ACR Bulletin

Covering topics relevant to the practice of radiology

Training That Transcends

The recipient of the 2018 ACR Foundation Global Humanitarian Award reflects on his efforts to improve radiological care in Tanzania.
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Seeing our trainees become some of the most successful practitioners in the country has been incredible.

June 01, 2019

The World Health Organization estimates that two thirds of the planet do not have access to basic radiology services: simple X-rays and ultrasounds. Improving that access to quality radiological  services in lowand middle-income countries is important to the College. Each year, the ACR Foundation selects an outstanding radiologist, organization, or program for its Global Humanitarian Award. The Bulletin spoke with the 2018 recipient,  Michael T. Nelson, MD, FACR, of Minnetonka, Minn., who has spent his 25-year career training assistant medical officers (AMOs) and radiology residents in  Tanzania.

How did you first get involved in humanitarian work?

At the University of Minnesota, I had a professor named Helmut C. Diefenthal, MD, PhD, who was the originator of the radiology program at Kilimanjaro Christian Medical Center in Moshi, Tanzania. He  taught me how to do biopsies. When he retired, he started a residency program in Moshi and asked me to give the radiology boards. Diefenthal also had this vision to train AMOs — similar to physician assistants in the U.S.

The first time I went to Tanzania was in 1988. Every year, I return there to give the boards, provide lectures, and serve as a consultant. We’ve now trained close to 150 AMOs across the country. In Moshi, they now have X-ray and ultrasound capabilities and — in some of the bigger cities — CT scanners. Over the past 28 years, I’ve been to Tanzania 33 times.

How have radiological services changed in Tanzania throughout your work there?

There are many more services available in Tanzania now than there were in the 1980s and 1990s. The last trip we took was in January. We presented two workshops on breast and liver screening. 

The nonprofits I work with just built an infusion center and are building a cancer ward next to it in Moshi. We’ll be assessing and building radiation therapy services there. The cancer center will allow  radiologists to see about 100 patients a day. The centers are funded by two nonprofits — the East Africa Medical Assistance Foundation and the Foundation for Cancer Care Boards in Tanzania.

What big challenges still exist in Tanzania?

Initially, the obstacles were that we didn’t have much funding. We also had limited equipment and facilities — so just trying to train and optimize the radiology services was a big challenge when I  began volunteering. Now, the biggest issue is trying to get patients to the clinic. We have a large area of 18 million people over a 300–500 mile radius, so usually the families accompany the patients  via bus or truck. We tried to obtain some funding for travel so the patients could get there, but Tanzanian radiologists could only treat about 7 percent of the population. That’s why we developed a  second radiology center in Northern Tanzania.

However, it was the residency program and training that really made the difference in care in the country. Today, the local physicians have really taken it over. The country’s healthcare system has been  rapidly expanding in the last five to ten years. They now have digital radiography, portable US, and PACS with digital reading.

Can you share any specific success stories?

Seeing our trainees become some of the most successful practitioners in the country has been incredible. Both the past and current chairs of the Kilimanjaro Christian Medical Center in Moshi were  trainees in our program. Ahmed Jusabani, MD, was in our first graduating class of doctors and is now an all-star in Tanzanian radiology. He has developed a really nice department with CT, MRI, and  IR labs at Aga Khan Hospital in Dar es Salaam. We’re really proud that every graduate gets a portable US unit when they leave the program. 

How has your volunteer work impacted you personally? 

It’s fulfilling to see the Tanzanians take this on as a project and continue it self-sufficiently. Now, they’re training other residents to perform radiological services. It looks like the training program will  transcend our group here in the United States because Tanzanians can now help train themselves. That doesn’t mean we won’t continue to help as consultants.. It’s rewarding to see progress in Tanzania on several different cancers, such as liver and breast cancer. It’s one of the few times you can actually see outcome changes on the work that you did.