Global radiology outreach comes in different varieties, but one of the best examples might be a two-year interventional radiology (IR) education and training program led by Yale, Emory, and Harvard School of Medicine teams traveling abroad.
Scaling IR training in the sub-Saharan East Africa country of Tanzania and beyond to Nigeria ultimately means subjecting fewer people to invasive surgery, potentially protecting people from the risks of anesthesia and dangerous postsurgical infections, and providing access to surgical procedures that address the needs of women and young girls, in particular, who may marry at 10 years old.
The advantages of interventional radiology are more pronounced in low-resource settings because the need in Africa is more acute. Healthcare teams can simply achieve more with IR, according to the co-founder of the Road2IR training program, Yale's Fabian Max Laage Gaupp, MD. Laage Gaupp joined Saurabh (Harry) Jha, MD, along with global IR enthusiast Stephen Hunt, MD, PhD, of Penn Radiology for this episode of the "Keeping Up With the Radiologists" podcast series.
"We essentially are building an axis in Africa, if we can, of people who can network together and help each other out both in terms of technical training but also in terms of supplies, also in terms of lobbying their various governments to give more resources. All of these things have to be done as a community, and we're building that community." — Stephen Hunt, MD, PhD, Penn Medicine
Africa is poised to hit a population of 1.2 billion by 2043, according to some estimates. Tanzania's population is currently around 65.4 million.
Although African countries will have unique sociocultural elements, and policies and goals that vary the political and healthcare business climate and supply chain, Africa should be considered a fruitful ground for expanding radiology practices globally, the radiologists discuss as they unpack the Road2IR program, how it worked, and lessons learned.
When Road2IR began taking shape in 2017, there were no practicing interventional radiologists in Tanzania. What was there was capacity and the support of hospital leadership, Laage Gaupp explained. The infrastructure was far from ideal, but the team wouldn't wait for the perfect setting, as you'll hear in this episode.
"What we've learned in Tanzania is that sometimes you just need to freestyle to a degree." — Fabian Max Laage Gaupp, MD, Yale School of Medicine
The Road2IR team set a goal to train three interventional radiologists per year as part of the two-year interventional radiology program, training added on to the existing three-year diagnostic radiology program, Laage Gaupp said.
Because interventional radiology requires in-person mentoring and patient follow-ups, planning for Road2IR involved recruiting volunteer teams of attending IR physicians, nurses, and technologists, navigating supply logistics, and securing visas and housing. Teaching trips were two weeks long, 10 months out of the year, or monthly.
Grants from the RSNA and Doximity, for example, helped the Road2IR interventional radiology training program, as did other donations. As the program would sometimes be on "the brink of collapse, something would come through," Laage Gaupp said. Road2IR received a $75,000 grant in 2020, for example. The infrastructure would expand in time.
A five-year program update published in March in the Journal of Vascular and Interventional Radiology offers Road2IR training program details not covered during the podcast. The training model's growth and quality were evaluated over a five-year period to determine whether the project created a sustainable foundation for IR services and training.
From October 2018 to July 2022, 1,595 procedures were performed: 1,236 nonvascular and 359 vascular, all with local fellows as primary interventional radiologists, according to the JVIR article.
Of these, 97.2% were technically successful, 95.2% were without adverse events, and 28.9% were performed independently by Tanzanian fellows and faculty with no difference in adverse event and technical success rates, according to authors that included Laage Gaupp and radiology colleagues from Harvard Medical School, Emory University School of Medicine, and the University California San Francisco, as well as Erick Mbuguje, MD, of Muhimbili National Hospital in Tanzania and Ivan Rukundo of Rwanda Military Hospital in Rwanda.
Ten IR physicians graduated from the Road2IR interventional radiology training program during the study period, followed by another three per year going forward. Partner training programs in Uganda and Rwanda mirroring the model commenced in 2023 and 2024, respectively. The authors of the JVIR update, the second since 2019, concluded that the training model "offers a practical and effective solution to meet many of the challenges associated with the lack of access to IR in sub-Saharan Africa."
Importantly, this Keeping Up With the Radiologists episode highlights that it is possible for some countries in resource-limited settings to build and retain a talented and skilled medical workforce if people are trained in their local environments. The episode offers a glimpse of the special needs of low-income and middle-income countries, where medical specialization is accelerating but still lags behind more developed and resource-rich countries.
"You've got to get the engine running, and then after a while, you find different places that you can stop and get your gas." — Stephen Hunt, MD, PhD, Penn Medicine
Penn Radiology's Hunt, a physician-scientist and interventional oncologist focused on precision medicine and cancer research and treatments, adds lessons learned from his global outreach work abroad in Nigeria and Nepal. Hunt advises the following:
- Identify the framework of hospital leadership that is willing to support building a program.
- Funding has to be there.
- Address how you'll get consumables and supplies there.
Hunt also reflects on his experiences in Nigeria in contrast to Laage Gaupp's in Tanzania, as you'll hear in this episode.
In Nigeria, more radiologists still leave than stay, the challenges greater in many respects. The work started with fundamental nonvascular procedures, in a hospital without a thoracoscopy or angiography suite at the time, Hunt explained. Ultrasound and ultrasound probes were key to progress because of the equipment's advanced technology for minimally invasive image-guided procedures and low cost.
"Train them on what they have," Hunt said, crediting companies such as Boston Scientific, Merit Medical, Varian, and Siemens Healthineers for their contributions toward building the supply networks.
Penn's program in Nepal is now teaching midwives to do high-risk pregnancy ultrasound.
Road2IR now serves as a blueprint for partner programs in Rwanda and Uganda, aiming to bring minimally invasive IR procedures to more patients in East Africa and beyond.
"We have a blueprint now. Things are going to be different from one country to another. Don't try to impose things." — Fabian Max Laage Gaupp, MD, Yale School of Medicine
Hear more details and commentary about Laage Gaupp's path to global outreach, get a sense of the regional partner program, and hear more reflections from Hunt. Listen now.
More impressions from this episode:
{01:59:11} How Laage Gaupp got to Tanzania with Road2IR
{03:59:01} What interventional radiology training means to Africa
{06:05:15} For anyone thinking of trying global work in Africa
{07:23:21} How the program started in Nigeria
{09:19:22} Don't let perfect become the enemy of good
{11:01:11} How do you begin training people abroad?
{12:33:22} Time commitment for global initiatives
{15:40:04} Building Road2IR, financing, foundation, fundraising, TikTok
{26:51:25} What's the motivator?
{31:57:12} Impact of global outreach, scaling radiology in Africa
{34:33:26} Medical and surgical needs in Nigeria
{36:15:25} Competition getting started, willingness to collaborate
{37:53:12} What makes a country good to work with and red flags
{42:25:27} Successes in Tanzania, obstacles in Nigeria
{47:04:00} Regional partner program, integrated network
Featured:
Saurabh (Harry) Jha, MBBS, is an associate professor of radiology at the Hospital of the University of Pennsylvania. Jha obtained a master’s degree in health policy research from the Leonard Davis Institute at the University of Pennsylvania. He earned his medical degree from the United Medical and Dental Schools of Guy’s, King’s and St. Thomas’ Hospitals. Jha developed Value of Imaging, a set of radiology educational resources.
Fabian Max Laage Gaupp, MD, is co-founder of Road2IR, an international accredited interventional radiology training program in Africa led by Yale School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, Emory University, and other institutions in North America and Europe. Laage Gaupp specializes in minimally invasive treatments for men and women.
Stephen Hunt, MD, PhD, is a physician-scientist at Penn Medicine and an assistant professor of radiology at the Hospital of the University of Pennsylvania. Hunt co-directs the Penn Image-Guided Interventions Laboratory and has worked abroad for global radiology outreach.
