Demand for minimally invasive treatments continues to rise around the world. Interventional radiology (IR) in particular is indicated for a broad range of conditions and has numerous advantages over more traditional surgical options, often significantly decreasing associated morbidity and mortality. Examples include image guided abscess drainage, nephrostomy and biliary tube placement, uterine fibroid embolization, and embolization in the setting of trauma, GI bleed, or postpartum hemorrhage. However, many low income countries have limited or complete lack of IR services. According to the WHO over 4 billion people globally lack access to diagnostic imaging, with likely more than 5 billion lacking access to IR. As of 2017, there was not a single interventional radiologist in Tanzania, leaving a population equivalent to that of California and New York combined without access to a broad range of life-saving treatments. Over the past four years, the “Tanzania Interventional Radiology Initiative” has initiated East Africa’s first IR training program, training the first generation of interventional radiologists in the country. Africa’s first Master of Science in IR curriculum at Muhimbili University in Dar es Salaam was officially announced in October 2019 ( https://medicine.yale.edu/news-article/yales-tanzania-interventional-radiology-initiative-approved-for-msc-program/ ), which gives testament to the rapid progression of the training program. An overview of the program was published in the Journal of Vascular and Interventional Radiology in 2019 ( https://www.jvir.org/article/S1051-0443(19)30687-6/pdf ). In September 2021, the first class of three fellows graduated, which will be followed by graduation of 7 fellows in 2022.
While this program most immediately serves the 60 million people living in Tanzania, training IR physicians locally will have regional impact. One of the first IR fellows who recently graduated from the program in Tanzania is from Rwanda, and has returned there as the first IR physician in the country. He has already begun the process of expanding these efforts there and plans to begin training the first generation of Rwandan IR trainees in 2022. One of the prospective 2022 graduates in Tanzania is from Nigeria and will return there on completion of her training.
I believe that expanding the many obvious benefits IR already provides to patients in high income nations can be quickly expanded to billions of people around the world in low income nations by training young physicians locally. IR provides a broad range of life-saving procedures and can have an immediate impact, as has been demonstrated in Tanzania over the past several years. I want to support and expand these efforts and contribute to building IR services in Africa, potentially reaching over one billion people who currently have no access to these important treatments. I have specific expertise in spine interventions to treat pain caused by spine fractures and hope to provide training for these procedures during my visit. I will also investigate the possibility of creating an interventional stroke program for future visits.
Muhimbili National Hospital is a 1500 bed tertiary care government hospital in Dar es Salaam, Tanzania. Interventional Radiology (IR) is a new specialty there, with a fellowship training program started about 5 years ago. Every month visiting international visiting faculty come for 2 weeks to teach and share experiences.
As an interventional radiologist my ability to volunteer and serve depends on expensive infrastructure and supplies. The hospital has top notch imaging but is frequently short of supplies and relies on donations from visiting faculty. My technologist and I brought 5 large cargo bags of supplies with us. Paying $100/bag for extra luggage was a bargain compared to the value of the supplies.
The IR staff (attendings, fellows, nurses, technologists, and support staff) embraced learning from us and included us as part of their family. We introduced the procedure of vertebroplasty as treatment for painful vertebral compression fractures and treated one woman with a malignant compression fracture who had been confined to bed for 2 weeks due to severe pain. After treatment, she walked out of the hospital a few days later.
Patients present with late stages of disease for biopsies, including children. I taught the use of CT fluoroscopy to perform CT guided biopsies. Since IR is relatively new at the hospital and in the country, there are no insurance codes for many of the procedures and patients are required to pay cash. $150 for a CT guided biopsy is inexpensive by American standards, but out of reach for many patients in Tanzania. My technologist started a fund to pay for IR care for children who would otherwise not be able to afford such care.
In some ways, working at the hospital felt like pushing water uphill. That's the perspective from working there only a few weeks. It is remarkable what they have accomplished in only 5 years, and the IR fellows now provide IR care at other hospitals in Africa, including Rwanda, Uganda, and Nigeria. Providing care on a mission is important, but teaching is an opportunity to have the care continue after the mission is over. It was a privilege for us to work at Muhumbili.
