Notes From the Road

This year's Goldberg-Reeder Fellows go the extra mile in underserved communities abroad.

Bocha forwebBochnakova spent her fellowship at the Georgetown Public Hospital Corporation in Guyana and hopes to return as an attending physician to support a future radiology residency program.

When you think of cutting-edge radiology, you probably don't image Guyana, Malawi, Nepal, or Peru. The Goldberg-Reeder Fellowship is designed to share knowledge of and assist radiology facilities in the developing world.

The latest group of Goldberg-Reeder Fellows brought their skills, expertise, and energy to these countries, who in turn provided important health care lessons to the Fellows. Fresh from their travels, the 2016 fellows are sharing their insights and experiences with the ACR Bulletin.

Growing Radiology Education in Guyana

"I was most surprised by the willingness and enthusiasm of physicians, residents, and technologists to learn more about radiology and improve their system," says Teodora N. Bochnakova, MD, who spent the month of November 2015 at Georgetown Public Hospital Corporation (GPHC), the only tertiary referral medical center in Guyana. To help retain medical professionals, RAD-AID (a nonprofit focused on improving radiology services in underserved countries) and institutions in the U.S. are developing the first-ever radiology residency program in Guyana, she adds.

Bochnakova taught medical students and residents in other specialties about radiology. She also worked with RAD-AID to assess the radiology resources at GPHC to help determine what equipment is needed to establish a radiology residency program there.

The radiology department at GPHC primary provides radiography and ultrasound services with limited resources; CT and MRI were available only in private hospitals at a high price.

Under challenging conditions, Bochnakova found ways to add value to patient care. "I learned to be adaptable in an unfamiliar setting and make use of the available resources," she says. "I would like to return to Guyana as an attending and contribute to the radiology residency program. Going forward, I hope to mentor U.S. residents interested in medical outreach."

Bochnakova is a PGY4 radiology resident at University Hospitals at Case Western University.

Finding Motivation in Malawi

Judy W. Gichoya spent the month of June 2016 at Kamuzu Hospital in Lilongewe, Malawi. As one of the world's least developed countries, Malawi struggles with high rates of infectious diseases and low access to health care.

While Kamuzu Hospital did have a 64-slice scanner, the facility lacked a PACS, any form of a scheduling system, and dictation software. Ultrasound was performed by both technologists and radiologists, but no images were saved and the final report was handwritten in the patient's passport.

Gichoya assisted the radiologist in interpreting MRI and CT scans and in performing ultrasounds and echocardiograms. "It's a referral hospital, so I also provided a consultant service for the referring physicians to guide them on appropriate study selection and discussing imaging results," he notes.

Gichoya also taught medical officers and forged personal and professional relationships.

"I networked with wonderful people from Malawi," she says. "I have been working on an open-source radiology information system for developing countries, and I am looking for supporters to bring this project to reality."

Gichoya is a PGY4 radiology resident at Indiana University in Indianapolis.

Not Giving Up on Nepal

Kapal FORWEBKapalczynski’s time hiking to remote Himalayan hospitals inspired him to create Porting for Patients, a program through which visitors to Nepal can allot unused luggage space to bring needed medical supplies to the area.Wojciech J. Kapalczynski, MD, traveled to Nepal in March and April of 2016 and worked at the National Academy of Medical Sciences/Bir Hospital in Kathmandu.

The radiology department did offer a full range of imaging modalities including film radiography, CR radiography, fluoroscopy, CT, MR, ultrasound and nuclear medicine.

One of Kapalczynski's goals at Bir Hospital was to help install a PACS. There was no full time IT support on site, so when an error came up with the PACS, often no one would attempt to troubleshoot. "I learned a tremendous amount about PACS and will be able to use this knowledge to optimize the PACS workflow," he recalls.

While in Nepal, Kapalczynski trekked through the Himalayas to visit several isolated hospitals. During his travels, he brainstormed ideas for bringing needed medical supplies to these remote areas. The result was Porting for Patients, which allows visitors to Nepal to donated some of their luggage space to bring medical supplies to the country. 

Kapalczynski is a PGY5 diagnostic radiology resident at the University of Texas Health Science Center at San Antonio. He blogged about his experiences in Nepal for the ACR Bulletin.

Practical Problem Solving in Peru

PerezForWebMany patients at the Cervicusco Clinic in Peru walked 8 to 12 hours to be seen by a physician, says Perez. The clinic’s outreach program also travels to rural areas,some of which have no electricity.Frances Perez, MD, spent May of 2016 working at the Cervicusco Clinic in Cusco, Peru. "The facility was fairly modern," says Perez. "However, the only modality for imaging was ultrasound. The ultrasound machines were donated and outdated, which meant that I had to train my eyes to interpreting images that were not the same quality I'm used to."

Cervicusco Clinic sends personnel to perform Pap smears in rural areas. During Perez's visit, they also provided ultrasound imaging. "The lack of electricity was something that I never thought of before going to a small town with nowhere to plug in an ultrasound machine," says Perez. "They actually ran wires from a neighboring town to generate electricity."

As a Spanish-speaking physician, Perez didn't expect a language barrier in Peru. However, many people in the rural areas spoke their native language of Quechua, and communicating was a challenge when no interpreter was available.

"I gained confidence in my ability to scan with an ultrasound machine, a skill I rarely use," says Perez. "I also hope to continue participating in global health imaging once I graduate from residency."

Perez is a PGY5 radiology resident at the Medical College of Georgia at Augusta University. Read more Bulletin content about her experiences in Peru.


By Heidi Splete, freelance writer for the ACR Bulletin

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