Antenatal Ultrasound Training in Resource-Limited Regions of Western Kenya
Maternal mortality continues to be a significant public health problem throughout the developing world. Sub-Saharan Africa accounts for approximately 50% of all maternal deaths globally. World Health Organization data suggests that the majority of these deaths could be prevented if emergency obstetric care were available at every birth. However, since almost half of all births in developing countries take place at home without a skilled birth attendant, life-saving obstetrical interventions are often delayed. This results in unnecessary maternal and fetal morbidity and mortality.
A new generation of affordable, hand-held ultrasound machines has opened the possibility for antenatal ultrasound screening programs in resource-limited settings, such as rural Kenya. However, given the general paucity of radiologists in Kenya, the training of non-radiologist clinicians in point-of-care ultrasound is essential. I had the pleasure of working with the Division of Global Health and Human Rights and Kisumu Medical Education Trust, our in country partner, to train midwives in point-of-care maternal ultrasound in Western Kenya.
Working with an ultrasound-trained Emergency Room physician from California and three Kenyan midwives with subspecialty training in ultrasound, we provided one week of refresher training in antenatal ultrasound to 16 nurse midwives from all over Western Kenya. The midwives participating in the refresher course had received initial antenatal ultrasound training through our program nearly 1 year prior. In the mean time they had integrated limited antenatal ultrasound services into their rural obstetrical practices.
It was great to reunite with the midwives whom I had worked with before and to meet and hear the stories of those midwives whom I was meeting for the first time. These dedicated health care providers shared powerful stories of how ultrasound had impacted their patients in positive ways. By identifying high-risk conditions early (i.e., placenta previa, twin gestation, and abnormal presentation), providers could arrange hospital delivery for these patients. In the absence of these ultrasound-based diagnoses, these patients may have delivered at home, potentially resulting in untreated complications of delivery.
