A Needs Assessment of Point-of-Care Ultrasound in Two University- Affiliate Hospitals of Gondar and Mekelle in Northern Ethiopia Shiyang Shen, Dr. Jonathan Houle, Dr. Louise Pilote McGill University, Montreal, QC, Canada

Introduction Methods 3. Feasibility & challenges of POCUS implementation

As life expectancy increases in low- and middle-income countries We conducted the needs assessment with qualitative We have found that the time for learning, using as well as (LMICs), non-communicable diseases (NCDs) pose the additional interviews online over Skype or Zoom, and an online cross-sectional teaching POCUS in addition to their current clinical practice will not be an added burden. In addition, we found that a lack of private burden on health systems. This is known as a double burden of survey. Our participants are resident, physicians and faculty examination rooms will not pose issues for integrating POCUS at the disease as chronic diseases are on the increase against the members of the internal medicine and surgical departments at the two university-affiliated hospitals. In addition, all of the participants background of health systems already overstretched by infectious University-affiliated hospitals of Gondar or Mekelle. The participants report that adding POCUS to physical examination or to bedside disease challenges. Furthermore, very few health centers have the were asked to provide information about their work environment, procedures will not impose significant additional cost to patients. radiological resources necessary to properly handle the increasing knowledge of POCUS, whether there is a need for a POCUS burden of NCDs. curriculum in their institution as well as any foreseeable challenges Some challenges identified were a potential resistance from the Point-of-care ultrasound (POCUS) is a portable, hand-carried should such curriculum be implemented. radiology department and two senior physicians mentions of a previous ultrasound device which is inexpensive compared to other forms of POCUS training program that was not sustained over-time due to lack imaging modality, and can be easily deployable and clinically effective of systemic implementation into their clinical curriculum as well as a in low resource settings. POCUS has the potential to alleviate some of lack of supervising individual. One participant raises the possibility of a that strain by allowing physicians to make faster, better decisions Results & Discussion conflict of interest for faculty members to take on the role of teaching about their patients as well perform safer bedside procedures. In POCUS beyond their usual work hours at the hospitals as they also addition, previous research has shown that POCUS training with work in the private sector. Lastly, there was limited information reported healthcare workers, mostly non-physician clinicians, in a rigorous and 1. General interest and needs for POCUS by the participants on local companies that repair, or service ultrasound machines, which may pose issues for equipment maintenance. sustainable manner has the potential to significantly impact the Our preliminary findings show that all the participants (n=9) have delivery of care in LMICs. a knowledge of POCUS, are interested to learn more about it and Limitation of Study believe that having a tailored POCUS curriculum can significantly Ethiopia is one of the many countries whose health system is • A major limitation of the study is the small participant sample size (n=9) and improve patient care in their institutions. spread thin due to the double burden of disease. We hypothesize that the lack of participants representing non-clinician healthcare workers, such as nurses, due to the difficulty of online recruitment of participants in Ethiopia. POCUS could impact the quality of care in cost-effective manner in the The main motivation for learning POCUS is due to significant two university affiliated hospitals of Gondar and Mekelle. delays, days to sometimes weeks, in obtaining imaging through their respective radiology departments. Very few studies have done a thorough needs assessment prior to the implementation of a POCUS program in LMICs. Therefore, our We identified that a lack of available ultrasound machines and Conclusions project aims to assess the needs for a tailored POCUS curriculum at training are the two major barriers of POCUS use. Specifically, we the two university-affiliated hospitals of Gondar and Mekelle in found at both partner sites that portable ultrasound machines are only Very few needs assessments have been done in POCUS Northern Ethiopia. restricted to be used in other departments, such as obstetrics and implementation in LMICS previously. We have found that gynaecology, and the current training of internal medicine and surgical implementing a tailored POCUS curriculum in the University-affiliated Ethiopia and Our Partners residents do not involve specific teaching components and zero hospitals of Gondar and Mekelle is needed and feasible. • Ethiopia is a landlocked country hands-on teaching for using POCUS for clinical diagnosis or bedside situated in the horn of Africa in the East of the continent. procedures. Future Steps: Some of our next steps include working with our • The country has a limited number of participants and establish contact with the radiology department at the health institutions due to an under- 2. Identified components of a tailored POCUS curriculum funded health sector which make two university-affiliated hospitals in order to build partnership and pre- access to healthcare services very The following components for a tailored POCUS curriculum have emptively mitigate conflicts with them. difficult (WHO). • University of Gondar is one of the been identified: cardiac assessment for ejection fraction and oldest and most well established valvulopathy, lung assessment for sources of respiratory distress or higher education institutions, located in failure, hepatobiliary assessment, volume status assessment, FASH Gondar, the former capital city of exam for tuberculosis and FAST assessment for trauma. Acknowledgements: Ethiopia. Dr. Tsebaot Tesfaye, University of Gondar • Mekelle University is one of the largest public universities in Ethiopia, located Ultrasound guided procedures has also been identified as a in Mekelle, Tigray, and about 783 Image from Encyclopedia Britannica (2011) desired component to be included in the curriculum. At University of kilometers north of Ethiopia's capital, Gondar, many bedside procedures, such as paracentesis and Addis Ababa. thoracentesis are performed blindly at bedside.