A Global Health Mission Extending More Than a Decade

Dr. Patricia Henwood is on the coronavirus front lines at Jefferson. Her experience training clinicians in Rwanda, Uganda, and other countries to use point-of-care ultrasounds to answer questions about TB, Ebola has prepared her more than most on how to handle a crisis.

At a young age, Jefferson physician innovator and not-for-profit founder Dr. Patricia C. Henwood saw her home as a gateway to the world. Both her parents worked internationally, and guests from dozens of countries visited her home regularly. “It gave me the perception that the world was a smaller place,” she says.

Now, the global health director in Emergency Medicine and academic partner in the Office of Global Affairs trains healthcare clinicians across the globe how to use ultrasound at the point-of-care. The collaborative and the technology are changing outcomes in TB, Ebola, trauma and non-communicable diseases. She’s also working with students and faculty at Jefferson to facilitate global health programmatic and research projects.

It is not hard to understand why Dr. Henwood has devoted much of her professional life to global health. In 2011 she co-founded a not-for-profit organization dedicated to providing Point-of-care Ultrasound in Resource-limited Environments (PURE) and has been a humanitarian on the front lines in Liberia for Ebola. Dr. Henwood’s career commitment to global health has seen her work on programs in Rwanda, Zanzibar, Colombia and more.

A global calling

From an early time in her medical career, Dr. Henwood felt compelled to support care delivery both in the U.S. and globally. It’s why she pursued the opportunity to assist with clinical efforts in Honduras, El Salvador and Ethiopia after her emergency medical technician (EMT) training. “I wanted to broaden my exposure and I saw such a significant need for improved access to care globally,” says Dr. Henwood, who is a board-certified emergency medicine physician who earned her medical degree from Sidney Kimmel Medical College at Thomas Jefferson University.

Fulfilling that global need soon became a passion. While training in Boston she worked with her colleagues from the Harvard Humanitarian Initiative who built and ran a field hospital during the post-earthquake humanitarian response in Haiti in 2010. This is where Dr. Henwood first realized the power of point-of-care ultrasound in such settings. This disruptive technology could impact patient care where more expensive and less portable imaging technology is not feasible. That’s when she launched PURE to support global ultrasound training and research programs in resource-limited settings. To date a majority of PURE’s work has been focused in sub-Saharan Africa, e.g. Rwanda, Uganda, Zanzibar and Liberia.

In Uganda and Rwanda, emergency medicine as a specialty didn’t exist when Dr. Henwood first started working there. Now it does, but there is still limited radiology training, and CT scanners are only available at a few hospitals, but usually only in major cities.

Ultrasound’s portability and versatility make it ideal in these settings where advanced imaging is hard to find or non-existent. The ultrasound devices can fit in the palm of a caregiver’s hand, easily connect to Wi-Fi, and can even use gel that can be made from dry food goods. “Ultrasound can help provide cardiac, pulmonary and abdominal assessments, obstetric scans and many additional studies,” Dr. Henwood says. “Having it readily available at the bedside gives caregivers the ability to answer lots of clinical questions rapidly and inexpensively.”

In Liberia, point-of-care ultrasound made a huge impact as the health system struggled during and after the overwhelming Ebola Virus Disease (EVD) epidemic, as there was most often no functional CT scanner in the country. At the time of Dr. Henwood’s work in Liberian Ebola treatment units, EVD had a near 50% mortality rate. Point-of-care ultrasound helped her and her medical team provide more accurate EVD assessments and gather data that ultimately led to the prescribing of broad-spectrum IV antibiotics as treatment for patients with severe EVD. Her ultrasound work in Liberia has been published in the New England Journal of Medicine, in addition to her research on Ebola and pregnancy.

Using ultrasound to identify TB

Currently, Dr. Henwood’s research is taking her to South Africa, where tuberculosis (TB) is a major health concern. According to the World Health Organization, South Africa is one of six nations that account for 66% of the world’s TB cases. In 2018 alone, more than 227,000 total TB cases were diagnosed in South Africa, and 59% were diagnosed in patients who were HIV-positive.

“We’re doing a pilot to see if point-of-care ultrasound has the potential to improve screening and diagnosis of pulmonary TB in adults,” says Dr. Henwood. She’s one of two ultrasound experts working as co-investigators on the study, which is funded by a grant from the Bill & Melinda Gates Foundation and is being performed in conjunction with the Africa Health Research Institute, Jefferson, and the London School of Hygiene and Tropical Medicine.

In early November, Dr. Henwood traveled to South Africa, where she rounded with local pulmonologists and radiologists to provide pulmonary ultrasound training and to share the specifics of the study protocol. The pilot seeks to enroll 200 participants over the next six months in a province where TB rates rank among the highest in the world. As part of the study, Dr. Henwood is helping to provide tele-ultrasound review, connecting providers in South Africa with her to review imaging studies — no matter where she is in the world.

“Tele-ultrasound also allows us to ensure high-quality assessments and continue to train providers in point-of-care ultrasound virtually, even though I’m 8,000 miles away in Philadelphia,” Dr. Henwood says.

A born educator

Dr. Henwood’s work has brought her plenty of acclaim, including news reports on her travels and a visit to the White House for an Ebola responder event.  But at her heart, she sees herself as a teacher.

“We’ve done several train-the-trainer programs in point-of-care ultrasound, and the first time I stood in the back of the room while one of my trainees trained a new group of medical students the tears definitely welled up,” she recalls. “Teaching has the power to take your impact to a whole new level.”

At Jefferson, Dr. Henwood will have the opportunity to expand her teaching role. She has already arranged for a Jefferson emergency medicine resident to help coordinate a tele-ultrasound training program in Rwanda and Uganda, building on Jefferson’s telehealth strength and our commitment to the global exchange of clinical and research insights. She envisions several future opportunities for Jefferson students to engage in global activities, both from Philadelphia and internationally.

Dr. Henwood also plans to create additional opportunities for Jefferson students to gain exposure internationally, and for international students to do the same here. She also sees local applications for Jefferson’s international health engagement. “A global-local approach is relevant since Jefferson supports many clinics in Philadelphia that aid underserved and migrant populations with similar barriers to care and burden of disease,” she says. “In an increasingly interconnected world, diseases do not recognize borders.” Dr. Henwood is applying lessons learned from the Ebola response to support Jefferson’s coronavirus/COVID-19 preparedness efforts.

In the same way her parents taught her that the world is small, Dr. Henwood will open up a world of education and global information exchanges to her students. “Jefferson’s commitment to bilateral sustainable global partnerships is what brought me back here as a clinician, educator and researcher,” she says. “It’s like coming home at the end of the day.”

UPDATE: As Jefferson has seen a rise in COVID-19 cases, Dr. Resa Lewiss, Director of Point-of-Care Ultrasound at Thomas Jefferson University Hospital, recently shared with Fast Company how the emergency department is using ultrasound in innovate ways to diagnose coronavirus more quickly than other techniques. She explains “Ultrasound has been a key tool for emergency medicine doctors for decades and is becoming indispensable during this pandemic in ways that will impact patient care for decades to come.”

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