Ultrasound in Africa

Two words summarize my review of the SonoSite Ultrasound MicroMaxx on this trip to Rwanda – incredible utility. It’s been used in nearly every way imaginable for patient care during my month. Here’s just a summary of some of the jobs it’s tackled:

• Roughly 30 transthoracic echo-cardiograms performed by a visiting cardiologist from Belgium
• ICU diagnosis of 4 symptomatic pericardial effusions. Real-time visualization of therapeutic drainage procedures.
• 10 pleural effusions and subsequent drainage.
• Obstetric use in both prenatal ultrasound (I carried the unit to Paulin’s house and performed an exam on his wife who is in her 2nd trimester). He was thrilled! Another exam was done to verify a potentially viable pregnancy in a woman with intermittent vaginal bleeding.
• Deep Venous Thrombosis (DVT) diagnosis in a woman of 35 years.
• Educational use for the residents displaying block anatomy during afternoon lectures.
• 10 peripheral nerve block procedures in the OR. One done on a patient with severe dyspnea, in need of a below-elbow amputation for an advanced, hemorrhaging tumor. The case was done with just an infraclavicular nerve block.
• Central line access on a 2 year old with 2nd degree burns over 40% of his body.
• Trauma surveys in the Emergency Department.

My good friend and local ICU doc, Bart Troubleyn has already threatened to steal the machine before my departure (Kim, are you hearing this?). If I don’t make it back alive to the States, follow the ultrasound machine! (see: Watergate Scandal)
Unfortunately for the hospital, the Micro-Maxx machine costs roughly $60k (I know this because my hospital in Walnut Creek just bought one), which is obviously beyond the financial means of a university hospital and trauma center that can’t even afford a CT Scanner (currently, patients in need of a scan, must be transported to a local private hospital who owns the only scanner in the country. There, they must beg staff for a scan on a patient who obviously can’t afford the fee).
The portability of the Micro-Maxx make it the perfect ultrasound machine for a hospital like the Central University Hospital of Kigali (CHUK). This machine looks just like a laptop computer and fits into a nifty backpack which has internal pockets for the transducer heads and power supply. Many hospital based ultrasound machines are roughly the size of washing machine, are incredibly heavy, and rarely leave their home department.
For instance, during the day in the OR, my cell phone would ring and Mark, the cardiologist would politely ask, “John, can I borrow the ultrasound machine?” Of course, I would say, ‘yes.’ He just walked across the path to the surgery department, put the back pack strap over his shoulder and walked back to cardiology. Five minutes later he would be examining the heart of a 35 year old woman complaining of severe dyspnea on exertion. A moment later he had his diagnosis – cardiomyopathy, with an ejection fraction of 15-20%. An hour later, Bart had the machine over in the ICU tapping the lung of patient with a recurrent pulmonary effusion.

Now the obvious question is –“how do we get one of these ultrasound units for CHUK, without forcing Bart to poison my coffee and steal it?”

SonoSite Micromaxx


Pericardial effusion


Yes, I can breathe much easier, now.


Bart (with Minnow), Mark and Apoline