Dr. Jonathan “Jono” Henry is an emergency physician based in Melbourne, Australia. After he gave a talk at the 2018 ASUM Conference in Auckland, Dr. Henry was asked by the Vanuatu Ministry of Health to assist with emergency services in their country. The Pacific archipelago nation is still struggling to emerge from a 2015 cyclone.
For six months Dr. Henry was based at Northern Provincial Hospital, located in the city of Luganville on the island Espiritu Santo. This is Vanuatu’s second-largest hospital, serving a population of 160,000. Naturally, Dr. Henry knew a portable ultrasound machine would be essential to his mission. In his request letter to Sonosite, he wrote:
“As you know from your support of previous projects, the use of ultrasound in the ED has enormous potential in resource-limited settings. For the entire population of 300,000, Vanuatu has limited conventional radiology and no computed tomography. Ultrasound imaging for patients presenting to NPH ED with abdominal, pelvic, thoracic, soft tissue, and musculoskeletal pathology is limited to an outdated ultrasound machine in the radiology department with restricted after-hours use and minimal technical support. Often the machine is offline due to service or unavailable operators.
I need access to a portable ultrasound unit…I am most interested in the M-Turbo or Edge II models, as their portability, durability, and high quality of imaging is suited to the rural hospital environment.”
Sonosite answered Dr. Henry’s call by loaning him the perennially popular M-Turbo. He soon gave the trusty handheld ultrasound machine a wide range of jobs. Three months into his mission, Dr. Henry reported back on cases where the M-Turbo was pivotal in helping obtain the correct diagnosis or treatment:
“Several cases so far have highlighted the utility of ultrasound in this resource-limited setting. A man presented after falling over 15 meters from a tree, landing heavily on his back. Having learned how to perform an eFAST scan during his ED rotation, one of the interns was able to diagnose a haemothorax, confirm the highest excursion of the diaphragm, then place a large-bore chest drain with optimal precision and safety.
A critically ill infant presented with recurrent seizures, severe hypernatremia, and pneumonia. After numerous hospital visits, they had extremely difficult venous access. Using the Sonosite linear probe, I was able to safely place a femoral venous line to obtain emergency bloodwork and treatment.
A middle-aged male presented overnight severely short of breath with acute pulmonary edema. I was reliant on bedside ultrasound to diagnose severe aortic regurgitation, interstitial edema with the presence of diffuse lung B-lines, and titrate antihypertensives to resolution of the B-lines.
The M-Turbo is used constantly, and imaging requests are made from all corners of the hospital. Echocardiography has revealed a wide variety of cardiac disease, including a high prevalence of undiagnosed rheumatic valvulopathies. Most expecting mothers can't access antenatal care, so obstetric scanning is invaluable when complications arise. With no CT scanner in Vanuatu, renal scanning helps to identify hydronephrosis and kidney stones. Procedural guidance has varied from drainage of a small loculated pleural collection, to troubleshooting indwelling catheters. Appendicitis, gallstones, bowel obstructions, and abscess quantification round out other frequent uses.”
Dr. Henry is looking forward to some well-earned R&R to enjoy Vanuatu's stunning weather, beaches, diving, food, and the endless generosity of his Ni-Van hosts. With three months left in his mission, he also plans on using the M-Turbo for even more life-saving applications. In Part Two, Dr. Henry will continue to report on the wide range of uses of a handheld ultrasound in a resource-limited environment.
Sonosite Global Health
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