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UNC Radiology Malawi Program Strengthens Local and International Ties

November 11, 2016
UNC Health Care

Thanks to the UNC Radiology Malawi Program, faculty and students at the UNC School of Medicine have been making strides to provide sustainable radiology technology to Lilongwe, Malawi. The program exists to provide radiologist support; technologist and radiographer education; development for working technologists, faculty, and students; and biomedical engineering development for equipment maintenance.

The program is a partnership between the Division of Radiologic Science and the UNC Department of Radiology. It also works with RAD-AID, a nonprofit focusing on global health radiology initiatives, as well as other universities and partners.

Since its creation in 2013, the program has sent eight teams to Malawi to focus on requested educational topics. 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.

The idea for the organization was sparked in 2012, when Robert G. Dixon, M.D., Fellow of the Society of Interventional Radiology and then-diagnostic radiology residency program director for the UNC Department of Radiology, saw a need for radiologist involvement in a global health setting. He considered the 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 Dixon that medical imaging and intervention should have a place in the global health landscape. Used in a sustainable, thoughtful manner, imaging services can 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.”

Around the same time, Joy Renner, M.A., director of the Division of Radiologic Science in the Department of Allied Health Sciences (DAHS), noted a concurrent vision for her radiologic technologist students. Those students graduate to become the health care professionals that obtain medical images. For global health radiology to be most successful, both sides of the radiology coin, the physician side and the technologist side, must be addressed. The 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.

Building a global community through radiologist support

Under the coordination of DAHS faculty member Melissa Culp, the UNC Radiology Malawi Program was created within the UNC Project Malawi to give outlet to the visions of Dixon and Renner. Because of the groundwork laid by Dixon and his continued involvement, significant progress is being made to meet the program’s objective of radiologist support.

Kamuzu Central Hospital (KCH), where the Program does most of its work, faces a number of issues related to providing adequate radiology treatment to its patients. Currently, Suzgo Mzumara, who has a bachelor of medicine and of surgery, is the only consultant attending radiologist 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.

Four teams with radiologists have traveled to KCH  to provide continuing medical education for Malawian clinicians, the consultant radiologist and the department medical officers. Topics have included pediatric radiology, trauma and orthopedic imaging, and breast imaging. 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, M.D., then a UNC-CH radiology resident, traveled to Malawi in 2014 as part of an assessment team. Because of this experience, global health radiology is one of her current career goals. 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, M.D., 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, M.D., 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 in 2017. They will be working with Mzumara and his medical officers at KCH and with other clinicians in UNC Project Malawi.

Now the Vascular-Interventional Radiology (VIR) fellowship program director, Dixon continues to lead the way in global health radiology. A VIR fellow, Aaron Kline, M.D., 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

The Division of Radiologic Science continues to strive for excellence within the partnership, including in the area of technologist education and development. For example, tuition assistance was provided to an MCHS faculty member for his higher education and to Malawian student technologists.

Additionally, 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 (MCHS). 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.

Sara Long, who has a master’s of education, and Andrew Woodward, M.A., both 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.

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 graduated, they continued 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.

Additionally, faculty and students are addressing resource shortages that hinder educational initiatives at KCH. During his first trip to Lilongwe, Woodward lamented that student technologists had no textbooks, no laptops and limited Internet access. 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.”

Together: A vision for the future

The UNC Radiology Malawi program is taking steps to address the goal of biomedical engineering with its extensive network of partners within the radiology community, including RAD-AID International and Haukeland University Hospital. 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 at KCH.

With the facilitation of Culp, the UNC Radiology Malawi program takes a team approach to address goals, emphasizing 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, ultimately succeeding in more comprehensively addressing medical imaging and interventional needs alongside radiology colleagues in the warm heart of Africa.

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