Future Tense

Don’t Take Ultrasounds for Granted

In South Sudan, a new, affordable machine is saving lives.

 The POCUS in use in Malakal, South Sudan.
Animation by Slate. Photo by Adi Nadimpalli/Médecins Sans Frontières.

This article is part of Update or Die, a series from Future Tense about how businesses and other organizations keep up with technological change—and the cost of falling behind.

The patient was probably going to die. But when she was admitted to Aweil General Hospital in northwestern South Sudan, all that anybody knew was that she was suffering from shortness of breath.

Aweil is remote even by sub-Saharan African standards, a 14-hour drive from Juba, the capital of this young and highly unstable country. The one X-ray in town is often broken and isn’t even at the hospital. Getting an accurate diagnosis is typically dependent on the clinical expertise of the health care professionals on staff and what they can ascertain with little more than a stethoscope. What that meant in practice, until recently, was that if you were admitted with shortness of breath, you would likely be diagnosed with pneumonia and treated as such, despite the fact that there are many causes of such common symptoms.

This particular patient was lucky. She happened to be pregnant, and the maternal and neonatal wards at Aweil are run by Medecins Sans Frontières, the global humanitarian agency that is constantly on the lookout for ways to improve medicine in the field. To that end, they have recently bought dozens of Philips’ Lumify ultrasound devices—small handheld transducers that plug straight into a standard tablet and convert it into a state-of-the-art diagnostic tool. In an American hospital, such things are convenient; in South Sudan, they can mean the difference between life and death.

This was one of those cases. The ultrasound revealed that the patient was suffering from mitral stenosis, a heart disease that, if untreated, is fatal for 50–60 percent of affected pregnant women, with the risk rising with each pregnancy. The doctors managed to deliver the woman’s baby through cesarean section and talked her through a tough decision to have a tubal ligation, which would prevent any more pregnancies.

Technologies that barely raise an eyebrow in developed countries can have a transformative effect when it comes to practicing medicine in dangerous or impoverished conditions. One of the best examples of this is POCUS, or point-of-care ultrasound. In the U.S., POCUS is an interesting choice for medical practitioners: It’s a way of performing an ultrasound right by a hospital bed, instead of wheeling the patient to an ultrasound machine. It’s also got a relatively narrow set of use cases, since there are so many alternative diagnostic tools, like MRIs and X-rays. In Aweil, by contrast, it’s POCUS or nothing, which means that ultrasound is used in dozens of nontraditional settings. A manual published by Partners in Health has 16 chapters, starting with trauma (ultrasound is great at detecting internal bleeding) and then taking a tour of the body from the heart to the liver, gallbladder, spleen, kidney, skin, and much more. Ultrasound, in places like South Sudan, is for much more than just looking at unborn babies: It is used every day to look at lungs, for instance.

MSF has trained dozens of local nonexpert clinicians to recognize the pattern of stripes in the lung that are indicative of bronchiolitis or viral pneumonia. To do this, you don’t need telemedicine, in which an expert radiologist in a developed country diagnoses the images remotely. These are diagnoses that can be made right on site, even when there is no cellular connection or even electricity. (All you need is a charged-up tablet.)

In South Sudan, says Carrie Teicher, “when you have an imaging tool at the bedside, it’s a game changer.” Teicher is the director of medical and operational research for MSF-USA and the Americas representative for MSF’s research arm, Epicentre, and she has used POCUS in all manner of contexts, including when she needs to take fluid out of a patient’s lungs.* With a simple portable ultrasound machine, she can see exactly where the needle is, making the procedure far more accurate.

Most excitingly, POCUS can be used, with only 12 hours’ training, to perform lung ultrasounds in a context where pneumonia is the leading cause of mortality in children under 5 worldwide. You don’t need an advanced medical degree: Any local clinical officer can be trained up on pattern recognition in an easily replicable manner. Accurate diagnosis of pneumonia (as opposed to finding it in every patient with shortness of breath) makes it much easier to treat—and also makes it much easier to tell whether the treatment is working.

All of this is possible because of recent advances in ultrasound technology. POCUS equipment has already come down in price from $30,000 a few years ago to $8,000 now, and is likely to become much cheaper still in the near future. The Butterfly iQ, for instance, promises to be less than $2,000 and comes with built-in A.I. diagnostics. It wasn’t specifically designed for use in remote field contexts, but its uses there could end up saving thousands of lives.

Right now, POCUS technology is being used mainly in Haiti and Rwanda, by Partners in Health, and in South Sudan and Niger, by MSF. But it’s certain to expand significantly, in what amounts to a quiet medical revolution where high-tech innovations get applied in some of the poorest regions of the world.

Correction, June 23, 2018: This piece originally misstated Carrie Teicher’s position. She is the director of medical and operational research for MSF-USA and the Americas representative for MSF’s research arm, Epicentre.