Authors: Chidinma L. Onweni, MD; Carla P. Venegas-Borsellino, MD; Jennifer Treece, MD; Marion T. Turnbull, PhD; Charles Ritchie, MD; and William D. Freem, MD
Abstract/Introduction: Medical-grade ultrasound devices are now pocket sized and can be easily transported to underserved parts of the world, allowing healthcare providers to have the tools to optimize diagnoses, inform management plans, and improve patient outcomes in remote locations. Other great advances in technology have recently occurred, such as artificial intelligence applied to mobile health devices and cloud computing, as augmented reality instructions make these devices more user friendly and readily applicable across healthcare encounters. However, broader awareness of the impact of these mobile health technologies is needed among healthcare providers, along with training on how to use them in valid and reproducible environments, for accurate diagnosis and treatment. This article provides a summary of a Mayo International Health Program journey to Bwindi, Uganda, with a portable mobile health unit, showing how point-of-care ultrasonography and other technologies can benefit remote clinical diagnosis and management in underserved areas around the world.
Results: After the 4-week rotation, a total of 391 patients had been seen: an average of 17 patients per day. This is a modest number, as the true number of patients seen is higher than 391 when private wards and pediatric patients are included. The Eko device was used in all patient encounters. Among the patients seen in Bwindi, we performed approximately 46 point-of-care ultrasound (POCUS) examinations in 33 patients during a period of 23 days (approximately 2 examinations per day). Lung, cardiac, optic nerve, vascular, and abdominal ultrasounds were performed according to clinical relevance (Supplemental Figures 1-4, available online at http://mcpiqojournal.org). The POCUS examinations took, on average, 10 to 20 minutes, depending on amount of ultrasound clarity and anatomic difficulties. In 15 of the 18 (83.3%) documented cases, use of these bedside diagnostic tools enhanced the formation of diagnoses and thereby positively affected the management and outcomes of these patients. In 4 of the 18 (22.2%), the initial diagnosis was confirmed, and management approach remained unchanged (Table).
Conclusions: The value of global health care delivery is changing rapidly and improving over time because of declining costs of MHU technologies. We describe this value through our experience in a community in Uganda. The global COVID-19 pandemic has forced a discussion on how to scale mobile health solutions rapidly at the point of care. Mobile health has emerged as a result of Moore's law, which has allowed smaller, faster, cheaper mobile smart phones, along with emergence of global connectivity via cellular and internet broadband (4G, 5G) communication systems. We changed the initial diagnosis and treatment 80% of the time with our MHU. We were very proud that local providers were performing ultrasounds by themselves by the end of the rotation and that they were very excited to learn more.