NYAGI Project - Executive Summary

Every 2 minutes, a “NYAGI” dies from complications of pregnancy.

VISION: Every mother has access to prenatal ultrasound.

MISSION: To save mothers’ lives with portable ultrasound screenings.

NYAGI (Now You Are the Group’s Interest) is the pseudonym for that mother living in a rural village, where life-saving medical care is not guaranteed. NYAGI also stands for that moment when all attention focuses on a pregnant mother in need.

The NYAGI team works to ensure that every expectant mother has access to timely, affordable, and effective prenatal ultrasound scanning to identify life-threatening conditions of pregnancy: pre- and post-delivery. 

Triage OUT™ (Obstetric Ultrasound Training) is a scalable train-the-trainer model that teaches master trainers, regional trainers, and local rural healthcare providers to develop high-quality prenatal ultrasound scanning skills using hand-held, portable ultrasound equipment.

The program harnesses (both online and offline) technologies to deliver multimedia learning resources: an online learning management system, remote and in-person live instruction, mobile apps for continuous learning and self-assessment, group image review sessions, and cloud-based resources to strengthen group and individual skills and to improve training consistency. NYAGI also uses mobile data collection tools to track learning progress and verify competence.

NYAGI is focused on rapidly teaching basic perinatal ultrasound skills to in-country healthcare providers to improve confidence, support earlier detection of prenatal concerns, and help expectant mothers receive appropriate, timely, and cost-efficient care, especially those living in rural areas.

Program Overview

NYAGI’s Triage OUT™ program is an innovative, effective, and efficient learning platform that delivers focused prenatal ultrasound training to healthcare providers working in low-resource areas. Using a scalable Train-the-Trainers model, master in-country trainers teach qualified, supported regional trainers, who in turn educate local rural healthcare providers.

The NYAGI approach is a comprehensive hybrid education system.

Multimodal Education Tools:

Online Resources:

  • Website on-demand training videos

  • Cloud-based image repository for feedback

  • Cloud-based reference library of additional educational resources

  • Learning progress dashboard with datametrics

Offline mobile:

  • Proprietary Mobile Phone app: X-NAV with NYAGI-specific modules

  • Phone app question bank for self-assessment

  • Customized iPad education apps: OB-NAV

  • Embedded iPad education library

  • Phone-based data collection tool

  • Self-confidence skills reporting phone app

  • Comprehensive knowledge tests 

In-person and Remote Live:

  • Skills verification tests 

    • Live Zoom interactive webinars

    • Objective Structured Clinical Exam (OSCE)

    • Live Zoom interactive skills assessment

NYAGI Triage OUT™ Objectives:

Integrate the NYAGI Triage OUT™ ultrasound screening system into existing healthcare systems.

  • Ensure all pregnant women, especially in rural areas, have access to a high-quality portable ultrasound to identify potential prenatal risks. 

  • Identify and triage pregnant women who require high-risk obstetric/neonatal care

 

Develop a sustainable, high-quality NYAGI Triage OUT™ ultrasound education program

  • Maintain quality assurance of ultrasound skills training

  • Reduce maternal and neonatal mortality and morbidity 

  • Future educational modules for emergency and pediatric triage ultrasound.

Train-the-Trainer Model: 

Qualified obstetric and neonatal providers work with NYAGI experts to learn the Triage OUT™ model. After completing full training, the Master Trainers teach portable ultrasound skills to regional and rural providers. The in-country Master Trainers are responsible for organizing and certifying these trainees. As needed, competent regional trainees may be advanced to train additional cohorts.

Program Leader:

A critical component of program success is appointing an in-country Triage OUT™ leader to serve as the primary liaison between NYAGI, government entities, and trainees. This individual should commit to at least 2 years to oversee and facilitate the program and, ideally, be compensated by the Ministry of Health or the implementing facility. 

Master Trainers 

Master Trainers are the core instructors responsible for training others within country. They are trained by NYAGI Expert Trainers and are typically medical leaders in obstetrics and neonatology. Ideal candidates are physicians or advanced midwives with strong English proficiency and the ability to effectively translate and teach course content to regional trainees.

Regional/Rural Trainees

Regional/Rural Trainees are primary obstetric and neonatal care providers, typically midwives or skilled birth attendants, trained by Master Trainers to perform basic triage scanning. 


Entity

NYAGI is a 501(c)(3) nonprofit public charity organization

Vision

A world where every pregnant mother, anywhere in the world, has access to medical providers skilled in basic prenatal ultrasound to help triage life-threatening conditions for appropriate care.

Mission

To save lives with ultrasound use in low-resource areas of the world.

Overview

Ultrasound is a powerful medical imaging tool - a visual stethoscope that is portable, immediate, and safe - but hard to learn. NYAGI Project helps to establish scalable and sustainable ultrasound education in underserved populations around the world to improve local healthcare. NYAGI experts train trainers who then teach other medical providers how to use ultrasound to identify health conditions that may need to be triaged for appropriate care.

We use an accelerated 3-step Train-The-Trainer program:

  1. Remote ultrasound skills training via Zoom taught by ultrasound experts is flexible to the unique needs of medical providers selected by our partner organizations.

  2. Supplement education with 7D Imaging, Inc. NAV™ software, online videos, and webinars. Modules include obstetrics, emergency medicine, orthopedic trauma, lung (COVID), cardiac and breast ultrasound. Mobile phones and/or portable tablet computers combined with the NAV™ software, serve as ‘teachers in a box’ for continued provider and patient education.

  3. Follow-up skills assessments via image quality reviews and proficiency examinations. NYAGI trains participant trainers who, in a similar process, train others, thereby ‘passing the knowledge forward’ and empowering their region to help triage patients for higher-level care as needed.

Partnerships

To achieve enduring, meaningful impact, NYAGI partners with in-country local NGOs, foundations, and government agencies with proven track records to support, educate and empower maternal-fetal healthcare workers. NYAGI assists in-country partners to “champion” projects and to acquire funding for scaling ultrasound as a triage tool regionally and nationally.

Projects

  • (2016 and 2017) Nepal: NYAGI partnered with One Heart World-Wide (OHW), to teach prenatal ultrasound skills to 60 physicians and skilled birth attendant nurses working in 28 rural/remote birth centers.

  • (2019 and 2020) Haiti: NYAGI partnered with Caris Foundation and Project Santé to teach prenatal and point-of-care ultrasound skills to 40 physicians, midwives, and nurses working in rural community health centers.

  • (2021-2022) Nicaragua: NYAGI partnered with Rotary Club for a project to teach trainers at a nursing college in Jalapa. NYAGI also added baby resuscitation training to the curriculum.

  • (2021-2022) Tanzania project focused on all-remote training for doctors and midwives to learn prenatal and emergency ultrasound and baby resuscitation skills.

  • (2024) NYAGI members visited Edna Adan Hospital in the capital of Somaliland, Hargeisa and partnered with a team of midwives who joined our Triage OUT program, equipping them to identify the pregnancies which could be at risk and advise mothers about receiving follow-up care.

Results

OHW data in Nepal show that each month 10-20 mothers in rural villages are referred to regional health centers for higher-level care based on ultrasound findings. Assuming these lives would otherwise have been lost, we consider those at least 10 mothers and their babies saved. In Haiti, we trained over 40 medical providers in-person and additional providers remotely during the Covid pandemic. Covid forced us to pivot to use and master remote, live, 2-way video training, which allows us to teach anywhere in the world without travel risks to our NYAGI team.

Financial Overview

NYAGI is a small and nimble organization. Our work is funded through donations, partner grants, and pro bono contributions from medical and organizational experts. Relationships with larger organizations with a shared purpose can provide resources to leverage results at scale.

Goals

NYAGI has shown it can save lives with ultrasound, especially in rural, low-resource areas of the world. Our goals are to develop partnerships with mission-aligned organizations to enhance portable ultrasound capacity. We strive to expand our reach to underserved populations around the world, where medical care is never guaranteed, to improve access to life-saving ultrasound.