Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-Denied Areas
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Transcript of Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-Denied Areas
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April 24, 2009Telemedicine Symposium, Bryn Mawr College
Nyaya Health's Ultrasound Program in Rural Nepal
Implications for Teleradiology in Resource-Denied Areas
Duncan Maru, PHD
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Overview
About Nyaya Health and AchhamGlobal Need for Radiology ServicesNyaya's ProgramUltrasound Design SpecsHuman ResourcesQuality Assurance and TeleradiologyImplications for X-Ray and Beyond
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Achham, NepalNumber of citizens: 250,000Number of doctors: 199.5% of babies are delivered
outside a health center1 in 125 deliveries result in death of
the mother60% of children are chronically
malnourishedAverage person makes $150 a yearNearest functioning airport and
hospital: 10 hour bus ride away, costs 1-2 months' average income
80% households have one male migrating to India
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Mission 1:
Facilitate resource distribution to resource-denied areas
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Mission 2:
Foster local human capacity and grassroots collective action
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Mission 3:
Apply evidence-based medicine principles and data monitoring
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Mission 4:
Involve the central government in pro-poor health infrastructure
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Mission 5:
Achieve transparency and collaboration in global health delivery
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Global Need for Radiologyover 50% of the world's population lack access to X-Ray and ultrasound
effective technology exists
what is lacking: financial support, training, evaluation, monitoring
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Ultrasound: Uses in Rural Areas
Referral to higher level facilities
Assistance in guiding procedures
Point of care diagnostics
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Ultrasound: Uses in Rural AreasCondition View InterventionObstructed Labor Abdominal Cesarean sectionEctopic pregnancy Abdominal SurgicalRetained products of conception Abdominal Dilation and CurrettagePeripartum hemorrhage Abdominal Medical managementCholecystetitis Abdominal Medical management; SurgicalTuberculosis (intra-abdominal) Abdominal Antibiotic medicationHydronephrosis Abdominal Medical managementAbdominal trauma Abdominal Medical and surgical managementAbdominal masses Abdominal Medical and surgical managementPleural effusion Chest PleurocentesisCardiac failure Chest Medical managementCardiac valve disease Chest Medical management; SurgicalPericardial effusion Chest Medical management; pericardiocentesisPneumothorax Chest Chest tubeHemothorax Chest PleurocentesisLong bone fracture Limb Reduction and fixationDeep vein thrombosis Limb AnticoagulationIntravenous Access Variable ProceduralAbscess Variable Drainage
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Nyaya’s Ultrasound Programstarted August 2008
from donation of GE Logicbook E through International Aid
with assistance from Yale Emergency Medicine faculty
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Ultrasound Design Specs
small, portable
power needs of a small laptop
robust; used in extreme environments
produces high-quality images
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Human ResourcesFocus on physician initially
Gradually building up capacity of midwives
Need to improve overall computer literacy
Can improve job satisfaction, retention, cost-effectiveness
Oversight is critical
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Quality Assurance
store-and-forward
review of static images by Yale faculty
Simple data collection and review
Open-access to datawiki.nyayahealth.org/UltrasoundProgram
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First 6 Months: Snapshot
primarily physician-conducted
Training of midwives ongoing
70 Obstetric, 99 Non-Obstetric
23% of OB and 40% of non-OB significantly changed management
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Selected Diagnoses and ProceduresHepatic massHydronephrosisCholecystitisEnlarged abdominal lymph nodesRetained placentaFetal demiseNormal pregnancyTuberculosisIV accessAbscess drainage
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Implications: TeleradiologyEffective teleradiology can be quite “simple” technology-wise
Key is regular oversight and data review
Investments in telecommunications can be well worth the expense
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Implications: X-RaySimilar issues in technology, staffing, evaluation, monitoring
Again: need financing and collaboration
Simple store-and-forward teleradiology can be highly effective
Open-access standards to improve transparency
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What you can do…Join the social movement. Donate, spread the word, fundraise.
Volunteer. Need for dynamic, financially and tech saavy global health leaders
More info at www.nyayahealth.org