From the November 2019 issue of HealthCare Business News magazine


After her time in Kenya, she dabbled with outreach for years, notably in Honduras, but she found it problematic. “It was brief work – going in with a team of people and then back out, but it never felt like it was something sustainable and impactful from a longitudinal perspective. When I came to Vermont about 20 years ago, there was sort of a breakthrough. The technology had started to change around that time. Ultrasound was getting smaller and less expensive. The portable handheld devices we use now could be solar-powered, cellphones became ubiquitous even in the most remote corners of the world and software tools allowed us to capture images in a different way at the point of care.”

So with colleagues both here and around the country, DeStigter formed the non-profit Imaging the World. The organization’s initial funding came from the Gates Foundation. The goal was to mitigate the lack of formal training in low resource areas. Simple in statement, incredibly challenging in practice. A big part of the problem was the fact that the majority of the population in Uganda lives in rural areas, but most of the country’s medical professionals live in the urban areas. So the focus was put into training the midwives and nurses who work at the rural clinics. “We trained the people we could train,” DeStigter said.

There was also training of sorts required of the general public. When ultrasound was first brought to the community health centers, many perceived it as magic, “and not in a good way,” DeStigter said. “They thought it could burn them, make them infertile, or kill their babies. So it required a large amount of focused community outreach. We partnered with the community health workers to go around and get the word out there. Slowly, over time, people in the community started to see that women who got the scan were having better outcomes. We started to see an increase in trust of the healthcare system.”

The efforts started to pay off. The team observed that a prenatal ultrasound scan often changes pregnancy management and saves lives. Later studies peg the percentage at about 25 percent of cases getting a change to the management of a pregnancy. But DeStigter didn’t want a repeat of past outreaches. She didn’t want the team to work in the country for short periods and then leave the health of women up to fate when the medical professional departed, taking any chance of additional training for the nurses and midwives with them. Instead, the organization worked to solve the problem of providing continuous education to retain skills and deliver on quality assurances. The group realized repeat visits by experts would be too expensive. Video conferencing required clearing technological hurdles that were set too high — namely the need for robust internet connections and costly data programs, making it a no-go in the rural areas in need. And bringing the nurses and midwives to some centralized location for training removed them from the field, yet they were often the only ones providing daily care at the rural clinics, so that wasn’t an option either. “What we did do was to use cine clips. They are photos taken in six sweeps over the pregnant abdomen. So the transducer captures all the information in a series of static images,” DeStigter said. Those images can be stitched together like a high-tech flipbook to make it look like it’s a video rather than a series of still-photos. Users can scroll forward and back, zoom in, take measurements and really study the image. The cines are anonymized for compliance and they’re compressed to the size of a photo and sent for secure, remote review by experts to make sure safe and reliable care is being provided.

November 2019 Magazine

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