1. Commission des affaires humanitaires HUG
Obstetrical ultrasonography real-time tele-training
in Congo Brazzaville
Authors: Julia Aeberli, Mathilde Dubail, Isabelle Eperon, Antoine Geissbuhler
Affiliation: Geneva University, Switzerland
Dolisie
Madingou
Gamboma
Brazzaville
INTRODUCTION
The Republic of Congo is facing a specialists’ shortage and an unequal distribution between urban and rural areas, limiting, amongst others, access to diagnostic ultrasonography. This project aims at establishing the feasibility of remote training by live teleconsultation in obstetrical ultrasonography, as a mechanism to support isolated, novice care professionals.
The project includes abdominal ultrasound for women during all stages of pregnancy.
Training is divided in two parts:
- Initial training in Brazzaville with experts in obstetrics,
- Real-time tele-training.
GOALS
- Develop an efficient remote training program for obstetrical ultrasonography which is reproducible and sustainable.
- Support partnerships between district hospitals of rural areas and the university hospital of Brazzaville, to overcome specialists’ shortage in remote areas.
- Improve obstetrical ultrasound access in rural areas.
- Enable the transmission of dynamic ultrasound to remote experts with an affordable internet connection.
- Develop a cost effective system to enable the sustainability of obstetrical ultrasound activities and to integrate them into the current health care system.
The mobile ultrasound equipment (dDopp)
METHODS
OBJECTIVES OF THE DOCUMENTS INTRODUCING OBSTETRICAL ULTRASONOGRAPHY
Pilot project in April 2017: Between the cities of Dolisie and Brazzaville
Conclusions and necessary improvements
- Adapt training objectives to the health professionals’ requests.
- Introduce the training with an initiation to informatics.
- Find an internet equipment affordable and a communication software adapted to the transmission of dynamic ultrasound examination.
- Integrate obstetrical ultrasound activities into health professionals’ medical practice and into the current economic health care system.
Phase 2 in February 2018: Extension of the tele-training program to the cities of Madingou and Gamboma
1. Improvement of the documents for the initial training and their approval by Dr. Isabelle Eperon, obstetrical gynecologist in HUG.
The training documents include:
- Initiation to computer use.
- User manual and didactic videos for the use of the dDopp (ultrasonography) software for obstetrical gynecology.
- Didactic documents and videos introducing obstetrical ultrasonography.
2. Communication software:
TeamViewer is a screen sharing software used for live transmission of ultrasound examination to remote experts. This software enables the experts to visualize a dynamic ultrasound examination thanks to a low bandwidth use. Moreover the experts can take control of the dDopp software to teach in an easier way if necessary. Oral communication is provided by hands free phone call.
3. Internet equipment:
Wireless routers from Airtel ensure connection between sonographers and remote experts. Router unit price is 32 CHF and monthly cost is 8 CHF per router for the use of 4G per week.
4. Initial training:
Three health professionals from district hospitals of Dolisie, Madingou and Gamboma have been identified by our local partners to follow the initial training in Brazzaville. During two weeks they have been taught how to use the mobile ultrasound equipment and basic ultrasound skills.
The initial training is shortened as possible to minimize the absence of health professionals in rural areas.
5. Tele-training:
The three health professionals pursue their training in parallel with their medical practice in their respective district hospitals. Twice a week, they receive pregnant women for ultrasound examination supervised by a live remote expert
100%
TELE-TRAINING FIRST RESULTS
- Possible transmission of dynamic ultrasound to remote experts with TeamViewer.
- Live teaching in obstetrical ultrasonography for remote health professionals.
- Improved access to ultrasound imaging for pregnant women thanks to free examination during the training period.
FUTURE PROSPECTS
- Assessment of the learners’ skills by the experts after 3 months of tele-training.
- Assessment of the quality and the evolution of learners’ ultrasound images by a qualitative study of collected the consultation reports, after 6 months.
- Evaluation of obstacles to obstetrical ultrasound imaging access thanks to patients answers to our questionnaires.
- Establishment of paying ultrasound examination, as soon as the learners are judged independent by the experts, to insure internet connection costs and to integrate ultrasonography into the current economic health care system.
PARTNERS
Commission des affaires humanitaires HUG
Diabaction Congo