King Faisal (a more modern private hospital) and the military hospital.



CHUK Hospital, Front Entrance. Kigali, Rwanda

Emergency medicine (EM) is a new specialty here, and many general practitioners (GPs) continue to staff the emergency room due to inadequate number of fully trained EM specialists. However, some GPs, who have been practicing clinically for many years, have now entered the emergency medicine residency alongside new graduates.

I am working in the emergency department (ED), running the residency ultrasound rotation. So far, I have had two residents per day on the rotation. They each rotate for one month through ultrasound training. We join rounds in the morning, and identify patients who may benefit clinically from a bedside ultrasound.  We spend 8 hours a day ultrasounding patients in the emergency department and communicating all our findings through the patient chart, and directly to the clinical team.  We are fortunate in that our machines are functioning well, and we have adequate supplies of ultrasound gel. 


This week we had a woman who had been waiting for three days for a cat scan of her abdomen to look for appendicitis.  Cat scans are not performed here until families can pay upfront for the test, and even then it is not uncommon for it to take days to occur.  We were able to locate her appendix on bedside ultrasound and diagnose her with appendicitis at no cost. 

Bedside Ultrasound Teaching with Residents: CHUK
In addition, we have been able to diagnose many patients with tuberculosis using the FASH exam, and finding para-aortic lymph nodes in combination with micro-abscesses in the spleen and/or liver. 

We have also been working on ultrasound guided procedural skills, in particular peripheral ultrasound venous access. This week we came in and a patient with DKA, who was acidemic, hypokalemic and very ill appearing, had waited overnight all night with no interventions, treatments or medication because the overnight team had been unable to gain peripheral access. The residents were able to use bedside ultrasound to obtain a peripheral IV line and the patient ended up doing very well, and was discharged home 2 days later.

While there have been some IRB delays with the research project I am planning to help out with here, I have been able to do some advanced lung ultrasound training for those individuals who will be working on the project in preparation of IRB approval.


I look forward to the second half of my rotation where I will continue to do ultrasound training with a new group of residents, and I will be giving some lectures during department conference day. 



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