Many of Pegasus Lectures’ long-term enthusiasts are familiar with our ongoing mission to support ultrasound changing the world of diagnostic medicine. Pegasus Lectures has joined efforts on three continents outside North America in the past decade, and I have had the honor to serve personally on half a dozen mission trips to rural villages in the African nation of Uganda and the mountainous Peruvian Andes in South America.
I am excited to share with you my most recent tour into the equatorial forests of northeastern Peru, over the next several weeks. The sponsoring organization I accompanied is named Medical Imaging Ministries of the Americas (MIMAs). Although coincidental, I do find it interesting that the word MIMAs can be derived from the Spanish “mimar”, which means “to care for” (as a mother nurtures her child).
MIMAs was started by Dr. Brian Garra, who created a new paradigm for performing and teaching ultrasound imaging outside industrialized regions. Dr. Garra’s first initiative using this system was tested successfully in Uganda, Africa through another charity he co-founded nearly fifteen years ago called Imaging the World (ITW). ITW’s focus was to bring diagnostic ultrasound imaging to under-served rural communities where still today as many as 1 in 24 women die during childbirth.
The system Dr. Garra pioneered is called Volume Scanning Imaging, or VSI. Whereas conventional ultrasound requires a medical technician to recognize normal and abnormal pathology of various organs in a grayscale image, augmented by color and spectral Doppler to assess flow characteristics, VSI requires a person only to learn a specific way of sweeping a transducer in order to scan through a volume (region) of the patient. Specific protocols were created for different organs, requiring several sweeps to assure that the entire volume would be assessed with consistency. These scans are based on anatomical landmarks such as the “Adam’s apple” for thyroid studies, or the rib cage, umbilicus, and pubis symphysis for obstetrics and fetal imaging. The video sweeps are then compressed and transmitted to a cloud-based server which can be accessed anywhere in the world. From there, someone trained in VSI interpretation can read the study and write a report that is electronically returned to the clinic where the patient was evaluated.
For this charitable tour, we partnered with a hospital in Santa Clotilde, Peru, staffed by a religious charity. Our prior experiences in Africa have shown that working with faith-based charities often provides more lasting success. Their staff is more inspired to help and serve the community, and there is generally lower turnover in staff due to this dedication.
The main hospital facility in Santa Clotilde supports over one dozen remote clinics up and down the Rio Napo, a tributary to the Amazon River. Our plan is to bring the VSI model to one of these clinics in the rural village of Angoteros, which is another 8 hours up the Rio Napo by boat from Santa Clotilde.
Santa Clotilde is equipped with limited conventional ultrasound. Our plan is to also train someone from the Santa Clotilde staff in VSI protocols as a means of increasing the number of VSI studies in the pilot program as well as to perform the necessary testing for validation. Once successful, the goal is to spread this approach to the remaining clinics, and then use the Santa Clotilde hospital and clinic system as a model to spread to other regional hospitals.
As you can imagine, there were many, many logistical challenges to address so that a trip like this could be successful. We needed to plan ahead for the shipment of equipment, travel, agreements, living quarters, scheduling, training, and about a hundred other issues. For this trip only Dr. Garra and myself would be representing the North American continent. We both navigated the tedious process of updating our vaccinations. For Peru, you are suggested to have Yellow Fever, Tetanus/Diphtheria (TD), typhoid, IPV, meningococcal, and hepatitis. I may be forgetting one or two, but anyone reading this with trypanophobia might be cringing right about now. Fortunately, I was mostly current on these from my half dozen past trips and only needed to get a TD booster.
As I said in the introduction, I am so excited to share this journey with you. Look for my next installment soon.
-Frank
Frank Miele, MSEE , President of Pegasus Lectures, Inc. Frank graduated cum laude from Dartmouth College with a triple major in physics, mathematics, and engineering. While at Dartmouth, he was a Proctor Scholar and received citations for academic excellence in comparative literature, atomic physics and quantum mechanics, and real analysis. Frank was a research and design engineer and project leader, designing ultrasound equipment and electronics for more than ten years at Hewlett Packard Company. As a designer of ultrasound, he has lectured across the country to sonographers, physicians, engineers and students on myriad topics.
