Emergency Ultrasound

International Ultrasound: A view from the frontlines of international ultrasound. An Interview with Dan Kaminstein, MD

By Ellen Stein, MD and Trish Henwood, MD

Intl_1Q: How did you come to be aware of and interested in ultrasound use in the international setting?

A: “Although I did not do a ton of traveling as a kid, I knew in medical school that I would want to work overseas. I chose residency at MCG (Medical College of Georgia) largely because of one individual, Dr. Ted Kuhn. He runs the International Fellowship at MCG and makes international experiences available to residents. I took advantage of these offerings during my residency and did several 2-3 week trips, to places such as Mali, Guinea, Senegal, and Bangladesh.

Although I initially chose to participate in these trips because of my interest in international medicine, I quickly realized how useful of a tool ultrasound was in settings where there often was no other imaging modality available. Dr. Kuhn had been ultrasound trained by radiologists rather than emergency medicine physicians, so he was using ultrasound in ways that you would not see in an American. ED, such as for the liver, infectious disease detection, and advanced OB applications. Amazingly, even in rural villages far from a city, there were basic ultrasound units, so the benefits of the device were abundantly clear.”

Q: What was your initial vision of how you would incorporate international work and ultrasound into your career?

A: “I originally thought I would travel around Africa with an ultrasound unit, set up temporary clinics to bring intermittent advanced diagnostics to those locations. Through my fellowship, however, I had the chance to teach in Peru, at a conference created by 3 incredible mentors, Ted Kuhn, Tom Heller (FASH exam) and Enrico Brunetti (world’s expert on Cystic Echinococcosis, HIV and TB ultrasound). That’s where things switched for me. I realized I wanted to teach others to do the imaging and I knew I specifically wanted to apply the ultrasound to diagnosing tropical infectious diseases. As part of my fellowship training I had spent 3 months at the London School of Hygiene and Tropical Medicine, which had piqued my interest in infectious diseases. This conference solidified it. I also met another major influence in my international ultrasound career at that conference: Dr. Rob Peck. He is a U.S. trained med/peds physician who lives in Tanzania full time teaching Tanzanian residents. Rob recruited me to come to Tanzania to teach him how to use ultrasound for both regular pathology and infectious diseases. My trips quickly morphed into my teaching Tanzanian residents and I realized that that had became my new vision.”

Q: What is your vision now?

A: “My vision is to work myself out of my current role of teaching and setting up the training programs. I look forward to the day when the people we currently are training are able to do the teaching themselves. I also hope to help them perform clinical research that will be of use to them both from a knowledge and a publishing/recognition perspective.”

Intl_2Q: What are the obstacles to accomplishing your goals with ultrasound internationally?

A: “Unfortunately the biggest challenge is one that might be a long time before it is fixed: technology. Machine have become more affordable over time, but are still a barrier to widespread implementation. Another challenge is ready access to ultrasound mentors. Some, such as Rob (Peck) make themselves available to review images and teach but they are not 10 feet away, as would be the case in most American teaching institutions.”

Q: Are there any downsides to what you are doing to spread ultrasound abroad?

A: “Regardless of how long you have been in a community or how well you know the politics, it is tricky to navigate hospital dynamics well. You do not want to alienate particular groups of people and create divides between individuals by giving training and units to particular departments. I feel like we have done that well, but it is something that always has to be kept in mind.”

Q: Do you have recommendations for how people can get involved?

A: “From an ultrasound standpoint, AIUM ( is the best place to get involved from the ultrasound side. I am still involved in the course in Peru, which is a great start for anybody interested specifically in the intersection of ultrasound with tropical infectious diseases And of course, I am happy to hear from anybody who would like to
learn more.”

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