Improving Global Care
Three radiology residents were recipients of the Goldberg-Reeder Travel Grant in 2016. They traveled to three continents — South America, Africa, and Asia.
Lauren J. Saling, MD, a fellow in abdominal imaging at UCLA, used her grant in May 2016 to travel to Guatemala City, Guatemala, to the Instituto de Cancerologia (INCAN), a cancer referral hospital that provides screening and treatment for all kinds of cancer.
Her project focused on establishing a PACS at INCAN.
What was the goal of your project?
Prior to our project, the radiologists at INCAN reviewed most of their images on film and had no way to compare cancer imaging to prior studies, so evaluating a patient's response to therapy was nearly impossible. Through the nonprofit RAD-AID, we worked to implement a cloud-based PACS, which obviates the need for onsite servers, a setup that is not really feasible in that hospital.
What were the radiology limitations that you saw?
There were many limitations both in radiology and in access to health care for patients there in general. Many of the issues we saw had to do with aging or broken equipment. The long repair delay meant patients might not have access to important imaging modalities such as CT for months at a time, while others may not have access to MRI at all. There is no PET/CT in Guatemala. Our PACS project helped improve the way physicians use their current technology, but to increase access for patients, continued improvements in equipment is vital.
Was there a language barrier? How did you overcome it?
The hospital conducts most of its business in Spanish, although a good number of their patients speak Mayan dialects. I speak some Spanish so I was able to navigate most problems, and I translated a bit for our technologists/informatics expert who we recruited through RAD-AID. It was challenging at times to work exclusively in Spanish, especially using some medical and technical terms that I hadn't experience with before.
Camilo Jaimes, MD, a neuroradiology fellow at Massachusetts General Hospital, used his grant in February 2016 to join a team of medical staff and technologists traveling to Black Lion Hospital at Addis Ababa University in Ethiopia. Their goal was to help educate the radiologists in how to read MRI scans, expand awareness around emerging applications of MRI, and optimization of MRI sequences to produce better scans for children.
What was the most memorable part of the experience?
I was part of a large team carefully chosen by my mentor. Kassa Darge, MD, PhD, the radiologist-in-chief at Children's Hospital of Philadelphia. The daily exchange of ideas with radiologists from the United States, UK, South Africa, and Ethiopia led to productive discussions. I was also able to attend a historic event — the graduation ceremony of the first two pediatric radiologists in Ethiopia, who completed their training through a multi-institutional program based at Black Lion Hospital and the Children's Hospital of Philadelphia. The legacy is that these two new graduates will continue to train future pediatric radiologists in their country.
What lessons did you learn?
Clinical practice and needs in other countries vary greatly from those in the United States. They have different problems, and while they possess many of the same tools, those tools may be used differently. In Ethiopia, ultrasound is the main modality used for the initial detection of abnormalities, diagnosis, and follow-up. Physicians there are extremely creative and skilled at using many tools that we often underutilize in the United States. There has been an accelerated adoption of MRI and other technologies that has outpaced the ability to train physicians. This unmet need poses a real role for global health outreach to bridge this gap.
Do you have any new goals for your life based on your experience there?
I am originally from Colombia and this trip inspired me to think about participating in similar initiatives to help advance pediatric radiology in Colombia and the rest of Latin America. For example, I would like to collaborate with existing societies, including the Society of Latin American Pediatric Radiology.
Sonya Y. Khan, MD, a fourth-year radiology resident at the University of Maryland Medical Center in Baltimore, used her grant in 2017 to travel to Aga Khan University Hospital in Karachi, Pakistan, to assess the university's radiological needs and create diagnostic imaging educational tools to better serve the community.
How did you choose your location?
Pakistan is a country where not only disparate economic conditions but also cultural mores can create misconceptions and barriers to women's health. During my research, I came across studies documenting the broader need for further subspecialty education among providers, not only in mammography and women's imaging, but also in other radiology subspecialties. Lack of subspecialty expertise is a significant barrier to diagnostic imaging services in developing countries, including Pakistan.
What was your project about and how did your background help?
I surveyed the ways in which we can modify and implement teaching tools for the specific use and needs within developing countries where access to subspecialty fellowship-trained faculty is limited. I focused on women's health providers in Pakistan, and began with Aga Khan University Hospital in Karachi because it has the only fellowship in breast imaging in the country. Working with radiologists in Pakistan, we developed and implemented trial versions of educational tools and received real-time feedback. My knowledge of the language and some familiarity with the culture made Pakistan an ideal setting for me to get detailed and nuanced feedback from radiologists, technologists, and referring physicians regarding their educational and equipment needs.
How will your experience impact your professional practice in the future?
To help educate medical staff on the differences between normal and abnormal images, future outreach will include sharing U.S. institutions' screening breast images. I am also developing an educational case series and remote lectures to address gaps in the training of radiology residents there. Long term, I hope to enlist U.S. colleagues in projects addressing specific educational needs in Pakistan, which will be designed for adaptation for use in other similar developing countries.
By Audrey Caldwell, freelance writer, ACR Press