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​Emergency Medicine is a vast field, encompassing a knowledge base of essentially every other discipline in medicine and a wide array of procedural skills; practitioners need to constantly stay up to date. This can be a daunting task and one that requires significant support to be achievable.

To support our graduates after they finish their two-year Emergency Care Practitioner training, we are launching the Continuing Education & Leadership (exCEL) Program. The exCEL Program will provide graduates with continuing medical education opportunities to review higher level content, learn new skills, and receive additional mentorship after they graduate. Furthermore, it will enable ECPs to attend regional retreats and larger scale conferences, take emergency care training courses, and access online resources. Once back at their home hospitals, we're working to set up visits to work with administration on integrating emergency care into their facilities and regular phone calls to support ECPs in their new environment.
The need for continuing medical education

In the US, continuing medical education (CME) is required in every field of medicine in order to provide the highest possible level of patient care. Innovations impact how patients should be assessed, treated, and cared for. As a result, medical professionals have to continue their education and stay on top of these changes. Only by doing so can they confidently provide patients with the level of care they deserve. And while continuing medical education is ubiquitous in the US, no such infrastructure exists for emergency care practitioners in Uganda. 

As GEC enters our 11th year training Emergency Care Providers, we’re concentrating on CME to achieve sustainability and maintain the excellent outcomes for patients cared for by the ECPs. We’re defining CME in the broadest terms possible—striving not to just maintain skills, but to continually build new skills as the practice of emergency medicine in Africa evolves. This will take creativity on our part, as the continuing education infrastructure for emergency medicine in Africa is in its most nascent stages.
Supporting our ECPs beyond the program

Since 2010, we've been funding ECPs to attend regional conferences. These conferences, while a high cost for us as an organization, are invaluable to trainees. ECPs use conferences to present GEC's work and make connections with providers in other countries and benefit from the high-level continuing education offered at each conference. 

Furthermore, ECPs serve as ambassadors of the ECP model, and the concept of non-physician emergency care providers is now recognized as a critical and successful component of emergency medicine development in Africa. 
"AFCEM inspired me to return home and continue moving emergency care forward in Uganda. It was very impactful to have our work, as ECPs in Uganda, acknowledged by important speakers from other African countries and to hear that, because of our success, similar programs are being started in other countries."
—Kizza Hilary, GEC’s Nyakibale Program Coordinator & ECP
While these conferences are valuable, they’re relatively infrequent. Thus, we deploy emergency medicine volunteers to provide CME opportunities for ECPs to review higher level content, teach new skills, and provide additional mentorship. This has been a highly successful part of our approach, but is insufficient as a stand alone method of continuing education, especially since the ECPs face challenges in their practice that are unimaginable to most doctors practicing in high income countries. 

​East African conferences on emergency medicine are being organized, large international organizations, such as the World Health Organization are offering training courses in aspects of emergency care, and more online resources are becoming available for ECPs. 

All of this continuing medical education comes with a cost

Our extensive volunteer network continually enhances the education we offer our trainees, we want to emphasize how critical it is for us to be able to offer them additional resources to further their education and training. 

The educational experiences we are providing the ECPs as they graduate and enter practice are building on the solid foundation we build over their two years of training. 

Please support ECPs to walk the path of lifelong learning and provide truly amazing care to those vulnerable patients they care for every day by donating to GEC. Together, we can continue to make lifesaving emergency medical care available to all Ugandans.​
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"I realized that by spending a few extra minutes evaluating this patient with bedside ultrasound, Alfunsi may have saved this man’s arm."

By Dr. Leigha Winters, GEC Volunteer

Reposted with permission from SONOSTUFF: Education and entertainment for the ultrasound enthusiast

​Having traveled and worked in under-resourced settings before, I thought I had some idea of the type of clinical situations I would be encountering while teaching in Masaka, Uganda with Global Emergency Care (GEC). However, during my three weeks at the Masaka Regional Referral Hospital, I was continually amazed by the breadth and acuity of conditions seen by the medical officers (MO’s) and Emergency Care Practitioners (ECPs) in the Accident & Emergency (A&E) department. They managed some of the sickest patients I have ever seen with foley catheters for chest tubes, only four oxygen wall regulators, one intermittently functioning defibrillator, and minimal IV medications. It was exciting to watch the ECPs utilize clinical and ultrasound knowledge acquired through their diploma program to direct and improve patient care.

Take, for example, the 20-year-old man who presented with proximal right forearm swelling. He had been stabbed in his forearm, just below the elbow, at the beginning of January (over two months ago). He had presented to the hospital immediately after the injury, and had the wound closed with stitches at that time. Sometime in the next two months, he started to notice right forearm swelling and pain. He had no fevers, and there was no obvious infection around the original wound. The swelling bothered him enough in late March for him to present for medical attention. The first medical officer to evaluate him was concerned that he had an abscess under his skin, so sent the patient to the A&E for them to cut open his forearm.

When first evaluated by one of the senior ECP graduates named Alfunsi, he recognized that something wasn’t right about this story. Alfunsi elected to put his ultrasound skills to use.
Upon placing the ultrasound probe on the patient’s forearm, he immediately realized this was not an abscess; the fluid collection didn’t look right. When color flow was placed on the large, round fluid collection, the fluid was pulsing! This was, in fact, either a pseudoaneurysm or aneurysm of the radial artery with a fistula between the cephalic vein and radial artery. In essence, the knife wound in January had poked a hole in the artery in the patient’s upper forearm and connected the artery to the nearby vein. Every time the artery pulsed, it had been pushing blood into the vein and the surrounding soft tissue. These ultrasound findings were reinforced by the fact that the patient had only a very faint pulse at his wrist near his right thumb (the distal radial artery), but a very strong pulse in his left wrist. If Alfunsi had cut open this wound, it would have bled all over the room, and the patient could even have lost his arm. Instead of antibiotics or cutting open the swelling with a scalpel, this patient needed a vascular surgeon to repair the artery and vein.

Alfunsi and the other ECPs took the initiative to call over the intern physician to explain the case. After reviewing the ultrasound findings with the ECPs, the intern agreed with them; this patient needed to be referred to a vascular surgeon. Since there are no vascular surgeons in Masaka (the hospital, in fact, does not even have a CT scanner, let alone sub-specialists), the patient was referred to a surgeon in Kampala. I realized that by spending a few extra minutes evaluating this patient with bedside ultrasound, Alfunsi may have saved this man’s arm.

This was one of many cases I witnessed in the Masaka A&E where ECP clinical knowledge and ultrasound skill greatly improved patient care and outcomes. It is incredibly powerful and fulfilling to watch expertise you have shared with ECP learners be directly translated into clinical care. In my experience, this information-exchange is the most impactful in incredibly under-resourced locations like Masaka, Uganda. Even small changes in knowledge base or imaging availability (i.e. having a bedside ultrasound available in the A&E for ECPs to use) has a huge impact on patient care, community health and system-wide practice. I am so grateful to the staff at the Masaka Regional Referral Hospital for sharing their enthusiasm and ingenuity with me during my time in Masaka, and so excited about the work that GEC is doing to help empower the medical community in Uganda.

Ultrasound Machine Fundraiser for GEC - 100% Match
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines. Can you help save lives with a contribution towards these new ultrasound machines?
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by Alexa Sabedra, GEC Volunteer

On our first day in Masaka, while sitting in on the chest pain lecture being given to the ECP 1s, Deus (an ECP 2 who was working in the ED at the time) quietly walked in and asked if Dr. Lori could bring the ultrasound to the ED.  On the way there he explained that a young woman in her early 20s had presented to the ED complaining of bloody stools and had low blood pressure. She had been seen by one of the intern physicians who was also working that day. The doctor thought that she had bleeding inside her intestines and was planning to admit her to the ward.  Deus heard about the patient and had noted that she had a positive pregnancy test. Knowing this information, he was concerned that something more was going on.

On arrival at the bedside the team found an unwell appearing young woman. She was pale, another ECP was repeating a blood pressure and having trouble getting a reading.  Deus wanted to perform an ultrasound exam to look for internal bleeding, a FAST exam. In a pregnant patient who is having abdominal pain or vaginal bleeding, a ruptured ectopic pregnancy could be the cause.  An ectopic pregnancy is when a pregnancy implants outside of the uterus, usually in the tubes. This is a life-threatening condition which is the leading cause of death in women in the first trimester worldwide.

Deus started the exam with a view in the right upper quadrant of the abdomen that looks at the liver and kidney. Almost immediately, he spotted the black stripe between those 2 organs and correctly interpreted this as free fluid (Blood!).  Already the team could tell that Deus had been right; that this was more than what it seemed. He next moved the ultrasound probe to her lower abdomen to look in the pelvis.  He was able to see the woman’s uterus which was empty. This is not the expected finding if it was a normal pregnancy. He moved the probe a little to the left and was able to see a gestational sac (the pregnancy)…but the sac was outside the uterus!!  There was more of the black free fluid in the pelvis as well. Now there was no question. This woman did indeed have a ruptured ectopic pregnancy that was the actual source of her bleeding and low blood pressure. This woman did not need to be admitted to the ward, and in fact would have likely died there had Deus not intervened.  The woman needed to go to the operating room right away. Deus knew this and called the surgeon who did just that.

We later learned that in the OR the surgeon confirmed the left sided ectopic pregnancy and bleeding.  They were able to remove the ectopic pregnancy and stop the bleeding. The woman lived and the next day was doing very well.  A life was saved thanks to the quick thinking of the ECP and his skillful application of ultrasound to confirm the diagnosis he suspected.

I think this case is very special.  As someone new to volunteering with GEC it really highlighted what an incredible resource the ECPs are for Uganda.  It is amazing how much they have learned from their training and how well they apply it to patient care to save lives!  In this case, the ECP was better able to evaluate the patient than even the physician. What is troubling is that the ultrasound machine that was here at Masaka is currently broken.  The cost of fixing it is nearly that of a new machine. When Dr. Lori and I came, we were lucky to have the generous support of organizations back home that allowed us to borrow a few machines to teach the ECPs while we are here, but they are sadly coming back to the U.S. with us.  While we are here, we have been working on ways to obtain a new ultrasound machine for the ECPs. Please help us reach that goal with a donation.
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"Here in our ultrasound images, we had been able to identify the root cause of his problem with no other test."
Going through all of the cases of patients that I saw with the ECPs at Masaka during my last trip, one case stood out for having so many beautiful ultrasound images. The ECPs were called to help with a foley placement on the wards. The intern physician had tried and had been unable to place the foley and so had asked the ECPs to try. Deus was the ECP trainer in charge that day and he brought along the ultrasound machine.

In front of us was an elderly gentleman, looking very ill, lying in bed, confused, moaning, on oxygen. The ECPs first took a look at his bladder with ultrasound and found an enormously dilated bladder. Next they looked at his kidneys...they were dilated with fluid on both sides. Whatever was obstructing his bladder, was obstructing the flow of urine all the way up to the kidneys. It became immediately apparent that this was the likely cause of his confusion. When urine cannot pass, the toxins and byproducts that urine is meant to expel build up. One of these, urea, causes confusion. Here in our ultrasound images, we had been able to identify the root cause of his problem with no other test. Deus noted that he was oxygen, so he looked at the patients lungs with ultrasound. The lungs were full of edema, or fluid. So, now we knew, that the kidney failure was enough to cause an overloading of fluid in his entire body causing even his lungs to be overcome with fluid.

They set about to the task of placing a foley. The catheter was expertly placed in urethra by one of the ECPs in training under the guidance and direction of Deus. A quick ultrasound exam showed the foley to be right where it should be in the bladder. Now the urine could drain from the bladder, then the kidneys and hopefully, the patient’s kidneys could continue to rid his body of the additional toxins and fluids that had built up. All around fantastic use of ultrasound.

Ultrasound Machine Fundraiser for GEC - 100% Match
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines. Can you help save lives with a contribution towards these new ultrasound machines?

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By: Dr. Michael Schick, GEC Ultrasound Director

​The eFAST exam is the most widely adopted ultrasound examination for use in the emergency department. This exam looks at six locations on the body and can identify blood in the abdomen, blood around the heart, and a collapsed lung. It take two minutes to perform. In the United States it is routinely done immediately after the initial evaluation of a patient who has had trauma, such as a car accident or other injury.

The ECPs have learned this exam and with very little else available to them for imaging internal organs in trauma patients. It is one of their favorite scans to do. One reason why...it makes their job simple and it helps them do the right thing for each patient.

Take for example a young boy who was in the emergency department the last time I visited. He was 8 years old and had fallen from a motorcycle (boda). He was tachycardic, slightly hypotensive, and he had severe abdominal pain and a peritoneal abdomen. The ECPs did a FAST exam and found free-fluid in his abdomen. The ECPs consulted the physician, who was initially hesitant, but after seeing the ultrasound images, felt it was appropriate to take the boy to the operating room. In the OR, his spleen was removed and he was discharged from the hospital in a just a few days. Ultrasound for the win!

Ultrasound Machine Fundraiser for GEC - 100% Match
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines. Can you help save lives with a contribution towards these new ultrasound machines?

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By: Dr. Michael Schick, GEC Ultrasound Director

As a second year Emergency Care Practitioner (ECP), Friday mornings are spent learning through simulation. On my recent trip to Uganda one of the morning simulations was a mass casualty event. In the simulation, a pregnant mother with her two children were riding on a boda when it crashed. Four patients, two with life threatening emergencies and two who were injured but less severely. The ECP running the case is tasked with rapidly assessing each patient, triaging them, quickly deciding who needs immediate intervention and assigning tasks to other ECPs. Each ECP is assigned to one of the patients with priorities set. It was a fun and engaging morning of learning and I was impressed with the skills demonstrated and questions generated by the ECPs. We discussed prior mass casualty events that have come through the ED at Masaka and how the ECPs divided tasks during those events. With road traffic accidents being so common and so deadly in Uganda, this is something the ECPs had witnessed many times. Entire buses that have rolled over, two bodas with several passengers each colliding, open trucks with several people in the back that veered off the road. Each event is challenging, intellectually and emotionally, and the ECPs shared what they had learned from these events.

That afternoon, we joined the other ECP trainers in the emergency department seeing patients. The ED was busy that afternoon and the ECPs were busing seeing several patients; one with a piece of wood stuck in the bottom of the foot, another with a large laceration of the hand, a patient with pneumonia, another with abdominal pain, another with malaria. A truck pulled up outside and Alfunsi went to assess the situation. When came back in, he announced that we had a mass casualty. The truck was loaded up with several injured men, all from the same accident, some walking, some unable to walk. A truck had rolled over on the road outside of town. We were about to do what they’d just trained for.

The ECPs began putting on personal protective equipment (gloves and gowns) and taking stretchers outside and making space in the crowded department. Alfunsi assumed the role of leader, directing the others who were doing primary and secondary surveys of each patient. One of the ECPs went bed by bed with the ultrasound machine doing EFAST exams.

Having working in US EDs and witnessed similar large scale trauma events over many years, I must say, the ease and rapidity with which the ECPs assessed and managed these patients was SMOOTH. What can seem like chaos for someone watching for the first time, is in fact well-orchestrated prioritization through systematic evaluation and when done right, it is a beautiful thing. When done poorly, patients can die. A true emergency provider looks past screaming and blood and fearful patients to see the problems that need an immediate intervention: abnormal vital signs, a positive FAST or pneumothorax. This is the difference between good training and poor preparation. The ECPs were completely unphased. Alfunsi had prioritized two of the patients as critical within five minutes. The ECPs managed each injury from large to small. One was sent to the OR and another needed transfer for a spinal fracture. The remaining patients were lower acuity and though some would be admitted, there were no further critical procedures needed.

Within one day, I’d seen the training and careful preparation in the morning and practical application of the same knowledge in the afternoon. A great day of Global Emergency Care at work.

Ultrasound Machine Fundraiser for GEC
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines.

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"As our primary diagnostic tool, ultrasound can provide a fabulous amount of confirmatory and ancillary information."
By: Dr. Michael Schick, Director of Ultrasound

While working in the emergency department at Nyakibale Hospital in Rukingiri, Uganda a two-year-old boy arrives with his mother for persistent vomiting. He appears ill, has an elevated heart rate, but no obvious fever. Gastrointestinal illnesses are extremely common in this region of the world and account for a large proportion of childhood deaths, related to dehydration.

While most children presenting with vomiting, will also have diarrhea from either invasive of non-invasive intestinal infections this child was not suffering from diarrhea. Vomiting in isolation in a young child can indicate a benign illness like common childhood viruses, food toxicity, but can often indicate life threatening intra-abdominal emergencies or intra-cranial emergencies such as meningitis.

The child was listless, tired and not fighting against our Emergency Care Practitioners (as many toddlers normally do); he was dehydrated, but other than that the patient had no signs of meningitis. As we undressed the child, our astute Emergency Care Practitioner found the patient’s abdomen to be distended, tympanic, and with an obvious umbilical hernia. If you have never seen an umbilical hernia, it is a large protrusion from the belly button.

​One risk of any hernia is that bowel or intestine can get stuck inside it and twist, which cuts off blood flow to the intestine. Like all things, without blood flow the intestine will die. Bowel will become obstructed, necrotic, and release stool contents inside the abdomen. Life threatening infection ensues and in this region, certainly death.

As our primary diagnostic tool, ultrasound can provide a fabulous amount of confirmatory and ancillary information. We first image the four quadrants of the abdomen, which in the upper abdomen demonstrates large, dilated loops of bowel with anterograde and retrograde peristalsis. This indicated the patient has a bowel obstruction.
In the lower abdomen, his bowel appears normal, which indicates the obstruction is higher than the bowel imaged. When we place the probe on the umbilicus we see intestine within it and adjacent free fluid. We have difficulty acquiring reliable color flow from the intestine.

We consult surgery immediately and the patient is taken to the operating theater. The surgeon successfully released the strangulated umbilical hernia. Even though we had feared intestinal necrosis and perforation, the surgeon found the bowel to be well perfused. The patient had an uneventful post-surgical course.
Ultrasound Machine Fundraiser for GEC
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines.
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By: Dr. Michael Schick, GEC Ultrasound Director

At Masaka Hospital in Uganda our Emergency Care Practitioners (ECPs) have acquired specialized emergency training in point-of-care ultrasound. In this specific diagnostic skill set, they are the most trained practitioners in the region. While teaching our ECPs ultrasound we often take to the medical wards, where pathology is plentiful. There we also interact with the ward medical/surgical teams, and often our “practice” scans drastically change management.

When we arrived on the medical ward we immediately find a young man tripodding on his hospital bed. If you have never seen a person tripod, it is alarming. It means they have their arms in front of them, supporting their body as they sit, struggling to breathe. In a healthcare setting that has no intensive care units or advanced airway interventions, this is a frightening presentation.

​The medical doctor tells us he is being treated for heart failure and pulls out a single view AP chest x-ray. Indeed, his cardiac silhouette, or the size of his apparent heart is large which is one of the signs we look for to indicate heart failure. But, I don’t see much fluid in his lungs, which is what you would expect in a typically heart failure exacerbation. Also, this is a young man, why does he have heart failure? It is usually a disease of the elderly. We considered a congenital heart defect as the cause, but still, it was a bit perplexing.

​I discuss with our ECPs that fluid around the heart or a pericardial effusion will also give you an enlarged cardiac silhouette on chest x-ray and, in this setting, cardiac tamponade from an infectious disease, such as tuberculosis or pericarditis, is a critical distinction. It is critical because the treatments are completely different. Cardiac tamponade requires drainage of the fluid around the heart with a needle and treatment of the underlying condition whereas heart failure is often treated with medications that reduce stress on the heart and remove fluid from the body. Cardiac tamponade and pericardial effusions are diagnosed primarily with ultrasound.

When we place the probe on the patient’s chest it is immediately clear he has a large, complex appearing pericardial fluid collection. He is indeed in cardiac tamponade, where the fluid around the heart is crushing the heart itself until it cannot function. He did not have heart failure and the treatment he was receiving had made him worse. He is near the brink of death. One of our ECPs assists with the ultrasound while one of the surgery medical officers drained the patient’s fluid at the bedside. The fluid removed was thick and concerning for a infection in the fluid.

In the United States, he would likely have gone to the operation room with a cardiothoracic surgeon and had his pericardium completely removed. Those resources are not available in Masaka. Though we were able to make the correct diagnosis and drain the fluid, the following day the patient died. He had likely died from sepsis associated with the infected fluid. If ultrasound becomes more widely available and training is more widely available, I believe young men like this patient can be saved. ​​

Ultrasound Machine Fundraiser for GEC
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines.
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"ECPs can be trained in 2 years, whereas it would take nearly a decade and a much greater cost to train physicians to do the same tasks. Patients dying in Uganda do not have time to wait."

​Over the past 15 years I've worked in a variety of global health settings around the world; what GEC has been doing over the past 10 years is certainly unique.

Recognizing the huge physician shortage in Uganda and throughout Africa, GEC is training nurses and clinical officers to provide quality emergency care appropriate to the settings where they practice.

The students are trained as ECPs. In the US, they would be called nurse practitioners or physician assistants. ECPs can be trained in 2 years, whereas it would take nearly a decade and a much greater cost to train physicians to do the same tasks. Patients dying in Uganda do not have time to wait.

I've been in Uganda for nearly 3 months assisting the ECP trainers with teaching and curriculum development. I have been impressed with the knowledge and skill levels of the trainers and students. The students are energetic and eager to learn practical skills and put them to use.

For example, two weeks ago we had a simulation of a mass casualty incident where multiple critical patients come to the Emergency Department (ED) at the same time. The students were taught to triage and prioritize care, and to organize and lead others involved.

Approximately an hour after this teaching session, a student found me in the lecture room and hurriedly exclaimed “there’s a mass casualty.” I couldn’t believe it.

I walked to the ED and learned that a truck had turned over. Multiple patients were brought in at once. Just as had been simulated, the patients were kept close together with supplies in the middle. An entire team was working together with the group being coordinated by one of the ECP trainers, Alfunsi.

The students quickly and calmly assessed the patients in a stepwise approach and addressed their critical needs. The scenario went just as practiced and all the care was provided by the ECPs. I did not join in, because I did not need to.

Giving Ugandans the skills, the tools, and the knowledge to take care of Ugandans is what GEC does, and does well. I have seen it in action.

Dr. Randall Ellis
GEC Global Health Fellow

​Thanks to you, and other donors like you, hundreds of thousands of people living in remote communities now have access to lifesaving emergency care.
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By: Lori Stolz, MD, GEC Ultrasound Director & Alexa Sabedra, MD, GEC Volunteer

On our first day in Masaka, while sitting in on the chest pain lecture being given to the ECP 1s, Deus (an ECP 2 who was working in the ED at the time) quietly walked in and asked if Dr. Lori could bring the ultrasound to the ED.  On the way there he explained that a young woman in her early 20s had presented to the ED complaining of bloody stools and had low blood pressure. She had been seen by one of the intern physicians who was also working that day. The doctor thought that she had bleeding inside her intestines and was planning to admit her to the ward.  Deus heard about the patient and had noted that she had a positive pregnancy test. Knowing this information, he was concerned that something more was going on.

On arrival at the bedside the team found an unwell appearing young woman. She was pale, another ECP was repeating a blood pressure and having trouble getting a reading.  Deus wanted to perform an ultrasound exam to look for internal bleeding, a FAST exam. In a pregnant patient who is having abdominal pain or vaginal bleeding, a ruptured ectopic pregnancy could be the cause.  An ectopic pregnancy is when a pregnancy implants outside of the uterus, usually in the tubes. This is a life-threatening condition which is the leading cause of death in women in the first trimester worldwide.
Deus started the exam with a view in the right upper quadrant of the abdomen that looks at the liver and kidney.  Almost immediately, he spotted the black stripe between those 2 organs and correctly interpreted this as free fluid (Blood!).  Already the team could tell that Deus had been right; that this was more than what it seemed. He next moved the ultrasound probe to her lower abdomen to look in the pelvis.  He was able to see the woman’s uterus which was empty. This is not the expected finding if it was a normal pregnancy. He moved the probe a little to the left and was able to see a gestational sac (the pregnancy)…but the sac was outside the uterus!!  There was more of the black free fluid in the pelvis as well. Now there was no question. This woman did indeed have a ruptured ectopic pregnancy that was the actual source of her bleeding and low blood pressure. This woman did not need to be admitted to the ward, and in fact would have likely died there had Deus not intervened.  The woman needed to go to the operating room right away. Deus knew this and called the surgeon who did just that.
We later learned that in the OR the surgeon confirmed the left sided ectopic pregnancy and bleeding.  They were able to remove the ectopic pregnancy and stop the bleeding. The woman lived and the next day was doing very well.  A life was saved thanks to the quick thinking of the ECP and his skillful application of ultrasound to confirm the diagnosis he suspected.

I think this case is very special.  As someone new to volunteering with GEC it really highlighted what an incredible resource the ECPs are for Uganda.  It is amazing how much they have learned from their training and how well they apply it to patient care to save lives!  In this case, the ECP was better able to evaluate the patient than even the physician. What is troubling is that the ultrasound machine that was here at Masaka is currently broken.  The cost of fixing it is nearly that of a new machine. When Dr. Lori and I came, we were lucky to have the generous support of organizations back home that allowed us to borrow a few machines to teach the ECPs while we are here, but they are sadly coming back to the U.S. with us.  While we are here, we have been working on ways to obtain a new ultrasound machine for the ECPs. Please help us reach that goal with a donation. ​
Ultrasound Machine Fundraiser for GEC
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines.

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