All Health Care Is Local, Part 1: Uganda

This groundbreaking technology is changing lives in Uganda. And it is affordable -- with a cost equivalent to about $1 per patient visit.
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The late Tip O'Neill, former speaker of the U.S. House, coined the phrase "all politics is local," by which he meant that politicians become successful by addressing the everyday concerns of the voters who elected them to office. In the same way, I believe that many of the "global" healthcare challenges we face can best be addressed by developing affordable, accessible and cost-effective solutions that satisfy patients' needs. Simple solutions can offer dramatic results, and local implementation means solutions are in tune with cultural preferences and economic realities. In other words, when it comes to improving people's lives, all healthcare is local.

Nowhere are opportunities to deliver simple, and locally relevant, solutions more evident than in sub-Saharan Africa, in a country like Uganda. Here, the non-governmental organization Imaging the World (ITW) is working to offer affordable, accessible and quality maternal medical services through a revolutionary concept that integrates technology, training and the community. ITW is making a significant impact on the lives of women and their families in rural villages where women have limited access to healthcare throughout their entire lives.

In fact, a pregnant woman in Uganda is likely to be very poor and part of a polygamous, male-dominated society. She will probably have at least six pregnancies in her lifetime. While these women may visit a health clinic at the beginning of their pregnancies, there is little chance they will return for additional antenatal care or a skilled delivery. Often, the nearest public hospital is two hours away by motorbike, and many women end up laboring for days or delivering on the sides of roads trying to seek medical attention.

With guidance from the Ugandan Ministry of Health, ITW is using ultrasound technology, in conjunction with a financially modest, state-of-the-art image compression and communications infrastructure, to enable rural clinics to provide life-saving local healthcare to the poorest regions in Uganda.

By using volume ultrasound scans to replace static images with a series of images that are gathered by sweeping the transducer across the organ or area of interest, the need for physician scanning is eliminated. This enables locally trained midwives to gather images without anatomy knowledge. The image sets are sent via cell phone to expert readers anywhere in the world. This groundbreaking technology is changing lives in Uganda. And it is affordable -- with a cost equivalent to about $1 per patient visit.

In 2012, ITW evaluated more than 1,000 pregnant Ugandan women. Since the program's inception, antenatal care visits have increased 80 percent and rural health center deliveries by 63 percent. In addition, the "magnet effect" of simply getting women into antenatal care clinics has also significantly increased preventive treatment for malaria and hookworm and screenings for HIV and other sexually transmitted diseases. The organization has also found that husbands who accompany their wives to the clinics become more engaged and gain a better understanding of what their wives need to stay safe and deliver healthy babies. In the future, ITW will expand in Uganda and elsewhere in sub-Saharan Africa. The ITW model enables this because local healthcare workers can be trained quickly and efficiently in ultrasound protocols.

This clinical model works anywhere that cell phone reception is available, and there can be many more applications: emergency medical services, disaster relief, military deployment and assistance for other medical relief organizations. The ITW program could also be a solution to providing low-cost, high-quality medical imaging to remote or under-resourced medical clinics in the United States and other developed countries.

ITW co-founder Dr. Kristen DeStigter says, "Ultrasound is the first step in launching a transformation in the continuum of maternal/fetal medicine that is already resulting in accessible, affordable, sustainable medical care of the highest quality for underserved populations in Uganda and other regions in sub-Saharan Africa, as well as the world."

As Chief Medical Office of Philips Healthcare, I am proud to be part of the company's vision to expand access to care by partnering with organizations like ITW that understand all healthcare is truly local.

This article is part one of a three-part series outlining the work being done locally around the world to expand access to care.


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