Do More With Less: Ultrasound

Life is not always easy, sometimes you just have to manage with what you have. To work with limited resources is one of the skills you acquire once you are a primary care physician and particularly in Africa.

This is also true concerning point-of-care ultrasound (POCUS); it is possible to do more with less. If you really understand how it works, you can find new ways to use your tools to get the correct diagnosis.

Now, I want to share with you the case of a 53-year-old male patient whose major complaint was joint pains, particularly in the left wrist and knee. Upon physical examination, the joints were warm, swollen, and painful. I hypothesized that the diagnosis was a primary gout episode but in my health facility I don’t have a uric acid test that I would ordinarily use for confirmation of the diagnosis. I then performed a POCUS examination to confirm the diagnosis by looking for the double contour cartilage line, which is a sign of gout in joints due to uric acid deposit at the surface of bone cartilage. I didn’t have a linear high-frequency probe, so I used an endocavitary probe just as you can see in the pictures.

Ultrasound images of the knee showing the double contour sign indicative of gout.

POCUS can greatly increase healthcare in low-income countries. Usually, the healthcare gap between upper-income and low-income countries is huge but, with POCUS, the same technics can be applied to both, with the same results, if ultrasound devices are available.

However, the problem remains that there is a lack of healthcare professionals who are skilled enough to use it and teach others. The problem is no longer an absence of devices but is now due to an absence of knowledge of how to use them.

Fortunately, due to COVID-19 lockdowns, we know almost everything that can be taught online. Therefore, it is time for us to think about establishing a new way to teach, learn, and practice ultrasound. Many ultrasound societies, such as the AIUM, ISUOG, and EDE, have started to share free POCUS education on their websites. Free online courses should be encouraged since they will lead us to the democratization of ultrasound, particularly in low-resource settings.

Yannick Ndefo, MD, is a general practitioner at St Thomas hospital in Douala, Cameroon.

Interested in learning more? Check out the following posts from the Scan: