Without Borders

ACR travel grand funds member-in-training volunteerism in Bangladesh and Uganda.without borders

To choose the practice of medicine is to build a life and career around helping patients. In that sense, many physicians inherently feel a strong commitment to assisting all communities in need, whether in their own backyard or across the globe.

Since 2009, the ACR has helped residents fulfill their desire to give back by awarding up to four members-in-training annually with a $1,500 Goldberg-Reeder Travel Grant, which funds volunteerism abroad. In this Q&A with the ACR Bulletin, 2011 grant recipients R. Peter Lokken, MD, MPH, radiology resident at Brigham and Women's Hospital in Boston, and Ginger Merry, MD, MPH, radiology resident at the University of California San Francisco, talk about their respective experiences at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in Dhaka, Bangladesh, and the Kamuli Mission Hospital in Kamuli, Uganda.

Q: With the grant, where did you travel

Lokken: Working with the icddr,b was a great opportunity and the grant made it feasible on my resident salary. I hoped that this volunteer activity might help form a relationship between the icddr,b and the ACR, so that the icddr,b could perhaps find further donors and other resources to improve radiology education and services, which could greatly impact patient care and research. I spent most of my time at the affiliated Dhaka Hospital, which provides clinical care to more than 100,000 people annually. Most of the inpatients are indigent, and the hospital has one of only a few wards dedicated to HIV in the country. I also worked in some of the field hospitals in rural areas.

Merry: I traveled to Uganda with Imaging the World (ITW) — a nonprofit organization — and Kristen K. DeStigter, MD, MS, ITW co-founder, and Mary Streeter, a sonographer from Vermont. The three of us began a project with a goal of increasing earlier detection of breast cancer in Uganda. This was a perfect project for me because I am beginning a breast fellowship in July 2012.

We developed a breast cancer diagnosis and treatment algorithm that incorporates the use of breast ultrasound. Already, ITW has implemented ultrasound protocols for obstetrical and basic abdominal studies, but there were no protocols for breast ultrasound. We went in October 2011 to conduct the pilot phase of the study in the Kamuli District of Uganda. This included finalizing the protocol and algorithm with our partners in Uganda at a stakeholders meeting, training staff on the breast ultrasound protocol, and training staff to perform ultrasound-guided biopsies.global volunteer 1

Q: What was surprising about your experience?

Lokken: Dhaka Hospital has a Siemens Acuson X500 ultrasound machine and conventional radiography on-site. CT, MRI, and even PET are available elsewhere in Dhaka. I was surprised at how the hospital was able to keep the equipment in good working order. I've worked in other places, like central Africa, where the majority of machines are broken because of the infiltration of dust and rain water, power surges, and lack of spare parts as well as service/repair representatives. Dhaka was different, in part because the city is large and has a decent infrastructure.

I was also impressed at the degree of imaging integration into the patient's overall clinical care. Again, in other resource-limited settings, physicians often don't have the luxury of learning from radiology specialists in medical school or general practice.

Additionally, in these areas, imaging is often unavailable or of reduced quality, so physicians aren't able to learn how to make the best use of it in their work. At Dhaka Hospital, physicians have a good sense of how radiology studies impact patient care. That is due, in part, to the great, locally trained radiologist on staff, Dr. Fariha Bushra Matin; I learned a lot from her.global volunteer 2

Q: What challenges did you face?

Merry: For this project, it was challenging to develop a clinical pathway and algorithm using ultrasound as the primary diagnostic tool for breast cancer, since it's not the current model in the United States. We are introducing a paradigm shift in how to approach the diagnosis of breast cancer. The diagnostic algorithm takes into consideration the needs of a country with limited resources. For example, diagnostic evaluation with mammography is not a realistic option in Uganda, but ultrasound is a readily available and affordable option.

Q: How was this experience rewarding?

Lokken: My favorite part is always meeting the patients and learning from the local staff — many of whom know so much about the local pathology and have found creative solutions despite limited resources. Additionally, because CT and MRI were not readily available, I had to challenge myself to detect findings that might typically be found through cross-sectional imaging at my hospital in Boston, and characterize them as much as possible. It was a great opportunity to improve my ultrasound skills.

Merry: On a personal level, it's very eye opening to see what health care and radiology look like in other countries. Despite the limited resources, the nurses and doctors who I worked with were passionate about providing the highest quality care possible to their patients and their compassion was inspiring. On a professional level, it was rewarding to provide resources and educational training. For example, I gave several lectures at Makerere University to the radiology residents, including a hands-on workshop on performing ultrasound-guided biopsies, which was made feasible by generous corporate donations of breast models designed for practicing biopsies. Traveling to Uganda and working with ITW has been a great opportunity that has allowed me to combine my interests in both global health and radiology.

By Alyssa Martino

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