We are estabilshing a longitudinal relationship with the teaching hospitals in Dar Es Salaam in Tanzania. As academic radiologists, myself and my medical residents (3 travelers) will be intervening by teaching Tanzanian medical professionals about breast imaging and intervention, as breast cancer continues to increase in this population. By teaching the radiologists, our goal is to allow native medical professionals to diagnose breast disaese, and to better understand intervention and and biopsy techniques. We will deliver a number of lectures, and teach all radiology modalities including mammography, ultrasound, CT, MRI, and radiographs. Our initial interventions and curriculum can be disseminated to the radiologists thoughout the country, improving care, sophistication, and diagnostic acumen.
In regards to breast cancer, we will directly and indirectly increase the sophistication of the native radiology providers in providing diagnosis and care for breast cancer patients. Similarly, our teaching in all areas of radiology will serve to improve diagnostic acumen, and the quality of care at Tanzania's largest medical teaching institution, with a long term goal of helping all patients who receive imaging in Tanzanian hosptials and clinics.
Although we will return in approximately six month intervals, our primary goal is to teach medical professionals who can in turn teach others, improving accuracy and service for patients.
I recently returned from two weeks in Dar Es Salaam, Tanzania, in East Africa, with a group of staff, residents, and medical students representing the Yale and Dartmouth diagnostic and interventional radiology departments.
Dar Es Salaam is the largest city in Tanzania. The radiology training has been growing tremendously, and the learners, both resident and attending physicians, are inspiring in their flexibility, eagerness to learn, and innate abilities. Although both men and women are represented, radiology in the Dar Es Salaam training program is comprised largely of women, which has exciting implications for the future of our specialty in Tanzania.
I traveled to Dar with my colleague Dr. Frank Minja, a Yale neuroradiologist, as a part of an ongoing intervention for the radiology residency program at Muhimbili National Hospital complex (MNH), a government supported institution which includes an orthopedic and imaging hospital and a University medical training facility. Both Dr. Minja and I benefitted from Doximity travel grants, which completely covered our travel, round-trip to Tanzania, and which has allowed us to start planning a return trip in February of 2019, to continue our medical mission with more US residents and an interventional radiology team.
While the primary focus for this trip was to begin the process of providing interventional radiology care, we also continued our teaching in diagnostic radiology, which has carried over from prior trips to Tanzania.
Once we arrived in Tanzania, we settled into our living situation, and began to recover from jetlag. And almost immediately, we started teaching, both interventional and diagnostic radiology. The interventional team had many challenges and opportunities, which are described by Dr. Minja in his summary. However, our diagnostic teaching consisted of a number of synergistic interventions, which included three hours of formal lectures for the Tanzanian medical residents each day. These lectures were image-rich and case-based. This format is used widely in United States radiology training programs. However, in Tanzania, residents are not as practiced in presenting in front of peers, and therefore our first task consisted of teaching image interpretation/findings, to improve their confidence.
From there, we were able to empower development in each resident as they practiced differential diagnosis considerations. They learned about getting out of one’s comfort zone in a supportive environment. We also simultaneously discussed the role of the radiologist in the US, and the importance of communicating findings and diagnoses to our colleagues, as we strive to add value.
While both our formal and “Socratic method” lectures were important, our time together at the radiology workstation and ”light box” was equally valuable. We spent approximately 2 hours a day discussing real cases and pathology, both with the Tanzanian medical residents, and the local attending radiologists. This time was perhaps the most beneficial as we started to generate positive feedback, working towards the goal of Tanzanian radiologists adding value for their referring colleagues.
We spent additional time during our two-week stay with hands-on, specifically practicing breast biopsy techniques, with the goal of increasing confidence in intervention for the Tanzanian residents and attending physicians.
One of the challenges in any of these outreach situations is to create mutual trust and “buy-in” from all concerned. As a group of residents and staff, we found that it was critical for us to be there, in Dar, daily witnesses to the challenges inherent in their health care system. Specifically, what barriers were they experiencing in their day-to-day workflow? How could we help, without threatening the local hospital culture? Each day we talked about empowering and stepping back, allowing local physicians to find their footing in adding value. We were also very careful to involve the leadership chain of command, optimizing continuity of mission and purpose.
We found that we received more than we gave. While our experiences and techniques were valuable, we gained so much from our daily interactions with this talented group of Tanzanian radiologists. We are truly looking forward to our remote interactions in the interim, and are already planning our next visit for February 2019! Thank you, Dox Foundation for helping to make this collaboration possible.