Recognizing a need
In 2012, Robert G. Dixon, MD, FSIR, the then-diagnostic radiology residency program director for the UNC Department of Radiology, saw a need for radiologist involvement in the global health setting. He considered the UNC School of Medicine and saw a strong presence in international medicine by other departments and services. Radiology is a cornerstone service for diagnosing and treating pathology in health care, so it made sense to him that medical imaging and intervention should have a place in the global health landscape. Used in a sustainable, thoughtful manner, imaging services will support the United Nations’ Sustainable Development Goals of health in the context of infectious and noncommunicable diseases, quality education for radiology and clinician colleagues, and reducing inequality in health care.
“As program director I had the opportunity to interview hundreds of medical students,” Dixon said. “As they told me their stories, they often cited their experience in other countries. It was then that I realized we, too, should be facilitating global health experiences for our trainees here in the Department of Radiology. In addition, as a mentor, I always advised students to be involved in service, here in the United States, or elsewhere if possible. This experience engrains young adults with the concept of service and the understanding of cultural differences in such an immediate way that it becomes a part of them.”
Dixon began to seek a path forward to implement and lay the groundwork for his vision.
During the same time, Joy Renner, MA, RT(R), director for the Division of Radiologic Science in the Department of Allied Health Sciences (DAHS), noted a concurrent vision for her radiologic technologist students. Those students would graduate to become the health care professionals that obtain medical images—the other side to the radiology coin. For global health radiology to be most successful, both sides of this coin must be addressed: the physician side and the technologist side. The UNC School of Medicine is uniquely positioned to address this need by uniting strong faculty members and departments with global engagement initiatives to foster the development of radiologists and technologists.
Working together to address the need
Under the coordination of DAHS faculty member, Melissa Culp, MEd, RT(R)(MR), the UNC Radiology Malawi Program was created within UNC Project Malawi to give outlet to the visions of Dixon and Renner. The program is a partnership between the Division of Radiologic Science and the UNC Department of Radiology to focus on sustainable global health radiology in Lilongwe, Malawi. Along with other universities and partners, the UNC Radiology Malawi program is a major partner in RAD-AID Malawi at RAD-AID International. RAD-AID is a 501(c)(3) nonprofit focusing on global health radiology initiatives.
The UNC Radiology Malawi program strives to meet three long-term bilateral goal initiatives:
1) radiologist support;
2) technologist/radiographer education and development for working technologists, faculty, and students; and
3) biomedical engineering development for equipment maintenance. Imaging modalities available at Kamuzu Central Hospital (KCH) include radiography, ultrasound, and computed tomography.
Since its creation in 2013, the program sent eight teams to Malawi to focus on requested educational topics; the groups have included radiologists, radiology residents, technologist faculty, staff and student technologists, and a medical student. In addition, the program hosted a Malawian faculty member to visit UNC during fall 2015.
Building a global community through radiologist support
Because of the groundwork laid by Dixon and his continued involvement, significant progress is being made to meet the objective of radiologist support within the UNC Radiology Malawi program.
Four teams with radiologists have traveled to KCH to provide CME for Malawian clinicians, the consultant radiologist, and the department medical officers. Topics have included pediatric radiology, trauma and orthopedic imaging, and breast imaging. Currently, there is one consultant (attending) radiologist, Suzgo Mzumara, MBBS, Med, at KCH, a 1,000-bed facility. With no radiology residency program available in Malawi, physicians must travel to Kenya, South Africa, or other surrounding nations for training. To address the goal of radiologist support sustainably, the program, along with partners from Haukeland University Hospital in Norway, is supporting Malawian medical officers from KCH as they begin radiology residency in South Africa.
Under Dixon’s mentorship, Melissa Davis, MD, then a UNC-CH radiology resident, traveled in 2014 to Malawi as part of an assessment team. Because of this experience, global health radiology is one of her career goals now. Currently at the Yale School of Medicine, she continues to be involved in global health outreach by supporting radiology residents whom she is mentoring. Davis is leading a team of residents and technologists to Jamaica this December to work with radiology colleagues in Kingston.
Another contributor to the program is Brett Murdock, MD, who is currently an assistant professor of radiology in the Division of Cardiothoracic Imaging at UNC-CH. Murdock strives to give back to the global health radiology community also. During his training as a radiology resident, he spent time at KCH: “The experience of working at Kamuzu Central Hospital with the UNC Radiology Malawi Program was like a manifestation of the most distilled version of what brought me, and countless physicians before me into the field of medicine,” Murdock said. “Never before has my work felt more needed or more appreciated. There are countless opportunities to do genuine, lasting good, and my time there enriched my life personally, and professionally to a degree I could not have imagined.”
Along with Sheryl Jordan, MD, RCC, the current diagnostic radiology residency program director, Murdock continues to champion the cause of radiologist and trainee involvement within UNC Radiology Malawi Program. Jordan envisions the establishment of a structured radiology global health curriculum for residents, and she seeks to continue the path of involvement in Malawi. Both Murdock and Jordan plan to visit KCH during 2017. They will be working with Mzumara and his medical officers at KCH and with other clinicians in UNC Project Malawi.
Now as Vascular-Interventional Radiology (VIR) fellowship program director, Dixon continues to lead the way in global health radiology. A VIR fellow, Aaron Kline, MD, will be joining the next UNC Radiology Malawi program work trip to assess VIR needs and serve as a bridge between the surgery and radiology initiatives at KCH.
Instilling global engagement in the next generation of technologists
What then of technologist education and development? The Division of Radiologic Science set the logistical groundwork for UNC Radiology Malawi program and continues to strive for excellence within the partnership.
An array of technologists, including faculty, staff, and students, have given guest lectures on requested topics at the Malawi College of Health Sciences Radiography Programme. A future objective for this goal is a full curriculum review at MCHS to permanently integrate these content areas into the courses for Malawian student technologists.
Andrew Woodward, MA, RT(R)(CT)(QM) and Sara Long, MEd, RT(R)(BD) from the Division of Radiologic Science have given hours of guest lectures at the College and provided professional development to staff technologists at KCH. Both frequently mentor UNC-CH student technologists from the division during their contributions on-site. “My involvement in the UNC Radiology Malawi Program has given me an opportunity to experience imaging in a different context, and has allowed me to engage new colleagues, students, and ideas—all of which has been a fun and exciting endeavor," Long said.
During his first trip to Lilongwe, Woodward lamented that student technologists had no textbooks, no laptops, limited Internet access, and few resources. How to address such a disparity of access to educational content? Together with his counterpart, Peter Shaba, the Head of Radiography Programme at MCHS, Woodward created a plan for student success by donating tablets and using the local cell phone network provider to access teaching tools. This unique approach supports e-learning in the classroom.
“I have found working with the radiographers at Kamuzu Central Hospital and the faculty at the Malawi College of Health Sciences very rewarding. I have been very fortunate during my education and career to have benefited from the kindness and willingness of professors and colleagues to invest in my learning as well as helping me hone my clinical and teaching skills,” Woodward said. “Traveling to Malawi has enabled me to share my knowledge and skills with a group of colleagues who are just beginning to have access to the newest in imaging technology and technology applications for the classroom.”
In striving to address the goal of technologist development in a comprehensive manner, some tuition assistance was provided to an MCHS faculty member for his higher education and to Malawian student technologists. To date, eight UNC student technologists from the Division of Radiologic Science have traveled to Lilongwe with faculty to contribute to guest lectures and projects. When these students graduate, they continue to support radiology global health by service in Malawi, Ethiopia, Laos, and low-access areas of the U.S. These alumni have become change-makers in global health.
Under the mentorship of Renner, the involvement of technologist faculty, staff, and student technologists continues to grow and support educational needs bilaterally in the partnership.
Together: A vision for the future
The UNC Radiology Malawi program has an extensive network of partners within the radiology community, including RAD-AID International and Haukeland University Hospital, with whom initial steps are being taken to address the goal of biomedical engineering. Additionally, with input of radiology nurses, Kathy Duncan and Carrie Furberg, from UNC, a nursing needs assessment was completed and is being addressed as an emerging goal in the KCH Department of Radiology. The program seeks holistic and interdisciplinary solutions to radiology needs in Lilongwe.
With the facilitation of coordinator, Melissa Culp, the UNC Radiology Malawi program takes a team approach to address goals and objectives with equal weight on input from in-country partners. Because of the vision of Dixon and Renner, two UNC departments are uniting to achieve more than either could do alone—to more comprehensively address medical imaging and interventional needs alongside radiology colleagues in the warm heart of Africa.
For more information on UNC Radiology Malawi Program, please visit the team site.
Program coordinator: Melissa Culp