Dr. Abdirahman Madar employs the same portable ultrasound device both in Minneapolis while treating patients and in his educational endeavors at Hargeisa Group Hospital in Somaliland.
In Minneapolis, this device serves as one of several diagnostic imaging options, offering a more cost-effective and efficient alternative to the more expensive alternatives at Hennepin County Medical Center.
In Somaliland, the device acts as the hospital’s sole diagnostic imaging tool, complementing a single CT scanner. For the most economically disadvantaged individuals, it can be a life-saving tool with no other affordable option to accurately detect conditions such as blood clots, cancer progression, and newly onset heart or liver failure.
Collaboration with Western doctors and medical organizations is crucial in delivering essential healthcare to the poorest populations in developing countries. In Somalia, Minnesota doctors establish this connection. The handheld ultrasound devices at Hargeisa Group Hospital are made possible through the fundraising and educational efforts of Drs. Madar and Max Fraden, who have coordinated funding and training for pilot projects at public hospitals, introducing ultrasound devices and establishing a non-communicable disease clinic that has already served approximately 1,100 patients. The doctors hope that the semi-autonomous Somaliland region’s government will eventually replicate these models in other public hospitals.
In Somaliland, the quality of healthcare is directly tied to one’s ability to pay, with private hospitals operating on an out-of-pocket system. Public hospitals, serving the roughly one-third of the population that cannot afford to pay, face significant underfunding. In contrast, Hennepin County hospitals have a substantial number of MRI machines, while Somaliland has only a few, all located in private facilities. Madar’s awareness of the healthcare resource disparities in his homeland began in high school when his father suffered a stroke, a condition stemming from hypertension that was left untreated. This experience motivated him to pursue a medical career with the goal of improving healthcare. After working as a surgeon in Somaliland, he moved to the United States to learn from Western medicine, but he remained dedicated to enhancing healthcare in his home country. While in Minnesota, he began sharing best practices with his former colleagues overseas. During the COVID-19 pandemic, he founded the Somalilander American Health Association, a charitable organization aimed at providing supplies and COVID-19 education in Somaliland.
Fraden, also a hospitalist at Hennepin Healthcare, had experience training medical professionals in Rwanda on portable ultrasound devices and non-communicable disease clinics, with promising results. Portable ultrasound imaging significantly improved care and outcomes in low- and middle-income countries, as shown in a 2023 study published in Nature. Once the primary threat of COVID-19 had passed, Madar and Fraden traveled to Somaliland together, where their projects received enthusiastic support from Madar’s former colleagues. They raised approximately $100,000, including equipment and funding donations from the Global Ultrasound Institute, the Butterfly Network, the government of Taiwan, the Amoud Foundation, and private donors in the Minnesota Somali community. In April 2022, they delivered the first eight ultrasound devices and opened the non-communicable disease clinic in November. They currently fund their own trips but are seeking larger grants for future projects.
Madar and Fraden provided a four-week basic training on the use of ultrasound devices to 20 general practitioners at Hargeisa Group Hospital, a 250-bed facility serving a city of 1.2 million. The training focuses on fundamental diagnostic skills, such as identifying lung fluid or kidney dilation. The ultrasound devices offer a more precise and efficient alternative to traditional diagnostic methods.
One significant case involved a pregnant diabetic woman who complained of sudden shortness of breath, chest pain, rapid heart rate, and a swollen right leg. Using the handheld ultrasound device, the doctors confirmed deep vein thrombosis with a pulmonary embolism, a potentially life-threatening condition. Without the new devices, the woman would have been referred to a private clinic, and if she couldn’t afford the $30 ultrasound, the condition might have been missed.
While Madar and Fraden are back in Minnesota, they continue to support their colleagues in Somaliland by reviewing images and diagnoses via WhatsApp through software connected to the ultrasound devices. The ongoing costs of using these devices are minimal, which they hope will facilitate government efforts to scale up the project.
The success of their projects is evident in the outgrowth of the clinic’s physical space, highlighting the need for expansion. Additionally, the doctors plan to initiate a new project focused on addressing Hepatitis C, which affects about 5 percent of the population in Somalia but lacks accessible treatment options. If they raise sufficient funds, Fraden intends to return to Somaliland in November to initiate this endeavor.
4 Comments