Intensive Care in Sub-Saharan Africa : A National Review of the Service Status in Ethiopia

Funding: This study was funded by the Ethiopian Ministry of Health Emergency and Critical Care Directorate. A.B. and R.H. are funded in whole, or in part, by the Wellcome Trust [220211] and UKRI GECO Grant MR/V030884/1 for their contribution to this study. ACKNOWLEDGMENTS The authors wish to thank all hospital CEO’s and medical directors for their honest and cooperative response, and data collectors and coordinators who visited facilities for their assistance with data col- lection. We thank Ermiyas Belay, MSc, from Wolkite University, Ethiopia, and Dilanthi Gamage from Network for Improving Critical Care Systems and Training (NICST), Sri Lanka for their assistance in analyzing the data. We are particularly grateful to Prof Bruce Biccard, PhD, from University of Cape Town for his assistance in presubmission manuscript review.Peer reviewedPublisher PD

Alternative Ultrasound Gel for a Sustainable Ultrasound Program: Application of Human Centered Design.

This paper describes design of a low cost, ultrasound gel from local products applying aspects of Human Centered Design methodology. A multidisciplinary team worked with clinicians who use ultrasound where commercial gel is cost prohibitive and scarce. The team followed the format outlined in the Ideo Took Kit. Research began by defining the challenge how to create locally available alternative ultrasound gel for a low-resourced environment? The End-Users, were identified as clinicians who use ultrasound in Democratic Republic of the Congo and Ethiopia. An expert group was identified and queried for possible alternatives to commercial gel. Responses included shampoo, oils, water and cornstarch. Cornstarch, while a reasonable solution, was either not available or too expensive. We then sought deeper knowledge of locally sources materials from local experts, market vendors, to develop a similar product. Suggested solutions gleaned from these interviews were collected and used to create ultrasound gel accounting for cost, image quality, manufacturing capability. Initial prototypes used cassava root flour from Great Lakes Region (DRC, Rwanda, Uganda, Tanzania) and West Africa, and bula from Ethiopia. Prototypes were tested in the field and resulting images evaluated by our user group. A final prototype was then selected. Cassava and bula at a 32 part water, 8 part flour and 4 part salt, heated, mixed then cooled was the product design of choice

Alternative Ultrasound Gel for a Sustainable Ultrasound Program: Application of Human Centered Design

<div><p>This paper describes design of a low cost, ultrasound gel from local products applying aspects of Human Centered Design methodology. A multidisciplinary team worked with clinicians who use ultrasound where commercial gel is cost prohibitive and scarce. The team followed the format outlined in the Ideo Took Kit. Research began by defining the challenge "how to create locally available alternative ultrasound gel for a low-resourced environment? The "End-Users," were identified as clinicians who use ultrasound in Democratic Republic of the Congo and Ethiopia. An expert group was identified and queried for possible alternatives to commercial gel. Responses included shampoo, oils, water and cornstarch. Cornstarch, while a reasonable solution, was either not available or too expensive. We then sought deeper knowledge of locally sources materials from local experts, market vendors, to develop a similar product. Suggested solutions gleaned from these interviews were collected and used to create ultrasound gel accounting for cost, image quality, manufacturing capability. Initial prototypes used cassava root flour from Great Lakes Region (DRC, Rwanda, Uganda, Tanzania) and West Africa, and bula from Ethiopia. Prototypes were tested in the field and resulting images evaluated by our user group. A final prototype was then selected. Cassava and bula at a 32 part water, 8 part flour and 4 part salt, heated, mixed then cooled was the product design of choice.</p></div

Ultrasound images taken with cassava gel.

<p>Images of the right upper quadrant FAST exam, positive gall stones and lung sliding taken with a Sonosite 180 ultrasound machine using cassava gel prototype.</p

Markets in Goma, Addis Ababa, and Bameko.

<p>(A) Vendors are interviewed in Addis Ababa Ethiopia at Merkato in Lideta sub city and Addis Ketema by research colleague Alegnta Gebreyesus, MD in Amharik. (B) Vendors are interviewed at the Virunga Market in Goma, DRC by research assistant, Rene Zaidi, in Kiswahili. Commercial ultrasound gel is demonstrated and this vendor suggests banana flour, sorgum or cassava root flour. (C) Vendors are interviewed at Bameko Mali by research assistant, Bouba, in Bambera. The vendor reviews photos of obstetric ultrasounds and suggests banana flour, sorgum or cassava root flour.</p

Marginal costs of cassava and bula gel.

<p>Marginal costs of cassava are 0.08USC and bula is 0.25USD per 240ml bottle. This is assuming no waste and perfect efficiency in production.</p><p>Marginal costs of cassava and bula gel.</p