Transforming care through ultrasound

In a hospital in Karachi, a Pakistani medical resident examines a patient who has pain in his side. The resident and her instructor scan the man with a hand-held device about the size of an electric razor and discover he has a backup of fluid in his kidney. The patient’s history and further tests confirm their diagnosis.

The instructor is Dr. Aisha Mirza, an emergency physician at Grey Nuns Community Hospital in Edmonton. And the hand-held device is the latest in point-of-care ultrasound technology, the Butterfly IQ. Aisha joined a medical mission to Pakistan in November with MedGlobal, a Chicago-based organization that aims to alleviate disparity in health care around the world.

In Pakistan, many doctors are working in rural areas where they don’t have access to X-rays. The new hand-held ultrasound device is expected to make a big difference, from assessing broken bones to examining causes of swelling to checking a patient’s heart for fluid.

“The poverty level in Pakistan is staggering, so these physicians are really relying on history and physical exams,” says Aisha, who is also an associate clinical professor in emergency medicine and family medicine at the University of Alberta. “The device helped us to really narrow down and focus on what this was.”

Dr. Aisha Mirza shows a colleague how the Butterfly IQ works.

Aisha uses ultrasound, which she describes as a sort of stethoscope that works with sound waves, in the emergency department at the Grey Nuns every day. She’s using a larger device called a Sonosite, which is about the size of a large laptop that is wheeled to and from the bedside. The ButterflyIQ is smaller and more portable because of its new proprietary chip technology. Once the device is approved in Canada, Aisha expects it to improve access to ultrasound here, too.

“Typically, ultrasound was very bulky and large, and now I can literally hold it in the palm of my hand.”

New research is showing the benefits of using ultrasound. For example, when looking for a blood clot in the leg, radiologists typically perform a long and complicated scan from the groin to the knee.

“But there’s really good literature suggesting that, for some patients, a point-of-care ultrasound focused on certain aspects of the leg can be done in under three and a half minutes and can be just as accurate with high sensitivity and specificity to rule that out. So that’s huge.”

Aisha started taking courses on point-of-care ultrasound after finishing her residency 12 years ago, when ultrasound was still used primarily in radiology. Eight years ago, she created an ultrasound workshop for medical students. Recently, the Canadian Association of Emergency Physicians included a recommendation in its guidelines that all emergency doctors should know how to use point-of-care ultrasound in several key areas, from trauma to cardiac to first trimester pregnancies.

Aisha demonstrates how to use point-of-care ultrasound to physicians in Karachi.

Many physicians who attended the week-long course in Karachi came from rural areas, travelling up to three days by train. The MedGlobal team raised money to buy 10 Butterfly IQ devices to leave with the physicians after their week of training. Each device plugs into a phone or tablet, and the scanned images can be uploaded to a cloud, so Aisha continues to provide feedback to her trainees.

“This is not a one-and-done thing. As a physician, you develop this skill, and you get better with time.”

Aisha, a master instructor with the Canadian Point of Care Ultrasound Society, helped create the course provided on the recent mission as part of the point-of-care ultrasound pilot program, and she plans to return to Pakistan with MedGlobal.

“It leaves you with such a good feeling that these are the pebbles, the steps that are going to be taken forward. This is going to have a sustainable outreach in this country. So it felt really rewarding to go and volunteer for something like this. I felt really privileged to be part of the mission.”

Aisha, who speaks Urdu, was born in Pakistan and moved to Canada with her family when she was two. She has gone back to Pakistan to visit and also returned in 2005 to help with earthquake relief. The memory of seeing the extreme poverty and challenging conditions inspires her to share her expertise with local doctors who can make an ongoing difference for their patients.

“Our goal is that, eventually, we won’t need to go back and train more physicians — they’ll be able to train themselves,” says Aisha. “It’s the whole process of teaching a man to fish instead of giving a man a fish.”

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