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Friday, August 14, 2015

Ultrasound in Tanzania is the gift that keeps giving

Another great trip! I have gotten to go with University of California at Irvine medical students to Tanzania for 3 years as their supervising MD. They do all of the work, pretty much, preparing lesson plans to teach clinical officer students basic ultrasound as well as designing study protocols, getting institutional review board approvals, and carrying ultrasound machines on fatigued shoulders through multiple airports. I get to teach them a bit about clinical medicine, field questions that they couldn't possibly answer and flaunt the MD on my nametag.

Ten students, just done with a pretty grueling first year, came to Mwanza, Tanzania this year and worked like dogs for a month teaching and doing research. Each year the project is a little bit different, with different research protocols along with improved and adjusted curricula. Their primary project is to teach a large group of students (this year about 100) who are in school to become clinical officers, roughly the equivalent of nurse practitioners. These students will go on to practice medicine in a country which has only 1 doctor per 125,000 people, the worst ratio in the world (Germany has 1 doctor for every 263 people, per The Economist 2015 World in Figures.)

UC Irvine teaches their medical students, starting in the beginning of the first year, how to do ultrasound at the bedside, which cements their knowledge of living anatomy and gradually expands during their 4 years to competence in recognizing all kinds of diseases which have ultrasound findings. This group of students is comfortable teaching basic ultrasound to their African counterparts, who are amazingly knowledgeable in anatomy and physiology. The African students get 3 weeks of lectures and daily hands-on sessions, learning how to get good ultrasound views of the heart, lungs, abdomen and even the womb in pregnancy.

Having a cadaver to dissect is apparently a luxury not available to these students, so ultrasound is their first opportunity to actually see inside a human body. Unfortunately 3 weeks is not nearly enough training to become competent in performing and interpreting ultrasounds, but these students will never be afraid to take the steps necessary to learn more, and they will never forget how the heart looks when it beats and how the liver, spleen and kidneys nestle close to each other at the peritoneal reflections.

There are ultrasound machines in Tanzania, and few people who know how to use them. There are not enough ultrasound machines in Tanzania, at least not ones that work, but as the technology gets cheaper, the older machines will be even cheaper, and if there are people who understand how powerful the technology is, they will buy them. The teaching project will not create radiologists, but it will make general practitioners push medical practice in the direction of including more bedside ultrasound. In my experience, this will save lives and reduce suffering.

Beside improving their understanding of anatomy, after 3 weeks most of the clinical officer students who were in the ultrasound class had skills which could have profound clinical impact. If provided with a functional ultrasound machine, they could determine the age of a fetus, the position of the placenta and the head, and determine the fetal heartbeat, an important indicator of fetal health. This information could result in appropriate referral for caesarian section, potentially saving the lives of both the infant and the mother. They could identify a pneumothorax in a patient with a traumatic chest injury, which would be easily treatable if found in time and maybe fatal if missed. They could identify bleeding into the abdomen or chest in patients who presented after motor vehicle crashes, which are terrifyingly common. They will be able to look at an ultrasound picture and see more than a bunch of blurry gray, black and white shapes.

This project is cool in so many ways. I love that students teach students. The process is very gratifying and makes the material even more exciting. The UC Irvine med students are now completely awesome at basic ultrasound, and they were only just good when we started. The teaching goes both ways. The African students have an accelerated curriculum so they teach the UC Irvine students things they don't know, as well as asking questions that make all of us think harder.

I have done overseas projects which directly help people in need, which is wonderful in its way, but this project potentially has legs. Teaching medical practitioners to be better at their jobs is really powerful and has the ability to affect the lives of many patients. In teaching what they have just learned themselves, while they are still excited about it, the U.S. medical students show the Tanzanian ones how to be teachers of each other and to love learning, which could end up being as important as what they actually teach. In Tanzania, medical students work incredibly hard for the opportunity to continue to work incredibly hard in overcrowded hospitals and clinics with inadequate resources. It feels like this project may make them just a little more effective and a little bit happier in the process.

Janice Boughton, MD, ACP Member, practiced in the Seattle area for four years and in rural Idaho for 17 years before deciding to take a few years off to see more places, learn more about medicine and increase her knowledge base and perspective by practicing hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling. Disturbed by various aspects of the practice of medicine that make no sense and concerned about the cost of providing health care to every American, she blogs at Why is American Health Care So Expensive?, where this post originally appeared.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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