Boulder doctor's nonprofit leading mission to Haiti to promote health through ultrasound
Dr. Cliff Gronseth's NYAGI group needs more iPads to advance its work
By Charlie Brennan
POSTED: 01/20/2019 11:00:00 AM MST
Dr. Cliff Gronseth performs ultrasound testing on Pam Chandler on Thursday. Gronseth is founder of NYAGI a Boulder-based nonprofit that brings ultrasound technology to impoverished communities around the world. (Cliff Grassmick / Staff Photographer)
How you can help
Those who want to contribute to the Boulder-based nonprofit NYAGI for its project in Haiti — for which members depart Jan. 26 — by donating used iPads can email firstname.lastname@example.org, or go to its website at nyagi.org.
A large team of Boulder-area physicians, health care professionals and other volunteers is headed to Haiti at the end of this month in a pioneering effort deploying sonography to save the lives of pregnant women, their unborn children and also mitigate a wider range of pressing medical needs.
The one-week mission seeks to match and build on the success that NYAGI — a Boulder-based nonprofit that brings ultrasound technology to impoverished communities around the world to empower health care workers to proactively identify life-threatening conditions — achieved in trips to Nepal in 2016 and 2017.
NYAGI stands for Now You Are the Group's Interest.
The organization's core goals were conceived by Boulder resident Dr. Cliff Gronseth, a physiatrist who is founder and managing director of Spine West, as well as the founder and chairman of the board of NYAGI.
Its aim is to combine ultrasound equipment, on-site training and a tablet-based expert that enables continuous learning in communities that might otherwise be hard-pressed to provide the kind of preventive and diagnostic care that has already proved life-saving.
"This is very much a local Boulder-initiated project," Gronseth said.
"We've got students from CU, local high schools, community professionals that have gotten behind this thing and our mission is 'saving lives...together.' Anybody can participate, and that's what's beautiful about it. It's not exclusive. It has a global reach, but the core of it has been Boulder-centered and initiated."
Stumbling into a solution
Gronseth said the origins of the project sprung from an accident he had several years ago while running, stumbling and suffering a sprained ankle after his dog Maia — it means "mother" in ancient Greek — suddenly stopped to smell something.
After hobbling to his office, he started scanning his ankle with ultrasound, and found, "I wasn't quite sure what I was looking at."
This 19-year-old new mother had given birth at home three days ago and had been bleeding since. Getting to the Melamchi Health Clinic included community members carrying her out of her village on a stretcher for half a day, then several hours on rough dirt roads (and she doesn't live nearly as remote as much of rural Nepal). The clinic was able to diagnose through ultrasound that she retained the placenta and arrange an ambulance to take her the remaining three-to-four hours to a hospital in Kathmandu for treatment. (Jason Houston / NYAGI / Courtesy photo)
"I thought, there must be a better way to learn this. Why don't we put all the information into an iPad that is relevant to what you are looking at, for immediate access, much like a GPS on your dashboard that gives you instant information relevant to what you are looking at?"
Gronseth soon developed a software program that merged anatomy and ultrasound, focused on his speciality, orthopedics. The result was 7D Imaging, of which Gronseth is founder and CEO. He noted that it has "become very well received by people in ultrasound and orthopedics," utilized now at institutions ranging from Johns Hopkins University to the University of Colorado Denver. Its software is donated to the NYAGI mission
Loaded into an iPad and paired with a cell-phone-sized ultrasound probe, Gronseth and partners have taken the technology to Nepal twice, once in October 2016 and again in June 2017. There, they trained local skilled birth attendants serving remote parts of the country in the use of ultrasound in tandem with the iPads, to combat preventable health crises for people who might be one forbidding mountain pass and several dicey bridges away from the nearest hospital or medical facility.
" An ultrasound is the perfect tool for diagnosing problems ahead of time," Gronseth said. "Ultrasound is amazing technology. It's like a flashlight into the body that is immediate and safe — and now it's portable.
"It acts like a crystal ball and you can see impending problems," he added. "A mother that has a placenta that is too low, that is asymptomatic; but when she goes into labor and starts to deliver, she just bleeds out. If they're in a remote village, there's nothing they can do and the mother and baby die. This is preventable."
One of Gronseth's major boosters is Boulder County resident Richard Green, who is on the board of directors for Liberty Global and is formerly president and CEO of CableLabs.
Green is excited about the technology supporting NYAGI's work, but also is impressed by Gronseth's enthusiasm, which, he said, breeds enthusiasm in others.
And speaking to the group's core mission, Green said, "It will have a huge benefit, where you have so many women dying simply because it was impossible to tell they were in trouble before the delivery, and you can't get them to the hospital. It's a way of screening people and getting a very important result. And you save two people."
'A life-changing experience'
In the 2016 trip to Dhulikhel, Nepal, working in partnership with the San-Francisco-based One Heart World-Wide, Gronseth's team distributed about 30 donated iPads with accompanying ultrasound probes.
"Combined with the iPads, it's a complete ultrasound system that can be thrown into a backpack, and you can hike up the to the remote villages and scan with it," Gronseth said. "We got photos from one of our SBAs (skilled birth attendants), where she went to one of the highest occupied villages in the world, in Nepal, and she sent pictures of her scanning the pregnant mothers in the village up there."
After that initial mission, Gronseth was told that about 10 mothers a month were being referred out of the mountains to regional health care facilities based on ultrasound findings.
"To me, that's about 100 mothers a year we're saving, just with ultrasound," said Gronseth, who was recently given the 2018 Humanitarian Service Award by the International Federation for Sonography Education and Research.
In June 2017, he said, "We went back (to Taplejung, Nepal) with a bigger team, again with expert sonographers who were volunteers and donating their time — but this time we also brought high school and college students, and they taught the tech side of it, local CU and high school kids from Boulder," which he said proved to be a life-changing experience, for some. Another 30 iPads with the accompanying software were distributed on that trip.
Angela Stevens, a co-founder, the clinic director and a midwife at the Birth Center of Boulder — Gronseth's software was beta-tested at her facility and she was pivotal in teaming Gronseth with One Heart World-Wide — was part of both the Nepal missions.
"I think for remote, global low-resource settings in obstetrical maternity, it's essential," she said. "Really, it's for identification emergencies that, if identified, can save a woman or a baby's life.
"I think it's great, what he's doing."
One of the high school students on the second Nepal trip was then-Fairview High senior Emma Houston, now a freshman at Union College in Schenectady, N.Y. She was accompanying her father, photographer Jason Houston. Her primary role, she said, was to provide tech support — making sure the iPads were charged, and troubleshooting any issues relating to their performance.
"I think what's really unique about this program, what I really appreciated is, we weren't just going in and throwing aid in, and not doing anything about it," she said.
"We were really teaching and we were helping build a foundation that could be used, and be more sustainable, rather than a short-term thing of, you go in and do your thing and leave, which is how I think of a lot of these programs."
Identifying 'normal from abnormal'
For the upcoming trip to Haiti, Gronseth and NYAGI will be working in collaboration with Caris Foundation, a Texas-based nonprofit which in December entered in into a cooperative agreement with the U.S. Agency for International Development to bolster health care there through a $98.5 million investment over four years.
About 25 people depart about midnight Jan. 26, with a tall task ahead of them, Monday through Friday of the following week, working with about 50 local physicians.
"We're going to give them a hands-on ultrasound education with live patients, and we're going to teach them OB-GYN emergency medicine, pediatric, cardiac and musculoskeletal ultrasound in a week," said Gronseth, explaining that his software offers individual modules focused on a variety of health issues, even cardiac problems.
"We're looking to teach life-threatening conditions that they can identify with ultrasound," he said. "They won't be expert sonographers, but they should at least be able to identify normal from abnormal; they can take a picture and send it to somebody who can help them identify what's going on."
In the days leading up to the group's departure, it is soliciting donations of used iPads which can be scrubbed clean, reset to factory settings and reloaded with the 7D Imaging software, to be used and distributed in Haiti. The iPads serve as monitors for the ultrasound images, as well as software manuals that health workers can go back to later, for step-by-step instructions.
"We're looking for pre-owned iPads, iPads discarded or sitting in a drawer somewhere, that we can use," Gronseth said.
"The iPads can save lives, because they can help educate. ...The iPads that are discarded technology in this country, they act like threads of connection from the high-income countries to the low-income countries, so we can kind of connect the world that way. It's very powerful."
In addition to used iPads, the Haiti-bound group also is welcoming financial contributions. Those looking to help out can contact NYAGI through its website, nyagi.org, or by email at email@example.com.
Willem Van Vliet, a retired professor of urban planning at CU, with 30 years of experience in international development at the United Nations, supports NYAGI as an informal advisor.
"The dedication and commitment of the NYAGI team is inspiring and a wonderful example of the good things Boulder can offer the world," he said.
It has certainly been an inspiration to the young people participating in its work.
"Right after the trip it sparked an interest in the medical field," said Houston, who is particularly interested in psychology.
"Now that I have had some space, I know that it made me realize I really want to do something that has meaning and allows me to have these direct experiences. It gave me a different perspective that will help my decisions later."
Dr. Cliff Gronseth of NYAGI reviews the 7D Imaging OB-GYN educational software ob-NAV, with a group of Nepalese Skilled Birth Attendants (SBAs) at an ultrasound workshop at the Dhulikhel Hospital. Dhulikhel, Nepal (Jason Houston / NYAGI / Courtesy photo)