Going the Distance

ACR's commitment to the Haitian radiology community continues with innovative education programs.going the distance

By now, you're probably familiar with the ACR's efforts to help rebuild radiology services in Haiti after a devastating earthquake occurred in January 2010.

Maybe you donated to the Haiti Radiology Relief Fund, for which members have raised more than $18,000. Or perhaps you watched video footage of destroyed hospitals in the country's capital, Port-au-Prince, highlighted in the September 2011 ACR Bulletin article, "Moving Mountains."

However, ACR international efforts didn't stop there. The College continues to follow through on its promise to build a long-term, potentially permanent relationship with the Haitian medical community. The past year's successes include a trip to Port-au-Prince in April 2011, approval of the delegation's recommendations from the ACR Board of Chancellors at AMCLC 2011, and Siemens' donation of an X-ray machine to Port-au-Prince's Grace Children's Hospital (GCH). Now, the ACR has partnered with other societies to provide the Port-au-Prince community with a one-of-a-kind educational program — hopefully, the first of many such activities.

Building the Future

For the past several months, the ACR has been busily planning reconstructive efforts in Haiti. "After the Board approved our recommendations [at AMCLC 2011], our first goal was to survey Haitian medical staff about their educational needs," explains Brad Short, senior director of the ACR Department of Member Services, who has been involved with these efforts since the disaster struck. "We needed to figure out the use of radiology equipment, support personnel, and personnel training." Once the survey, which has been sent via e-mail to hospital facilities and radiologists in Haiti, is completed, ACR staff and members will use the results to plan an educational program in Port-au-Prince. The survey included such inquiries as "What type of X-ray film processing does your facility currently use?", "Has any kind of radiology training already taken place at your facility?", and "Please rank the type of diseases or conditions most commonly diagnosed."

Paul H. Ellenbogen, M.D., FACR, from Texas Health Presbyterian Hospital, Dallas, chair of the ACR Board of Chancellors, suggested planning the educational training program, utilizing survey data. As 2011 Board vice chair, Ellenbogen traveled to Haiti with the ACR going the distance in textdelegation and saw the earthquake's destruction firsthand. "There are three reasons the ACR has decided to partner with Haiti," he explains. "First, the proximity to the United States makes travel relatively easy. Second, Haiti is the poorest country in the Western Hemisphere. And third, several ACR members have been actively involved in Haiti for the past 10-15 years."

One of the most significant pieces of information learned during the delegation's 2011 trip, according to Ellenbogen, is the high incidence of volunteer or donor fatigue. In other words, volunteer groups often visit or donate to Haiti with good intentions but never follow through or produce real change. Ellenbogen and other ACR members did not want to become another one of those groups. "We're going to stand by the country's radiology personnel and implement a long-term cooperative effort to do everything we can to provide equipment and reach out to Haiti's people," elaborates Ellenbogen. "With this educational program, I believe we can accomplish a great deal and show the sincerity of the College's commitment."

Tending to the Details

Though the specifics of the program are still being developed, several ACR members plan to travel to Haiti to perform a two-day training session for radiologists, radiologic technologists, ultrasonographers, and other imaging staff. Attendees will participate in lectures and hands-on didactic training, with topics determined by incoming survey data.

Although the survey is not yet completed, some initial decisions about the program have already been made. "The principal modalities [taught] will be ultrasound and plain film," says James P. Borgstede, M.D., FACR, from the University of Colorado in Denver, Colo., chair of the ACR Foundation International Outreach Committee, who visited Haiti in April 2011 and is involved in planning the program. According to Douglas "Rusty" Brown, M.D., professor of radiology at the Mayo Clinic in Rochester, Minn., the fact that the country only has a few modalities at its disposal isn't necessarily a detriment. "The portability of ultrasound makes it an ideal tool," explains Brown, who is helping to plain the training course. The ACR is also teaming up with the Society of Diagnostic Medical Sonography and the American Society of Radiologic Technologists to take advantage of their technical expertise.

"Education is especially important in Haiti because there are very few learning opportunities compared to the United States," says Borgstede. One reason this program is so critical is that Haiti no longer has a radiology residency program, and only 19 practicing radiologists exist in the entire country. According to Melanie Y. Brierre, relief and reconstruction project coordinator for the nonprofit organization International Child Care (ICC), which is providing support to GCH, "The proposed ACR program is unique — no radiology exchanges or training programs have been offered at GCH for a number of years. A program like this is sorely needed and will be much appreciated." John Yates, M.D., ICC international director, adds that "The practical training to be offered to nonradiologists is invaluable given that Haiti simply does not have enough radiologists to meet the country's demand [for imaging services]."

Nonetheless, meeting the needs of Haiti's medical community will not be easy. "Things often go wrong," explains Brown. "We may lose power one day, or someone will not be able to get there on time. That's one of the things I've learned during my time [in Haiti]: unexpected problems will occur, but you go with the flow and adjust." Borgstede agrees, noting that the language barrier also makes a program of this type challenging. "We can't be certain that everyone attending the program will speak English," he explains. "We need to match our abilities to theirs, which means thinking about language issues."

Sustainable Aid

The College's commitment to overcoming whatever challenges arise — from language issues to unreliable power sources — to help restore imaging service in Haiti is indicative of the broader goal to establish a long-term relationship. "We don't want to just come in and hold a one-time course," explains Brown. "We want to provide training that the Haitian medical community needs, and then continue to backup their radiology infrastructure." Short agrees: "What's important is the next step. We're going to learn from this process and use what we know to improve future educational endeavors in Haiti."

This long-term investment will evolve with the restoration of GCH, which is well underway according to Yates and Brierre. Thus far, "with the assistance of hospital construction design and building experts, financial consultants, and others, the ICC Relief and Reconstruction team has successfully completed a needs assessment, strategic business plan, and construction design brief for GCH," says Yates. Meanwhile, GCH moved its patient services to a transitional facility across the street, which is likely to host the ACR program.

As the rebuilding of GCH continues, your contributions can make a difference. All donations to the ACR Haiti Radiology Relief Fund go toward efforts on the ground — for material shipments and essential educational programs, such as the one currently in development. But more help is needed. To donate or learn more, visit https://internationalservice.acr.org.

By Alyssa Martino

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