So, we had the first-ever ultrasound conference at Nyankunde. Was it a great success? Yes! Would I want to do it again? Maybe after a while. Maybe after I've forgotten how stressful it was, and how much work.
Ultrasound is a passion of mine. Medicine, and surgery in particular, is a challenging undertaking , even in the best of circumstances. In the US, an arsenal of sophisticated diagnostic tools is available to doctors to figure out what is going on inside. Radiologists are standing by to interpret the images. Here at Nyankunde, I have very little. But I have Ultrasound! I use ultrasound every day - but it still blows my mind. How does this machine use sound waves to "look" past the skin and construct a image of what is inside? I kind of understand it, but really I don't. What it means for me is that I have, in my pocket, an X-ray/ CT scanner/ MRI. I can use it to guide procedures and give targeted anesthesia. I work in the bush, under austere conditions, but I don't have to give crappy medical care. I can have a good idea of what's going on in the inside and I can give my patients the care that they deserve. Innovative companies have shrunk down the behemoth, intimidating consoles into a probe that fits in my pocket and plugs into my cell phone. The prices of this technology have shrunk by orders of magnitude, such that this Star Trek Technology exists in the here and now and is within the grasp of a bush-surgeon such as myself.
I remember once having a discussion about what is “appropriate care”. My definition went something like this. “Appropriate means that you are giving horrible care, but it’s OK because you are in a horrible place.” I don’t want to give “appropriate care,” I want to give the very best care I possibly can, and ultrasound plays a central role. But here’s the thing. When you take an x-ray, you get a single static image and it requires no great skill to push the button. Ultrasound is a skill that must be learned and the skilled ultrasonography is a hunter, probing into the dark to answer questions. “Is there an abscess, a leak, a fracture, a fault?” It requires an understanding of anatomy, physiology and pathology. It can be used from the top of the head to tip of the toe, but it is an art.
OK, I guess I got a bit carried away, but I’m passionate. We had three goals for the ultrasound conference. One was overt, but the other two were covert. The obvious one was to introduce Congolese doctors to more advanced aspects of ultrasound and give them a taste for ways in which this could improve their patient care. Most of them could take an ultrasound and figure out if there was a baby in there or not, but few could go much further. The covert goals were to improve the general impression about Nyankunde, to quell the spurious rumors and let the medical community understand that we are still here and open for business. The other goal was to get to know doctors in the area and to find ways to encourage fellowship and spiritual growth.
So, we ended up with 16 participants from outside institutions and a few from here. It was a good, manageable number. We spent two days going over various ultrasound topics (cardiac, pulmonary, musculoskeletal, trauma, vascular, etc.) In the mornings we had didactic sessions and in the afternoons we practiced on human volunteers and on one unfortunate goat who made the ultimate sacrifice. After we had practiced putting in IV catheters and sticking needles, the goat became dinner.
In the evenings we tried to provide some entertainment. We had one evening around a bonfire, a talent and game night, a film and a hike up on the ridge to watch the sunset. We succeeded in generating a little buzz in the media and even scored an article on “Radio Okapi,” including an interview with yours truly. By the end of event, I was exhausted. Despite all the challenges, I felt like we succeeded in achieving our goals.
It was interesting to get to know some of the Congolese physicians working in the area. They are a good lot, but there are some rough edges. I think that Congolese doctors do not have a understanding of the aspect of ongoing medical education. They finish medical school, attend an abbreviated and inadequate practical training (six months!) and are unleashed on the population with a notion that they are now doctors and that they know! Any sort of ongoing education usually consists of seminars concerning the guidelines for the treatment of malaria or tuberculosis. There are very few opportunities for ongoing training or specialization. My hope is that we can look for chances to inspire in physicians the desire to learn.
The limited factor for ultrasound is simply the paucity of decent equipment that is out there. Many hospitals are using older ultrasound units. They do not have access to better equipment. The price point is changing, however. A very serviceable hand-held portable ultrasound can be had for around 2000$. (Consider looking up Butterfly IQ on the internet.) This is, of course, still way out of the reach of most Congolese physicians and hospitals. If I were Bill Gates, I would take a small portion of my massive wealth and work to get portable ultrasound units, along with practical training, in the hands of medical practitioners across Africa. Obviously, I am not Bill Gates, and what I can do at my level is try to encourage and inspire Congolese doctors to use ultrasound to provide better care for their patients. Any enthusiastic partners out there are welcome to come alongside me.
Anyway, the Ultrasound Conference has obviously occupied my mind a bit. On other fronts, we are doing well. We have enjoyed a season of calm in the region. We continue to deal with challenging cases. This past week we worked on a 2-year old who could not swallow due to a stricture of the esophagus. This poor child had been basically living on candy, and had the rotten teeth to prove it. We initially did a gastrostomy tube for feeding. We encountered some anesthetic issues and nearly lost the child. This past week we were able to dilate the stricture. His mother is ecstatic to see him actually eating and drinking.
The family is doing well. Emmanuel is learning so much and it is fun to see him reading and writing a bit. His spelling is very phonetic and it takes a bit of deciphering. This weekend we enjoyed camping up on the hill. The “Hill Hut” is more or less complete and it provides a great place to get away. Our camping gear is up there and all we have to bring is food and water.
That’s the news from Nyankunde. Thank for your thoughts, your support and your prayers. We feel so privileged to serve in this needy place, and it is only possible by our partnership with people like you!
Warren for the Coopers
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