Enhancing the resident experience with global health electives.

Received April 23, 2011; accepted after revision July 28, 2011. H ave you ever wondered how you would do your job if the power went out for several hours each day? How would you work up an abdominal mass without access to CT, MRI, or pathology? What kinds of diseases occur in places without vaccination programs, access to clean water, prenatal care, or antibiotics? As radiology residents in the United States, we have the opportunity to use the most advanced diagnostic and interventional tools and make important contributions to patient care. However, we may become quite reliant on these advanced imaging modalities to make simple diagnoses. Global health electives can provide the trainee with a broader vision of health care, while bringing much-needed medical imaging services to patients with limited access. During my fourth year of radiology residency, I arranged a 4-week radiology rotation at Kilimanjaro Christian Medical Center (KCMC), a 500-bed tertiary hospital at the base of Mt. Kilimanjaro in Tanzania (Fig. 1). After an Internet search of available programs, I chose KCMC to work with Dr. Helmut Diefenthal, a retired radiologist who has been running a rigorous radiology training program in Tanzania for the past 20 years. Dr. Diefenthal spent his early life as a medical missionary, working as a general practitioner in rural clinics in Malaysia and Tanzania. After teaching himself how to obtain and develop radiographs to diagnose patients with tuberculosis, he developed a passion for imaging and decided to pursue a radiology residency in the United States, with the aim of someday returning to Tanzania. At the age of 65 years, he retired from his practice at the University of Minnesota and moved back to Tanzania to establish the radiology department at KCMC, now a highly functional department performing 70–80 radiographs, 50–70 sonograms, 10–20 CT scans (using a single-detector CT scanner), and several fluoroscopy studies daily. Dr. Diefenthal’s efforts have greatly increased radiologic expertise in East Africa. He has trained more than 15 radiologists in a 4-year training program and 65 assistant medical officers (AMOs) in a 2-year training program. The workdays at KCMC were long, usually running from 7:30 a.m. to 8 p.m. The day began with visits from orthopedics, surgery, medicine, and pediatrics services to review all of the abnormal imaging results from the prior day. These daily multidisciplinary sessions were incredibly useful for patient care and teaching. We also visited the patient floors often to perform ultrasound or deliver abnormal results because there was no paging system. I felt as though we were practicing in a different era, one before high volume and digital imaging isolated us from our patients and colleagues. After the morning conferences, we covered the various services (radiography, ultrasound, echocardiography, CT, and fluoroscopy), breaking for lunch and lectures from 3:30 p.m. to 6 p.m. and returning to the hospital for more film reading from 6 p.m. to 8 p.m. (Fig. 2). As a visiting resident, I taught informally throughout the day and gave a series of lectures to the residents. Many of my cases, such as diagnosis of hepatocellular carcinoma or acute aortic syndrome, were based on multiplanar and multiphasic CT and MRI, modalities not available at KCMC. At times, I thought that these cases were impractical. However, the residents were eager to learn these concepts, knowing that it was only a matter of time before more advanced imaging became available to them. In return, they taught me ultrasound and echocardiography and shared with me their personal stories. Many residents had struggled and left their families behind to pursue their training in radiology. The experience of working side-by-side with Dr. Diefenthal, a knowledgeable and hardworking 85-year-old, was very memorable (Fig. 3). I learned about diseases that we rarely Sekhar et al. Global Health Electives