That’s how Dr. Vargas, a physician trained in Tropical Medicine and Hygiene and GUSI instructor, described his relationship with point-of-care ultrasound (POCUS). For the past six years, he has been working in Chiapas, Mexico, a resource-limited region where access to advanced imaging like CT, MRI or even X-ray is often impossible. In these settings, POCUS is not just a diagnostic tool, it’s a lifeline.

From Medical School to the Highlands of Chiapas

His journey with POCUS began fresh out of medical school while working in the highlands of Chiapas, Mexico. “I was exposed to many tropical diseases: tuberculosis, dengue, fungal infections, among many others. These are conditions you don’t often see in high-resource settings, but they’re common where health systems have left patients neglected.” With only rapid diagnostic tests available, he picked up an ultrasound probe and quickly realized its transformative potential.

A Life-Saving Diagnosis: When POCUS Makes the Difference

One of his earliest cases involved a patient living with HIV who had recently been hospitalized for COVID-19. Two weeks after discharge the patient returned to his care with fever, cough, and now palpitations. A quick bedside cardiac ultrasound revealed a pericardial effusion which prompted immediate investigation with a bedside FASH exam (Focused Assessment with Sonography for HIV/TB) ultimately revealing para-aortic lymphadenopathy, a sign of extra-pulmonary tuberculosis. While confirmatory tuberculosis testing was pending, the ultrasound findings were enough to mobilize the Ministry of Health and expedite the initiation of TB treatment.

In this case, POCUS didn’t just guide the workup, it directly accelerated access to life-saving care. For this patient, ultrasound quite literally made the difference between life and death.

The Global Burden of Tuberculosis

According to the WHO 2023 Global Tuberculosis report, an estimated 10.6 million people fell ill with tuberculosis in 2022, equivalent to 133 incident cases per 100,000 population. Among all incident TB cases, 6.3% were among people living with HIV. TB mortality continues to weigh heaviest in South-East Asia and Sub-Saharan Africa, underscoring how diagnostic delays can carry devastating consequences.

POCUS as an Extension of Daily Practice

POCUS is an “extension of what I do every day,” Dr. Vargas adds. His experience is a testament that alongside a physical exam, a quick bedside scan can improve the daily clinical workflow, provide real-time information, and enable rapid assessment. In Chiapas, most patient concerns cluster around respiratory issues, gastrointestinal problems, or gynecological concerns, similar to those seen in higher resource healthcare systems. The main difference is the availability and use of diagnostic tools. In low-resource settings, POCUS often becomes the first and only imaging option, guiding rapid decision-making and life-saving interventions. If the same patient complaints are universal, then the value of POCUS should be as well. Rather than being viewed as a fallback when advanced imaging is unavailable, POCUS can be embraced in high-resource settings as an equally powerful tool.

While bedside ultrasound does not replace the diagnostic value of CT or MRI scans, “a lot of times you will be able to diagnose and have a different management just by using POCUS.”

Global Adoption and the Future of POCUS

Globally, the bedside innovation of POCUS has shown great value already as South Asia and Sub-Saharan Africa have started to incorporate it into their medical care. Dr. Vargas’ longtime work in under-resourced medicine further reinforces the everyday value of POCUS and infectious diseases. Regions alike where infectious pathologies predominate can similarly adopt this effective and cost-efficient technique, providing patients with faster answers and ultimate life-saving treatment. (Beam et al., 2025)

Integrating POCUS into infectious disease specialty training is vital to improving care in resource-limited settings. This technology doesn’t just support diagnosis, it accelerates treatment and saves lives.

Reference:

Beam M, Abdull Wahab SF, Ramos M. Point-of-Care Ultrasound in Resource-Limited Settings. Med Clin North Am. 2025 Jan;109(1):313-324. doi: 10.1016/j.mcna.2024.06.005. Epub 2024 Aug 1. PMID: 39567101.

Article contributed by Eileen Perez

From Lima to Sacramento: A Medical Student’s Journey

Eileen Perez was born and raised in Lima, Peru until the age of eight when her family immigrated to California. She completed her early education between the Central Valley and the Bay Area before earning a Bachelor’s degree in Biopsychology at UC Davis, where she came to call Sacramento home. During her gap years she traveled throughout Europe, spent much deserved quality time with family and friends, and cultivated her passion for medicine and community engagement. Now a fourth-year medical student at Touro University California, she is excited to begin the residency application cycle as an Internal Medicine candidate.

(She loves exploring new restaurants and cuisines though remains loyal to Peruvian food as her #1. She also loves all water-related activities whether hiking to waterfalls, walking along the beach, paddle boarding, or (someday soon) jet skiing in the ocean)

Discovering the Power of Point-of-Care Ultrasound

I first became interested in ultrasound during our in-lab sessions in my second year of medical school. I was fascinated by the ability to look inside the body in real time, using a tool that was safe, quick, and non-invasive. As a visual and hands-on learner, I still remember the moment I first saw the heart beating on the screen; I was instantly drawn in. Not long after, I was introduced to point-of-care ultrasound (POCUS). To me, it represented more than just a diagnostic tool but a turning point in how we could break down barriers of accessibility and resources, ensuring patients receive timely, high-quality care.

In many rural areas of the Philippines, expectant mothers often face long travel times, high costs, and limited access to diagnostic tools. POCUS for Maternal Health in the Rural Philippines is changing that story. With handheld ultrasound devices and targeted training for local health workers, life-saving prenatal scans are now within reach for communities that need them most.

This article explores 10 powerful ways point-of-care ultrasound (POCUS) is bridging gaps in maternal health across the archipelago — and why it’s a game changer for women, babies, and healthcare providers alike.

Introduction

Point-of-care ultrasound (POCUS) is redefining maternal healthcare in underserved regions worldwide. In the Philippines, where rural communities face persistent challenges in accessing quality prenatal care, POCUS is becoming a game changer. This blog explores 10 powerful ways POCUS for maternal health in rural Philippines is closing diagnostic gaps, saving lives, and empowering frontline healthcare workers.

1. Bringing Ultrasound to Remote Villages

In many rural provinces of the Philippines, pregnant women may live several hours away from the nearest hospital with ultrasound services. This often means traveling by boat, motorbike, or jeepney across difficult terrain — a trip that can be both costly and physically exhausting for expectant mothers. The result? Many women simply skip essential scans altogether.

With POCUS for maternal health in rural Philippines, healthcare providers can now carry handheld devices directly into these communities. These lightweight, portable scanners can be connected to a tablet or smartphone, allowing midwives and rural doctors to perform pregnancy ultrasounds right inside barangay health stations or community clinics. This eliminates the need for long-distance travel, cuts costs for families, and ensures timely prenatal monitoring.

2. Detecting High-Risk Pregnancies Early

Conditions like placenta previa, breech presentation, multiple gestations, or abnormal placental attachment are leading contributors to maternal and neonatal complications. According to World Health Organization (WHO), many of these issues can be detected as early as the second trimester with a single quality ultrasound scan.

POCUS for maternal health in rural Philippines enables midwives, nurses, and general practitioners to identify these risks well before delivery. In one Philippine pilot project, over 31% of pregnant women scanned had an unsuspected complication that could have endangered them or their babies during birth. By catching these conditions early, rural healthcare workers can refer mothers to hospitals with surgical capacity, arrange safe transportation, and prepare necessary interventions before emergencies occur.

3. Empowering Community Health Workers

In the absence of OB-GYNs, rural midwives and nurses are often the primary — and sometimes only — healthcare providers for pregnant women in the Philippines. Unfortunately, their traditional toolkit is limited to blood pressure cuffs, fetal dopplers, and physical assessments, which cannot reveal many dangerous conditions.

Through targeted training programs like the Catanduanes Ultrasound Fellowship, these frontline providers are now learning how to perform and interpret obstetric POCUS. Even with short, focused training, studies show midwives can achieve diagnostic agreement rates of over 90% with experienced sonographers. This skillset gives them the confidence to make informed, immediate decisions and strengthens their role as trusted maternal health advocates within their communities.

4. Increasing Antenatal Visit Attendance

One of the most underestimated benefits of introducing POCUS into rural clinics is its impact on antenatal visit attendance. Expectant mothers are far more likely to attend regular checkups when they know they will see their baby’s image or hear the heartbeat — making each visit more engaging and meaningful.

Research from similar programs in Asia and Africa has shown a clear rise in prenatal visit compliance after POCUS was introduced. In the Philippines, local midwives report that expectant mothers often bring family members to witness the scan, creating a positive community culture around maternal health. The emotional connection and reassurance provided by ultrasound can transform antenatal care from a purely medical task into a bonding experience for both mother and family.

5. Improving Emergency Preparedness

Pregnancy complications often strike without warning, but many can be anticipated with proper screening. POCUS for maternal health in rural Philippines allows providers to detect risks — such as abnormal fetal positioning, signs of preterm labor, or low amniotic fluid — months before delivery.

By identifying these red flags early, rural clinics can prepare an emergency plan, secure transport to referral hospitals, and alert higher-level facilities in advance. In provinces where one doctor may serve tens of thousands of people, this proactive approach is lifesaving. It also prevents last-minute emergencies that place both mothers and healthcare systems under extreme pressure.

6. Reducing Maternal and Neonatal Mortality

Maternal mortality remains a serious challenge in the Philippines, with United Nations Children’s Fund (UNICEF) reporting that around 13 women die every day from pregnancy-related complications. Many of these deaths are preventable with timely diagnosis and intervention.

In rural pilot programs, handheld POCUS devices have been credited with reducing preventable maternal deaths by as much as 6% and neonatal deaths by nearly 15% through early detection of complications. When paired with timely referrals, these scans ensure high-risk pregnancies are managed in safer settings, leading to healthier outcomes for both mother and child.

7. Cost-Effective Technology for Low-Resource Settings

Traditional ultrasound machines can cost tens of thousands of dollars and require specialized facilities. In contrast, portable POCUS devices like the Butterfly iQ are far more affordable, require minimal infrastructure, and can be operated with a mobile phone.

For rural health units with tight budgets, this technology represents a game-changing investment. One device can serve hundreds of pregnancies per year, allowing continuous monitoring without the overhead of a full hospital-based imaging department. The low maintenance requirements also make them practical for clinics in remote or typhoon-prone areas, where resources are scarce and resilience is essential.

8. Real-Time Specialist Support with ScanHub

Even with basic training, some cases require specialist input. ScanHub enables rural providers to share scans instantly with remote experts for second opinions. This is especially valuable in the Philippines’ island provinces, where specialist access can be limited by geography.

Through secure cloud sharing, obstetricians and radiologists in urban centers can review images and provide feedback within minutes. This ensures accurate diagnoses, informed treatment plans, and continuity of care — all without requiring the patient to travel long distances for a consultation.

9. Simplified Scanning with ScanHub

ScanHub is GUSI’s mobile application (available on both the Apple App Store and Google Play Store) that enables even minimally trained providers to perform quality scans. Its intuitive design ensures POCUS for maternal health in rural Philippines can be integrated quickly into local clinics.

While traditional ultrasound training can take years, tools like ScanOne and ScanHub are designed to simplify scanning for new users. Their intuitive interfaces guide health workers through basic obstetric protocols step-by-step, ensuring consistent and reliable results.

This democratization of ultrasound use means POCUS for maternal health in rural Philippines can be integrated quickly into busy clinics, even when staff have limited prior imaging experience. It also makes scaling up ultrasound access across rural health networks far more achievable.

10. Building Sustainable Local Ultrasound Networks

Short-term training programs can spark change, but sustainable improvement comes from ongoing mentorship. The Catanduanes Ultrasound Fellowship is a prime example — offering graduates continuous education, tele-ultrasound supervision, and case reviews to keep skills sharp.

By creating a network of trained ultrasound “champions” across the province, the fellowship ensures knowledge is passed on, devices are actively used, and more providers are trained over time. This model can be replicated across other underserved areas, building a nationwide web of skilled providers ready to deliver safe, effective maternal care.

Conclusion: From Local Impact to National Transformation

POCUS for maternal health in rural Philippines is more than just a diagnostic tool — it’s a lifeline that is rewriting the story of maternal care in underserved communities. By detecting complications early, empowering local healthcare providers, and harnessing technology like ScanHub for real-time specialist support, we are closing the gap between rural and urban maternal health. The progress seen in provinces like Catanduanes shows what’s possible when innovation meets commitment. With sustained training, community engagement, and access to portable ultrasound technology, this impact can scale nationwide — ensuring no mother is left without the care she needs, no matter how remote her home may be.

Transform your practice with GUSI’s proven training programs:

• In-Person Courses – Master techniques with live instruction
• Fellowships – Become a POCUS expert through intensive training
• Online Courses – Learn anytime, anywhere with expert guidance

FAQs

1. Can POCUS replace traditional ultrasound in all cases?
No. POCUS is best used for screening and triage, with complex cases referred to specialists.

2. How long does it take to train a midwife in POCUS?
Basic obstetric POCUS training can be completed in 2–5 days, with ongoing mentorship recommended.

3. What is the role of ScanHub in maternal care?
It enables remote consultations and real-time specialist support for rural providers.

4. Can POCUS help with non-obstetric conditions?
Yes. POCUS is also used for cardiac, abdominal, and lung assessments in primary care.

5. How can donors support POCUS programs in the Philippines?
By funding devices, training, and mentorship programs for rural healthcare workers.

References

• Global Ultrasound Institute. POCUS Training Programs. https://globalultrasoundinstitute.com

• • World Health Organization – Recommendations on Antenatal Care
  • World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO, 2016.
  • UNICEF Philippines. Maternal and newborn health in the Philippines. UNICEF, 2023.
  • Moyo SR, et al. Point-of-care ultrasound in low-resource settings: a scoping review. Global Health Sci Pract. 2022.

Tuberculosis (TB) remains the world’s leading cause of death from an infectious disease, with over 10.8 million cases and 1.25 million deaths reported globally in 2024. In low-resource settings, early diagnosis continues to be a massive barrier to care. Could lung ultrasound (LUS) help fill that gap?

In this June 18 webinar, hosted by Global Ultrasound Institute (GUSI), Dr. Mena Ramos and Dr. Kevin Bergman brought together TB researchers, family physicians, emergency doctors, and ultrasound educators from six continents. This compelling discussion highlighted both the promise and the limitations of using Lung Ultrasound for Tuberculosis detection, triage, and clinical decision-making.

1. The Global Burden of TB and the Case for Lung Ultrasound for Tuberculosis

Dr. Lukonde Zimba (University of Zambia) opened the session with sobering statistics: Only 50% of people with TB are diagnosed or reported, and access to care remains highly inequitable. A scalable, low-cost tool like lung ultrasound may help detect more cases earlier, especially in resource-constrained areas.

TB disproportionately affects the most underprivileged populations. We need tools that meet people where they are.

2. What the Research Shows About Lung Ultrasound for Tuberculosis

Dr. Matthew Fentress (University of California, San Francisco) presented a systematic review of lung ultrasound findings in pulmonary TB, drawing from both older and recently published studies. He highlighted the diagnostic potential of specific LUS features:

• High Sensitivity for Subpleural Nodules and Consolidations (56% to 100%), especially when used as composite indicators
• Low Specificity for Composite Findings (44% to 66%), which limits standalone utility
• Inability to Visualize Cavitary Lesions in most cases, a known shortcoming of LUS
• AI Integration as a rapidly growing area of research that could scale access

He cautioned against generalizing LUS results without standardization, noting that no universally accepted set of criteria yet exists to define a positive scan for TB.

There is no standard definition yet of a positive ultrasound for TB. We need more research to define key lesion combinations.

3. Malaysia’s Frontline Study: Lung Zones That Matter Most in Lung Ultrasound for Tuberculosis

Dr. Nafisa Idris (Hospital Kuala Lumpur, Malaysia) shared results from a multi-center observational study involving 140 newly diagnosed pulmonary TB patients. The study excluded patients with prior TB or other chronic pulmonary conditions, focusing on correlating LUS findings with chest X-rays.

Key findings included:

• The R1A and R1B zones (right anterior upper chest) had the highest yield of positive LUS findings, aligning with known oxygenation and anatomical patterns of TB.
• Pleural irregularities were the most consistent finding, seen in 98% of patients.
• LUS showed greater sensitivity than chest X-ray in detecting early, peripheral disease, though the correlation with X-ray was moderate.

She described how this informed their emergency department triage process. Patients showing suspicious symptoms but inconclusive chest X-rays could be isolated and prioritized for TB workup using LUS findings as justification.

“In the ED, when X-rays show nothing but clinical suspicion is high, LUS gives us the evidence to isolate and protect.”

 4. Global Clinical Applications of Lung Ultrasound for Tuberculosis: Case Stories from Mexico to Ethiopia

Panelists from three continents shared how LUS is applied in everyday clinical settings:

• Dr. Bruno Vargas (Partners in Health, Chiapas, Mexico) works in mountainous areas where patients must travel hours over dirt roads to access x-ray machines. He described LUS as a lifesaving extension of physical examination. In two illustrative cases, LUS findings such as pericardial effusion and pleural irregularity helped convince TB program officers to initiate treatment even before sputum results were available. He emphasized that LUS empowered frontline clinicians to act quickly.

“It’s not about replacing X-rays—it’s about getting patients diagnosed and treated when access is a barrier.”

• Dr. Temesgen Beyene Abicho (Bahir Dar University, Ethiopia) discussed how LUS plays a central role in emergency and critical care. In scenarios such as TB-related pericardial tamponade or pleural effusion, LUS is used for diagnosis, monitoring, and procedural guidance. He stressed how its portability and real-time capability made it indispensable for unstable patients, especially when radiology is far away or unavailable.

“From rapid diagnosis to guiding pericardiocentesis, point-of-care ultrasound is everything in the ED.”

• Dr. Tom Heller (Lighthouse Clinic, Malawi/Germany) highlighted the limitations and dangers of misclassification. His experience with HIV/TB co-infected patients emphasized the need for specificity. Subpleural consolidations—while common in TB—are also seen in bacterial pneumonia, lung malignancies, and embolism. He advocated for clearer definitions and more robust combinations of sonographic signs, possibly aided by AI, to build trust among TB officers and health ministries.

“Ultrasound isn’t one test. We need to define which signs matter—and in what combinations.”

5. The Role of AI in Scaling Lung Ultrasound for Tuberculosis

The panelists agreed: Artificial intelligence could help bridge the gap between LUS’s clinical potential and its practical application. A recent AI study from West Africa, shared during the webinar, demonstrated how algorithms trained on image patterns achieved the World Health Organization’s target sensitivity and specificity thresholds for non-sputum TB diagnosis.

However, panelists also expressed caution. AI must be interpretable, transparent, and clinically grounded. As Dr. Heller noted, “AI can’t be a black box—we need to understand what it’s doing and why.”

• “AI may be the bridge that allows minimally trained providers to use ultrasound effectively at scale.”

Still, the consensus was clear: LUS is not a replacement for chest X-ray or microbiological confirmation. It is a contextual, adjunct tool to aid decision-making, particularly where other diagnostics are inaccessible.

Quick Takeaways on Lung Ultrasound for Tuberculosis

• Lung ultrasound shows high sensitivity for TB-related subpleural lesions but lacks specificity
• Right upper lung zones (especially R1A/R1B) are critical scanning areas for PTB.
• AI-enhanced ultrasound could expand diagnostic reach in low-resource settings.
• Clear lesion definitions are essential for programmatic adoption.
• LUS is not a stand-alone test, but a useful adjunct for triage and clinical decision-making.

Conclusion: From Curiosity to Clinical Impact

This global dialogue revealed a shared vision: using point-of-care ultrasound to close diagnostic gaps in TB care. While many unanswered questions remain—particularly around specificity and standardization—the consensus is that lung ultrasound is worth exploring, researching, and integrating contextually.

“Pick up the probe. Start scanning. Learn from your patients. This is how we build better systems of care.”
—Dr. Bruno Vargas

As GUSI continues to convene clinicians and researchers worldwide, the next steps are clear: more research, more rigor, and more collaboration across borders. Lung ultrasound might not be the silver bullet for TB, but it is proving to be a sharp and scalable tool for global health.

Want to learn more about POCUS and tuberculosis?

Visit globalultrasoundinstitute.com to stay updated on upcoming webinars, publications, and training opportunities.

Want to Watch the Webinar Recording?

The full recording of the June 18 webinar, “Clinical Applications for Lung Ultrasound and Tuberculosis: Multi-Regional Perspectives,” is available now on our website.

▶️ Watch the recording here!

FAQs

1. Can lung ultrasound diagnose tuberculosis on its own?
No. Lung ultrasound is best used as an adjunct to clinical evaluation and other diagnostic tools like chest X-rays and sputum testing.

2. What lung zones should be prioritized for scanning in Tuberculosis?
The right upper anterior zones (R1A and R1B) show the highest frequency of abnormalities in confirmed PTB cases.

3. How does AI help with ultrasound in Tuberculosis?
AI can improve image interpretation and help standardize findings, making it easier for minimally trained providers to use Lung ultrasound.

4. Is lung ultrasound better than chest X-ray?
Lung ultrasound may detect peripheral lesions missed by chest X-ray, but it cannot visualize central or cavitary lesions well.

5. What are the biggest limitations of Lung ultrasound in tuberculosis care?
Low specificity, operator dependency, and the lack of standardized definitions for tuberculosis-related findings.

Have feedback or questions?

Tag us on social or email us at support@globalultrasoundinstitute.com. Let’s keep the global conversation going.

References

1. WHO Global TB Report, 2024

2. Fentress M. et al., Systematic Review on lung ultrasound in tuberculosis, 2021

3. Idris N. et al., Malaysian PTB Lung Ultrasound Study, 2025 (presented)

GUSI’s Role in Advancing POCUS Education

The Global Ultrasound Institute (GUSI) offers a range of educational resources tailored to equip healthcare providers with POCUS skills, including:

• FASH Module: Part of the Essentials Course, this module provides in-depth training on the FASH protocol.
• Fellowship Programs: Designed for individuals aiming to become POCUS champions or train others in ultrasound techniques.
• In-Person Courses: Hands-on training sessions for those who prefer experiential learning.

By Marcela Osorio, MS4

This blog post, authored by Marcela Osorio, MS4, delves into the critical role of the Focused Assessment with Sonography for HIV-associated Tuberculosis (FASH) exam in diagnosing extrapulmonary tuberculosis (EPTB) among people living with HIV (PLHIV). Drawing from a qualitative study conducted in collaboration with the Global Ultrasound Institute (GUSI), Marcela shares firsthand accounts from frontline healthcare providers in Lesotho, Zambia, and Malawi. These narratives highlight the challenges and triumphs of implementing the FASH protocol in resource-limited settings, emphasizing its impact on patient care and the ongoing fight against HIV/TB co-infection.

Introduction

In regions burdened by high rates of HIV and tuberculosis (TB), timely and accurate diagnosis of extrapulmonary TB (EPTB) remains a significant challenge. The Focused Assessment with Sonography for HIV-associated Tuberculosis (FASH) protocol emerges as a vital point-of-care ultrasound (POCUS) tool, enabling healthcare providers to detect EPTB manifestations swiftly and affordably. Developed in 2010, FASH is tailored for resource-limited settings, offering a rapid bedside assessment to identify sonographic signs indicative of EPTB in people living with HIV (PLHIV) .ScienceDirect

This article delves into the experiences of frontline providers in Lesotho, Zambia, and Malawi who have integrated FASH into their clinical practice after engaging with the Global Ultrasound Institute’s (GUSI) training modules. Their insights underscore the protocol’s impact on patient care and highlight the ongoing challenges in implementing POCUS in resource-constrained environments.

The Focused Assessment with Sonography for HIV-associated Tuberculosis (FASH) exam is a rapid and affordable point-of-care ultrasound (POCUS) protocol used specifically in patients living with human immunodeficiency virus (PLHIV) to diagnose extrapulmonary tuberculosis (EPTB) — a disease often difficult to diagnose given its non-specific symptoms and paucibacillary nature. In light of the recent uncertainty in global access to tuberculosis (TB) and HIV treatment, along with recent reports noting an increase in EPTB incidence1-4, I partnered with GUSI to conduct a qualitative study exploring how frontline providers who had watched GUSI’s FASH module were using the FASH exam in their fight against HIV/TB. In today’s climate, hearing these perspectives is critical, especially for those of us removed from these clinical realities. Here is what I learned from providers in Lesotho, Zambia, and Malawi.

Setting the Scene

The providers who were interviewed (n=4) largely specialized in Family Medicine and  practiced in semi-rural settings. Three participants had never received FASH training prior to GUSI training; one was already a POCUS expert. All identified HIV/TB co-infection as a major contributor to hospitalization in their communities. In their general care for PLHIV, they described patients’ extreme poverty and community stigma towards HIV as significant barriers to care. Interestingly, one also noted that TB had become stigmatized because of its association with HIV.

“There’s still a lot of stigma around that [tuberculosis] as well. So people get quite scared of ‘if I’m coughing for more than a week or two, oh no, then maybe that’s TB…oh, I need to check for HIV to make sure I’m not infected’, and it becomes a fracas of almost like a circus when they’re trying to get hold to understand that anyone can contract it…”

In caring for patients with HIV/TB co-infection, providers identified limited diagnostic equipment for pulmonary TB and EPTB (e.g. Gene Xpert, Urine LAM, CT Scan, MRI) as another key challenge. Participants noted that sometimes chest X-Ray (CXR) is the only tool available in trying to diagnose disseminated or EPTB, which is not appropriate. Sometimes, the challenges compound, with even the CXR machine becoming unavailable.

FASH Favorites

As they tackle some of these impossible challenges, our participants all believed FASH to be a very valuable tool, both for the diagnosis of EPTB in PLHIV, and as a way to bypass these hurdles to quality care. One provider stated that FASH helped her bypass some of her patients’ financial limitations.

“…some patients do not – well, most patients, not some – do not have the financial capacity to be able to afford CT scans. But one thing that has helped is the POCUS, because we are able to scan…”

Others also noted that the FASH exam not only helped them establish a diagnosis and subsequent treatment in less time, but also built their confidence in their EPTB diagnosis when other tests come back with indeterminate or negative results.

“I think it’s a brilliant tool…it ends up lessening the time to get to correct treatment…if it wasn’t there, I think it would take longer…7 days or 14 days for results and you still have a patient in the ward waiting for the results to get the correct regiment of treatment for them to get better. But with this we are able to, not exactly blindly, but in some way get the correct treatment for them to have.”

“…if I’m dealing with a patient that we think has severe HIV disease, and we highly suspect that maybe they may have disseminated TB, then FASH is one of the things that you do…So, if the rest of the investigations are negative and maybe only FASH was able to pick, for example, pericardial effusion, and you insist the patient to get treated for TB and they improved, then your confidence obviously goes up.”

Overall, our participants all felt that healthcare workers in areas with high prevalence of HIV/TB can greatly benefit from using the FASH protocol to diagnose EPTB, and can even easily teach other colleagues to do the same.

“It’s very, very useful in this setting…it’s a simple protocol and it’s easy to follow and easy to teach, and provides excellent diagnostic information”

Implementing FASH: Opportunities and Obstacles

Although providers were eager to use the FASH protocol, they also identified obstacles to implementing it in their practice.

Overwhelmingly, providers felt that the lack of POCUS equipment and consumables hinder their FASH use. Many stated that there are less than a handful of butterflies, or only one ultrasound machine, for the entire hospital. One shared that sometimes a colleague may take the POCUS bag home by mistake, which means they are unable to access that tool for the entire day. Another shared that sometimes the equipment is there, however there simply is not enough gel to obtain an accurate picture. Interestingly, one provider shared that this lack of equipment not only delays care, but also makes it harder for workers to practice on an individual basis to improve their skill.

”I think we have 3 butterflies for the program. So, we use them when we are during rotation. That’s how it’s a bit limited for me to actually practice on my own…some challenges with FASH is that if you’re not updating yourself or practicing more, getting the correct depth, or gain, or the right picture can be a challenge individually to get to the right diagnosis…”

Another frequently mentioned challenge was the lack of knowledge and confidence in FASH among colleagues. Sometimes, there simply are not enough providers trained in how to conduct the FASH exam for the amount of patients who could benefit. Other times, consultants are mistrusting of the accuracy of a bedside FASH exam, despite it being evidence-based.

“…I think it’s still being slowly accepted into the community of doctors. Some would rather have a radiologist give you the results and the scans than for them to look at a live POCUS scan that you would do…”

Lastly, this lack of knowledge in the FASH exam results in unmet mentorship needs for those on the frontlines eager to improve their FASH skills.

“…whatever I do for a patient today, I should be able to discuss that with someone with more experience or similar experience…maybe they can look at it in a different way, and you know, help each other to learn…if possible, to create a forum where people can share their experiences, like hands-on experiences, patient stories, and what they have done, what they found, what lessons they can get from the technique to finding pathologies and making decisions towards my patient. That will affect my…capabilities or my competence.”

Conclusion

Although our sample was small (n=4), the insights were clear: HIV/TB and HIV/EPTB co-infection remains a critical threat in resource-limited settings, and providers are eager to use tools like FASH. However, they need better access to devices, consumables, training, and longitudinal mentorship.

I would be remiss if I concluded this report without mentioning the recent changes to the United States President’s Emergency Plan for AIDS Relief (PEPFAR). Three providers noted that recent PEPFAR policy shifts have disrupted their patient care. Below are excerpts of their testimonies.

“Like today, we have just received the news that one of the medicines we use in the management of HIV is out of stock. That rings a bell a lot, because it means procurement and everything has been affected. So, as Malawi, we haven’t been spared. We are affected as well.”

“…some of the direct impact that I’ve heard already has been: PEPFAR would be the supplier of the fuel and vehicles to transport people to the referral hospital. Now that the people working for them are no longer, and the program is not going on, that is no longer happening.”

“I had a few colleagues who were under the PEPFAR, not just here in Zambia, but in other countries, where that aid was cut down. As an implementation going forward, they haven’t said anything, they’ve just given people leaves of absence.”

Reflections

As I listened to the stories of providers fighting the non-stop fight against HIV/TB, the word that kept echoing in my mind was “privilege” — the privilege that comes with being a trainee in the United States with great access to HIV and TB treatment. Privilege opens the door of selective amnesia and invites us to walk in. It entices us to forget about the problems that do not apply to us and absolve ourselves of responsibility. As we all grapple with the current unprecedented, violent disengagement in global health and global health research, and as we ask ourselves how we can help in our global health partnership, we must recognize our privilege, and how it beckons our responsibility. HIV, TB, and EPTB, along with the defunding of their care, demand expanded access to diagnostic tools like POCUS and FASH. As POCUS advocates, how can we improve access to POCUS devices and supplies abroad? How can we support sustained mentorship for colleagues on the frontlines?

As a start, I would encourage you to interview your own global health colleagues and ask them what they need from you right now. For those of you committed to tackling the deep inequalities inherent within the field of global health, I would encourage you to read Dr. Madhupar Pai’s recent article, “Shifting power in global health will require leadership by the Global South and allyship by the Global North”, published in The Lancet, where he offers tangible steps, big and small, to do so.

To conclude, I will leave you with the words of one of the providers that impacted me the most as he reflected on the FASH exam:

“I think it’s a beautiful tool. Even as it is, I can’t think of anything I would wish to add, except probably to start thinking of what ways we can make it more available, more accessible for us in a resource-limited environment. I don’t know how that can be. I can’t even hazard a guess. But I know we need it a lot…Think of ways to help us in the resource-limited environments, even if it’s payments, or installments, or things like that, because it’s quite frustrating to get such great training and then you’re so limited in applying what you’ve been trained on because you don’t have access to the equipment…”

Acknowledgements: Special thanks to the providers who gave of their precious time to share their stories and experiences; to my mentor and research advisor Dr. Daria Szkwarko; to the Global Ultrasound Institute team, namely Dr. Kevin Bergman, Dr. Mena Ramos, Jahheart Rabina, and the rest of the GUSI Informatics team; and to Dr. Tom Heller. This research was supported by the National Institutes of Health (NIH): National Institute of Allergy and Infectious Disease (2R25AI140490).

References

1 Rolo M, González-Blanco B, Reyes CA, Rosillo N, López-Roa P. Epidemiology and factors associated with Extra-pulmonary tuberculosis in a Low-prevalence area. J Clin Tuberc Other Mycobact Dis. 2023;32:100377. doi:10.1016/j.jctube.2023.100377

2 Oda G, Lucero-Obusan C, Schirmer P, Chung J, Holodniy M. Risk Factors for Extrapulmonary Tuberculosis Among US Veterans, 1990-2022. Open Forum Infect Dis. 2024;11(12):ofae698. doi:10.1093/ofid/ofae698

3 Brehm TT, Terhalle E. [Extrapulmonary tuberculosis]. Dtsch Med Wochenschr. 2023;148(19):1242-1249. doi:10.1055/a-1937-8186

4 Li T, Yan X, Du X, et al. Extrapulmonary tuberculosis in China: a national survey. Int J Infect Dis. 2023;128:69-77. doi:10.1016/j.ijid.2022.12.005

Quick Takeaways

• The FASH protocol is a valuable POCUS tool for diagnosing EPTB in PLHIV, especially in resource-limited settings.
• Clinicians report improved diagnostic confidence and expedited treatment decisions after implementing FASH.
• Challenges such as equipment shortages and training gaps hinder widespread adoption.
• GUSI provides specialized training modules, fellowships, and in-person courses to support POCUS education.
• Visual aids and structured protocols enhance understanding and application of FASH in clinical practice.

Conclusion

The integration of the FASH protocol into clinical practice has demonstrated significant benefits in diagnosing extrapulmonary tuberculosis among people living with HIV. By enabling rapid, bedside assessments, FASH empowers healthcare providers to make timely and informed treatment decisions, particularly in settings where advanced diagnostic tools are scarce.

However, to maximize the protocol’s impact, it is essential to address the challenges hindering its widespread adoption. Investments in equipment, comprehensive training, and ongoing mentorship are critical components in this endeavor. Organizations like the Global Ultrasound Institute play a pivotal role in advancing POCUS education, offering tailored resources that equip clinicians with the necessary skills to implement FASH effectively.

As we continue to confront the dual epidemics of HIV and tuberculosis, tools like the FASH protocol represent a beacon of hope, bridging diagnostic gaps and enhancing patient care in the most vulnerable communities.

Frequently Asked Questions (FAQs)

Q1: What is the FASH protocol?

A: The Focused Assessment with Sonography for HIV-associated Tuberculosis (FASH) is a point-of-care ultrasound protocol designed to detect sonographic signs of extrapulmonary tuberculosis in people living with HIV.BMJ Open

Q2: How does FASH benefit clinical practice in resource-limited settings?

A: FASH enables rapid, bedside assessments, allowing for timely diagnosis and treatment decisions without reliance on advanced imaging technologies.

Q3: What training resources are available for learning the FASH protocol?

A: The Global Ultrasound Institute offers comprehensive training modules, fellowships, and in-person courses focused on POCUS and the FASH protocol.

Q4: What challenges might clinicians face when implementing FASH?

A: Common challenges include limited access to ultrasound equipment, shortages of consumables like gel, and a lack of trained personnel or mentorship opportunities.

Q5: Can FASH be used in patients without HIV?

A: While FASH is specifically designed for PLHIV, some of its components may be applicable in broader contexts. However, its diagnostic accuracy is most validated in HIV-positive populations.

For more information on the FASH Exam, please visit GUSI’s FASH Module, found under the Essentials Course’s “GUSI Additional Topics” section, along with the protocol published in The Ultrasound Journal.

If you need further assistance or additional edits, feel free to ask!

Join the Conversation

Have you implemented the FASH protocol in your clinical practice? What challenges and successes have you experienced? Share your stories and insights to inspire and inform others in the global health community.

In April 2025, Global Ultrasound Institute (GUSI) hosted a transformative two-day Hands-On POCUS Training for Primary Care training at the Hilton San Francisco Financial District. This immersive course was specifically tailored to the needs of primary care providers, including family physicians, internists, urgent care professionals, and advanced practice clinicians. Participants were eager to integrate ultrasound into their daily practice to improve diagnostics and deliver more patient-centered care through hands-on POCUS training for primary care. Whether they were family physicians, internists, urgent care providers, or advanced practice clinicians, each participant brought a shared goal: to strengthen their diagnostic skills and bring more patient-centered care to the bedside.

Let’s explore the structure of the training, key learning takeaways, and how GUSI is shaping the future of frontline diagnostics. The training was immersive and intentionally practical. Go with us as we  share an inside look of what learners experienced, and how GUSI’s hands-on approach is helping clinicians build confidence with every scan.

“Instructor Bruno Vargas was especially effective in his teaching style and I greatly appreciated his advice, tips and tricks. Everyone really was incredible.”
— George Allen Fritts III, DO, Family Medicine, Texoma Medical Center

Hands-On POCUS Training for Primary Care Course Structure and Learning Objectives

The San Francisco course followed GUSI’s proven two-day format, blending didactic content with live scanning sessions. The curriculum covered high-yield POCUS applications in primary care:

• Cardiac ultrasound for assessing function and volume status
• Lung ultrasound for diagnosing pneumonia, effusion, and pneumothorax
• Abdominal scanning, including FAST, aorta, renal, and bladder
• Gallbladder and biliary evaluation
• Soft tissue and musculoskeletal ultrasound
• Basic obstetric scanning for early pregnancy
• Ultrasound-guided procedures: IV access, joint injections

Each topic was grounded in real-world clinical scenarios, preparing learners to translate theory into practice immediately.

“Great training overall—efficient and informative. My second GUSI course and I plan on more.”
— Soliman Yaqub, MD, Family medicine, Health Point

Emphasis on Hands-On POCUS Training for Primary Care

At GUSI, we believe real learning happens through doing. During this course, participants rotated through hands-on skill stations, working in small groups to scan live models and phantoms. GUSI faculty were present at each station, offering step-by-step guidance and helping learners fine-tune their image acquisition, interpretation, and clinical decision-making.

Personalized Faculty Feedback and Support

The instructors weren’t just experts in ultrasound—they were approachable, invested, and deeply experienced. Their approachable, collaborative teaching style helps learners feel supported while mastering new techniques. Attendees received individualized coaching on probe handling, anatomy recognition, and clinical integration. 

OSCE-Style Assessments: Putting Skills Into Practice

A highlight of the Hands-On POCUS Training for Primary Care course was the OSCE (Objective Structured Clinical Examination)-style session, a hands-on clinical skills assessment simulating real patient encounters. This format allowed learners to demonstrate their new competencies and gain confidence using POCUS in time-sensitive environments. It was challenging in the best way—fun and encouraging.

“Loved the time given for hands-on scanning. The OSCE at the end was super fun!”
— Gayatri Khanna, MD, Geriatric Medicine, Kaiser Permanente 

Why Hands-On POCUS Training for Primary Care Matters

POCUS gives clinicians the ability to act fast and see more—without needing to leave the exam room. Whether it’s confirming a pleural effusion or identifying heart dysfunction, ultrasound at the bedside improves workflow and builds patient trust. With no radiation and immediate results, POCUS aligns with the goals of patient-centered care and evidence-based medicine.

We’ve seen this in action around the world. In Kenya, a large-scale Butterfly Network implementation enabled over 500,000 scans across 224 rural facilities. With average scan times dropping from over two minutes in 2023 to under two minutes in 2024, it’s a clear example of how quickly clinicians can build proficiency—and impact care.

Educational Pathways with GUSI

GUSI offers multiple training tracks beyond in-person courses:

• POCUS Fellowship Program: A longitudinal training pathway for clinicians who want to become ultrasound champions or educators in their health systems.
• Online POCUS Learning: Learn on your own schedule with our flexible, on-demand library.
• In-Person POCUS Courses Across the U.S.: For those who thrive in hands-on settings, we continue to offer regional trainings with our expert faculty.

Key Benefits of Hands-On POCUS Training for Primary Care

• Improved clinical decision-making
• Faster diagnosis and treatment
• Radiation-free imaging at the bedside
• Reduced healthcare costs and delays
• Enhanced patient-provider communication

“We’re not just teaching ultrasound—we’re teaching a way of seeing.”
— GUSI Faculty

Quick Takeaways

• GUSI’s San Francisco hands-on POCUS training for primary care course empowered clinicians through real-time, practical ultrasound education
• The curriculum focused on the most relevant POCUS applications for primary care
• Learners gained confidence through live scanning and personalized POCUS coaching
• The OSCE session tested clinical application in a low-pressure setting
• GUSI offers fellowships, online content, and international in-person courses

Training that Translates to Better Care

More than just a skills workshop, this course was about shifting how clinicians see, think, and care for patients. Through hands-on POCUS training for primary care, expert mentorship, and a supportive community, learners left prepared to integrate POCUS into their daily routines. Whether you’re evaluating heart failure, confirming bladder retention, or guiding a joint injection, the confidence that comes from GUSI training makes a measurable difference.

Thank you to all who joined us in San Francisco! We look forward to supporting your continued POCUS journey.

FAQs

What is the duration of this hands-on POCUS course?
GUSI’s POCUS course spans two full days with hands-on and didactic sessions

Who should attend this training?
Primary care clinicians including MDs, DOs, NPs, and PAs who want to improve bedside diagnostic capabilities.

Do I need prior ultrasound experience?
No. The course is designed for all levels, from beginners to advanced learners

Are there online options available?
Yes. GUSI offers several on-demand POCUS courses through our website

How do I become a POCUS educator?
Apply to GUSI’s Fellowship Program for advanced training and mentorship in POCUS.

Let’s Keep the Conversation Going

Have you taken a POCUS course with GUSI? We’d love to hear your experience. Contact us or share this article with your network.

References

• Butterfly Network, 2024
• GUSI – In-Person Courses
• GUSI – Fellowship Program

Explore future courses and join our POCUS community at:
https://globalultrasoundinstitute.com

POCUS Leads the Way: Safer Care, Less CT Scan Risks

At Global Ultrasound Institute (GUSI), our mission has always been rooted in a simple yet powerful goal: empowering clinicians with the knowledge and hands-on skills they need to provide real-time, POCUS-informed,  patient  care — anytime, anywhere.

Providing patients with safe, reliable diagnostic answers is a universal need in healthcare. That’s why we are so deeply moved when research like the recent studies led by University of California, San Francisco (UCSF) invite the medical community to pause, reflect, and rethink how advanced imaging is used, particularly in the final chapter of life.

When Scans Don’t Help: The Case for Reassessing Imaging in End-of-Life Care

In San Francisco Chronicle’s recent coverage of a UCSF-led study, researchers highlight the growing concern over the overuse of CT scans in patients with advanced cancer. While CT is undeniably a powerful tool in modern medicine, the study underscores that in many late-stage cases, scans may offer little to no clinical benefit — and could even cause harm.

As Dr. Anand Narayan, senior author and UCSF radiologist, explains:

“There are patients who are experiencing symptoms like pain or shortness of breath, and imaging can help identify the cause. But for some patients, the scans don’t change management, and the results may lead to further invasive tests or false hope.”

This insight calls for a more thoughtful, patient-centered approach to imaging decisions, especially in end-of-life care, where comfort and dignity often take precedence over diagnosis.

The Hidden Cost of Radiation: Long-Term Risks of CT Imaging

In parallel, a groundbreaking study published in JAMA Internal Medicine estimates that 103,000 radiation-induced cancers could result from CT scans performed in 2023 alone — a figure that could represent 5% of all future cancer diagnoses in the U.S. The study places CT’s contribution to cancer risk on par with known hazards like alcohol consumption and excess body weight.

While the benefits of CT scans in trauma, cancer staging, and acute diagnostics are indisputable, these findings are a reminder: with great diagnostic power comes a responsibility to use it wisely. The cumulative effect of repeated scans — especially in patients with chronic illnesses or during prolonged hospitalizations — can pose lasting health consequences.

The Role of POCUS: A Patient-Centered, Radiation-Free Alternative

Both studies reflect an urgent need to rethink how and when we image. At GUSI, we believe point-of-care ultrasound (POCUS) can help bridge this gap. POCUS offers real-time, bedside, radiation-free insights — enabling clinicians to answer focused clinical questions quickly and safely.

It’s important to note: POCUS is not a replacement for CT scans. Rather, it’s a powerful adjunct, particularly suited for scenarios where minimizing risk, improving patient comfort, and expediting care are top priorities. For example, POCUS is ideal for evaluating fluid status, guiding procedures, and rapidly assessing heart or lung function — all without exposing patients to ionizing radiation.

As emphasized in the Chronicle article:

“These findings underscore the need for clinical decision-making to prioritize patient-centered goals of care and reduce the use of imaging that is unlikely to influence management.”

Teaching a New Way of Seeing

Through our globally recognized, POCUS training programs, GUSI works to ensure that clinicians can see more, know more, and act sooner. By integrating POCUS into routine practice, healthcare providers can reduce unnecessary testing, enhance diagnostic confidence, and maintain a sharp focus on what matters most — the health and humanity of every patient.

Whether at a hospital bedside, a rural clinic, or a community health center, POCUS empowers healthcare workers to make imaging decisions that reflect both clinical necessity and deep compassion.

We’re grateful to the researchers and journalists who continue to spotlight these vital issues, and we remain committed to this shared mission: to build a future of healthcare where every test, every scan, and every decision is made not just with precision, but with purpose.

Because when we teach ultrasound, we’re not just teaching a technique. We’re teaching a way of seeing.

Sources:

• JAMA Internal Medicine: Projected Lifetime Cancer Risks From CT Imaging
• San Francisco Chronicle: CT Scans May Be More Harmful Than Previously Thought

POCUS training in Kenya is gaining momentum through GUSI’s partnership with AMPATH, delivering hands-on ultrasound education to frontline providers. This initiative aligns with our mission to enhance global healthcare access by equipping medical professionals with essential ultrasound skills that improve patient outcomes.

Scaling POCUS Access Through Strategic Partnerships

This training is part of a larger four-year initiative of POCUS training in Kenya led by AMPATH and Moi University, funded through Panorama Global with support from Novartis, Eli Lilly and Company, and MSD for Mothers with device support from Butterfly Network and GE Healthcare. The program aims to enhance patient-centered primary care by integrating POCUS technology into healthcare systems across six counties in western Kenya. Over the course of the project, 4,000 healthcare workers will be trained, and 190 ultrasound probes will be distributed to rural facilities, significantly expanding diagnostic imaging accessibility.

POCUS Training in Kenya: Expanding the Frontline

Following the success of the first cohort, this marks the second cohort of training under the AMPATH-led project in Western Kenya. Over the course of two weeks, we are training 95 mid-level healthcare providers, including medical officers, clinicians, and nurses. These professionals serve in Level 2, 3, and 4 healthcare facilities, ensuring that critical ultrasound skills reach the frontline of patient care.

Currently, the training is in its second week, focusing on healthcare providers from Webuye West and Webuye East subcounties. Our expert instructors are guiding participants through comprehensive modules on Breast Ultrasound, Obstetric Ultrasound, and Cardiopulmonary POCUS applications. By providing hands-on training and real-world applications, we aim to empower these providers with diagnostic tools that can significantly enhance maternal, cardiac, and pulmonary healthcare in their communities.

Why POCUS Is Essential in Resource-Limited Settings

POCUS training in Kenya has proven to be a game-changer in resource-limited settings, where access to advanced imaging is scarce. By enabling healthcare workers to visualize and diagnose conditions such as heart failure, breast cancer, and obstetrical complications earlier, we are improving treatment outcomes and saving lives. With POCUS, clinicians can make informed decisions faster, reducing the need for patients to travel long distances to hospitals and ensuring timely interventions.

At GUSI, we believe that ultrasound technology should be accessible to all who need it, regardless of location or resource availability. By working with partners like AMPATH, we continue to bridge the gap in ultrasound education and expand the reach of POCUS across healthcare systems worldwide.

Stay tuned for more updates as we advance this mission and support healthcare professionals in delivering life-saving care through ultrasound. Join our mission and learn POCUS techniques to support your medical practice and improve your standard of care today.

For more information, visit: AMPATH News.

These dedicated midwives gained essential skills in obstetric ultrasound, enabling them to identify high-risk conditions such as low-lying placenta, twin pregnancies, abnormal fetal heart rates, and more. As they return to health facilities in the Western and Sahara regions—many without existing ultrasound access—their new expertise will help safeguard the lives of countless mothers and babies.

Our guest blog contributor this month, Dr. Adjoa Boatemaa Bonsu, shares her inspiring journey from trainee to trainer and the transformative impact of this workshop. For more inspiring voices, see participant Modesta speak about working as a midwife in rural Ghana, and her excitement about scanning.

Earlier in my journey, an elated first-time pregnant woman walked into the clinic for an ultrasound scan. She radiated joy, eager to see the first glimpses of life growing inside her. But the doctor’s worried expression did not match her excitement. Instead of a baby, he had found a molar pregnancy.

The news was devastating, but through it all, I remember his steady reassurance: “Thankfully, we are seeing it early.”

In Ghana, where many conditions are diagnosed too late, early detection is a rare but invaluable gift. This doctor—a dedicated family physician—was the first to bring and operate an ultrasound machine in my small town. As a high school student shadowing him, I witnessed firsthand how technology could alter the course of a patient’s story. That was my first encounter with ultrasound–it was more than just an observation; it was a revelation. It was the moment I fell in love with diagnostic imaging, all because of a pregnant woman’s story.

Years later, I find myself standing on the other side of the journey. Now a radiology resident, I never imagined that my first experience teaching POCUS would be to midwives—women who dedicate their lives to ensuring safe pregnancies and deliveries. They stand as the first line of defense, the trusted hands guiding mothers through the uncertainties of childbirth. With ultrasound at their disposal, these midwives could detect complications at the point of care, preventing tragedies before they unfold. It was a profound full-circle moment, bridging my earliest inspiration with my current calling.

I was honored to be part of GUSI’s OB POCUS Fellowship, in partnership with the Society of Family Physicians of Ghana (SOFPOG). The program was designed to build POCUS teaching capacity, followed by a week of hands-on training for midwives and ongoing mentorship. The opportunity was thrilling, but as the training approached, so did the doubts.

A week before the program began, I was consumed by imposter syndrome.

“How can we expect to equip ‘ultrasound-naïve’ midwives with these skills in just four days?”

“What if I fail as a trainer?”

“What if the training isn’t effective?”

The fears were relentless, gnawing at my confidence. But what I didn’t realize was that I was about to witness something extraordinary.

With eager and passionate learners, GUSI’s structured curriculum, and a clear set of scanning protocols, the impossible became possible. By the end of the very first day, my anxieties melted away like morning mist under the sun. The midwives absorbed the knowledge with remarkable speed, their hands growing steadier with each scan, their confidence blooming with each success. The progress was nothing short of phenomenal.

At the conclusion of the program, the midwives left not just with new skills, but with the power to change lives. They would return to their communities, armed with the ability to detect complications and safeguard the health of countless mothers and babies. But what I gained was equally invaluable. I left with an overflowing heart, a sense of fulfillment so deep that it silenced every doubt I had before. I realized, in that moment, that being a trainer was not just something I was capable of—it was something I was meant to do.

Ultrasound skills are too crucial to be reserved for only a select few. The ripple effect of training spreads far beyond the classroom, reaching mothers, families, and entire communities. And as these newly trained midwives go on to teach others, a new generation of trainers will rise. The impact will be limitless, a cycle of knowledge and empowerment that will continue long after we have moved on.

And that, I believe, is the true power of teaching.

Adjoa Boatemaa Bonsu, MD
Vice President of Ghana Association of Doctors in Residency
Radiology Resident Korle-Bu Teaching Hospital, Ghana

At the forefront of modern medical advancements, Point-of-Care Ultrasound (POCUS) is rapidly transforming patient care. In a strong commitment to both educational excellence and technological innovation, the University of Alabama at Birmingham (UAB) Heersink School of Medicine’s Department of Medical Education has teamed up with the Global Ultrasound Institute (GUSI) to provide state-of-the-art POCUS training for faculty, residents, and students.

The Power of POCUS in Clinical Practice

POCUS represents a significant leap forward in diagnostic technology, allowing clinicians to make rapid, accurate diagnoses at the bedside. Through hands-on sessions led by GUSI’s expert team—including Mena Ramos, M.D., Co-Founder and Co-CEO of GUSI, along with instructors Ian Thomas, Angelina Voronina, Tim Kinney, Kinner Patel, Ben Beduhn, Will Dixon, Fatema Hassam, Eva Tovar Hirashima, Tom Heller, Sebastian Schoneich, Nea Salas, Sally Graglia, Jason Chen, Keasha Guerrier, and Kimberly Okoyeze—participants  gain firsthand experience in leveraging POCUS to enhance clinical assessments.

Comprehensive Training with Real-World Impact

GUSI’s training model is built around interactive, practical exercises, which cover a wide range of imaging techniques in cardiac, pulmonary, abdominal, vascular, and musculoskeletal imaging. With a focus on simplicity and ease of use, POCUS enables healthcare providers to perform on-the-spot diagnostics that would otherwise require costly and time-consuming formal imaging procedures. This is particularly beneficial in emergency or resource-limited environments where timely decision-making is essential.

Faculty participants have had the unique opportunity to operate POCUS devices on standardized patients, with guidance from GUSI staff, to understand the profound impact this technology has on patient examination. UAB’s continued focus on faculty training further solidifies its commitment to staying at the cutting edge of medical education and innovation.

A Valuable Opportunity for Students

Not only have faculty and residents benefited from these training sessions, but UAB has also actively encouraged its students to participate, recognizing the valuable learning experience GUSI provides. Students have had the chance to engage both as trainees alongside faculty and as standardized patients during ultrasound demonstrations, gaining hands-on experience that will serve them throughout their careers.

“I want to learn everything! I don’t think I would’ve learned this much in a single day if it weren’t for this course. It’s been exciting, and I’m learning so much.” – Jinali Shah, Narendra Modi Medical College, India

“This training gives us a way to actively contribute in clinical settings rather than just observing. Learning ultrasound allows us to play a more hands-on role in patient care, making us more effective as future doctors.”    – Yalnaz Mohasin, Royal College of Surgeons in Ireland – Bahrain

“It was intensive, packed with high-quality training, and even better than I expected! We covered all systems, and I never thought I could acquire these skills so easily. Now, I don’t just see the holistic picture—I see it through the lens of ultrasound. It’s a game-changer in clinical decision-making.” – Chakib Khouri, University of Balamand in Lebanon

A Lasting Impact on Medical Practice

The feedback from participants speaks to the effectiveness of the training. Michael Oler, Associate Professor at UAB’s Selma Family Medicine Residency, shared his enthusiasm after attending the workshops: “This is the best course I’ve had in 45 years of continuing medical education. It’s changed the way I practice more than any other course and it comes at the end of my career. I very much appreciate it.”

Expanding the Future of Medical Education

The coordinated effort between UAB and GUSI marks a major milestone in the integration of POCUS technology into medical education. By expanding access to this training, the partnership is paving the way for future advancements in bedside diagnostics, with the potential to transform healthcare delivery worldwide.

As UAB continues to strengthen its leadership in medical education, GUSI remains proud to be a part of this transformative journey—empowering clinicians with the tools and skills needed to make life-saving decisions at the point of care.

Advancements in medical technology continue to transform patient care, and SAGE AI, powered by the Global Ultrasound Institute, is at the forefront of this evolution. Designed to serve healthcare professionals at every level—from beginners to seasoned experts—SAGE AI provides instant, evidence-based answers to ultrasound-related medical inquiries. 

By leveraging cutting-edge artificial intelligence, this innovative tool empowers providers to make informed decisions, improve patient outcomes, and stay ahead in an ever-evolving healthcare landscape. Accessible anytime, anywhere, SAGE AI is revolutionizing ultrasound education and practice, ensuring that medical professionals have the support they need—when they need it most.

This month’s newsletter focuses on Sage AI as a solution to enhance POCUS learning and clinical application through AI-driven, real-time educational support, with Dr. Scott Grogan, DO, MBA, RMSK, FAAFP, a board-certified Family Medicine physician with specialized training in ultrasound and medical education. 

“Training, or lack of training, is often cited as the major barrier to the implementation of point-of-care ultrasound (POCUS) in clinical practice. Both users and leaders often overlook the need for in-the-moment supervision and guidance. Practitioners who wish to use the technology are not only limited by access to readily available equipment but also by the uncertainty of how to perform, optimize, and interpret POCUS examinations. Immediately available supervision from trained POCUS clinicians is often not available to guide those seeking to perform such exams. Clinical references are available but require time and effort to navigate in the hopes of finding answers to the questions that one has prior to, during, and after a POCUS exam. Sage AI, Global Ultrasound Institute’s (GUSI) POCUS educational tool, is now available to help provide rapid access to guidance and images to learners and clinical sonographers.

Sage AI is built on the foundation of GUSI’s educational library and offers quick and efficient answers to general and specific questions without having to navigate a book or resource library. As an example, when I asked Sage AI to “Help me image the biceps tendon” the ”What is the best way to view the subscapularis tendon?” Sage AI quickly delivers a concise, how-to instruction specific to the patient positioning, maneuvers, and tricks to optimize the view. It also offers links to the GUSI source content, instructional videos, images, and related journal articles. Similarly, Sage AI can help learners correct mistakes. When asked how to correct an off axis four chamber cardiac view, Sage AI reveals compact troubleshooting tips to optimize an apical window. 

Regardless of the area of the body, Sage AI opens new opportunities for a modern style of remote mentorship. It can provide confidence to new learners intimidated by unfamiliar POCUS exams or findings. There is comfort in a mentor by your side to reduce the time and cognitive burden of learning and mastering a new skill. Sage AI is yet another mentorship tool in the GUSI educational support armamentarium reducing barriers to meaningful POCUS use and improved patient outcomes.

As technology continues to evolve, so too does its potential to enhance the clinical learning experience. Sage AI holds great promise in providing on-demand, real-time support for healthcare providers. While the tool is still being refined, particularly in terms of user accessibility and functionality, its future is highly promising. I am excited about the upcoming integration of Sage AI into mobile applications. Once fully implemented, it will undoubtedly become an indispensable resource for developing clinicians, fundamentally transforming ultrasound education and enhancing clinical decision-making at the point of care.” 

Scott Grogan, DO, MBA, RMSK, FAAFP
Ohio University Heritage College of Osteopathic Medicine
Family Medicine Residency graduate from Madigan Army Medical Center, Tacoma, WA