I will be traveling to rural Nepal at a remote hospital called Bayalpata Hospital along with my colleague Dr Ramu Kharel. There I plan to conduct a weeklong workshop to teach the healthcare workers how to use ultrasound to diagnose upper extremity fractures. As an expert in point-of-care ultrasound, I have designed a curriculum and secured multiple ultrasound machines to deliver to these workers. They will keep these machines to be able to use them permanently.
Currently, these patients have to travel long distances to be able to receive an x-ray to determine if they have a fracture. Because of this, there is a delay in diagnosis, and in some cases, because of the long journey they never get diagnosed or receive treatment. We will be giving the local healthcare providers the ability to diagnose these injuries on the spot where the patients live. This will result in overall improved care in managing traumatic injuries to these patients' upper extremities.
Our intervention would be serving the people of rural western Nepal. This is an extremely remote facility. The nearest facility is over 10 hours away. This population was chosen as they would benefit hugely from this intervention, and the physician I am collaborating with, Dr Ramu Kharel, has significant experience in working with this population specifically.
Upper extremity fractures are common in rural Nepal. Access to care is poor due to the limited availability of diagnostic imaging. Point-of-care ultrasound is a rapid, affordable, and mobile imaging modality that has demonstrated high diagnostic sensitivity and specificity for the detection of upper extremity fractures in adults and pediatric patients. Evaluation techniques can be taught using short courses with significant results regardless of previous experience. As such, our intervention where we will teach the local healthcare providers how to do this exam and give them the ultrasound machines to be able to do this has the potential to significantly improve access for this population.
The majority of people living in Acham, Nepal and the surrounding areas lack access to basic imaging, including X-ray. Patients sustaining fractures in this area face major challenges in access to care. After teaching the midlevel health providers there how to perform an ultrasound to diagnose upper extremity fractures, they immediately started to use it in their clinical practice. Within one week of teaching them, nearly 10 cases of fracture were diagnosed with the use of ultrasound.
With time, this initial cohort of health providers will teach other providers in this region how to use ultrasound to diagnose upper extremity fractures. This will allow patients with upper extremity fractures, who previously would have had to make in some cases a multiple day journey to get an xray, immediate access to imaging to determine if they have a fracture and need further care or not.
