Kelsey Greenwald, MD: Mass General & Brigham and Women’s Hospital EM PGY3

Sierra Leone: April 2021

 I spent four weeks at the Koidu Government Hospital in Sierra Leone, training local community health workers and physicians in using ultrasound to provide direct medical care. Koidu Government Hospital has 200 patient beds, an x-ray machine, and limited lab capabilities. There is no CT scanner at this hospital or any of the surrounding hospitals. During the four weeks, I spent the mornings rounding with the medical team in the Emergency Room, Female Medical Ward, and Male Medical Ward. The next four hours would be spent training individual physician and community health workers in using ultrasound to augment the care of their patients. For example, a patient would arrive in the Emergency Room acutely short of breath with low oxygen saturation. We would use ultrasound to evaluate the patient’s heart and lungs to help determine the etiology of their presentation and direct the patient’s management. The additional diagnostic insight gained from the ultrasound made a critical impact in determining the care of the patient. On several occasions, use of the ultrasound immediately led to an emergent procedure being performed (a chest tube or an exploratory laparotomy in the operating room). During the afternoon, two hours were spent on formal lectures on the use of ultrasound. Ultrasound has proven critical in stabilizing and caring for the patients at Koidu Government Hospital.