Road2IR program

Created - 01.09.2022

We recently visited Dar es Salaam, Tanzania and spent two weeks at the Muhimbili National Hospital (MNH) as part of the Road2IR program. This is a phenomenal success story that we wanted to share with our fellow BSIR/RCR members, and hope that it will inspire some of you to reach out and find other such rewarding opportunities.

The Road2IR program was started in 2017 by Fabian Laage Gaupp and Frank Minja from the United States, together with Azza Naif, Erick Mbuguje and Ivan Rukundo from MNH, Tanzania’s largest public tertiary referral medical centre. At the time, there were no interventional radiologists in the country, and there was a need to establish a training program. Road2IR started o® with US based volunteer teams of radiologists, nurses and technologists (radiographers) travelling to Tanzania for two weeks every months, supplemented by additional online teaching. Tanzanian trainees were enrolled into a two year Master of Science program.

Shemin

I came across the program during a chance conversation in September 2020 with my friend Dr. Khalid Ballal, a consultant IR at King’s College, London. I had been looking to get involved with an outreach teaching/training program, and Khalid told me about his Road2IR experience. The following morning I had a chat with Fabian, and we settled on provisional dates in January 2022. Management at Manchester Foundation Trust kindly agreed to support me and sanctioned my leave. The Road2IR team arranged my medical indemnity along with a letter of welcome from the hospital authorities. They booked my flights and arranged accommodation in a very comfortable Airbnb apartment within walking distance of the hospital, and on 15 January I found myself boarding a flight from Manchester bound for Dar es Salaam.

I was received at the airport by a couple of the IR fellows, who helped me settle in. Monday morning 7:30 AM saw our first team meeting, where I was introduced to all the fellows as well as Dr. Naif, who is now one of the first two junior IR faculty in Tanzania, having completed her two years of IR fellowship through the program in September 2021. In total, the team currently comprises of two junior faculty, seven second year fellows, four first year fellows, two trained nurses qualified to give sedation, and three radiographers. Each day starts with a morning brief where the list is discussed and each case presented in detail by the fellow who will be performing it. An outpatient clinic runs in parallel with the operative list. In the evenings, the fellows summarise the day and share any learning with the team.

During the following two weeks, we undertook several fluoroscopy and ultrasound guided procedures. Since the kit is largely sourced from surplus supplies from several countries and various institutes, each procedure must be planned carefully by looking through the available hardware to identify the best possible combination of kit. There is a large element of innovation, and thinking on your feet. More complex cases such as TACE, central vein recanalization and lower limb angioplasty were performed in the hybrid theatre which is a part of Muhimbili Orthopaedic Institute (MOI). These latter procedures are areas of expansion for the service, and they will look to rapidly increase their numbers in the coming months.

For my part, I focused on close supervision and one to one teaching and training with the fellows as they performed the cases. On occasion, there was a need to scrub in to provide some hands-on support. The team is extremely enthusiastic and hardworking, which made the whole experience all the more enjoyable. The patients are grateful for their care, and it is plain to see that the introduction of IR services has been a boon to the hospital and the population it serves.

Apart from practical teaching, we took time out during the afternoons and evenings between and after cases to engage in some didactic teaching. This was in addition to regularly scheduled Thursday afternoon online teaching sessions. It wasn’t all work, since the team is used to welcoming visiting faculty on a regular basis. During the evenings, di®erent fellows would accompany me to di®erent parts of the city where I had the opportunity to enjoy varied local and international cuisine. Dar es Salaam is a large and vibrant city and a beautiful place to visit. Since the service currently runs Monday to Friday, I also managed to squeeze in a one day safari to Mikumi National Park on the intervening Saturday.

This trip has been one of the most fulfilling and enjoyable experiences of my life. The Road2IR program is a wonderful story, and I feel privileged to have been a small part of it. I plan to visit again in July, and am already looking forward to it!

Greg

My previous work in Uganda for a similar project allowed me to meet Fabian and his wonderful team in Tanzania at an SIR conference in Austin in 2019! The passion and determination were contagious and made me actually believe that this is a viable training model for African countries to increase the desperately low number of interventional radiologists in the country.

Unfortunately, life and of course Covid got in the way and I only managed to fulfil my promise to the team in Tanzania this last January when I also had the opportunity and pleasure of spending 10 days with the team at MNH. As with Shemin, the team made sure that I was very well looked after and that I had everything I needed to settle in. The days were long but very productive. We were starting with a team briefing which was followed by cases and patient clinics. I was impressed by how many different types of procedures the team can actually now perform given that 5 years ago there was no interventional radiology service!

It was also great to see trainees outside Tanzania coming to Dar es Salaam to train in order to then transfer their knowledge back to other African countries like Rwanda and Nigeria! Despite the limitations in kit the team has also managed to build a significant stockpile however there is always need for donations of kit and especially of drains and biopsy needles. Unfortunately, the supply chain is still non-existent and we need more help and support by the medical devices industry to change this and offer life-saving interventions to the people of sub-Saharan Africa.

Finally, as in Shemin’s case my time there was not just all work and no play. During my weekend off I had the opportunity to visit the beautiful island of Zanzibar, where I had the opportunity to go on a boat trip to the famous prison island and taste local flavours at a spice tour somewhere in the jungle of the island. My trip to Tanzania was an unforgettable experience and I would unreservedly recommend it to anybody who wants to combine having a great time with some volunteering work and support the growing IR movement in sub-Saharan Africa!

Dr. Shemin Abhay Mehta, Consultant Interventional Radiologist, Manchester University Hospitals NHS Foundation Trust

Gregory Makris, Honorary Interventional Radiology Consultant, Guys and St Thomas’ Hospitals, London