April 24, 2009 Telemedicine Symposium,  Bryn Mawr College Nyaya Health's Ultrasound Program in Rural Nepal Implications fo...
Overview <ul><li>About Nyaya Health and Achham </li></ul><ul><li>Global Need for Radiology Services </li></ul><ul><li>Nyay...
Achham, Nepal <ul><li>Number of citizens: 250,000 </li></ul><ul><li>Number of doctors: 1 </li></ul><ul><li>99.5% of babies...
Mission 1:  Facilitate resource distribution to resource-denied areas
Mission 2:  <ul><li>Foster local human capacity and grassroots collective action </li></ul>
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 <ul><li>over 50% of the world's population lack access to X-Ray and ultrasound </li></ul><ul><li...
Ultrasound: Uses in Rural Areas <ul><li>Referral to higher level facilities </li></ul><ul><li>Assistance in guiding proced...
Ultrasound: Uses in Rural Areas
Nyaya’s Ultrasound Program <ul><li>started August 2008 </li></ul><ul><li>from donation of GE Logicbook E through Internati...
Ultrasound Design Specs <ul><li>small, portable </li></ul><ul><li>power needs of a small laptop </li></ul><ul><li>robust; ...
Human Resources <ul><li>Focus on physician initially </li></ul><ul><li>Gradually building up capacity of midwives </li></u...
Quality Assurance <ul><li>store-and-forward </li></ul><ul><li>review of static images  by Yale faculty  </li></ul><ul><li>...
First 6 Months: Snapshot <ul><li>primarily physician-conducted </li></ul><ul><li>Training of midwives ongoing </li></ul><u...
Selected Diagnoses and Procedures <ul><li>Hepatic mass </li></ul><ul><li>Hydronephrosis </li></ul><ul><li>Cholecystitis </...
Implications: Teleradiology <ul><li>Effective teleradiology can be quite “simple” technology-wise </li></ul><ul><li>Key is...
Implications: X-Ray <ul><li>Similar issues in technology, staffing, evaluation, monitoring </li></ul><ul><li>Again: need f...
What you can do… <ul><li>Join the social movement.  Donate, spread the word, fundraise.  </li></ul><ul><li>Volunteer.  Nee...
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Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-Denied Areas

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April 24, 2009
Telemedicine Conference
Bryn Mawr College, Philadelphia, PA

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Nyaya Health Ultrasound Program: Implications for Teleradiology in Resource-Denied Areas

  1. 1. 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
  2. 2. Overview <ul><li>About Nyaya Health and Achham </li></ul><ul><li>Global Need for Radiology Services </li></ul><ul><li>Nyaya's Program </li></ul><ul><li>Ultrasound Design Specs </li></ul><ul><li>Human Resources </li></ul><ul><li>Quality Assurance and Teleradiology </li></ul><ul><li>Implications for X-Ray and Beyond </li></ul>
  3. 3. Achham, Nepal <ul><li>Number of citizens: 250,000 </li></ul><ul><li>Number of doctors: 1 </li></ul><ul><li>99.5% of babies are delivered outside a health center </li></ul><ul><li>1 in 125 deliveries result in death of the mother </li></ul><ul><li>60% of children are chronically malnourished </li></ul><ul><li>Average person makes $150 a year </li></ul><ul><li>Nearest functioning airport and hospital: 10 hour bus ride away, costs 1-2 months' average income </li></ul><ul><li>80% households have one male migrating to India </li></ul>
  4. 4. Mission 1: Facilitate resource distribution to resource-denied areas
  5. 5. Mission 2: <ul><li>Foster local human capacity and grassroots collective action </li></ul>
  6. 6. Mission 3: Apply evidence-based medicine principles and data monitoring
  7. 7. Mission 4: Involve the central government in pro-poor health infrastructure
  8. 8. Mission 5: Achieve transparency and collaboration in global health delivery
  9. 9. Global Need for Radiology <ul><li>over 50% of the world's population lack access to X-Ray and ultrasound </li></ul><ul><li>effective technology exists </li></ul><ul><li>what is lacking: financial support, training, evaluation, monitoring </li></ul>
  10. 10. Ultrasound: Uses in Rural Areas <ul><li>Referral to higher level facilities </li></ul><ul><li>Assistance in guiding procedures </li></ul><ul><li>Point of care diagnostics </li></ul>
  11. 11. Ultrasound: Uses in Rural Areas
  12. 12. Nyaya’s Ultrasound Program <ul><li>started August 2008 </li></ul><ul><li>from donation of GE Logicbook E through International Aid </li></ul><ul><li>with assistance from Yale Emergency Medicine faculty </li></ul>
  13. 13. Ultrasound Design Specs <ul><li>small, portable </li></ul><ul><li>power needs of a small laptop </li></ul><ul><li>robust; used in extreme environments </li></ul><ul><li>produces high-quality images </li></ul>
  14. 14. Human Resources <ul><li>Focus on physician initially </li></ul><ul><li>Gradually building up capacity of midwives </li></ul><ul><li>Need to improve overall computer literacy </li></ul><ul><li>Can improve job satisfaction, retention, cost-effectiveness </li></ul><ul><li>Oversight is critical </li></ul>
  15. 15. Quality Assurance <ul><li>store-and-forward </li></ul><ul><li>review of static images by Yale faculty </li></ul><ul><li>Simple data collection and review </li></ul><ul><li>Open-access to data </li></ul><ul><li>wiki.nyayahealth.org/UltrasoundProgram </li></ul>
  16. 16. First 6 Months: Snapshot <ul><li>primarily physician-conducted </li></ul><ul><li>Training of midwives ongoing </li></ul><ul><li>70 Obstetric, 99 Non-Obstetric </li></ul><ul><li>23% of OB and 40% of non-OB significantly changed management </li></ul>
  17. 17. Selected Diagnoses and Procedures <ul><li>Hepatic mass </li></ul><ul><li>Hydronephrosis </li></ul><ul><li>Cholecystitis </li></ul><ul><li>Enlarged abdominal lymph nodes </li></ul><ul><li>Retained placenta </li></ul><ul><li>Fetal demise </li></ul><ul><li>Normal pregnancy </li></ul><ul><li>Tuberculosis </li></ul><ul><li>IV access </li></ul><ul><li>Abscess drainage </li></ul>
  18. 18. Implications: Teleradiology <ul><li>Effective teleradiology can be quite “simple” technology-wise </li></ul><ul><li>Key is regular oversight and data review </li></ul><ul><li>Investments in telecommunications can be well worth the expense </li></ul>
  19. 19. Implications: X-Ray <ul><li>Similar issues in technology, staffing, evaluation, monitoring </li></ul><ul><li>Again: need financing and collaboration </li></ul><ul><li>Simple store-and-forward teleradiology can be highly effective </li></ul><ul><li>Open-access standards to improve transparency </li></ul>
  20. 20. What you can do… <ul><li>Join the social movement. Donate, spread the word, fundraise. </li></ul><ul><li>Volunteer. Need for dynamic, financially and tech saavy global health leaders </li></ul><ul><li>More info at www.nyayahealth.org </li></ul>
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