Stella Nabudde had gone for the routine antenatal visit at Busanza Medical Centre in Bududa District. When the doctor realised that her blood pressure had shot up and yet she was in her 37th week he recommended bed rest.
He also wanted to carry out a scan to see if the baby could be evacuated. Unfortunately, they could not do so because they did not have an ultrasound machine. At the main hospital in Bududa, there was no power because the power transformer had a malfunction.
Globally, medical costs are rapidly rising and healthcare is becoming gradually unaffordable in low-resourced settings. However, clinical investigations such as ultrasound scan are necessary for accurate diagnosis and appropriate treatment considering the Sustainable Development Goals. This, therefore, calls for affordable imaging technologies, to meet the needs and resources of rural communities.
According to Dr Joyce Naiga Kasujja, a radiologist at Mengo hospital, radiology has been identified as one the most effective diagnostic method with the modalities such as x-rays, ultrasound, Computed Tomography (CT), Magnetic Resonance Images (MRI) as well as Fluoroscopy.
Medical imaging using ultrasound is the cheapest because of the low maintenance costs, no need for prior preparation by the patient and non-invasive as no blood or tissue samples are needed.
Although there are fully fledged ultrasound machines that are installed in hospitals, there can be small, compact lightweight ultrasound machines that look like laptops, which are portable and can be used in areas where there are power fluctuations or where there is no electricity at all. They are also known as bedside ultrasound machines because they can be moved to the bed where the patient is instead of moving the patient to the room for radiology.
“Midwives have been taught to incorporate the scans into antenatal care services provided at health centres. This has enabled them to ensure both the mother and foetal welfare by being able to make referrals when there are l complications,” says Dr Nayiga.
According to her, it has necessitated the use of portable ultrasound machines in places where people can only afford solar electricity or where there is no electricity at all. Here, the health worker will need an extra battery or fully charge the battery that can operate for three hours without a power source.
The bigger picture
The availability of a low-cost antenatal ultrasound programme may assist progress towards Millennium Development Goal 5 by encouraging women in a rural environment to come to a health care facility for skilled antenatal care and delivery assistance instead of utilising more traditional methods.
Role of ultrasound in pregnancy
Most previous investigations into the use of routine antenatal ultrasound have taken place in the developed world where full-size ultrasound machines are used by trained sonographers. This type of high cost programme has been found to be unfeasible in the low resource setting. This is one of the reasons why portable ultrasound scans are now preferred.
According to the United Nations Children’s Fund, for every 1,000 live births, at least 63 infants die before their first birthday in Uganda. Many of those deaths come from complications that could have been predicted by ultrasound technology.
What you ought to know
Traditional scans still better
Nayiga says, “The applicability of the machine is that it can be used in emergency cases where the patient cannot be moved to the imaging room and the health worker can easily institute management immediately rather than waiting for a report. It also has a saving mechanism where the image can be saved and sent to someone in case the health worker fails to interpret the image correctly.”
Portable ultrasound has a wide variety of applications, but has gained the strongest place in obstetrics and gynaecology because it is free of the complications attributed to ionising radiation as used in X-ray or the CT scans. However, the portable ultrasound scans are not a total replacement of the fully fledged machines. When the health worker detects a problem that is not clear with the portable machine, they must refer such a patient for a full body scan.
“The limitation to these scans is that they perform limited tasks. There are portable machines that can have multiple-functionality but are very expensive (about Shs150m) and not affordable in low resourced areas,” Nayiga says.
Bringing services closer
The Ernest Cook Ultrasound Research and Education Institute (ECUREI) at Mengo Hospital has a platform which offers modern training in Imaging and Biomedical services fields relevant to Uganda and Africa at large. The training is undertaken by midwives and personnel with a medical background.
Many midwives have been trained and one of them is Angella Njeri, a midwife and in-charge at Nawanyago Health centre III, Kamuli District. She enrolled for the programme in 2012 where she was trained on how to interpret the ultrasound scan images for six months.
“After the training, I was under supervision for six months until I was able to do the interpretation on my own. Having the portable ultrasound scans at our health centre has been key in saving many mothers and their children at the same time.”
According to her, although most of the mothers she receives at the health centres are referrals, there has been a huge turn up of pregnant women for the antenatal care, which was not the case before.
The ultrasound scan imaging at Nawanyago Health Centre III is done on Tuesdays and Thursdays and Njeri sees more than 30 mothers a day.
Ensuring affordability being a rural area, the hospital charges a fee of Shs10,000 from every mother and recommends two scans during the first trimester and the third trimester when the foetal parts have fully developed.
“By the time the mother comes for the second scan, the foetal parts are fully developed and we are able to assess if she will deliver normally or is likely to develop complications such that we advise her to deliver from a bigger health centre where complications can be managed,” Njeri says.
Besides the hospital referrals, there are times when she is called upon when a mother has got an emergency case of over-bleeding where she cannot be brought to the hospital.
She says, “With the portable ultrasound machine, I am able to go and save such a mother because it is portable and I do not need power all the time. It can be recharged on a solar power system or run for hours without a power source.”