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Emergency Ultrasound

International Ultrasound: View from the frontline: Ultrasound in Cambodia

By Ellen Stein, MD and Trish Henwood, MD

 

Drs. Rothsovann (“Sovann”) Yong & Chris Clingan

Cambodia1

A bit of background:
Chris and Sovann grew up on different continents, but since meeting during fellowship at UMass in Worcester, MA, their professional paths have joined on two sides of the ocean: Lowell, MA and Phnom Penh, Cambodia.

Sovann was born in Cambodia. She came to the US as a refugee. She completed her MD and EM residency at UMass, where she also finished a 2-year fellowship in Disaster Medicine and Emergency Management. From early in her residency, she knew she wanted to help improve the medical system in Cambodia. Initially she thought her contribution would be in the form of teaching emergency medicine and improving pre-hospital systems. Much like the rest of the world, Cambodia has minimal pre-hospital organization and no formal emergency medicine training. She contacted the Angkor Hospital for Children, where she had volunteered during medical school, and they requested emergency ultrasound training knowing its diagnostic value would substantially impact patient care in the absence of advance imaging modalities such as CT scans. This was not what she had in mind but given that they knew exactly what they wanted, she agreed and began to plan the program. It was shortly after completing fellowship and getting the project off the ground that she met Chris.
Cambodia2Chris is a Seattleite who attended medical school at Vanderbilt and completed his EM residency training at UC Davis. During his 3rd year of residency, he realized the impact ultrasound could have in the developing world and volunteered with an ultrasound training program in Rwanda. His experiences ingrained in him the value of this technology and the desperate need for training in under-resourced settings. With this in mind, he came to Massachusetts to complete an ultrasound fellowship at UMass, where he overlapped with Sovann and their professional partnership took form. 

Angkor Hospital for Children (AHC): May 2013 – January 2016
AHC is an NGO that employs many expats who have been trained in countries such as the U.S. As a result, many of the providers were aware of the benefits of ultrasound and were eager to train Cambodian providers in these skills. The UMass Emergency Department generously donated a retired ultrasound machine to the program and after years of planning, it was up and running. Over the course of the next three years, Sovann, Chris and a number of UMass faculty, fellows and other ultrasound-trained physicians visited the pediatric hospital 4-5 times per year, many returning for multiple visits. They trained nine pediatric ER/ICU physicians through a combination of didactics and hands-on sessions when they were in-country. When they were back home in Massachusetts, they performed quality assurance by reviewing images saved to Dropbox. In January 2016, these nine Cambodian physicians graduated. Chris and Sovann’s work is not done there quite yet as they plan to promote sustainability by training these graduates to train other residents and staff and to perform research.

Sihanouk Hospital Center for Hope (SHCH): February 2016 and beyond
Sovann and Chris had no break before project #2 began. After leaving UMass, they had both moved east to Lowell MA, and joined the staff of Lowell General Hospital. Coincidentally, a primary care physician in Lowell had worked in Cambodia and was creating a formal tie between SHCH and Lowell General. When the SHCH director heard about the work Chris and Sovann had done at AHC, he immediately requested that they adopt his hospital as their next site for ultrasound education. As a gesture towards solidifying this sister-hospital relationship, Lowell General donated a new ultrasound machine for use in this effort. In order to plan for inevitable hardware and software issues, they wisely chose a manufacturer that had in-country support. The unit donated to the children’s hospital previously had had to be sent back to the US for repair when it had broken down, something they wanted to prevent in this case. Sovann and Chris anticipate they will travel to Cambodia 4-5 times per year for the next 2-3 years to complete this initial training.

Cambodia3Words of wisdom from Sovann & Chris:
If you are interested in bringing ultrasound to under-resourced settings:

1) Go where you have personal connections. If you are set on going to a particular location where you have no contacts, go there to volunteer on an established project and start to lay the groundwork and make those connections. THEN you can return in the context that interests you but not until you have the relationships. If you are not set on a particular location but want to do good work, go where you have connections (friends of colleagues, contacts you make at conferences, friends from residency, etc.)  It’s all about the connections!

2) Anticipate that nothing will go as planned and adopt an ‘it will be okay’ mindset. Frequent trips and established methods of trans-continental communication will help, as whatever does not get done on one trip can usually get completed on the next.

3) Provide the services and training that is requested rather than what you personally want to contribute. The recipient hospitals/staff know what they need. Don’t fight for what YOU think they need.

4) Consider making your contribution one of education rather than of direct care. This is in the spirit of the Chinese proverb: “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.”

5) Anticipate that you may have to spend some of your own money but also get creative with how to fund trips. Ask your hospital if CME money will cover your trip. Combine forces with a funded group performing research. The bottom line is money for international work can be limited so set your expectations appropriately.

How to get involved: If you are an interested senior EM resident with strong ultrasound skills, an ultrasound fellow, or attending, please contact Sovann & Chris for more information.


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