Ultrasounds are extremely useful in diagnosing many life-threatening conditions all over the body, including in the heart, lungs, kidneys, and bladder. They can determine if a patient’s lungs are filling with fluid and detect rheumatic heart disease in children. However, the machines can be bulky, expensive, and require a trained technician.
Dr. Peter Rice, a volunteer and the director of HVO’s internal medicine project in Nepal, saw this challenge at Lumbini Medical College (LMC) in Tansen, Nepal when he volunteered last spring. “I went for the first time as a general internist giving lectures to medical students and rounding with residents and attendings,” said Dr. Rice. “During rounds, they dragged up an ancient ultrasound machine with only one probe. They were very interested in learning and were trying to teach themselves through YouTube videos. They needed formal instruction and decent equipment. When I left, I proposed we could make this happen.” As soon as Dr. Rice returned home, he began to take the next steps.
Training on simple, bedside ultrasounds for non-radiologists is becoming standard for internists and physicians in emergency rooms and ICUs. The machines used bedside are smaller — as small as a laptop or even a large cell phone. Having easily transportable machines transforms the level of care health workers can provide. “You can’t always get an ultrasound very quickly,” said Dr. Rice. “You can learn a lot about the heart, lungs, kidneys, bladder, and blood vessels with these little devices. It can change your clinical decision making on the spot.” In Nepal, small hospitals do not necessarily have x-ray machines, so ultrasounds an important way to fill in the gap. “Sometimes it’s difficult to determine if a patient’s lungs are filling with fluid due to heart failure or some other cause. The bedside ultrasound allows one to quickly determine if the patient is in heart failure or not. It can also accurately distinguish between pneumonia and heart failure, diagnose kidney stones or infections, find blood clots in people’s legs, diagnose abnormal heart valves, or detect pericardial effusion.”
Dr. Rice had taken a five-day course on point of care ultrasound (POCUS) at Cornell in 2023 and connected with one of the teachers, Dr. Tanping Wong. They kept in touch, and after Dr. Rice returned from his first trip to Nepal, he contacted her for assistance. “I emailed her and said, if I come up with the machines, can you come up with the teachers?” said Dr. Rice. Dr. Wong loved the idea and has helped connect Dr. Rice and HVO with experienced POCUS trainers. She also suggested enrolling learners in an online program through the Global Ultrasound Institute, an online platform with teaching videos that also allows you to upload images and receive feedback.
In 2024, Dr. Rice provided LMC with the funding needed to purchase two bedside ultrasounds. In January 2025, Dr. Juan Lopez Tiboni became the first POCUS instructor to visit LMC. He provided three weeks of formal didactic instruction to residents and attendings in the internal medicine department. Dr. Rice sent him with two donated handheld ultrasounds.
In March, Dr. Rice will return to LMC bringing with him two more handheld machines he is donating to the college. Another POCUS instructor will join him, and a third instructor will go in June, Dr. Wong will go in the fall, and then one of her colleagues. The steady schedule of volunteers will provide consistent training.
“It has been very successful,” said Dr. Rice. “Other departments heard about this and want to be involved. The surgeons, pediatricians, anesthesiologists – they want in on the training. Our last instructor gave a weeklong course to all of them. There’s a lot of excitement.” One of the two handheld machines Dr. Rice will bring in March will be gifted to the surgeons and the second will go to the pediatricians. He is hoping to donate an unused machine from his hospital to the anesthesiologists. “Anesthesiologists have a specific need – they want to learn how to do ultrasound nerve blocks,” he explained. “In our country, if you have a procedure on your knee, you can have a nerve block that puts lidocaine around the nerve instead of using general anesthesia. Nerve blocks are such an important tool, but the anesthesiologists at LMC have been limited by lack of training and equipment.” Dr. Rice hopes to start a new HVO project in anesthesia at LMC to support this training.
The importance of bedside ultrasound training is becoming increasingly recognized around the world. “There are other people and institutions helping low-resource medical training centers train on POCUS because it’s very pertinent to low-resource settings,” said Dr. Rice. “Handhelds are financially accessible, and many places don’t have access to formal technology. Dr. Tiboni has already conducted training in Gaza, Afghanistan, and Rwanda.” Dr. Rice took part in a volunteer trip in the Himalayas where he traveled from village to village with a medical team that included a clinician with a handheld ultrasound, something Dr. Rice noted was very useful. “We were able to diagnose a case of advanced tuberculosis with lung abscesses and a near-term woman whose baby was breach and needed a clinic.”
Dr. Rice appreciates HVO’s focus on education. “I think HVO has a good model, a really good model. I’ve done other trips which were great, but at times I had to wonder. If you just come in and see patients for a month and then leave, there’s no continuity or follow up. It’s not as helpful as one might hope. Teaching is a really nice strategy.”
If you are interested in learning more about the project or would like to get involved, please contact Natalie Cary at n.cary@hvousa.org.