A friend of mine, William Cherniak – a family medicine resident in Canada at the University of Toronto- has been working on a project. Not just any project, but a global impact project with the help of KIHEFO (Kigezi Healthcare Foundation) and his own group that he created called TO-the World. What is this project, you ask? Well, it was to show how minimizing maternal to child transmission (MTCT) of HIV can be helped by simply having and letting the women know in the region that a portable ultrasound has arrived. This project will be presented at Global Health 2013
The project in brief: “In alignment with the WHO 2010 guidelines for MTCT elimination and the Ugandan government’s adoption of plan B+; KIHEFO, in collaboration with TO – the WORLD, designed a structured maternal health camp [sMHC] centered on providing expectant mothers in rural Uganda with a free obstetric ultrasound [OBU]. The four‐pronged approach of MTCT elimination was followed in the design of the sMHC. In one day, 45 women rotated through registration, pre‐test counseling, testing for HIV and Syphilis, family planning, obstetric ultrasound and, for the women identified as being high risk by triage, dental and/or medical services. Each woman received fansidar, multivitamins, folic acid and filled in a pre‐ designed questionnaire. In total, 10 women identified themselves as being HIV+ at registration, surprisingly only half were currently being treated with ARVs. An additional two women were diagnosed as being HIV+ during the health camp. All women received counseling and were started on ARVs for life. Only 7 women had ever previously had an OBU, and all 45 women verbally identified that the reason for attending the antenatal health camp was to receive a free OBU.” – Now that is just amazing. The power of what a portable ultrasound can have on a community in fighting MTCT of HIV. Bring the ultrasound, and they will come – that is your way to start the healthcare and assessment they need.
They continue to state how they hope to solve the problem of high maternal death and high infant death rates: ” Solving the Problem – Ultrasound and Outreach to Reduce Maternal Mortality. As stated above, the leading causes of maternal mortality include hemorrhage, eclampsia, obstructed labor, infections, and birth defects. Studies have shown that obstetric ultrasound imaging can prevent most outcomes by providing early diagnosis and intervention. By providing useful information such as whether or not the mother is carrying twins, has an ectopic pregnancy or otherwise a mother and her partner can make an informed decision about whether or not to deliver at home with untrained professionals, or a health center where they can receive life‐saving treatment. Furthermore, the World Health Organization (2003) recognizes ultrasound technology as ideally suited to low and middle income countries, as it is relatively low‐cost, low input, and easily maintained and transported. Additionally, studies conducted on the use of ultrasound technology in two rural hospitals in Rwanda have indicated that after an initial training period, an ultrasound program led by local health care providers can be sustainable and lead to accurate diagnoses. Ultrasound imaging is beneficial to rural populations as it is a simple a nd non‐invasive procedure. This helps to reduce levels of fear from women who have previously maintained their cultural preferences for receiving treatment and giving birth with untrained birth attendants in their local villages.
Sustainability: Various
studies
on
obstetric
ultrasound
imaging
as
a
sustainable
and
appropriate
technology
to
developing
nations,
and
its
capacity
to
reduce
rates
of
maternal
mortality,
have
been
conducted
in
rural
regions
of
Rwanda,
Botswana
and
Tanzania.
In
northern
Tanzania,
a
study
conducted
amongst
women
who
were
receiving
ultrasound
imaging
for
the
first
time
indicated
that
the
majority
of
women
were
satisfied
with the
information
provided
from
the
procedure,
despite
not
initially understanding
its
purpose.
The
ultrasound
procedure
provided
women
with
the
ability
to
see
fetal
positioning,
fetal
sex,
and
to
recognize
any
potential
pregnancy
complications.
Information,
particularly
the
latter,
resulted
in
guiding
treatment
for
the
woman’s
particular birth
– helping
her
make
an
informed
decision
as
to
where
and
how
she
would
deliver.
This
particular
study
in
Tanzania
concluded
that
the
ultrasound
imaging
was
useful
in
reducing
the
risk
of
maternal
mortality,
although
the
treatment
should
be
accompanied
by
a
thorough
education
campaign
and
consent program.”
The future? “Currently, TO – the WORLD is in the process of raising funds to purchase two portable ultrasound machines. These machines will be purchased locally in Uganda to ensure sustainability in maintenance and economic stimulus for the communities in which they serve. Multiple outreach camps will be conducted in 2014 with the previously designed model based on the WHO four‐pronged approach to MTCT elimination of HIV.
The WSJ actually spoke of what happens when an US machine is taken to a developing country – more antenatal visits!
Here is the video William made to support his cause:
1. Report
of
a
WHO
Technical
Consultation.
Towards
the
elimination
of
mother‐to‐child
transmission
of
HIV.
Accessed
March,
2013
at
http://www.who.int/hiv/pub/mtct/elimination_report/en/index.html
2. IRIN
Humanitarian
News
and
Analysis
–A
service
of
the
UN
office
for
the
coordination
of
human
affairs.
Accessed
March,
2013
at
http://www.irinnews.org/Report/96308/UGANDA‐Government‐
adopts‐new‐PMTCT‐strategy
3. WHO
Executive
Summary,
April 2012.
Use
of
Antiretroviral
Drugs
for
Treating
Pregnant
Women
and
Preventing
HIV
Infections
in
Infants.
Accessed
March,
2013
at
Click to access PMTCT_update.pdf
4. World
Health
Organization. Statistics
on
Maternal
Mortality
in
Uganda,
accessed
March,
2013
at
http://www.who.int/healthinfo/statistics/indmaternalmortality/en/index.html
5. Kigezi
Healthcare
Foundation
website,
accessed
March,
2012
at
www.kihefo.org
6. Maternal
Health:
Investing
in
the
Lifeline
of
Healthy
Societies
and
Economies.
Africa
Progress
Panel
Position
Piece.
September
2010.
7. Yaw
A.W.,
Alexander
T.O.,
and
Edward
T.D.
The
Role
of
Obstetric
Ultrasound
in
Reducing
Maternal
and
Perinatal
Mortality,
Ultrasound
Imaging
‐ Medical
Applications,
InTech,
Accessed
March,
2013.
Available
from:
http://www.intechopen.com/books/ultrasound‐imagingmedical‐applications/the‐
role‐of‐obstetric‐ultrasound‐in‐reducing‐maternal‐and‐perinatal‐mortality.
8. Shah
S.P.,
Epino
H.,
Bukhman
G.,
Umulisa
I.,
Dushimiyimana
J.M.,
Reichman
A.,
Noble
V.E.
Impact
of
the
introduction
of
ultrasound
services
in
a
limited resource
setting:
rural
Rwanda.
BMC
InternationalHealth
Human
Rights.
2009;27:9‐4
9. Firth
E.R.,
Mlay
P.,Walker
R.,
Sill
P.R.
Pregnant
women’s
beliefs,
expectations
and
experiences
of
antenatal
ultrasound
in
Northern
Tanzania.African
Journal
of
Reproductive
Health.
2011;
15(2):91‐
107