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

Margaret Salmon,Nerys Benfield,Alegnta Gebreyesus,Aklilu Azaza,Sarah Wendell,Alexa Bissinger,Haimanot Geremew,Mundenga Mutendi Muller,Maurice Salumu,Christian Salmon

doi:10.1371/journal.pone.0134332

Abstract

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.

Highlights

Clinician-performed point of care ultrasound (POCUS) is emerging as a useful diagnostic tool for healthcare providers in limited-resource settings. [1,2] Several early studies demonstrated that ultrasound significantly impacts diagnosis and management of patients
Local Experts were identified based on these results and interviewed by research assistants to query for local suggestions that were similar to the materials selected. 72 vendors in Kindu & Goma, Democratic Republic of Congo, Addis Ababa Ethiopia and Bameko Mali were interviewed in groups
The women were shown photos of physicians performing ultrasonography and given samples of commercial gel and the design challenge was discussed. (Fig 1) Participation was determined if a vendor commented either to the research assistant or other vendors to discuss the topic

Summary

Introduction

Clinician-performed point of care ultrasound (POCUS) is emerging as a useful diagnostic tool for healthcare providers in limited-resource settings. [1,2] Several early studies demonstrated that ultrasound significantly impacts diagnosis and management of patients. [3] The value of ultrasound has gained increasing recognition by ministries of health in low and middleincome countries (LMICs), non-governmental organizations (NGOs), and the World Health Organization (WHO). [4]Despite the evidence, utilization of bedside ultrasonography by providers in low-income settings remains limited. Clinician-performed point of care ultrasound (POCUS) is emerging as a useful diagnostic tool for healthcare providers in limited-resource settings. [5,6,7] the cost and availability of commercially produced ultrasound gel in rural, limited resourced healthcare settings is prohibitive and limits the number and quality of scans available to clinicians even with in-place equipment. This situation is unfortunate, as persons in lower resource countries have higher morbidity and mortality in obstetric and trauma care, two of the areas in which ultrasound has proved most useful for patient management. Vendors who sold bulk starch-like grains and flours were recruited

Methods

Results

Discussion

Conclusion