FASH: Focused Assessment with Sonography for HIV/TB – A Practical Manual. Tom Heller, 2013, Munich, Germany

Abstract

FASH: Focused Assessment with Sonography for HIV/TB – A Practical Manual. Tom Heller, 2013, Munich, Germany. TALC-Teaching Aids at Low Cost. ISBN: 978-0-9558811-8-3 (softcover and CD) It is regrettable that some of the world's most challenging health problems exist in populations least likely to be able to afford the care and control of these diseases. That is certainly true of many of the high burden areas of human immunodeficiency virus (HIV) and tuberculosis (TB), in which a CD4 cell count may be difficult to obtain and a viral load is completely unavailable. Access to modern techniques for TB diagnostic testing in numerous high-incident areas is still limited. Point-of-care ultrasound has recently emerged as a convenient diagnostic tool for many illnesses, including TB, prevalent in resource-poor settings where other more sophisticated testing and imaging modalities may not be available or affordable. Because of use of portable, point-of-care ultrasound, many patients can receive a rapid presumptive diagnosis at the bedside or in the clinic. FASH: Focused Assessment with Sonography for HIV/TB – A Practical Manual by Tom Heller was developed by the author to assist with the diagnosis of TB and extra-pulmonary TB, especially with HIV co-infection. Dr. Heller, an expert in infectious diseases and ultrasound, has dedicated a significant part of his professional life to working among the poor with HIV/acquired immunodeficiency syndrome in KwaZulu-Natal, South Africa. The FASH concept grew into a training curriculum for health care workers in settings in which complications of HIV infection are common. Dr. Heller has successfully taught the FASH technique in multiple African and Middle Eastern countries. The content of his curriculum is now available in this text. The book is a small-footprint paperback with a firm cover that can easily be carried in a backpack or pocketbook into any corner of the world. It is nicely organized into the basics of point-of-care ultrasound followed by chapters on the ultrasound of TB of the abdomen; effusions; lymph nodes; liver; spleen; and heart and chest. Almost every page has at least one photograph, radiograph, or ultrasound image, many in color. The image quality is exceptionally good and the diagrams are professionally executed and to the point. For example, in the chapter on the spleen, there are 10 quality images of the spleen showing normal images of the spleen and images of the spleen in patients with TB and other diseases that might be confused with TB, such as lymphoma. All images are nicely reproduced and appropriately annotated. The manual has been made available through TALC (Teaching Aids at Low Cost) for a price of £5 according to their website (www.talcuk.org/index.htm). This cost is the production cost and neither the author nor publisher receives a profit. This feature enables anyone to be able to purchase the manual at minimal cost. Surprisingly, at this price, attached to the back cover is a CD that contains the e-book version of the manual. The e-book contains the images in two formats: a Firefox HTML document that does not require internet access and the separate MPG image library. Clicking on the Firefox link took me to the images in Quick time and clicking on the MPG images took me to the same image but without annotation and explanation. All worked flawlessly on my computer without installing plug-ins or software and all movies were looped for continuous viewing. Also, to my delight as an educator, the book states that all material in the manual may be reproduced for non-profit use provided permission is first obtained from the author and publisher. This feature is of incredible value for those of us who teach ultrasound or infectious diseases to health care workers. Dr. Heller has provided a great service to patients, doctors, sonographers, and educators with the low-cost publication of this manual and e-book with included image library. This service is especially true for those of us who struggle caring for patients with HIV and possible co-infection with TB in resource-limited settings. Dr. Heller, congratulations on the diligence of your work. For the simplicity, style, and portability of this manual, well done. For making it inexpensive so that everyone can afford a copy, our gratitude. Thank you for making your images (with permission) available to those of us who teach. And most especially, thank you from those who cannot thank you themselves, the patients with HIV and TB whose lives will benefit from the application of FASH to their health needs.