Sonography and the Seeds of Education in Underserved Rural Clinics

How many of us began our sonography journey thinking about the number of callbacks that we would log per shift, the number of patients that we would scan in an 8-hour day, or, even worse, the number of career-ending ailments that we would amass? Zero; we didn’t. tammySterns_2017

We saw ultrasound as a way to contribute to something bigger than ourselves.

The complex, yet simplistic, science of sound drew us to the field. Looking at the screen and seeing the images come to life was fascinating, and being the first to see presenting pathology while shedding light on the diagnosis mesmerized us. The thought that even after 20 or 30 years in the profession we would encounter images of structures that we’d never seen before was enticing, and the opportunity to be a life-long leaner was thrilling.

Patient interaction and our role in their medical experience appealed to us. Not too much, not too little, but just the right amount of patient care time that allowed us to interact with them and leave a positive imprint on their journey. We imagined we would sit by their bedsides, walk them casually back to the exam rooms, and listen as they shared.

Our patients would come first.

Instead, too often, we found ourselves in the middle of a never-ending battle between cost-effectiveness and patient satisfaction reports. We logged more hours of callbacks than we ever thought possible, sometimes having difficulty even finding the correct key to open the ultrasound office door. We strived to create the profession that we had imagined within the confines of the variables that we’d been given. We did the best that we could, often to the detriment of our own bodies.

And, somewhere along the way, we forgot the wonder of our profession.

About 10 years ago, I had the opportunity to participate in my first overseas medical trip. A group of physicians and a few sonographers, with portable machines strapped in backpacks, were intent on sharing sonography with some of our peers an ocean away. It was during this trip that I saw the purest form of ultrasound come to life. We had one of the simplest of machines and the most basic of lectures and yet they came from miles to learn. The patients sat all day in the heat waiting for the opportunity to have an ultrasound scan. I witnessed ultrasound identifying and explaining pain that had existed for years. I saw tears of relief, joy, and despair as people received answers that changed their lives.

A few years later, I was able to return to the same place. I fully expected to find that they had not utilized our lessons on sonography to their fullest. Instead, our previous pupils greeted us with dog-eared textbooks, mastered skills, and the desire to know more! The seeds of education that we had planted had flourished as they realized the potential ultrasound held for their rural clinics. It offered the ability to quickly investigate and diagnose and you could see the wonder of ultrasound that we had once experienced reflected in their eyes.

Seven years ago, my family and I had the opportunity to move to a developing country. Living in the second-poorest country in the western hemisphere with limited medical availability, I now see every day the wonder of our profession come to life. All the benefits of ultrasound that we learned as students, that are often taken for granted, are the benefits that allow lives to be changed every day.

Portability – I can scan in a makeshift clinic, under a tree in a field, or in someone’s handmade shelter while they lay on the floor.

Inexpensive – Portable machines are relatively inexpensive and diagnostically sound, making them perfect for short-term trips or as gifts to native physicians.

Quick – Within minutes, we can scan and find answers to problems that have hindered the livelihood of those who are sick and in pain. One of my first patients was an OB patient who had been in labor for several days without any progress. A quick scan revealed placenta previa.

Relatively Safe – Without the worry of radiation and chemicals, ultrasound, when utilized by those who are qualified, provides a safe method of imaging.

True, my exam room isn’t exactly ergonomically correct and there are times that chickens and roosters run underfoot. I’ve had to prop the machine on a rock and scan in the brightest sun of the day. But I’ve also witnessed a mother’s face when she sees her baby for the very first time without me having to operate under the time constraints of efficiency. I’ve held a father’s hand as he realized that the pain he’s had for years isn’t the cancer he so greatly feared but a simple fix. I’ve scanned at the bedside of a daughter who lay dying without any medical options, and I fall more and more in love with our profession every single day.

Experience the wonder of ultrasound again.

If given the opportunity, I encourage you to participate in a medically related trip or volunteer opportunity. You will see firsthand how our profession and our images impact the world one life and one scan at a time. You don’t have to move permanently as we did to a developing country. Opportunities also abound in your local community from volunteering your time as a clinical instructor to scanning for local centers. Expand your horizons and allow yourself to experience the wonder of ultrasound again.

 

How have you seen ultrasound incorporated into medical care in other nations? Do you have an ultrasound story to tell? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

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Tammy Stearns, MS, RT(R), RDMS, RVT, FSDMS, is Director of Women’s Ministry and Sonographer for Project H.O.P.E. in Managua, Nicaragua. She is also the President of the Society of Diagnostic Medical Sonography and an adjunct professor of Diagnostic Medical Sonography at Adventist University in Orlando, Florida, and a sonographer consultant for Heartbeat International.  She is also the author of “Know Hope” and “Living Worthy”.

Flying Samaritans, the Seed to Pediatric Point-of-Care Ultrasound

There are some experiences in life that seem to have a tremendous impact on the person you become, and the career path you decide to take. When I started working with the Flying Samaritans in medical school, little did I know that it would change the trajectory of my career.

Kids from El Testerazo Mexico

The kids I fell in love with in El Testerazo, holding the pictures I had taken and shared with them. They came by even if they weren’t sick. Of note, they are now in their 20s with families of their own.

Since the UC Irvine School of Medicine was so close to the USA-Mexico border, the UC Irvine Flying Samaritans chapter was actually a driving chapter. Each month we drove down to El Testerazo, Mexico, to give medical care and medications to an underserved community. I immediately fell in love with the community and the children of El Testerazo, Mexico. They would all laugh at my then broken high school-level Spanish but would appreciate my trying. There was also something about the group of undergraduates (who ran the clinic), medical students, residents, and attending physicians who volunteered their time there that brought back the humanity to medicine. The experience was challenging and rewarding at the same time—to work with limited resources, but to become a trusted member of their community was priceless. Each time I went to the “Flying Sams” clinic, I remembered why I went into medicine in the first place.

During my time with the “Flying Sams,” I worked with a then Emergency Medicine resident, Chris Fox. When he told me he was going to Chicago to do a 1-year Emergency Ultrasound fellowship, I thought he was crazy.

Old ultrasound machine

The ancient beast of an ultrasound machine that we had in the “Flying Sams” clinic.

Not only was he leaving sunny Southern California, but he was going to spend a year looking at ultrasounds? When I looked at ultrasounds, I could barely make out structures; images looked like the old tube TVs from the 1980s. When Fox returned, he said, “Steph, the next big thing will be pediatric ultrasound.” Again, I thought he was crazy. But slowly, by seeing how ultrasound impacted the management of our patients in El Testerazo, I realized the brilliance in this craziness. Chris Fox’s enthusiasm and “sonoevangelism” was infectious. I think nearly everyone in the “Flying Sams” ended up eventually doing an ultrasound fellowship. Even though the ultrasound machine in the clinic was old, and images were of limited quality, we were still able to impact the medical care of this community that became near and dear to my heart.

And so it began…my passion for emergency ultrasound (now referred to as point-of-care ultrasound) and for Global Health. My initial goal was to become good at performing ultrasounds. As I quickly realized, I was one of the only people who had experience in pediatric point-of-care ultrasound. I felt a tremendous responsibility to become as knowledgeable and skilled as possible if I were going to teach others this powerful tool. After 4 years of undergraduate education, 4 years of medical school, 3 years of a Pediatrics residency, and 3 years of a Pediatric Emergency Medicine fellowship, I decided to do an additional 1-year fellowship in Emergency Ultrasound. With medical school loans looming and so many years without a “real job,” I was reluctant to do this. This California girl moved from sunny Southern California to Manhattan to embark on a 1-year Emergency Ultrasound fellowship. This was a move far outside of my comfort zone for so many reasons. And that was one of the reasons why it ended up being one of the best decisions I’ve ever made. It has been a privilege to be a part of this growing community… to take better care of the most vulnerable of patients… and to give this tool to other doctors around the world. I certainly would have never had these experiences or opportunities if it weren’t for the “Flying Sams” and Chris Fox; to both, I am forever grateful.

 Are you involved in global medical education? If so, what led to your decision to go into the field? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Stephanie J. Doniger, MD, RDMS, FAAP, FACEP is the Editor of the first pediatric point-of-care ultrasound textbook “Pediatric Emergency and Critical Care Ultrasound,” and is currently practicing Pediatric Emergency Medicine and Point-of-Care Ultrasound in New York. She has additional training in Tropical Medicine and is in charge of Pediatric POCUS education for WINFOCUS Latinamerica.

Who Runs the AIUM?

Have you ever wondered what or who runs the AIUM? Of course you know about the elected officers, and the AIUM staff that works in the home office, but do you know that there are approximately a dozen committees and/or task forces that help the organization run throughout the year?

The volunteers may be elected or appointed to the committees and tasks forces, and they are not paid or compensated for their time. Frequently, there are many committee members who accept appointments and nominations year after year. Who would possibly be willing to take on extra work and added expense, just to help the AIUM?

Bagley_6Who are the volunteers?
Ordinary people like me! That is who! I have been volunteering with the AIUM since 2009, and have found, as they often say when you volunteer, that I get more than I give. My personal life mission is one of giving back, both to my profession and to my community. I believe anyone who volunteers for the AIUM will give you a similar answer: There is an obligation to give back because someone once gave of his or her time to help me.

How did I become a volunteer?
I did not wake up one day and think to myself, “Today is the day I should volunteer for the AIUM.” Instead, a mentor suggested to a liaison organization that I should be their representative to the AIUM Bioeffects and Safety Committee. At the first meeting, I was hooked. The work gave me new energy and excitement about my profession. I could not get enough bioeffect and safety knowledge.

When my time as a liaison ended, I asked a fellow committee member to nominate me to the committee. As luck would have it, my work proved that I was serious, and the members elected me to the committee.

How can you become a volunteer?
Maybe you are thinking to yourself right now, I am energetic and have a lot to give, but I do not know how to get involved. What should I do? If you have a mentor in the AIUM, ask him or her to nominate you to a committee.

If you do not have a mentor I suggest that you start by serving as a resource member to the committee that best matches your skills and interests. A resource member might assist the members on projects. You can offer up your talents by contacting the chair and letting him or her know that you want to help. Once your work is visible, you can ask a member to nominate you to be a committee member.

You Get More Than You Give
I have gained so much from working on a committee. I have new knowledge about bioeffects and safety that has allowed me to take on a larger advocacy role. I have new knowledge to integrate into the courses that I teach, and I have developed lectures to educate all medical imaging professionals about ultrasound bioeffects and safety. The work on the committee has inspired my own research projects that have resulted in award-winning manuscripts.

My confidence in my knowledge has improved, and I am willing to try new and difficult projects that I would not have dreamed of trying in my pre-committee life. I have made friends and have gained new mentors. I know that regardless of how much effort I have given, the committee has given me exponentially more.

Member, Pay it Forward!
None of us ever gets where we are on our own. In addition to our hard work, our mentors and our colleagues help us on our professional journeys. Volunteering is a way to pay it forward.

If you are an active volunteer, now is the time to make sure your good work is continued! Mentor a new member, and help him or her get involved. Suggest that he or she become a resource member or nominate him or her to a committee. Bringing new people into the volunteer world ensures that your good work continues, and it provides for the AIUM’s future.

Interested in volunteering for the AIUM? Check out the volunteer page. What has been your volunteer experience? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jennifer Bagley, MPH, RDMS, RVT, is an associate professor for the College of Allied Health at the University of Oklahoma Health Sciences Center, Schusterman Campus in Tulsa. She currently serves on the AIUM Bioeffects Committee and is a former member of the Technical Standards Committee.