Targeting Imaging Needs and Challenges in Tanzania
A resident’s experience conducting a RAD-AID Radiology-Readiness Survey.
By far, my favorite part of radiology residency has been the ever growing presence of global health outreach and my interactions with others in learning about the challenges unique to different countries. I love figuring out innovative solutions to overcome these challenges and generating discussions to spread the spark of imagination.
Recently, I was given the opportunity to be part of a three-person team headed by Dr. Woojin Kim, MD, traveling to Tanzania to help with a Radiology-Readiness Survey being conducted by RAD-AID, a non-profit organization with the overall mission to improve radiology resources in areas of need across the world.
We were asked to assess a project in development by the local group NSK Hospitals Limited, which is setting up a new diagnostic center, consisting of imaging, pathology laboratory, dialysis, and physician specialists in the Arusha region of Tanzania.
After traveling for almost 24 hours, we landed at Kilimanjaro Airport in Tanzania and hit the ground running. The next few days consisted of hours of meetings, many of which were back-to-back, with a variety of wonderful people, including representatives from GE, the Tanzania Atomic Energy Commission, the Medical Radiology and Imaging Professional Council, local IT representatives, technologists, and clinicians from nearby hospitals. Our three-person team divided up the survey questions, which cover topics ranging from patient demographics to the radiology equipment being used to the financial infrastructure put in place for payment and reimbursement. Despite my jet lag, I felt more driven with a stronger sense of purpose during this experience than at any other point in my residency. I listened, I learned, and I asked questions when I wanted to learn more.
So what did I learn? I learned about the scarcity of imaging resources in Tanzania, including the number of machines available (very few to none, especially for the more sophisticated modalities such as MRI or mammography) and the limited training capabilities given the lack of machines to practice on. I learned about what Tanzanian patients in private and governmental settings generally present with, including the high rate of trauma due to heavy motorcycle use, low rates of helmet use, and lack of proper traffic management. Additionally, I gained unexpected insights, including the high demand for certain technologies, like 3-D images for obstetrics, which patients had seen in India and were asking for in Tanzania. None of this information could have been extracted without spending quality time at these meetings.
On one of our last days during the survey, we visited multiple hospitals in the Arusha area of Tanzania, including the Mount Meru hospital, the Arusha Lutheran Medical Center, and the Kilimanjaro Christian Medical Center. Step inside any of these hospitals to truly understand what “need” means. It takes very little to realize the tremendous gap between what we have in highly developed countries such as the United States, compared to countries with a scarcity of resources, such as Tanzania. Throughout our hospital visits, we encountered a wide breadth of situations, from those running old-fashioned film processing in a darkroom (after the automatic processor broke and was unable to be repaired) to practices handing the only copy of a report to patients as they walk out the door. We saw a donated mammography machine that could not be used due to the lack of a functioning automatic processor. We also saw fairly advanced departments with one or two CT scanners, including a 64-slice CT scanner. Certain radiology departments had modern color Doppler ultrasound units, while others used ultrasound units with limited probes and lack of color Doppler usage.
The bottom line is that the need for a modern, sustainable imaging center in Arusha is clear. For many patients in the region, there are no viable options for receiving a MRI scan other than making the long journey to either Dar Es Salaam or Nairobi, Kenya, which could take anywhere from five to ten hours by car.
The area has essentially no mammography units, up-to-date ultrasound equipment, or appropriate IT infrastructure. NSK Hospitals Limited has the potential to significantly alter the diagnosis and treatment of patients in this region. Furthermore, the partnership with RAD-AID allows for utilization of all possible data to inform the process in order to ensure the success of such a center. All in all, this was a remarkable experience to be part of as a resident. My eyes were opened to the challenges in Tanzania, but
I also gleaned a great deal of understanding about what goes into ensuring that a radiology practice is able to succeed. I learned from our conversations with different people in Tanzania but also from listening to my other team members speak from their perspectives as a radiology attending and a sonographer. It goes without saying that in global health outreach, having a multifaceted team is as important as the project itself.
By Mindy Yang Licurse, MD