WFPI Member Organizations: Teaching & Training in Medically Underserved Areas

 


 


TB infection control - teaching in Swaziland, SASPI

TB infection control in Swaziland is a priority health concern given the high rate of people living with HIV/AIDS and co-infected with TB (85%in adults and 60% in children).

The South Africa Society of Paediatric Imaging/SASPI (click here and scroll down for details) has expanded its mission to include outreach support to centres in South Africa and neighbouring countries lacking paediatric radiology expertise.

ICAP (Columbia University) has been supporting regional multidisciplinary mentorship teams in Hhohho, Lubombo and Manzini Regions in their integration of HIV and TB issues into health facilities in collaboration with CDC Atlanta and the MOH. ICAP has also been working with the national HIV and TB program to reinforce and centralize TB/HIV collaboration activities including building technical capacity of site providers to decentralize TB services.

In this regard, ICAP and SASPI collaborated and planned an outreach activity in September 2014 to develop skills for radiology use to diagnose and manage TB in children in different referral health sites. The activity entailed a 3 day visit from radiologist Dr. Jaishree Naidoo (Charlotte Maxeke Hospital, Johannesburg, and  President, SASPI) and radiographer Mrs Stella Legoabe to conduct on-site radiology sessions with radiology technicians and clinicians. 

The visit rationale: support a QI exercise on the radiology department with the technicians and  facilitate an on-site session with physicians to strengthen their reading skills of X-rays and with sonographers in point of care ultrasound when diagnosing TB in children. 

Image: general store towards Pigs Peak mountain region in Swaziland. © Caitlain, Hertfordshire, UK


CENTRES VISITED:

GOOD SHEPARD HOSPITAL, LUBOMBO REGION - the current regional referral hospital of the Lubombo Region. It covers a region with mainly a rural population of around 200,000 inhabitants. The hospital offers 250 beds and provides adult and paediatric services (OPD, IPD, HIV clinic, TB clinic, general surgery, ophthalmology). There is no paediatrician or radiologist present; general practitioners and nurses are allocated to paediatric services. The clinicians interpret the x-rays. The facility offers 3 radiographers, 1 trained in sonography. Image right: Jaishree Naidoo teaching at GSH

PIGS PEAK HOSPITAL, HHOHHO REGION - the current regional referral hospital of the Hhohho region. It covers a region with mainly rural population of around 200,000 inhabitants. HIV care and treatment services include integrated and comprehensive clinical care (i.e ART initiations, ART refills, Pre- ART, diagnosis and treatment of TB). The outpatient department provides services to an average of 2600 patients per month. There is 1 paediatrician in the hospital, no radiologist,  2 radiographers and 2 supportive staff in X-Ray. Image left: Pigs Peak Hospital

MBABANE GOVERNMENT HOSPITAL,HHOHHO REGION - the current national
referral hospital of the Lubombo region. It offers 440 beds. Available health care services: HIV clinic, TB clinic, cervical cancer screening, Cryo and Leep therapy, KS clinic, ICU, Surgery, and Radiology. MGH hospital /ART clinic provides mentorship and supervisions for 12 baby clinics with a catchment population of 63,726 people. 
There is 1 radiologist, Dr Chen from Taiwan, who is an adult chest specialist. Dr Chen reports on the plain films, and CT’s. A trained sonographer does the ultrasounds. There is 1 paediatrician in the hospital. Image right: Mbabane Government Hospital

BAYLOR CENTER in Mbabane. Dr Pilar Ustero Alonso, the global TB program associate director of the Baylor College of Medicine, took the SASPI team on a tour of the Baylor Center and the new TB Clinic due to open in 2 months. This TB clinic will be freely available to the public. Patients will have access to investigations like gene expert and the necessary radiological investigations for adequate diagnosis of TB. There will be a digital x-ray and ultrasound machine.

Discussions were held on SASPI’s possible involvement in training new staff in Paediatric X-ray, ultrasound technique and interpretation of pulmonary and extra pulmonary manifestations of TB. Oportunities for telereading assistance were also explored.


   

Stella Legoabe (above left) and Dr. Jaishree Naidoo (above right, below) teaching radiographers and radiologists on the lateral chest X-ray and PoC ultrasound



During the teaching and training sessions at the different centres, the critical importance of lateral chest x-rays in assisting with the diagnosis of TB was emphasized. Click below for 7 minutes videso on the interpretation of frontal and laterial x-rays in TB, produced by SASPI member Prof. Savvas Andronikou.

 

Savvas' Seven Minute Snippets

Interpreting CXRs 
Pediatric tuberculosis
Clues from the frontal film 

http://vimeo.com/77954925 

          

 

Savvas' Seven Minute Snippets

Interpreting CXRs
Pediatric tuberculosis
Clues from the lateral film

http://vimeo.com/77954926 

 


The SASPI team also observed that ultrasound equipment lacks a linear, high frequency ultrasound probe, essential for better detection and assessment of splenic micro abscess/lymphadenopathy in TB.  

The future 

Due to the shortage of specialists, paediatric x-rays are interpreted by the medical officers and interns. These doctors need support in interpretation of difficult cases. However, there is no digital x-ray machine and therefore images would need photographing for uploading via mail/a platform. SASPI has offered to assist the doctors in the interim but a more sustainable solution needs to be found.

The new TB clinic at the Baylor Center is a welcome addition to Swaziland's healthcare services as it will provide access to pathology and radiological investigations in one center. SASPI has offered it assistance with the training of the new staff in paediatric x-ray and ultrasound technique and interpretation of pulmonary and extra pulmonary manifestations of TB.

Click here for WFPI's TB Corner



Ultrasound, Rwanda

 

The French-speaking Society for Pediatric and Antenatal Imaging (SFIPP) offers assistance to medically underserved areas as part of its scope of action.

 

The 2nd course of pediatric Ultrasound for general practitioners was held in Rwamagana, Rwanda, organised by Drs Anne Geoffray and Edith Rivoal, pediatric radiologists in France and members of SFIPP (French society for pediatric and prenatal imaging, WFPI member). 25 general practitioners (GPs) coming from all district hospitals or health centres in Rwanda attended this 4 days course run from 3-6 February 2014. The educational aim: provide these primary health centres' GPs with the basics of pediatric ultrasound so as to diagnose their patients and make timely decisions regarding the transfer of patients to another hospital for further surgical treatment or imaging.

There are only 7 radiologists in Rwanda for a population of 10 million people. All of them work in Kigali and have access to CT and MRI.

Photo: students and teachers, 2nd course of pediatric ultrasound for general physicians, February 2014, Rwamagama, Rwanda 

This second course was again both theoretical and practical:  theoretical presentations in the morning (normal anatomy, main pathological anomalies, how to reach a diagnosis, etc.),  practice on patients from local facilities in the afternoon. Every doctor attending the course was able to  conduct practice studies on each day of the four days. The course covered all  pathologies, with a main focus on abdominal, and the teaching included transfontanellar for  neonatal evaluation. All the participants were actively engaged in the course, raising many questions. A short evaluation was undertaken on the last day.

As was the case last year, we plan to stay in contact and monitor this group so to ascertain the realities of their practice and discuss their difficulties with them. We could consider organising a second-level course in the coming years. For us, the teachers, it was again a busy but rewarding time. The students are enthusiastic and willing to learn, the needs are important. We also learned a great deal through our involvement in this educational initiative.

Anne Geoffray, Edith Rivoal
01/04/2014 

 

Pediatric Imaging training, Palestine

Dr. Aadil Ahmed, a SASPI (South African Society of Pediatric Imaging member, visited Palestine in June 2013. Here is his report.

I was in Gaza from the 15th to the 22nd June 2013. The IMA (Islamic Medical Association of South Africa) put me in contact with PMA (Partners Medical Aid) who arranged the trip with the Palestinian Health Ministry.

Gaza is approximately 41 km long with a maximum width of about 15 km, and is completely enclosed with minimal access via the Rafah border crossing with Egypt (image left). It hosts a population of about 1,8 million people. The 4 largest government-run hospitals are Shifa Hospital (largest, but mainly adult services, with some pediatric surgical service), Nasr Hospital, Rantissi Hospital, and European Gaza hospital. There are a handful of radiologists with various levels of training. A radiology training program has been started, currently with about 8 trainee radiologists. The program is struggling due to poor equipment, lack of supervision, and no structured teaching program and radiology service.

I spent 3 days at the two paediatric hospitals and one day at European Gaza hospital, delivering pediatric radiology lectures to radiologists and some to the paediatric department as well. I also conducted practical paediatric ultrasound  and fluoroscopy training, and went through interesting and difficult MRI and CT paediatric cases.

Nasr Hospital for children: about 150 beds with PICU, neonatal ICU and outpatients. Small, poorly equipped radiology department:- x-ray unit, and poor ultrasound(better ultrasound machine in neonatal ICU for portable studies performed there). One general radiologist, a MO, and some trainees that rotate. Large compliment of paediatricians. Teleconferencing facilities.
Nasr Hospital, reception

Rantissi Specialist Paediatric Hospital: Oncology, renal, neurology, surgery departments. Equipment: digital fluoroscopy unit, conventional x-ray, multi-slice CT(6 slice), ultasound(very poor quality, no Doppler capability). There is one recently qualified radiologist running this department, with some trainee's rotating through. MRI cases are sent to the European Gaza hospital, but there is limited access and no MRI anesthesia service.

CT, Rantissi Hospital

 

European Gaza hospital:
serves the southern part of Gaza. Adult and paediatric hospital  with 250+ beds. Reasonable equipment: 64 slice CT, 1.5T MRI, ultrasound and conventional x-ray. Fluoroscopy unit was down.