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ACR 2019 Global Humanitarian Award winners bring radiology to those most in need
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A lot of doctors go into an area and perform procedures for hundreds of patients and then leave — they’re done. My goal is bringing in new equipment, meeting the technicians and RTs, and choosing locations where the program will most likely succeed.

—Richard N. Hirsh, MD, FACR
August 07, 2019

Women are the bedrock of our societies. That belief drives the work of this year’s ACR Foundation’s 2019 Global Humanitarian Award winners, who are making a global difference in the lives of women, their families, and communities by creating accessible breast health services.

The Global Humanitarian Award (GHA) recognizes individuals, organizations, and programs committed to increasing access to quality radiology services in developing and underserved countries. The World Health Organization estimates that half of the world’s population lacks access to basic radiological services, and the ACR Foundation hopes this recognition will encourage more volunteer outreach to improve patient care globally.

The award for individual work went to Richard N. Hirsh, MD, FACR, a radiologist who, for more than 30 years, has led breast cancer and mammography training projects in multiple countries in Eastern Europe and Central America, as well as India, Israel, and Vietnam. Following the early years of his work, Hirsh decided to set up his own nonprofit, Radiology Mammography International.

Residual Radiology

Creating sustainable programs for breast health, cancer detection, and treatment has always been the goal, Hirsh says. “A lot of doctors go into an area and perform procedures for hundreds of patients and then leave — they’re done,” he says. “My goal is bringing in new equipment, meeting the technicians and RTs, and choosing locations where the program will most likely succeed.”

Mammography equipment has been donated over the years by large medical equipment and imaging companies. “We try to leave one or two machines at different sites in the country we’re visiting,” Hirsh says. “Many of these areas, especially in the Balkans, were at one time war-torn.” Whatever radiologists they may have are likely overworked, understaffed, and have little or no equipment when Hirsh and the team arrive.

Hirsh tries to return about six months after the initial visit to the country. On the next trip, the team of radiologists and RTs provide breast imaging and address staff and patient questions. Field service engineers are there too, making any necessary repairs to the equipment. Health educators are also an important component of the team, Hirsh says, as well as anyone who speaks the native language. Letting the local community know about the availability of services and emphasizing that you want the program to work long-term are key to these types of efforts.

Hirsh says his volunteer groups set out to train local healthcare staff and volunteers on how to use new mammography and US equipment. “Everything we do here in the United States we try to share — our knowledge and our skills.”

Hirsh says that people have asked him over the years why he doesn’t focus on things like clean water, immunizations, or other basic, life-saving medical services. “It’s simple,” he says, “I focus on breast cancer because I’m a radiologist. If I were some other kind of doctor, maybe I’d focus on other things.” Plus, he adds, especially in underdeveloped countries, it’s critical that women get the healthcare attention they need. “They are the core of the family — the foundation, in any society,” says Hirsh. “They are a stabilizing force.” The majority of cancer cases — 57 percent — now occur in low- and middle-income countries. And 65 percent of cancer deaths worldwide occur in these countries.

Trailblazing Teleradiology

Mamotest, a telemammography network (the first in Latin America) in Argentina, won the GHA organization award. The Pan American Health Organization has ranked Argentina as second most at risk for breast cancer deaths in all of Latin America — with approximately 20 women from that country dying each day from the disease.

“My father is a radiologist, a breast imager. He used to visit me when I lived in Europe, where I worked mostly as an entrepreneur involved in start-ups,” says Mamotest founder Guillermo E. Pepe. “He would express to me his frustration about the situation in Argentina. He said that all the women he diagnosed had come to him too late.”

“Our network of clinics allows us to support women who have few economic resources by giving them access to a quality breast exam,” says Pepe. Yearly breast exams are hampered by lack of technology (old analog equipment), a shortage of breast imagers in rural areas, and few national wellness campaigns to stress the importance of breast screening.

Mamotest now runs a dozen diagnostic clinics in six provinces throughout Argentina. These clinics are set up with state-of-the-art mammography units (digital and 3D) and equipped for breast US and stereotactic biopsy. This is giving women access to screening services once out of reach — before it’s too late. The imaging performed at the clinics is sent to a central location, where radiologists and other medical specialists evaluate the scans and submit a report — usually within 24 hours.

Pepe spends a lot of time trying to raise capital and expand Mamotest’s services to more women. “We also promote new laws in Argentina that will support women’s healthcare,” he says. According to Pepe, Mamotest has been credited with the passage of new legislation that allows women one workday off per year to see their OB-GYN and to get a mammogram.

“The good news is that many organizations — state government and the Catholic Church — are supportive of what we want to do,” Pepe says. “The challenge is that Argentina is lacking in economic resources. We’re really trying to partner with anyone, hospitals or non-governmental organizations, to spread the word about our wellness campaign throughout the country.”

Mamotest is already serving 50,000 Argentinian women each year. “Soon we hope to offer teleradiology services in other Latin American countries beyond Argentina,” Pepe says. Pepe has meetings scheduled with officials in Paraguay, for instance, to explore offering services there.

“We need to democratize access to this kind of high-quality diagnostic care for women,” Pepe believes. “We can prevent suffering and save the lives of the women who are the fundamental rock of our societies.”

Life-Changing Choices

“You don’t find time; you make time,” Hirsh says. All of the projects he has been involved with included teams of professionals who had full-time jobs. They used personal vacation time to make the trip, with no additional pay. “It’s a sacrifice,” he says, “and it takes some convincing to convey the value — not just the value to patients, but the value it brings to physicians as human beings.”

Author Chad Hudnall,  senior writer, ACR Press