University of Nebraska Medical Center

Dodoma, Tanzania May 2015

Here are some pictures. We are teaching V Scan  ultrasound to our colleagues, and you will see that we are preparing for a Rheumatic Heart Disease screening project, because of the high prevalence of RHD and severe consequences for children and adults. I will be working with cardiologist, and with two of my MPH colleagues to accomplish this outreach project for all presenting pregnant patients in 3 out of the 7 districts here, randomly of course! ha!

Little babies were scanned at the Dodoma General Hospital. We were scanning after requested consults for babies with NEC, pneumonia, and another with pulmonary edema and possibly congenital heart disease. The baby with pneumonia, “Maria” was an orphan, being raised by the Mother Teresa order in Dodoma, Tanzania. She had been thrown in the gutter by her mother at one day of age, with her throat slit. She was retrieved by a good Samaritan, and taken to the orphanage run by the nuns. She was nine months old in this picture, and died in 12 hours after we were called for consult. She had been on 5 days of antibiotics for pneumonia, was needing ventilation, and probably also Acylovir, as the history demonstrated two others from the orphanage also hospitalized in the same unit………the photo with two babies in bed together. There is no bubble C-Pap machine, no ventilator for this baby and no Acyclovir. The patient was reportedly HIV negative (sero-status negative, is the code word), but I was recommending Bactrim, to be added to the Gent/Ancef that was on-board and the pneumonia was unresponsive to this regime. Perhaps if we had been there the day before she would have made it. Her eyes were so dear, and she was patient with the 68 breaths/minute, just wearing out! I was able to syringe a bit of fluid in orally, we bolused her with an IV purchased at the pharmacy across the street, and I purchased Tylenol for her fever of 39 degrees Celsius. It was not a happy day for us, as a team of Tanzanians and Americans, discouraged with how little our impact is at times.

I helped a mother with a baby with obvious Kwashiorkor and marasmus express milk and spoon feed between his efforts to suckle. The baby was about one year of age, and 10 pounds; his foot size gave you a good idea of the degree of malnutrition. He was severely dehydrated and the mother was working hard to increase his nursing. He died in the evening at around the same time as baby Maria.

I am working along side medical officers, a trainer from George Washington University, Keith Boniface, MD, Emergency Department, radiology consultant, faculty GWU. He came for a 2-day intensive training that was coordinated by me and the expert clinicians invited to participate, with much delight on their behalf. I have a pocket V-Scan that I use clinically every day. The images are then uploaded to Dr. Boniface to read, and for consultation, except the OB ultrasounds that are my specialty.

In the OB ward I use the V Scan for diagnosis of twins, of placentation, of amniotic fluid levels and for biophysical profiles for the babies. It is a godsend for me, as in the last two weeks I have had two sets of un-diagnosed twins and when I relayed that information to the attending medical officer after doing my clinical Leopold’s, the information was not ‘believed’! So, with the ultrasound, I can prove positively, that there are two heads, two heart beats, and proceed with the deliveries. I also use the scan with postpartum hemorrhage after stabilization to make sure that there are no retrained products. The level of acuity here is intense, as you know.

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