Justin Moher, MD
Justin Moher, MD
Pediatric Emergency Medicine · Houston, TX

Ultrasound in an Emergency Department in Malawi

September 15th
Lilongwe, Malawi

Project Description

This project aims to improve pediatric emergency care at Kamuzu Central Hospital (KCH) in Malawi through the creation and implementation of a point-of-care ultrasound education program. Point-of-care ultrasound involves the use of ultrasound at the bedside as a diagnostic tool and therapeutic adjunct. At KCH, as in many global health settings, access to imaging, such as X-rays, CT scans, or MRIs is limited due to the need for expensive equipment and specialists. If access exists, our critically ill patients can afford neither the time nor travel. Point-of-care ultrasound is inexpensive, non-radiating, provides immediate results at the bedside and has been shown to be able to be taught to clinicians with limited or no prior training. We aim to create a novel and feasible ultrasound scanning protocol based on the most common and high yield diagnoses and to develop a locally-led, sustainable training program to improve the care of urgently and emergently ill children. Ultimately, we hope this project will be transferable to other global health sites to further widen its impact.

My work in the Pediatrics Department at KCH is part of an ongoing collaboration between U.S.-based institutions and the Malawi Ministry of Health. In addition to the above project and in partnership with the local physicians and clinicians, I will be aiding in clinical, educational and other research efforts to aid the care of acutely ill children at this important referral hospital in the capital city.

Population Served

Malawi is a landlocked country located in southeastern Africa with a significant health burden with a high under 5 mortality rate and a large prevalence of HIV/AIDS, tuberculosis, and malaria. Kamuzu Central Hospital is the national referral hospital in the capital city of Lilongwe serving the central region of Malawi. The pediatric ward admits more than 27,000 patients per year and manages all medical emergencies. In the emergency zone, a small staff of nurses and clinicians will care for often over 100 acutely and critically ill children each day. My project will serve to benefit this especially vulnerable population of sick children and the dedicated local clinicians who care for them. As sustainability is an important factor in this educational program, I hope the impact will continue for years to come.

Expected Impact

This project will provide local clinician partners with skills in point-of-care ultrasound to better care for their critically ill children. Through the ability to have improved bedside diagnostics, children will be able to receive more appropriate care, faster which has been shown to decrease mortality and improve long-term health outcomes.

This project will not only teach clinicians in the skills of point-of-care ultrasound, but will also aim to train trainers, thus allowing knowledge to be passed on to others and to eventually function independently.

Trip Photos & Recap

Over the 4 week trip, I was able to provide care for critically ill children in the Pediatrics Department at Kamuzu Central Hospital in Lilongwe, Malawi. Amid this clinical work, I had the privilege to work alongside, teach and learn from local trainees, clinical officers and physicians in the department. This trip also allowed me to continue my work in the development of a point-of-care ultrasound (POCUS) educational training program. The preliminary portion of the study involving an epidemiological survey of clinical POCUS use and pathology identified in the department was completed. With this work, my group will go on in future visits to create a locally relevant POCUS scanning algorithm, begin a pilot educational program, and eventually create a sustainable POCUS training curriculum to improve the care of children.

The pictures I have provided show the inner courtyard of the hospital where mothers’ vibrant chitenge cloths dry on the line; respiratory equipment drying outside; and of myself scanning in the resuscitation bay of the Emergency Zone.

Thank you to Doximity for your support in helping to care for the critically ill children in Malawi.