Tuesday, April 5, 2016

Emergency Medicine Bedside Ultrasound Training CHUK hospital in Kigali, Rwanda Part II

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

For the second half of my rotation in Rwanda, I have continued working with the emergency medicine residents in the ED with a focus on ultrasound education.  I have Rwandan EM residents scanning with me 8 hours a day, though we are frequently interrupted to help out with coding patients.  There are many people who die at CHUK hospital each day due to lack of resources that we have ready access to in the United States.

Outside of the ED at CHUK
Chronic dialysis is not an option, and we regularly watch patients die from hyperkalemia or fluid overload in the setting of renal failure.  Many patients come in with spinal cord injuries from trauma or motor vehicle accidents, and we often do not have enough cervical collars to use for these patients. There is only one suction machine to share around the ED, so many patients die from blocked endotracheal tubes. 

Despite these daunting problems, I have noticed significant progress in the 1.5 years since I was last working at CHUK. They now have ventilators and monitors in the ED, which is new.  In addition, the emergency medicine residency is new. While those who work at CHUK every day sometimes get frustrated and feel progress is too slow, being away for a while, the change is clear.

While many other resources are limited, the one thing that is consistently available in Rwanda- both at CHUK and in the district hospitals is bedside ultrasound.  Providing the knowledge and skill set to use this tool appropriately has value.
Scanning with one of the EM residents in Rwanda

The high volume of road traffic accidents makes the ultrasound training very important for the EM residents.  Patients have to be able to pay for a CT scan in order to receive one, and often the scan still takes a day or more to receive after it is paid for.  Using ultrasound at the bedside can aid in a much faster, and more affordable diagnosis.  Finding signs of internal bleeding on an ultrasound can expedite a patient to the OR.

During our scan shifts, we have diagnosed ocular injuries, fractures, pleural effusions, pneumothoraxes, cholecystitis, pericardial tamponade, small bowel obstructions, TB and cancer.  Often ultrasound in developing worlds plays a huge role in cinching a more timely and accurate diagnosis.

As I wrap up my time here, I must say I found it to be a valuable experience.  While it is difficult to effect change in a short amount of time, I think having smaller goals is useful.  I am not necessarily going to get patients to come to the hospital earlier in their disease course, but I can arm physicians there with ultrasound skills to more accurately diagnosis them when they arrive looking for help.

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