Research in global health: The Introduction of FAST in Uganda Jennifer Y. Wang

Challenges in global health research Identifying mutual areas of research interest Resource building Training in research techniques (laboratory, epidemiology, and statistics) Determining feasibility and cost-effectiveness Using available technology for data transfer/sharing There are several challenges that arise when embarking upon a research study in collaboration with an institution abroad. I will describe them here, and you will see how they play a part in our research project. The results of the study must have some utility and potential benefit for that country. Determining feasibility and cost-effectiveness of the intervention/program being studied

Injury in Uganda Road traffic crashes top the list of injuries Result in 30% of casualty visits Injury prevention!! Improve patient management upon hospital arrival Improve patient management upon hospital arrive. Like many other developing nations, there is no ambulance system. Patients may arrive hours or days after injury, and therefore Time is of the essence!!

Current Management Plain X-rays Peritoneal Aspiration Ultrasound by ultrasonographer (if available) “Observation” Exploratory laparotomy And now…FAST Focused Assessment with Sonography for Trauma Free fluid in pericardial, RUQ, LUQ, pelvis views

FAST study WHO Guidelines of Essential Trauma Care 2004: ultrasound is “desirable” Identified in a April 2005 meeting to be area of interest for Ugandan surgeons Innovations Grant from UCSF Global Health Sciences Portable US machine donated by Sonosite

Study Aims Aim 1: To evaluate the feasibility of FAST training for surgeons at a major Ugandan trauma center. Aim 2: To compare the management and outcomes of Ugandan trauma patients before and after the use of FAST, and to assess its cost-effectiveness. As typical of many global health projects, the goal of the project revolves primarily around training/teaching, evaluation of the training, feasibility, and cost effectiveness. The cost-effectivenss aspect can have important policy implications, as this is a government/public hospital and proper evidence can demonstrate to the Ministry of Health that it is cost effectivenss to have US machines

FAST course November 13-16, 2006 ~20 hours of training 19 participants plus ultrasonographer Daily lectures, practical sessions, and final practical exam

Website created by the Mulago-UCSF Malaria collaboration

This is a sample image, annotated as to positive or negative and with an arrow pointing to positive finding. The instructors check the website periodically for updated images and send comments back to the surgeons in Uganda.

Ongoing work 1st 4 weeks of images In 13/23, instructors agreed with all 4 images In 10/23, instructors agreed with 3/4 images Surgeons continuing to acquire FAST images (need 25 each) Data collection on trauma outcomes underway- 83 subjects from Dec 1 to mid Jan. Final factor in progress is increasing accessibility to the sonosite machine while maintaining its security. Based on the tight control over their regular US machine, we are fairly confident that their new Sonostie machine will be kept quite safe. However an important aspect of the feasibility of FAST is whether it can be kep both safe and available for use.

Acknowledgements The UCSF team: Dr. Peggy Knudson, P.I.; Dr. Rochelle Dicker, Co-I; Dr. Jeremy Durack, Radiology Resident; Eric Chen, MS3 @ UC Davis Our colleagues at Mulago: Dr. Jackie Mabweijano, Victor Angajoubi, Mr. Isaac Ezati, Geoff Lavoy