Tina Slusher, MD

Nigeria Trip June 20-30, 2024

Dr. Ashley Bjorklund and I had the privilege of helping facilitate, co-lead, and teach neonatal/pediatric POCUS (point of care ultrasound) with Dr. Sunil John (Stephen John’s Dad and Chandy John’s brother) at Ahmadu Bello University Teaching Hospital in Zaria, Nigeria. The class “students” were members of the Stop Kernicterus and Infection+ in Northern Nigeria consortium (Jos University and Bingham University Teaching Hospitals (both in Jos); Aminu Kano Teaching Hospital in Kano; and Ahmadu Bello University Teaching Hospital in Zaria. Prior to the intensive hands-on- in-person course, a didactic educational session reviewing the basics of POCUS was held virtually, led by Dr. John. Participants also began recording scans and the images were shared for virtual case discussion.

Finally in October, the team of instructors (Suni, Ashley, and Tina) joined the students in Abuja, Nigeria for an intensive hands-on POCUS class. We had a very fun and productive week learning and practicing POCUS for five full days. The course required flexibility with all to often present challenges of power outages (national power grid failure), limited number of correct probes (only a couple linear), learners trying to teach while learning themselves (primarily me), and homemade models not lasting quite as long as was hoped. (Yes, we made several of our own models from gelatin, water, “Metamucil”, and glycerol and/or soy cheese and balloons in a skillet over kerosene burner in our guesthouse conference room with the help of some of the students). With the kind permission of their parents, we had a few children participating as patient models for many of the scans. The students were incredibly engaged, often remarking how rapidly they could put the learned material to use. Nineteen colleagues received certificates verifying their participation in this course!

The team has an ongoing group chat where unidentified images can be shared for discussion with the instructors or other team members. These centers are actively pursuing further learning opportunities for themselves and then beginning to teach and implement what they have learned through venues in their own universities’, the Paediatric and Neonatal Associations in Nigeria, etc. We are grateful to Drs. Ron Johansen, Steve Dunlop, Fidelia Bode-Thomas, and Kemi Ige for both their help pre-course and for loaning us machines to teach with but more point-of-care affordable devices/probes are urgently needed in each of these institutions. We have since been able to send one set of low cost probes to the students in Abuja, but more are desperately needed. 

Probably the most impactful aspect of the trip was shortly after returning to Kano, watching the neonatologist who had just learned to use the ultrasound well, use it to diagnosis RDS and adjust CPAP and move a UVC into correct position prior to an exchange transfusion. While learning POCUS is often a “extra” for our US physicians, this skill is an essential in settings where access to other radiology and diagnostic modalities is limited.  

We had lots of fellowship and fun despite limited free time. We enjoyed the Nigerian cuisine and saw a large “cat” we have never seen before. Sunil, Ashley, and I were given beautiful homemade garments and hosted royally by ABU, Zaria. 

I also had the privilege of teaching in two of our other partner sites during this trip. First in Cambodia at Chenla Children’s Hospital with Dr. Krysten North where we are working on their feeding protocol building on Dr. Jameel Winters previous teaching. Then following Nigeria, I taught in the Tiny Feet Big Steps Conference hosted by Dr. Steve Swanson in Arusha Tanzania with participants and faculty from all over Africa and beyond. It was fun to see many of the former residents we had hosted and to teach alongside Drs. Kari Roberts, Kendra Martinez (former global chief resident) and Drs. Margaret Nakakeeto and Beatrice Odongkara from our Uganda partner sites.

• Orubu E, Satrom K, Ezenwa B, Fajolu I, Lund T, Obi A, Ezeaka C, Slusher T. Real-world use of the CarestartTM glucose-6-phosphate dehydrogenase rapid diagnostic test to determine G6PD deficiency in Nigerian neonates. J Trop Pediatr. 2024 Oct 4;70(6):fmae050. doi: 10.1093/tropej/fmae050. PMID: 39607988.

• Vorkoper S, Agot K, Dow DE, Mbizvo M, Mugo C, Sam-Agudu NA, Semitala FC, Zanoni BC, Sturke R. Building locally anchored implementation science capacity: the case of the adolescent HIV implementation science alliance-supported local iS alliances. Front Health Serv. 2024 Oct 14;4:1439957. doi: 10.3389/frhs.2024.1439957. 

• Osa-Afiana C, Adebayo G, Adedeji I, Oladimeji T, Nwachukwu A, Michael D, Danjuma G, Edewor U, Owhonda G, Okpokoro E, Okech B, Sam-Agudu NA. Facilitators and Barriers to the Adoption and Implementation of UNICEF's Service Delivery Framework (SDF) Strategies - Stakeholder Insights from the Pediatric Breakthrough Partnership Project in Nigeria. Conference on the Science of Dissemination and Implementation in Health. 2024 Dec 9

• Sam-Agudu, NA. An Introduction to Implementation Science (IS):. Cameroon HIV/AIDS Research Conference, Douala. 2024 Dec 5