Sharing Critical Ultrasound Knowledge in Eritrea

August 17, 2020

Emergency room consultant Norbert Pfeufer, MBA, has developed and organized ultrasound workshops for anesthetists in Eritrea, Africa, for a number of years. This has helped to support doctors in the area that are faced with many daily challenges, including language barriers and a lack of resources. Pfeufer explains:

“Eritrea is a country situated in the Horn of Africa, and is home to approximately 6.3 million people. The inhabitants belong to one of nine different nations, each with its own language, and form a wide demographic of ethnicities and religions. This large population, when in need of critical care, is treated in a single clinic, the Orota Referral Hospital in the capital city of Asmara, which provides medical services to people all over the country. The combination of a large population with a distinct lack of supplies, including medical consumables and technologies, puts a strain on Eritrea’s limited resources.”

The implementation of ultrasound as a diagnostic tool is expected to significantly increase the quality of care that can be provided to patients in Eritrea. The relief organization, Eritrean Hilfwerk Deutschland (EHD), originally privately-funded anesthesia ultrasound training at Asmara College of Health Sciences, as Pfeufer discusses:

“In 2018, I worked with the EHD to provide introductory ultrasound courses for anesthetists at the college, as I knew from my own experiences the benefits that ultrasound could bring to these environments. The funding supported the acquisition of a Sonosite M-Turbo system, the same model that I use every day in emergency settings in my clinic in Germany, and so I was able to clearly demonstrate all the advantages that the instrument can bring.”

After the success of the EHD funded courses, the German government have now provided publicly-funded courses directly for the doctors at Orota Referral Hospital:

“We are currently running an ultrasound course that lasts several weeks. This allows us to teach the doctors about the benefits of ultrasound, but to also highlight the ways in which the M-Turbo is suitable to such a busy environment, thanks to its robustness, mobility and user-friendliness. The clinic has 200 beds for a wide range of specialties—internal medicine, pediatrics, general surgery, trauma surgery, ENT, and gynecology, as well as an emergency department and intensive care units for both children and adults. The portable and flexible nature of the M-Turbo makes it the perfect tool for this kind of environment, where it could be useful for several different conditions.”

Based on the successful demonstration of ultrasound during the course, the team were subsequently asked to use the Sonosite M-Turbo to support the intensive care unit of the hospital. “We provided ultrasound support to simplify a tumor puncture in the neck of a patient in intensive care,” Pfeufer explains. “We were also able to use the device successfully in an emergency coniotomy with atypical anatomy, showcasing the system’s versatility and necessity in these fast-paced environments.”

Since the program was initiated, Pfeufer and the team have now developed a full curriculum, with several different courses, to teach to the doctors in Eritrea:

“Our courses have now progressed to cover a wide range of topics beyond the introductory material. We look at the physics behind ultrasound technology, artefacts, basics of hardware, and mediation of the emergency protocols: FAST, E-FAST, FATE, RUSH. The participants also get hands-on experience, with daily training sessions performed in small groups using the instruments on both healthy volunteers and patients.

It’s a fantastic experience. Recently, we worked our way through the emergency protocols, where we were able to demonstrate the use of ultrasound on patients with pneumothorax, pericardial tamponade, deep vein thrombosis, defective heart valves, ascites, and gallstones. Participants found the visualization of clinical images fascinating, and everyone was incredibly interested in using ultrasound to detect the various conditions, including my colleagues. They were all eager to give it a go! The follow-up courses will focus on abdominal sonography, echo, nerves, lungs and gynecology. For this purpose, other specialists will travel to Asmara. It’s very exciting and we hope to continue with this level of success in future courses.”