April 24, 2009 Telemedicine Symposium, Bryn Mawr College Nyaya Health's Ultrasound Program in Rural Nepal Implications for Teleradiology in Resource-Denied Areas Duncan Maru, PHD

Overview About Nyaya Health and Achham Global Need for Radiology Services Nyaya's Program Ultrasound Design Specs Human Resources Quality Assurance and Teleradiology Implications for X-Ray and Beyond

About Nyaya Health and Achham

Global Need for Radiology Services

Nyaya's Program

Ultrasound Design Specs

Human Resources

Quality Assurance and Teleradiology

Implications for X-Ray and Beyond

Achham, Nepal Number of citizens: 250,000 Number of doctors: 1 99.5% of babies are delivered outside a health center 1 in 125 deliveries result in death of the mother 60% of children are chronically malnourished Average person makes $150 a year Nearest functioning airport and hospital: 10 hour bus ride away, costs 1-2 months' average income 80% households have one male migrating to India

Number of citizens: 250,000

Number of doctors: 1

99.5% of babies are delivered outside a health center

1 in 125 deliveries result in death of the mother

60% of children are chronically malnourished

Average person makes $150 a year

Nearest functioning airport and hospital: 10 hour bus ride away, costs 1-2 months' average income

80% households have one male migrating to India

Mission 1: Facilitate resource distribution to resource-denied areas

Mission 2: Foster local human capacity and grassroots collective action

Foster local human capacity and grassroots collective action

Mission 3: Apply evidence-based medicine principles and data monitoring

Mission 4: Involve the central government in pro-poor health infrastructure

Mission 5: Achieve transparency and collaboration in global health delivery

Global Need for Radiology over 50% of the world's population lack access to X-Ray and ultrasound effective technology exists what is lacking: financial support, training, evaluation, monitoring

over 50% of the world's population lack access to X-Ray and ultrasound

effective technology exists

what is lacking: financial support, training, evaluation, monitoring

Ultrasound: Uses in Rural Areas Referral to higher level facilities Assistance in guiding procedures Point of care diagnostics

Referral to higher level facilities

Assistance in guiding procedures

Point of care diagnostics

Ultrasound: Uses in Rural Areas

Nyaya’s Ultrasound Program started August 2008 from donation of GE Logicbook E through International Aid with assistance from Yale Emergency Medicine faculty

started August 2008

from donation of GE Logicbook E through International Aid

with assistance from Yale Emergency Medicine faculty

Ultrasound Design Specs small, portable power needs of a small laptop robust; used in extreme environments produces high-quality images

small, portable

power needs of a small laptop

robust; used in extreme environments

produces high-quality images

Human Resources Focus 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

Focus 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

Quality Assurance store-and-forward review of static images by Yale faculty Simple data collection and review Open-access to data wiki.nyayahealth.org/UltrasoundProgram

store-and-forward

review of static images by Yale faculty

Simple data collection and review

Open-access to data

wiki.nyayahealth.org/UltrasoundProgram

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

primarily physician-conducted

Training of midwives ongoing

70 Obstetric, 99 Non-Obstetric

23% of OB and 40% of non-OB significantly changed management

Selected Diagnoses and Procedures Hepatic mass Hydronephrosis Cholecystitis Enlarged abdominal lymph nodes Retained placenta Fetal demise Normal pregnancy Tuberculosis IV access Abscess drainage

Hepatic mass

Hydronephrosis

Cholecystitis

Enlarged abdominal lymph nodes

Retained placenta

Fetal demise

Normal pregnancy

Tuberculosis

IV access

Abscess drainage

Implications: Teleradiology Effective teleradiology can be quite “simple” technology-wise Key is regular oversight and data review Investments in telecommunications can be well worth the expense

Effective teleradiology can be quite “simple” technology-wise

Key is regular oversight and data review

Investments in telecommunications can be well worth the expense

Implications: X-Ray Similar 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

Similar 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

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

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