Portable Ultrasounds for Medical Care in Venezuela

Summary

Point of care ultrasound (POCUS) is an innovative and cost-effective tool to improve the diagnosis and management of urgent, common medical conditions. POCUS is highly valuable in resource-limited healthcare settings, where alternative options for imaging can be prohibitively expensive for patients or otherwise unavailable. In 2023, Healing Venezuela donated 3 devices to the Razetti Medical School and the results were so impactful that this project has expanded the programme to other health institutions. Thanks to the generous donations of our GivingTuesday Campaign in 2024, we have purchased 9 devices to expand the programme to other medical schools in Venezuela. 

Project Update 

Point-of-care ultrasound (POCUS) is an essential tool in the field of internal medicine (IM), providing key data that improves real-time medical diagnostic and management decisions (1) Over half of US medical schools and internal medicine residency programs include POCUS skills as curricular core competencies (2,3) however in countries with lower-resourced health systems, there is very limited access to POCUS training or technology (4), often due to a lack of equipment, available trainers, and longitudinal curriculum (5).

Venezuela’s complex economic crisis has resulted in a myriad of consequences to the health sector, including an under-funded public healthcare system. (6) In environments like this, POCUS has been documented to have a particularly powerful impact on clinical decision making (7,8) given that other diagnostic technologies may be unavailable or too expensive.

Given that Venezuela has such high potential for benefitting from POCUS as a diagnostic and management tool, in 2023 we funded three portable ultrasound devices to support an inaugural POCUS Training Course in a partnership between experts at New York University School of Medicine and medical education leaders at the Luis Razetti School of Medicine at the Central University of Venezuela (UCV). This initial course resulted in 19 internal medicine physicians (professor-level) being fully trained to use donated POCUS devices in the fields of: cardiac ultrasound, lung ultrasound, abdominal ultrasound, skin and soft tissue ultrasound, and ultrasound for the identification of deep vein thromboses. Pre- and post-course knowledge exams and post-course skills exams were conducted, and results demonstrated success of the training program.

The funds raised during the 2024 GIving Tuesday campaign have been used to purchase 9 additional devices (see invoice in Annex) for use at other teaching hospitals across Venezuela, an expansion that we are conducting in partnership with UCV and the Venezuelan Society of Internal Medicine, the specialty’s leading national professional society. As we prepare to distribute the new devices, we have also continued to strengthen our POCUS training program with the existing devices, which is detailed in this report.

Goals and Metrics

The goals of this programme are:

1. To increase the number of internal medicine physicians trained in the skilled use of POCUS for bedside diagnosis and management;
2. To increase the number of patients who are beneficiaries of POCUS exams;
3. To continue building a sustainable training program that includes continually improving our training materials, hosting and participating in relevant academic conference, and supporting research on the impacts of the POCUS program on patient health outcomes.

Progress has been made in these areas and is measured using a combination of quantitative and qualitative methods. Testimonials were obtained from physicians receiving the training and patients who are beneficiaries of the training.

Goal 1: Cohorts of Physician Learners. The first goal of this project was to train physicians in the use of POCUS. To date, 55 Internal Medicine doctors have been trained (see table 1 for details)

Goal 2: Patients Impacted by POCUS. The second goal was to perform medical exams in the Hospital Razzetti Internal Medicine services. Since the beginning of the year, a total of 141 patients have been beneficiaries of the use of POCUS.(see table 2 for details) 

Goal 3: Training Program Notable Events. During the first months of 2025, we participated in several events, papers are being prepared and a new study was initiated in January. More specifically: 

(1)   International Academic POCUS Conference (UCV-NYU) about the use of POCUS to diagnose Tuberculosis in patients with HIV: February 12, 2025: https://youtu.be/RejRZB0lVNc

(2)   Publication of our initial cohort study of the initial training program in the international medical journal “POCUS Journal” (accepted; to be published April 2025)

(3)   New study initiated in January 2025 at Luis Razetti School of Medicine: “The Diagnostic Accuracy of POCUS in the Diagnosis of Deep Vein Thrombosis in Hospitalized Patients”

(4)   Our POCUS Training Program is becoming formalized into the UCV Internal Medicine Postgraduate Curriculum, as of January 2026.

Next Steps 

We are currently in the process of setting up a distribution plan for the new devices. It is not a delay, but it is a process that requires thoughtful pre-planning to ensure the donated devices will have the appropriate maintenance, storage, and supervised use in each location. We are doing this in partnership with the Venezuelan Society of Internal Medicine, a trusted national network of specialists with existing medical education programs in all teaching hospitals in Venezuela.

Challenges and Opportunities

We anticipate that there will be an early learning curve to incorporating the devices into each new hospital at which they are introduced, including coordinating the necessary training and setting up expected workflows. We plan to have a supervision plan in place so that all involved parties have the technical and administrative support required for program success.

Bibliography

1. Schnobrich DJ, Gladding S, Olson APJ, Duran-Nelson A. Point-of-Care Ultrasound in Internal Medicine: A National Survey of Educational Leadership. J Grad Med Educ. 2013;5(3):498-502. doi:10.4300/JGME-D-12-00215.1
2. LoPresti CM, Schnobrich DJ, Dversdal RK, Schembri F. A road map for point-of-care ultrasound training in internal medicine residency. Ultrasound J. 2019;11:10. doi:10.1186/s13089-019-0124-9
3. Russell FM, Zakeri B, Herbert A, Ferre RM, Leiser A, Wallach PM. The State of Point-of-Care Ultrasound Training in Undergraduate Medical Education: Findings From a National Survey. Academic Medicine. 2022;97(5):723. doi:10.1097/ACM.0000000000004512
4. Becker DM, Tafoya CA, Becker SL, Kruger GH, Tafoya MJ, Becker TK. The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health. 2016;21(3):294-311. doi:10.1111/tmi.12657
5. Henwood PC, Mackenzie DC, Rempell JS, et al. A practical guide to self-sustaining point-of-care ultrasound education programs in resource-limited settings. Ann Emerg Med. 2014;64(3):277-285.e2. doi:10.1016/j.annemergmed.2014.04.013
6. Page KR, Doocy S, Reyna Ganteaume F, Castro JS, Spiegel P, Beyrer C. Venezuela’s public health crisis: a regional emergency. Lancet. 2019;393(10177):1254-1260. doi:10.1016/S0140-6736(19)30344-7
7. Groen RS, Leow JJ, Sadasivam V, Kushner AL. Review: indications for ultrasound use in low- and middle-income countries. Trop Med Int Health. 2011;16(12):1525-1535. doi:10.1111/j.1365-3156.2011.02868.x
8. Fleshner M, Fox S, Robertson T, Fujita AW, Bhamidipati D, Bui T. Impact of Point-of-Care Ultrasound in Medical Decision Making: Informing the Development of an Internal Medicine Global Health POCUS Curriculum. POCUS J. 7(1):144-153. doi:10.24908/pocus.v7i1.15620

• Tables 1 and 2 with Metrics per Goal (DOCX)
• Invoice Payment 9 POCUS (PDF)