Radiologists look back on their experience with the ACR's Goldberg-Reeder Travel Grant.
You've just transferred to a new hospital, and things are looking rough. At best, you have an ultrasound machine at your disposal, but no sonographer. Patients come to you clutching their films, sometimes walking for miles to get to your door.
The power goes out from anytime between noon and six o'clock, flooding the reading room with darkness, effectively halting your progress on the work you wanted to finish. Despite this seemingly unending chaos, however, you are surrounded by a flood of residents eager to learn, patients and referring physicians in need of your help, and a host of opportunities ahead.
This is a snapshot of what the world of a resident traveling under the Goldberg-Reeder grant might look like. Each year for the past six years, the ACR Goldberg-Reeder Travel Grant has funded several residents to volunteer in impoverished areas overseas. The Bulletin caught up with several alumni to find out what they're up to now and what lessons they carried with them beyond the plane ride home.
Sihanouk Hospital in Cambodia specifically caters to the poor. During my first day, I was on rounds with the other medical teams and noticed a patient in the corner of the room. He was intubated and was surrounded by family, with one member squeezing the manual resuscitator. At first I thought the family members were employees, but then I realized that each of the members were taking turns "breathing" for the patient. I kept waiting for someone to connect the endotracheal tube to a machine, but it never happened. They only had one machine and it was alreay being used. Going on rounds with other teams is different, but then we get to see things like this — it's nice to see the faces of the patients that go with our images and learn their stories. — Morlie L. Wang, MD
The women that I worked with in Botswana constantly blessed me. They think that what doctors do is incredible — that we will immediately make the cancer go away. Because of that, they would go around petting me and giving me all the blessings in the world. By the end of my trip, not only were the women trying to get me married off, but the patients and everyone else was in on the act too. — Surbhi Grover, MD
One of the things that we encountered at first was a difficulty creating professional relationships. The doctors at Kilimanjaro Christian Medical Center were very busy, and it would be arrogant to expect them to simply set their work aside and solely pay attention to us. So we would go on clinical radiology rounds and try to interact with the general surgery teams and the clinical teams. We'd see their patients and interact with them as well. By taking a patient-centered approach, we were able to create relationships and share information. — Daniel L. Cooke, MD
Words from the Wise
Be prepared for things to move slowly. Don't expect everything to fall on a time-table, says Cooke. Adhering to a strict schedule is helpful in the U.S., where we have the capabilities to do things quickly. But in places where you have regular power outages and no internet, things will slow down fast, so you have to be flexible.
Don't let anxieties stop you from going. When Wang applied for the grant, she was hesitant to tell people. Wang was afraid of the opposition she might face because many of her friends and family believed she had too much on her plate already, and that she shouldn't leave her two young children. With the support of her attending physicians, she went anyway. The experience paid off, and Wang discovered a love of teaching in Cambodia. "My children are proud of the work their mother did when they were younger," Wang says.
Your time and knowledge are your best resources. The old adage about teaching a man to fish is true; nearly every Goldberg-Reeder alumnus noted that what residents already possess are the best things that they can donate. While many physicians and hospitals find it prudent to donate equipment, often these donations are only good until the machines need service, as many places do not have the resources to maintain the equipment. It's important to teach the residents about procedures that they can do with the resources they have readily available.
Understand the needs of your host country. This is another piece of advice that nearly all Goldberg-Reeder alumni gave. The hospitals you travel to will be completely different from the settings you are used to — power outages are often frequent, and physicians there will have different priorities from your own. For example, Aarti K. Sekhar, MD, noted that in Ethiopia, the volume of imaging is not as high in the United States, and the radiologists there spend a great deal of time directly interacting with patients and even going on rounds with the referring clinicians. It's also a good idea to try and find out about your host site's priorities before you travel, although sometimes that isn't possible.
I've become much more efficient. In Botswana, things tend to happen at their own pace, so you really have to step up and make things happen. If there's an emergency, people may take it lightly, so you have to jump on it and be a true advocate for your patient. — Surbhi Grover, MD
My time abroad cemented how much I love to teach. In Cambodia, I noticed that every single student was passionate about learning. Even the secretary would ask me to come over and show her what I was showing the residents. Now, in addition to my fellowship, I do online teaching at a local hospital. The students in Cambodia made me realize I like teaching and that, in return for my efforts, I helped cultivate students who were smarter and more capable than they were before. And that's the best reward for a teacher. — Morlie L. Wang, MD
Going to these countries makes you more empathetic and flexible. Any time you work with people who are in a very different situation from you, you have an opportunity to learn from that experience and make personal connections. Living in a place where there is limited access to hot water or electricity also has helped increase my flexibility and the range of what I can do with limited resources. — Aarti K. Sekhar, MD
Passing the Torch
Unsurprisingly, several of those who have participated in the Goldberg-Reeder grant have continued to do work in global health. Surbhi Grover, MD, who traveled to Botswana in 2012, will join the faculty at the University of Pennsylvania next September. From there, she will return to Botswana, dividing her time between countries. "I always wanted to work in international and clinical settings, where I can both treat patients and contribute to research," she says. Cervical cancer in particular is prevalent in India and sub-Saharan Africa. "They need more oncologists there, and they welcomed me with open arms," she notes.
Aarti K. Sekhar, who traveled to Tanzania, is now an assistant professor at Emory University, in Georgia. After her experiences in Africa and because of her international background, she decided she wanted global health to be a significant part of her career. Now, Sekhar works as a faculty advisor in an Emory program that sends residents to Ethiopia for month-long rotations. She travels with the residents to Emory's sister hospital in Ethiopia, where they train others to perform procedures such as CT and ultrasound-guided biopsies, go on rounds with residents from other specialties, and interact with patients at the bedside. "These experiences abroad are really informative and valuable," Sekhar says. "The Goldberg-Reeder helped me decide what I wanted to do in my career, and now I want to help my residents have that experience."
By Meghan Edwards