ASE Global: Focus on India
December 2012
OVERVIEW OF A VISION FULFILLED
Project Leader: Partho P. Sengupta
Sonographer Participants: Neha Soni-Patel, Gurpal (Gee) Bhogal, Carlene McClanahan, Jennifer Neary, Marti McCulloch, Lynette de los Santos, David Adams (team leader)
Industry Participants: LeaAnne Dantin (GE), Yair Ziv (GE), Steffen Mueller (GE), Zachary Smith (Core Sound Imaging), Jim Reuter (StatVideo)
ASE Staff: Rhonda Price
Submitted by Partho Sengupta:
We just boarded the bus back to Delhi, the organizers (some of whom are my close friends) queued to bid us good bye. The last 30 minutes before departure saw the usual intense exchange of emails, phone numbers, last minute photos, exchange of memories, and invitations for returning.
Patients who underwent the pre-anesthetic evaluation and the focused ultrasound examinations have now been assigned beds in the massive Sachkhand Hall, awaiting their turn for the operating room, enthusiastic for regaining back their lost vision. Over the next two days, thousands of cataract surgeries will be performed at a brisk pace. They will use local anesthesia which would contain adrenaline and phenylephrine drops - both potent cardiac medications.
During pre-anesthetic evaluation, doctors evaluated patient’s symptoms and auscultated under noisy surroundings hoping to exclude cardiac lesions that would put the patients at risk for an adverse cardiac event in the perioperative period. Many patients did not make it to the wards because they were having uncontrolled hypertension. Those who had known heart diseases were also advised to return to the community hospital at a later date for cataract surgery under topical anesthesia in monitored settings. For the remaining patients finally selected for cataract surgery, we performed focused echocardiograms to ensure that a structural heart disease was not missed in the fast paced, crowded and noisy environments of the camp where a cardiac murmur could be difficult to distinguish.
The second part of education was achieved in a Cataract camp organized at a spiritual institution in North India (Dera Sacha Sauda, Sirsa, Haryana). We had seven sonographer educators who travelled to the cataract camp to oversee and supervise seventeen physicians. Throughout the camp we grouped together at periodic intervals to discuss the plans and directions, sharing what we had individually seen. The most incredible moments were those when we detected severe cardiac abnormalities - and we could not believe that these were patients who had been examined and deemed fit for surgery! We saw all kinds of abnormalities that were not picked up during the pre-anesthetic examinations- ranging from severe mitral and aortic valve stenosis to severe left ventricular dysfunction, and pulmonary hypertension. Amongst valvular lesions, it was common to see aortic regurgitation - perhaps these were missed because a regurgitation murmur is the most difficult to discern in noisy backgrounds.
At the end of each day, I went through the list of patients who had disease that would be considered prohibitive risk for a fast paced community cataract surgery. These patients were advised to seek follow up care and surgery in the local hospital at a later date under monitored settings. Thus, the hypothesis that physicians could be trained quickly to use pocket ultrasound for detecting significant cardiac diseases during mass screening event for cataract surgery was confirmed.
The official read for the number of scans that have been uploaded is still awaited. Over 60 readers worldwide would be interpreting the scanned images. The final reports from expert readers will be useful in confirming the accuracy of physician trainees and help further patient triage. The rumors are that we may have come close to over 1000 studies, or maybe the numbers are just over what we did last January. These numbers however are incredibly astonishing because it involved scanned images from physician learners who were undergoing a very disciplined scanning protocol under the guidance of sonographer educators. The enthusiasm with which the physicians participated and stayed committed reflects their interest in learning and the need for structured training programs. Certificates of participation were distributed on the last day. Vote of thanks were proposed to the sonographers with special appreciations expressed for David Adams, Marti McCulloch, LeaAnne Dantin from GE Healthcare and Zachary Smith from Core Sound Imaging. We expressed our heartfelt thanks to members of Dera Sacha Sauda, for allowing us to be a part of this camp and our gratitude to his excellency Saint Gurmeet Ram Rahim Singh Insan (also called lovingly as Pitaji) for motivating all of us. Pitaji took special interest in teaching our group the unique method of meditation that is offered here to countless people free of any cost, the same way as the thousands of cataract surgeries will be carried out over the next two days for poor people free of costs.
Overall this global outreach event has been a rewarding experience, an amalgamation of new technology assessment, education, humanitarianism that touched countless individuals - new learner physicians, sonographers onsite and overseas, patients, volunteers, doctors, social reformers and physician readers. Like last year, we are returning back enriched, feeling good that so many lives will have a new vision of the world.
Submitted by Rhonda Price:
As I write this, the volunteers have all departed and I’m waiting on my return flight from Delhi. Everyone left exhausted, but with stories to tell, memories for a lifetime, and new friends. Many checked off a few items on their “bucket list.” We managed a trip to Agra to see the Taj Mahal, and then everyone left Delhi in the middle of the night, heading towards the faces of loved ones missed, their own beds, and the joy of a regular routine. It was a special week.
Sachkhand Hall was filled with cataract surgery candidates.
ASE at Taj Mahal, left to right: Zachary Smith (Core Sound Imaging), Gee Bhogal, Carlene McClanahan, Marti McCulloch (in front), David Adams, Neha Patel, Lynette de los Santos, Jennifer Neary.