Stories from the Road: Ultrasonography Course with the African Head and Neck Society

Maxwell Kligerman, MD, MPH, and Merry E. Sebelik, MD, on behalf of the Humanitarian Efforts Committee

The African Head and Neck Society (AfHNS) was established in 2016 with the aim of fostering collaboration, education, and clinical excellence among head and neck surgeons in Africa. One common barrier to patient care in resource-constrained settings is access to affordable and timely imaging studies. Point-of-care ultrasonography (POCUS) has been shown to increase access to diagnostic imaging, reduce delays in care, and improve health outcomes. 

In December 2024, the AfHNS organized one of its first in-person symposiums since the COVID-19 global pandemic. We were absolutely delighted when the AfHNS and symposium organizers at the University of Cape Town (UCT) reached out to extend an invitation for our team from Emory University in Atlanta, Georgia, to help organize a dedicated head and neck POCUS course as part of this larger symposium.

Location and Need

Specialty-specific POCUS training has been difficult to access in Sub-Saharan Africa. To combat this challenge, the AfHNS organized its first POCUS training course in May 2018 in Accra, Ghana. This was followed by an American College of Surgeons exported course in December 2018 at UCT, and a subsequent course at the annual AfHNS meeting in Harare, Zimbabwe, in 2019. The initial training courses were a huge success; however, owing to the COVID-19 pandemic, subsequent POCUS training with the AfHNS was put on hold.

Our task was to design a one-day course that could provide practical experience and insight into advanced ultrasound techniques, empowering attendees to make more precise diagnoses and optimize patient care in resource-limited settings.  We quickly got to work helping to design an appropriate curriculum, recruiting vendors, publicizing the event, and designing an IRB-approved survey assessing access to ultrasound and potential utilization amongst AfHNS members.     

A Head and Neck POCUS Course

Author Maxwell Kligerman, MD, MPH, proctoring ultrasound-guided skills practice.After months of preparation, the course took place on December 9, 2024, at the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. Attendance was free. There were over 25 in-person attendees who had traveled from six different countries to attend, including Kenya, Madagascar, Ghana, Uganda, Ethiopia, and South Africa. Attendees were a mix of attending surgeons and resident trainees and came from both otolaryngology and general surgery training backgrounds. The course featured several hours of lecture and live POCUS demonstration followed by hands-on procedural practice using ultrasound phantoms. Machines to support the course were generously provided by MindRay, Philips, and SonoScape.

We also broke into small groups to evaluate patient volunteers with various head and neck pathologies, such as thyroid nodules, parathyroid adenomas, and salivary gland tumors. Several returning course attendees had completed prior POCUS courses. The repeat attendees, along with some excellent local radiologists, volunteered to help proctor some of the small group sessions, in turn helping promote POCUS training skills.

Overall, helping to organize the third annual AfHNS Head and Neck POCUS Course was a huge honor and a wonderful experience. In the future, we hope to focus effort more on “train-the-trainer” concepts so that the ultrasound champions among AfHNS members can independently administer the ultrasound course and promote even more sustainable learning. 

Personal Reflections

Author Merry E. Sebelik, MD, discussing ultrasound basics at the POTUS training course.“The POCUS course emerged as a highlight of the meeting, providing benefit to delegates from Africa who frequently encounter substantial resource limitations that hinder access to essential radiological investigations in the management of head and neck patients. We hope this course will become a permanent fixture on the AfHNS calendar, promoting ongoing collaboration between the AfHNS, the University of Cape Town, and Emory University,” said Matthew White, MBChB, faculty surgeon and symposium co-organizer at the University of Cape Town.

“The course was the first ultrasound skills training I’ve ever had, so for me it was a great and memorable experience. Ultrasound and FNA were demystified, and I even got to find a thyroid nodule incidentally during the practice session. Everything about the course was helpful…I now feel like I have a bit of an insider view on neck ultrasounds and can appreciate the images and not have to fully rely on the radiologist report,” said Kofi Agyeman, MD, otolaryngology resident at Korle-Bu Teaching Hospital in Accra, Ghana. 

A closeup of attendees practicing ultrasound-guided needle placement. Machines to support the course were generously provided by MindRay, Philips, and SonoScape.“I thoroughly enjoyed the ultrasound course. The skills I gained will impact my practice when I return home to Madagascar. With these new techniques, I hope to be able to diagnose and assess patient conditions more accurately during consultations, enabling immediate decision-making at no additional cost to patients, a critical factor in our setting…Fortunately, we have access to an ultrasound machine at our clinic, which will allow me to apply these skills directly,” said Angelo Valisoa, MD, head and neck surgeon at the University of Cape Town.