C.D.H.

L
COMMUNITY DIAGNOSTICS, HEALTHIER LIVING BRINGING ULTRASOUND SERVICES TO WHERE THE NEEDS ARE
Email: kobsrahnk@gmail.com / ntambik21@gmail.com
Timely Diagnosis Appropriate Management
Contact: +256 782 316 535 / +256 704 295 155


1. PROJECT INFORMATION

Title: COMMUNITY DIAGNOSTICS for HEALTHIER LIVING
(C.D.H.L)
Report period For the period since commencement to 31
ST
/August/2014
Lead Author of Report KOBUSINGYE REHEMA (Coordinator) and NTAMBI
MUSA (Radiographer)

Principal Investigator(s), Co-Principal Investigators and Recipient Organization(s):

Kobusingye Rehema - Coordinator - 0704 556 883 kobsrahnk@gmail.com
Ntambi Musa - Radiographer - 0704 295 155 ntambik21@gmail.com

2. PROJECT OVERVIEW

C.D.H.L Mobile diagnostic ultrasound was established two years ago with a vision of bringing
diagnostic ultrasound closer to the people who need the services, most importantly, the people in
far away and hard to reach areas of Uganda.

With our primary goal being to enhance the livelihoods of the people in remote areas by bringing
ultrasound services closer to them, we devised the name Community Diagnostics for Healthier
Living (C.D.H.L) with our mission, Bringing Ultrasound services to where the needs are,
and our slogan, Timely Diagnosis, Appropriate Management.

Having worked in these very remote areas for quite some time, we realised that on several
occasions, patients are required to undertake investigations that include but are not limited to
Laboratory tests, ultrasound scanning and x-ray imaging.

Owing to the affordable cost of the equipment required to set up a basic medical laboratory,
many of the laboratory tests can be performed almost anywhere even in these remote areas. On
the other hand, however, x-ray and ultrasound investigations are not easily accessible in these
remote areas. This is largely attributed to the usually very high cost of the required equipment
and the scarcity of the technical people (radiographers) to use the machines.
C.D.H.L
COMMUNITY DIAGNOSTICS, HEALTHIER LIVING BRINGING ULTRASOUND SERVICES TO WHERE THE NEEDS ARE
Email: kobsrahnk@gmail.com / ntambik21@gmail.com
Timely Diagnosis Appropriate Management
Contact: +256 782 316 535 / +256 704 295 155


The few radiographers that are available in the country, dread working in hard to reach areas and
prefer jobs in the major towns and trading centres. This leaves the people in these remote places
with no choice but to endure long journeys in search for the radiology services.

Many of these Ugandans live below the poverty line and only a few of them can earn an average
of two dollars ($2) per day while a great majority earn less than one dollar (< $1) per day.

As a result of the meagre incomes, many of them fail to get the investigations done because of
the hefty transport costs and the unbearably high charges for the radiology services in the town
centres.

In such scenarios, the clinicians may opt to manage the patients symptomatically or even
undertake risky surgical procedures in a bid to help the patients. This would at times help save
the situation but it on several occasions led to the worsening of the patients condition or even
death in cases like raptured ectopic pregnancies.
Most importantly, this affect mothers more than the rest. In cases of transverse lies and as well as
in breech presentations.

It was on that background that we thought of bringing ultrasound services closer to these people
within their communities so as to help them especially the mothers and try to offer them the
service without having to move long distances and help them have timely diagnosis for
appropriate management.

When the idea was conceived, we introduced it tour friend and sister, Dana form Tucson in the
U.S, who helped us and got us the machine and also transported it Uganda.
7. Core purpose of the project
Improve the livelihoods of the people by bringing ultrasound services to where the needs are.
8. Specific Objectives of the Project
Improve the livelihoods of the people living in these hard to reach areas.
Help patients receive the best health care possible without having to travel long distances.
Improve the health of the people by giving them timely diagnosis.
Enhance the clinicians practice by giving them appropriate diagnosis.
Help improve the financial status of the communities by helping them save what they
would have spent on transportation and examination charges.


C.D.H.L
COMMUNITY DIAGNOSTICS, HEALTHIER LIVING BRINGING ULTRASOUND SERVICES TO WHERE THE NEEDS ARE
Email: kobsrahnk@gmail.com / ntambik21@gmail.com
Timely Diagnosis Appropriate Management
Contact: +256 782 316 535 / +256 704 295 155


3. Coverage / Scope of Operation:
We have for the last two years been operating in the areas of Eastern Uganda, including the
districts of Mayuge, Kamuli, Luuka and the Islands of J aguzi in lake victoria.

4. Achievements of the Project
There is increased awareness of the availability of the service in the communities and mothers in
particular have increasingly turned up for the service.

During our many escapades, we managed to save numerous situations including three ectopic
cases that had, two days prior to our arrival, been diagnosed as suspected P.I.D, salpingitis and /
or ovarian masses.

In these villages, owing to poor hygiene and lack of quick access to quality health care, many
women of child bearing age are prone to P.I.D and subsequent tubal blockages that eventually
predispose them to ectopic pregnancies.

It was also reported to us that a few months earlier, three mothers had had amenorrhea for about
one and half to two months, later developed severe L.A.P that resulted in profuse bleeding and
subsequent death. According to the history, it seems these mothers could have died of
Haemorrhagic shock following raptured ectopic pregnancies.

This prompted us to carry out a survey (ultrasound investigation) on the majority of the women,
results of which showed that almost 90% of them had either, salpingitis, complex ovarian cysts,
chronic cystitis or all of the above conditions.

The ultrasound machine that we got from Dana and the Rotary club has done a tremendous job in
saving the lives of these people. Being that it has a rechargeable battery; it was the perfect
machine for the job in these hard to reach areas.

Our operations are constantly evolving to meet the needs of the community and the clinicians as
well and we are trying to maintain continuous quality improvement. By utilizing our services,
clinicians enhance their practice, allowing patients to receive the best care possible without
having to travel long distances.
C.D.H.L
COMMUNITY DIAGNOSTICS, HEALTHIER LIVING BRINGING ULTRASOUND SERVICES TO WHERE THE NEEDS ARE
Email: kobsrahnk@gmail.com / ntambik21@gmail.com
Timely Diagnosis Appropriate Management
Contact: +256 782 316 535 / +256 704 295 155


5. CHALLENGES:
However, due to the transport means available in these areas, the machine is exposed to too
much dust and sometimes water when it happens to rain during our outreaches.
It was during one such awkward times that the strap of the bag (the ultrasound machine bag)
broke and the machine fell and was severely affected to the extent that it has developed a habit of
switching off during examination after working for about fifteen minutes.

It then has to be allowed to rest for about five minutes and then restarted. Initially it would
switch off only once or twice during the course of the day. But nowadays, the damage seems to
have intensified and the frequency of switching off has increased.

In some complex findings, we need to print the images for the referring clinician but we have no
sono-printer to do the printing.

We have also faced a challenge of paying the radiographer especially during the time when
Rehema is back to school and she needs to pay her tuition.

The transportation means in these areas are also a big challenge especially to the safety of our
machine. As reported earlier, the machine fell down as the radiographer was traveling on a motor
cycle (boda boda). This greatly damaged the machine to the degree earlier on explained.

6. Suggested Solutions
Solicit for funding to facilitate the radiographers salary.
Seek for assistance on improving on the transport means.
Acquire a sono-printer for printing images of complex results
8. PROGRESS STATUS

In general, we are so proud of the great impact that this project has had on the people of the hard
to reach areas of eastern Uganda and we look forward to expanding the operations to other areas
of the country that lack yet need the service.

We also look forward to acquiring portable x-ray machines that can be placed in some centres
with access to electricity so as to render a more rounded radiological service.

C.D.H.L
COMMUNITY DIAGNOSTICS, HEALTHIER LIVING BRINGING ULTRASOUND SERVICES TO WHERE THE NEEDS ARE
Email: kobsrahnk@gmail.com / ntambik21@gmail.com
Timely Diagnosis Appropriate Management
Contact: +256 782 316 535 / +256 704 295 155


Attached are some of the sono-images from the several investigation done using our Mobile
Ultrasound Equipment.
Please find attached a zipped folder of some of the images.
Images.rar

In future, we hope to start tabling our results in a more graphical representation.

Wish you the best Dear Dana. Greeting from all the people in our areas of jurisdiction.

Images.rar