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Uganda: almost complete reliance on ultrasound for radiological diagnoses

3 October, 2019

Author: Rachel Wilkins Sonographer, The Rosie Hospital, Cambridge Hospitals NHS Foundation Trust

Ultrasound keyboard with sticking plasters

As I walked up to the hospital chapel each morning, I was blown away by the sheer volume of the music and singing erupting from inside. 

At Kumi Hospital in Uganda, each morning begins with gospel style hymns and prayers. This alone highlights the human spirit of the hospital staff and their will to overcome adversity in a country with such limited resources but so much strength.

Kumi hospital is a not-for-profit organisation that serves a population of approximately 4million people in eastern Uganda and is funded mostly by charitable donations. I was lucky to spend six weeks volunteering as a sonographer at Kumi, as well as a free government run hospital in nearby Soroti and a private clinic. 

I was predominantly scanning on an ultrasound machine that was older than me and which was covered in so many plasters in a vain attempt to fix the machine buttons, that it was difficult to be sure which button did which function. 

Doppler was out of the question and, for cultural reasons as well as the lack of infection control, the transvaginal probe could not be used for the purpose for which it is designed. However, my colleagues taught me that a TV probe can have multiple uses because of its shape and high frequency. Without a linear transducer available, the transvaginal probe was used for multiple MSK, lumps and bumps and paediatric applications. It was also useful for assessing immobile patients, in areas otherwise inaccessible. 

Adaptability with the limited resources available was a common theme during my time in Kumi and something I think is also one of the strengths of sonographers in the UK. Whether it’s working with immobile patients or patients with a high BMI, sonographers are regularly required to modify machine settings and scanning techniques.

The other difference between ultrasound in Uganda and the UK, was the range of pathologies. No more gallstones and fatty livers but instead features of PID, HIV and TB were most prominent. I also scanned a patient with worm induced biliary obstruction, which apparently is a fairly common finding!

The difference between the government run facility, charity led hospital and private clinic was also striking, although private does not necessarily mean better. The machine at the private facility appeared superior on the surface (it wasn’t covered in plasters and you could actually read the button functions), but the image quality was appalling and to save gel it was either mixed with water, or gel substitutes such as vegetable oil were used. 

The volume of people to be examined at the government run free hospital was huge, with patients camping outside with their families after travelling for miles to try and get a diagnosis. 

One of the things that struck me most about my experience in the Ugandan ultrasound departments was the almost complete reliance on ultrasound for radiological diagnoses. Without the availability of cross-sectional imaging such as MRI and CT, accurate ultrasound diagnoses were crucial for patient management and the great importance of the sonographer’s role and the responsibility we have as a profession was reinforced. 

In day to day work life in the UK, it is easy to forget the vital role sonographers play and we sometimes overlook the wide range of ultrasound capabilities when there are other imaging modalities also available. Ultrasound can save lives and accurate clear reports are essential for effective patient management.

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