Updated: Aug 23
What is Point of Care Ultrasound?
Imaging tests are important to diagnose and treat many diseases, but access is often very limited for patients in low-resource settings. In contrast to the larger ultrasound machines normally used in a radiology or obstetric department, technological improvements have allowed the development of affordable, portable ultrasound machines which can be used at the bedside by healthcare staff. This technique is known as “Point of Care Ultrasound (POCUS)” and has seen an increase in use in many situations in high-income healthcare settings, especially emergency and intensive care, but is also ideal for use in resource-restricted settings. Not just for emergency care, but also where there may be no other imaging tests available.
This opportunity has created a strong demand from doctors in Ghana for quality assured, structured training in Point of Care Ultrasound, where they can learn a skill set that is most relevant to the needs of their patients. Many current Point of Care Ultrasound courses are of short duration, teach a limited skill set and may not be formally accredited. Many are also expensive and not accessible to participants from low income settings.
We believe that clinicians in countries like Ghana should be given a better, broader and more affordable grounding in bedside ultrasound to allow them to make full use of the potential of this tool. Clinicians are well placed to perform and interpret ultrasound examinations: the patient is with them having an examination and does not need to go anywhere else. This will save patients valuable time and money in situations where they may need to travel long distances for any further tests.
Studies have also shown that ultrasound examinations for hospital patients in places with very busy and understaffed radiology departments take place sooner if performed by clinicians at the bedside. They also have unique knowledge of the patient's history and examination findings and in some situations can use it to perform treatments more safely.
First Pilot week in Ho, Ghana
The Sound Sonography programme was designed by a broad team of experts: radiologists and general physicians with extensive experience in Ghana and similar healthcare settings, academics at the University of Salford sonography training programme in the UK and POCUS specialists from emergency care, obstetrics and infectious diseases.
The first part was delivered online through the University of Salford e-learning platform, followed by a first hands-on training block, hosted by our Ghanaian partners at the University of Health and Allied Sciences in Ho. The second hands-on training will run later in the year. In between these training weeks, participants are supported remotely. Quality assurance of the module through the University of Salford will give participants and their patients the confidence that they have completed a quality programme.
Dr Eszter Momade, Emergency Medicine specialist at Cape Coast hospital, performing a bedside ultrasound scan on a healthy volunteer, guided by one of the trainers, Dr Jim Connolly, and observed by fellow participants.
A wide variety of training content
We delivered teaching in topics such as emergency scanning in patients involved in accidents, in lung ultrasound (including for COVID and Tuberculosis), kidney ultrasound, abdominal vessels, and ultrasound-guided insertion of cannulas.
Dr Ingeborg Welters, Critical Care Consultant at the Liverpool University Hospitals NHS Foundation Trust, gave a Zoom lecture about ‘Cardiac Impairment and Fluid Status’, followed by a lively Q&A session.
Dr Ingeborg Welters, Critical Care Consultant, delivering a Zoom lecture about ‘Cardiac Impairment and Fluid Status’.
We also had an inspirational lecture from Dr Wanjiku Kagima, an emergency medicine specialist in Nairobi, who is completing her PhD on the role of POCUS in acutely breathless patients in Kenya. Following the lecture, several of the participants expressed their interest in conducting ultrasound research in their own patient population in Ghana. Dr Katy Szczepura, a physicist from University of Salford led another remote Q&A session around ultrasound physics.
A flying start
As organisers, we expected most of the participants to be complete novices. In fact, many of the candidates had some limited experience with ultrasound, particularly echocardiography. This experience allowed them to learn more quickly; they already had some of the dexterity needed to handle the ultrasound probe.
Dr Bennett Owusu performing an ultrasound scan on the lungs of a healthy volunteer.
We were pleased how many of the candidates had managed to complete all the pre-course material, despite their very busy lives. There were many hours of lectures and papers digested by the candidates in the 5 weeks before the course. Some of them overcame significant IT issues to engage with the material; this engagement made the learning process during the training much faster.
We were also excited by how quickly the participants picked up the skills and their thirst and enthusiasm to learn more and more. As trainers, we had to respond to this demand by adapting and in some cases even rewriting the lectures to include more detail and more complex findings. The group wanted to and were clearly able to take their ultrasound skills to a high level. It was a joy to teach and work with such a motivated group. They have a very clear sense of how ultrasound will transform their treatment of patients and are constantly sharing examples of this.
We will continue to provide the participants with active remote mentorship and aim to deliver the second hands-on module, focusing on obstetrics and infectious diseases in early Autumn. Meanwhile, everyone can upload anonymised cases onto a secure collaboration platform and will hold regular meetings with trainers for case discussion. A lack of such continued support of participants after short ultrasound courses can result in low rates of ongoing use of ultrasound and loss of confidence and skill.
The aim of our partners and of the Sound Sonography team at Worldwide Radiology is to develop their skills and knowledge to become trainers on future courses and leaders in point of care ultrasound in Ghana. The participants we met certainly show great promise in this regard and we look forward to working with them in the future!
This project is proudly delivered in partnership with