By Mary Hearty

With the disruption of essential health services in many healthcare facilities due to Covid-19, pregnant women living in Embakasi area in Nairobi Metropolitan, are lucky to access mobile ultrasound services in the comfort of their homes and in local clinics.

Jionee Ultrasound Mobile Service (JUMS), a healthcare facility located in Embakasi area, has been fulfilling the needs of pregnant women residing in the area. This is by performing ultrasound scans at home and in local health facilities which lack access to the scan equipment.

The mobile ultrasound service initiative enables mothers to get access to ultrasound scans at the comfort of their houses and in local health facilities during the COVID-19 pandemic. This allows them to have a fulfilling prenatal care experience amidst the pandemic.

Further, the mobile healthcare service shields the pregnant women from getting exposed to the deadly coronavirus by reducing their visit to hospitals that are known to be Covid-19 hotspots.

Consequently, the home services have helped in reducing perinatal and neonatal mortality since pregnancies with complications that require full bed rest can be managed from home.

Although the JUMS centre has been supporting pregnant women and other patients before COVID-19 pandemic began, their demand for antenatal care have tremendously increased amid this crisis.

Joaquin Choge, Lead Sonographer and Co-founder of Jionee Ultrasound Mobile Services, says that before COVID-19 pandemic, they did about 10 ultrasound scans on a monthly basis for home services. However, when the pandemic crisis was at its peak, the number jump to about 200 patients monthly.

Joaquin Choge, lead sonographer and co-founder JUMS

“We are able to go to the patients, and this has helped enhance accessibility of the services for the patients who live far from our facility. Again, the mothers will not spend a lot in terms of travelling expense, and it will help save their time. And this is what we need for our Kenyan women.,” he clarified.

In Nairobi, almost every woman attends at least one antenatal visit. However, only a few have access to ultrasound scans due to poverty and lack of these equipment in some healthcare facilities. It is for this reason that the mobile ultrasound service providers introduced “pay less for more” initiative, to ensure that every pregnant woman during their gestation period can receive at least one ultrasound scan thus contributing to quality healthcare.

“This is by ensuring that every public holiday we provide these services at a relatively affordable price as low as Shs. 700. Consequently, it allows pregnant women who cannot afford the cost of our service on normal days, which ranges between Shs. 10-16, to also have the opportunity to access the scans, especially during this pandemic. The normal rates for an ultrasound scan service in Nairobi is about Shs. 2000. However, we have ensured that this is not limiting our patients through this initiative,” Choge noted.

Just like traditional ultrasounds, the portable ultrasound machines have helped pregnant women to observe the progress of their foetus, and know complicating obstetric conditions like placental breech at the comfort of their houses, and in local health facilities that they now consider safer.

“Those patients with issues like cervical incompetence or issues with the placenta, we are able to deliver the services to them from home. As a result, it helps the mothers alleviate the risk of losing the pregnancy. We have begun the journey of conception with some mothers throughout their pregnancy, they have gone through the first 10 weeks, then 20 weeks, up to 36 weeks and 40 weeks of gestation period,” Joaquin affirmed.

Mercy Mwende, mother to a seven-month-old-boy, and a resident of Embakasi is among the pregnant women who have benefited from the mobile ultrasounds offered by JUMS.

“Over the past years, I have experienced two still births, one miscarriage, but now I am happy and grateful that God has blessed me with a baby boy, despite the challenges brought by COVID-19 pandemic,” Mwende said.

Mercy Mwende with her seven month old baby

“When I got pregnant, I started going for antenatal care visits at the second month. And on my first visit, the doctor did some urinal tests and found traces of blood. Besides, I had an issue of abdominal pains so the doctor advised me to go for an ultrasound scan in order to identify the cause of the pain. Afterward, the results showed that there was a problem with my placenta. Therefore, I needed regular scans to give the doctor an easy time monitoring the progress of the foetus, and a lot of bed rest especially during the first trimester,” she explained.

With the doctor’s instruction to take more rest, reduce her movements, and do regular scans, Mwende was in a dilemma considering the long distance to the hospital, which again put her unborn baby at risks.

“This time round, I really wanted to have a smooth pregnancy experience and a successful delivery. Unfortunately, the pandemic also presented new challenges in terms of finance, fear of contacting the disease in the hospital or on the way to the hospital in public vehicles,” she said.

According to Mwende, the surging reported cases of healthcare workers contracting the coronavirus in their line of duty created fear and anxiety of going to the hospital. “The hospitals became unsafe, and even the health workers were afraid of attending to us, everyone was afraid of one another.”

Mwende’s household was also affected financially yet she needed medical attention to save the life of her unborn baby.

“Our financial situation was a challenge at the same time my baby’s life was also at stake, unless I followed the doctor’s instruction to have frequent ultrasound scans to observe its progress. I needed Shs 1000 for the scan, Shs 500 for bus fare and at least Shs 200 for lunch each time I visited an hospital,” she said.

With these many challenges plus her condition, Mwende shared her predicament with a chemist attendant, who later referred her to Jionee Ultrasound Mobile Services.

“Their cost and the quality of services was promising. Moreover, I would get my scans done at the comfort of my house. So, I booked an appointment with them and payed only Shs 1200,” Mwende noted.

She said: “I did four ultrasound scans with Jionee until I successfully delivered my baby boy and I feel grateful. It was relatively affordable and it saved the time I would have spent going to the hospital and waiting on a long queue. In addition, I felt safe because it helped reduce my chances of contacting the disease either in public transport vehicles or at the hospital, as well, I was able to have more time for bed rest considering my condition.”

The World Health Organization guidelines on managing pregnancy and childbirth indicate that around 15 percent of all pregnant women will develop a potentially life-threatening complication that calls for skilled care, and some require a major intervention to survive.

Therefore doctors, midwives and other healthcare providers in general are encouraged by the WHO to support interventions that strive for efficiency and reliability of antenatal care.

Purity Kemunto, mother to one girl, is also full of praise for JUMS: “Sometimes you can go to the clinic for the scan alone and find a long queue of pregnant women waiting for the same service. Whereas, the mobile ultrasound service, I only book for an ultrasound scan appointment, and I get the same service done within a shorter time at the comfort of my house.”

Personally, I have benefited from this mobile ultrasound. According to my experience, I loved that the modernity of the mobile ultrasound enabled me to clearly see the gender of my unborn baby, its face and her movements, and the gestational age of my pregnancy. It was the most phenomenal moment of my life as a young mum to be.

According to Choge, an ultrasound scan is one of the major contributors to the good management of the patient. This is because they enable the doctor to advice on the mode of the delivery, the care that the baby will require before and after delivery, and it will help the mother in planning. Again, it enhances the social aspect of the mother and the baby. Their bond becomes stronger once they see their baby on the screen, he says.

Although, local health facilities without these ultrasound machines have partnered with Jionee Ultrasound Mobile Services and subsidized their costs. This has enabled pregnant women who are still not aware of the house services offered to get access to them in their facilities.

Douglas Wahinya, a reproductive health specialist and Director of Waikiki Hospital in Tassia in Embakasi said: “An ultrasound scan done in our facility costs about Shs 1500, whereas, the one done at home costs between Shs 1000 to 1500 depending on the type of the ultrasound image. We realized that not all women can afford to do a scan at home, so we negotiated the cost to favor other pregnant women too.”

Douglas Wahinya in his office

According to Wahinya, the mobile ultrasound service has enabled them to get access to professional ultrasound service for antenatal care, because the service providers have ensured all their health personnel are qualified and registered.

Community-oriented Services International (COSI) hospital, a communal healthcare clinic in Embakasi in Nairobi, has also been benefiting from the mobile ultrasound services for antenatal care for its clientele. Because of the mobile ultrasound service, patients are able to access quality services from professional sonographers in our facility.

Sebastian Mmbwavi, a Clinical Medic at COSI said: “The mobile ultrasound service is easily accessible so we do not have to refer patients in need of ultrasound scans to higher facilities.

Additionally, it allows us to detect complications in pregnant mothers like Placenta Previa at an early stage so that we can refer them for appropriate management during their pregnancy and delivery.

Also, it has helped reduce congestion in referral hospitals, especially during the COVID-19 pandemic since the patients can now have their ultrasound scans done at the primary level.

Another benefit is that it has aided in saving time for pregnant mothers to acquire medical services.
For instance, when a pregnant woman visits our facility with severe bleeding. As we stabilize the patient, we can as well perform necessary scans, thanks to the mobile ultrasound service.

The clinician stated that ultrasound scans do not have any effects to the unborn baby because the machine uses sound waves unlike x-rays.

Furthermore, he said that COSI hospital has been receiving at least five pregnant women in need of ultrasound scans in weekly, and about three women come for antenatal care visits in a day.

Sebastian Mmbwavi, a clinician at COSI hospital

These portable ultrasound scans perform the same function as the traditional scans such as detecting pregnancy complications without symptoms, identifying the number of foetuses, gestational age, gender of the foetus, and position of the placenta, among others. In turn, life threatening obstetric conditions such as ectopic pregnancy are prevented from developing at an early stage.

Nevertheless, unlike traditional scans, their modernity enables pregnant women to clearly see how their unborn baby’s face looks like, its facial expressions, posture, and gender while in the womb, through a three- and four-dimensional image, also known as 3D and 4D respectively.

Joaquin said that although all these ultrasounds use sound waves to create a picture, the common traditional ultrasound scan creates image of a developing foetus only in two dimensions (2D). It gives an outline and a flat looking image, but can be used to see the internal organs of the baby.

“On the other hand, 3D images are used to show external images, and this helps us to diagnose issues like cleft lip whereas the 4D ultrasound image enables us to monitor the foetus’s movements in the womb.”

Additionally, the sonographer said that with the modern mobile ultrasound scans, they are able to do the Doppler, echoes, 3D and 4D imaging, as well they require less skills to operate.

He further explained: “In terms of portability, we are able to serve patients who cannot move like those with physical disabilities. We are also not limited to any conventional space, we can reach patients at home, in village chemists, clinic. In the first point of healthcare, we are with you. And this is the main advantage of these mobile ultrasound scans over the conventional ones,”

Since we have no donors, we bought the machines ourselves from one of the largest manufacturers in China, who agreed to work with us. The cost of each portable ultrasound machine ranged between USD 15,000 and USD 20,000 (1.5 to 2 million shilling). Whereas the conventional ones cost at least USD 20,000.

Besides, both the traditional and the modern ultrasound use medical ultrasound gel during the scanning process. “Reason being, to reduce the air between the patient’s skin and the transducer in order to produce a clear image. The ultrasound gel is thick and sticky, and this allows it to spread over the skin without running off like water,” the sonographer said.

According to Oxford dictionary, a transducer is an electronic device used to convert energy into another. “For instance, during ultrasound scans in pregnant women, the microphone-like device coverts energy into sound then the sound is converted again into an electrical signal which produces an image,” Choge explained.

The sonographer stated that unlike traditional ultrasound machines, the portable ones favour patients who need full bedrest like those with cervical issues during their pregnancy. He added that since the portable ultrasounds use battery unlike the traditional ones, pregnant women living in marginalized areas where there is no electricity can still access them.

“These portable ultrasound machines do not need electricity, they use batteries. And their batteries can serve up to 10 patients before going off. So, mobile ultrasound scans are among the technologies that could help strengthen our country’s healthcare system and solve issues of majority of the population that cannot access such services,” Choge acknowledged.

Despite the positive impacts of this mobile ultrasound service offered by Jionee to pregnant women, I felt concerned that neither Linda Mama nor National Health Insurance Fund (NHIF) – government health insurance is yet to cover the cost of ultrasound scans for pregnant women in need.

“At the moment, health insurance has not been able to cover our services because we are mobile. Insurance companies in Kenya have not really recognized the aspect of mobile ultrasound services. But we still strive to see whether it will be considered in future. We also hope that the cost of the insurances will be subsidized to allow everyone to be able to pay an insurance scheme,” the Co-founder of Jionee Ultrasound Mobile Services revealed.

Such life-saving equipment should be available in all counties in Kenya, and should be accessible to all expecting mothers free of charge.