I found the East Africa Medical Assistance Foundation on the Internet first.
The Foundation was looking for radiologists to go to the Kilimanjaro Christian Medical Center (KCMC) in Tanzania to teach and work in the radiology department. For a long time I had been thinking of doing some volunteer work so, after some short hesitation, I made up my mind to go.
The KCMC, with its 500 beds, is one of the four regional hospitals in the country of 35 million people. There are 20 permanent radiologists and 30 assistant radiologic officers in the department founded by Helmut Diefenthal, who still works 12 hours a day and manages everything, including the chores. He gives lectures every day at 5 o’clock for the residents (even on Fridays). If there is a visiting professor at the department, he or she gives the lecture in the afternoon.
There are 18 residents, eight doctors and 10 AMOs, who are mainly between 35 and 50 years old, with years of experience as internists or general doctors preparing to be specialists in radiology.
They live far away; some were from Zambia, and one was from Zimbabwe. The transportation is bad and expensive, thus most of them got to see their family two to three times annually.
The conventional X-rays take place in three rooms, on quite old but still working Siemens machines. In one of the rooms, the trauma cases are examined with a mobile X-ray. The fluoroscopy is a Philips Diagnost, with OK quality. The mammography equipment has been out of order for two years. Despite all this, the quality of the pictures is good.
There are five ultrasound machines; one to two transducers belong to each of them. The best is an Ultramark 7 machine, which is used for cardiology examinations very often and for Doppler of the limbs. The CT quality is surprisingly good; it is an eight-year-old Philips Tomoscan SR 4000 spiral.
The hospital works at full capacity, with masses of people flowing from hundreds of kilometers away. The journey takes days sometimes, and the waiting for results and the follow-up appointments take another few days. Since the patients pay for everything, only a few people can afford to go to the hospital.
An average day at the radiology department starts at 7:30 a.m. The different departments come one after another (orthopaedia, internal, pediatrics, etc.), and 60 to 70 X-rays, 50 to 60 ultrasounds and four to five CTs are taken. The patients are almost without exception very severe cases; there is barely a negative result. There is rheumatic carditis; tuberculosis; AIDS; malaria; vitiums; and extreme, untreated fractures. The ultrasound examinations are performed by residents. Besides the stomach, many small parts, the skull, the heart and the eye are examined the most.
There is the strange custom that all patients arrive in the morning. The patients from the ward are taken, too, and everybody waits until they get called. I didn’t see a single negative CT in the four weeks I was there. Brain tumors, bleeding and widespread tumors were detected a lot.
Tanzania is one of the countries most infected by AIDS, which is in the background of the large number of tuberculosis and other opportunist infections in children and adults.
The establishment of this good radiology department, with its effective way of teaching, is a huge achievement. The residents are eager to learn and should be given a lot of respect for choosing an even harder life than being a European doctor.
I gave a lot of lectures, not only for radiologists but for pediatricians, and I took part in the daily work, especially in the evaluation and controlling the US and CT.
I was met with so much love, friendliness and humanity. The students sat there day after day in a hot, sunny room without an air conditioner and asked questions and paid attention because they wanted to learn radiology.
Thanks to Ro and Helmut Diefenthal, I met a lot of nice and interesting people, even outside the hospital. The Diefenthals took me on an excursion to Tarangire, one of the most beautiful national parks in Tanzania, where I spent unforgettable days with them.Eva Kis, M.D., Ph.D., Pediatric Radiologist. First Department of Pediatrics of Semmelweis Hospital, Budapest, Hungary
Past volunteers who have worked with us in East Africa have had very rewarding professional experiences and personal adventures.
I have had the very good fortune to have made three trips to Moshi and KCMC (Kilimanjaro Christian Medical Center) – in January and February 2000, 2003 and 2005. I’ve gone at the same time of year because it’s easier to get vacation time from my group (I practice in Seattle), and it’s a nice time to visit Tanzania – particularly if you want to go on safari or climb Kilimanjaro – both of which I would recommend.
Helmut and Ro are delightful hosts and incredibly dedicated individuals – it’s truly amazing to see what they have built for KCMC and the East Africa region in terms of the day-to-day service and the legacy of a radiology training program. They train both physicians (radiologists) and non-physicians (AMOs – assistant medical officers). They now have 43 AMO graduates and five radiology resident graduates. Presently, there are nine AMO students and nine residents in training. Most of the graduates work in regional, district and NGO hospitals in Tanzania – and some in Zambia.
I have worked with many of the students through their early years and followed their progression through graduation – with three of the former residents now on staff at KCMC. They function at a high skill level in all aspects of the department.
Though my role changed with each of my visits, the focus of visiting physicians remains primarily on teaching. This involves various didactic lectures. (Although I do mostly ultrasound, and that was the focus of my talks, they were very appreciative of other talks, developed after watching the daily practice that might add to their knowledge and experience). Daily departmental conferences, larger institutional conferences, working sessions with all the trainees, review of ongoing cases, film review sessions as well as more didactic sessions occupy much of the day.
For those with a sense of adventure who want to experience another part of the world and give something back, I suggest you consider this opportunity.Bill Marks, M.D. , Radia Medical Imaging Seattle, WA
My name is Dr. Ruth English and I am a consultant radiologist with a subspecialist interest in breast imaging in the Oxford Radcliffe Hospitals NHS Trust in Oxford, UK. I have made four visits to Kilimanjaro Christian Medical Centre, my first being in February 2003, which is when I was introduced to Dr. Diefenthal and his wife.
My hospital in Oxford has had a voluntary link with KCMC since 2002 when Dr. Griff Fellows, a retired urological surgeon, realized the value of mutually supportive links between teaching establishments in developing countries and the western world. His vision was of a multidisciplinary link between the two organizations, through which, at the request of individual departments, ORH would endeavor to provide teaching and training within KCMC for one week each year and ongoing support, mostly via e-mail whenever possible throughout the year. During my first visit in 2004, the ORH group consisted of a pediatric surgeon, a pediatrician, two theatre nurses, an ENT surgeon, an audiologist and a urologist. Since then, a dentist, a medical physicist and an anesthetist have joined the group.
On my first day in 2004 I was met by Dr. Lyimo, the head of the department who has since retired, and was introduced to Dr. Diefenthal who gave me a very warm welcome and told me about the history of the department, the constraints under which they work, and their achievements and aspirations. He kindly allowed me to show my teaching material to the AMOs and residents and to spend time in the department learning first hand about imaging in a developing country. During that first visit and my three subsequent visits I have never failed to be impressed by Dr. Diefenthal’s enormous energy and dedication to the work of improving the educational opportunities of the young doctors and AMOs of Tanzania and by Mrs. Diefenthal’s loyalty and support to her husband as well as her work as a radiographer within the department. Since 2006, Dr. Diefenthal has started a digital imaging teaching collection which will be a significant addition to the teaching material available in the department.
Since my first visit, the link between KCMC and Oxford radiology has deepened. Three Oxford radiographers have made visits to support radiographic QA and technique and positioning training, and I have held sessions on techniques for barium and HSG procedures. This year, Dr. Diefenthal kindly handed over all the department formal teaching sessions to Dr. Gibson, the medical physicist, and myself, and we did joint sessions each afternoon covering between us aspects of radiation physics and a clinical topic. Dr. Kalambo, now the head of the department, also asked us to advise on the curriculum for the proposed Diploma in Radiography.
In furthering the collaboration, in 2005 and 2006 Dr. Diefenthal and I arranged for a resident to visit Oxford for a two-month attachment to my department for further study. I am hoping that another resident will come to Oxford in autumn this year.
It is my great hope that the collaboration between KCMC and Oxford will continue to be fruitful and a valuable experience for all involved in it and that ultimately all our patients will reap the benefit.Dr. Ruth English, Consultant Radiologist Oxford, UK