As an academic Diagnostic and Interventional Radiologist at Duke University Hospital, I have over 20 years of experience with trainee education. This will be my fourth year teaching the Diagnostic and Interventional Radiology (IR) residents at Muhimbili National Hospital in Dar Es Salaam, Tanzania.
For the Diagnostic Radiology residents, I plan to give lectures on imaging of abdomen. Lecture topics include: bowel, pancreas, spleen, liver, biliary system, kidneys/urinary tract, uterus/ovaries, vascular system. For the IR residents, I will supervise/perform image-guided biopsies and drainages and provide consultation for inpatient and outpatient triage and pre-procedure planning.
Last year, I saw many cases where the new IR services made a significant difference in the lives of patients. Physicians taking care of inpatients now regularly come to the IR clinic to discuss what IR could do to help or save their very sick patients. For example, we were consulted about a man with a lung mass and large malignant pericardial effusion. He couldn’t get his lung mass biopsied because the pericardial effusion prevented him from being able to lie flat on the CT table to get the lung biopsy. We drained 600 mL from his pericardial sac and then completed the lung biopsy the next day. In another case, a woman from Arusha, Tanzania, heard about the new IR program at Muhimbili and drove several hours from Arusha to get a breast biopsy in our clinic—she had a hard mass in her breast and she needed a biopsy in order to start treatment. We did her biopsy and she was very grateful. It is cases like these that make me want to return.
This year I look forward to teaching the Diagnostic Radiology and IR residents. Several of the prior IR residents who completed their training are now permanent IR staff at Muhimbili National Hospital. It will be great to see them again. They are always appreciative to learn about new concepts and techniques and that we can teach them.
Because of Road2IR, 60+ million people in Tanzania now have access to Interventional Radiology services which provided image-guided minimally invasive therapeutic and diagnostic procedures for a wide range of medical conditions which include trauma, cancer, infection, and vascular disease.
Patients can now access Interventional Radiology services in Tanzania instead of having no treatment or having to go outside the country. Road2IR established the first and only 2 year Interventional Radiology training program in Tanzania, graduating 16 residents since 2021 and 3 more this year.
This is my fourth year teaching the Interventional Radiology (IR) residents and providing medical care for patients at Muhimbili National Hospital (MNH) in Dar Es Salaam, Tanzania. I will describe several cases which reflect the types of diagnoses and treatments I provided.
One patient had recently been treated in India for ovarian cancer and developed worsening abdominal pain. To evaluate the cause of her abdominal pain we performed an ultrasound in IR clinic. I supervised the IR resident while he performed an ultrasound of the patient’s abdomen. The ultrasound exam which showed a large (greater than 10 cm) right subdiaphragmatic fluid collection with complex fluid, likely an abscess. We then performed an abdominal CT which showed the extent of the right subdiaphragmatic collection as well as another very large abscess in the central abdomen (greater than 20 cm) which we could not see with ultrasound because it contained a lot of gas from infection. Subsequently, I supervised the IR resident to perform a CT-guided drainage of the abscess collections which relieved her symptoms.
Another patient came to IR clinic with a history of abdominal pain and already had a CT done closer to his home which showed a large fluid collection (greater than 10 cm) between the stomach and pancreas. He was referred to our IR clinic for possible percutaneous drainage. In reviewing the CT, this fluid collection appeared to be due to a gastric ulcer perforation which was not recognized in the outside CT report. Due to the potential communication of the fluid collection with the gastric ulcer, we felt that percutaneous drainage could increase the risk of developing a gastro-cutaneous fistula. Instead of percutaneous drainage, this patient first needed medical or surgical treatment to heal the gastric ulcer. Unfortunately, I had to leave before the final decision on this patient’s care was determined, but I felt I had impacted this patient’s care by correctly diagnosing the cause of the fluid collection.
One morning, a diagnostic radiologist from the MNH Diagnostic Radiology department asked me to review a case of a patient who had a history of conjoined twins. I expected to be viewing images of conjoined twins in utero. To my surprise, the conjoined twins were lying in a bassinet in the exam room, now 10 days old. They asked me what kind of imaging would be best to evaluate the health of these babies and evaluate the extent of internal connection between them. I recommended an ultrasound which I subsequently performed. The babies were conjoined at the hips and had only one anus, one bladder opening, and no external genitalia. I was able to identify normal and separate livers, spleen, and kidneys. I discovered internal scrotal sacs and testicles identifying that the twins were male, which was not known until that moment. Although the outcome for these otherwise healthy babies is unknown, I felt I contributed to their care.
These examples reflect the groups of people impacted by my trip. The patients I treated had their symptoms relieved and their medical condition improved. Under my supervision, I helped the IR radiology residents learn how to perform image guided biopsies and drainages. The IR radiology residents also learned that decision making in Interventional Radiology requires a strong understanding and knowledge base of Diagnostic Radiology, in order to make informed decisions that serve the best interest of the patient. As this new Interventional Radiology department has grown and become more widely known, referrals for IR treatment have increased. However, as in the case of the gastric ulcer perforation, not all medical conditions can or should be treated with IR techniques and it is an important lesson is to know the limitations and risks of IR procedures. Lastly, I forged new connections with the Diagnostic Radiology radiologists at Muhimbili National Hospital. After I completed the ultrasound of the conjoined twins, we exchanged contact information so, in the future, if they needed help or advice, they could contact me directly.
