RADIOLOGY PARTNERSHIP IMPROVES CARE THROUGH TRAINING

With a friendship built on chai and samosas, Loice Sitienei, MBChB, MMed, and Matt Johnson, MD, are growing the long-standing AMPATH radiology collaboration with new education and care efforts at Moi University School of Medicine (MUSoM) and Moi Teaching and Referral Hospital (MTRH) in Kenya.

Dr. Matt Johnson and Dr. Loice Sitienei

Dr. Sitienei, chair of the Department of Radiology and Imaging at MUSoM and a radiologist at MTRH, and Dr. Johnson, associate director of global health for radiology and professor of radiology, imaging sciences and surgery at IU School of Medicine, are coordinating remote radiology lectures by IU School of Medicine faculty for 22 radiology residents at MUSoM and are working towards the establishment of a more robust interventional radiology clinical service at MTRH and eventually an interventional radiology fellowship.

“Having the subspecialists teach our residents is a game changer for us,” said Dr. Sitienei. “We are having subspecialists who are very good at specific subjects teach our residents far better than I would do as a general radiologist.” During the past 8 months, more than 54 remote lectures have been delivered by IU School of Medicine faculty (subspecialists) on topics such as chest imaging, abdominal imaging, breast, pediatrics and nuclear medicine.

“The foundation of AMPATH is taking what people are good at and sharing it,” said Dr. Johnson. “We had many people here at IU who wanted to help, but they were unsure how. The remote lecture series proved to be the perfect conduit for them. It's pretty exciting.”

Atul Agarwal, MD, assistant professor of clinical neuroradiology at IU School of Medicine, delivered one of the lectures. He and Dr. Johnson both plan to travel to Kenya in the new year with residents from IU and Duke University. “He's a great neuroradiologist teaching what he does best every single day to our residents” said Dr. Sitienei.

There are just three full time radiology faculty at Moi University and a total of 12 radiologists at MTRH. Overall, Kenya currently has about 200 radiologists total for a population of more than 54 million people (about 1 per 270,000 people). In contrast, there is one radiologist per approximately 6,000 people in the U.S.

Dr. Sitienei believes the lecture series is contributing to improved student performance and patient care. “You could tell, these students have more confidence and radiology content than they had previously,” she said. “And I believe that translates also to healthcare.”

The IU team is now looking into the possibility of sharing existing lectures created for IU learners with the three classes of radiology residents. “That would be great, because we have first, second and third-year residents whose needs are different at any particular point. So, with online recorded lectures, the residents can listen to them according to their area of interest or need at that point,” said Dr. Sitienei.

The new initiatives build on many years of AMPATH radiology collaborations in education and care programs that have previously been led by Joseph Abuya, MBchB, MMed, Moi University, and Marc Kohli, MD, from AMPATH Consortium partner University of California-San Francisco.

Dr. Sitienei in Indianapolis

Dr. Sitienei traveled to IU this summer for several weeks and the clinical exposure opened her eyes to even more possibilities. Among her many experiences, she spent time with Katie Neimeyer, MD, a breast radiologist and assistant professor of clinical radiology and imaging sciences at IU School of Medicine, who is also making trips to Kenya and working to improve breast imaging education and care. “The visit made a difference and was a great experience. New skills were acquired such as clip and wire localization for breast tumors. It also allowed me to know what areas we can improve on at MTRH such as better specialized viewers for mammography.” said Dr. Sitienei.

The AMPATH colleagues have more big plans for the future of radiology in western Kenya.

As an interventional radiologist, Dr. Johnson uses the most current imaging technology to stop internal bleeding, treat cancer, place shunts and catheters, drain fluid and so much more. “I used to think that maybe jet fighter pilot was cooler, but this the coolest job there is. Best job you can possibly have,” said Dr. Johnson.

At IU, interventional radiologists use fluoroscopy inside an angiography suite to see inside the human body. Dr. Johnson describes it as a “live x-ray.” A person lies on a table with an X-ray source underneath them and an image intensifier that receives the X-rays above them. That system allows an interventional radiologist to see internal organs in real time and to fix things inside the body using needles, wires, and catheters rather than through surgical incisions. “It’s almost magic,” mused Dr. Johnson. He said that there are literally procedures from head to toe that can be performed with interventional radiology (IR) techniques.

His life’s dream is to bring an angiographic machine to MTRH, “But it costs a million and a half dollars,” he lamented.

The entire country of Kenya currently has just 9 interventional radiologists compared to 22 at IU Health in Indianapolis where Dr. Johnson practices. Dr. Daniel Chepsorir and Dr. Cornelius Kepchirchir are the only interventional radiologists at MTRH.

Without an angiographic unit, they perform IR procedures using ultrasound or CT guidance. Despite working long hours every day, the wait for a procedure is long and the procedures that can be done without fluoroscopy are limited.

 “We would help prevent many deaths, for example from road traffic accidents. We have patients who come in bleeding from pelvic or other fractures, and we lose some because we are not able to do some of these minimally invasive procedures,” she continued. “Oncology patients can be assisted in IR from diagnosis, through treatment and even palliative care such as pain management.”

An angiographic machine would also enable a fellowship in interventional radiology at Moi University. Dr. Sitienei and Dr. Johnson are already drafting a curriculum. “I want to go and teach people how to do IR. That's what I'm good at,” said Dr. Johnson who is past president of the Society of Interventional Radiology (SIR). Dr. Sitienei dreams of being one of the first fellows in the Moi University IR fellowship program.

“That would definitely change healthcare, because we would be able to train more interventional radiologists which would reduce waiting time for these patients and allow earlier diagnosis and treatment,” added Dr. Johnson.