(from left) Sharlene Teefey, M.D., Vikram Dogra, M.D., and Brian Mullan, M.D., visited Uganda as part of the RSNA International Visiting Professor Program.

With just a dozen or so radiologists serving a population of 27 million people with limited, 15- to 20-year-old equipment, physicians in the east African country of Uganda clearly have their work cut out for them.

Despite the tremendous challenges, however, doctors there are eager for additional knowledge and the ability to better care for their countrymen. Brian Mullan, M.D., said that was one of the first things he noticed during a September trip to lecture radiology residents on ultrasound and CT as part of an RSNA-sponsored International Visiting Professor Program.

The 14-day trip included stops at Mulago National Hospital, a government hospital, and Mengo Hospital, a missionary hospital, in Uganda's capital city of Kampala. Dr. Mullan, an associate professor of radiology at the University of Iowa in Iowa City, said the goal was to teach the residents new things they could do, with the resources they have, to further help patient care.

"They have two CT scanners in the country and they don’t have the opportunity to practice imaging as often as we do," said Dr. Mullan. "But they are very capable, very compassionate and their limitations do not slow them down. Since there are so few radiologists, we also had a goal to train non-radiologists to do this type of work."

Working alongside Dr. Mullan were Sharlene Teefey, M.D., a professor of radiology and director of diagnostic ultrasound at the Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis, and Vikram Dogra, M.D., director of ultrasound and a professor of radiology and urology at the University of Rochester, New York.

Uganda is an agriculturally rich country but access to medical care is limited by more than just the number of radiologists and the dated equipment—unreliable electricity, lack of technical support, limited donations, poor logistics and poverty are also factors, said the radiologists.

"They can do a lot of interventional procedures if they have catheters and such, but that equipment is donated and the donations are limited. It's decided on a weekly basis, almost, what they can do," Dr. Mullan said.

Even if the equipment is available, some patients in Uganda still wait years to see a doctor.

"When you see these people, it is shocking to see how extreme their conditions are," said Dr. Mullan. "In American waiting rooms, people complain about how long it takes to see a doctor. In Uganda, some people have waited five years or longer."

Drs. Mullan, Dogra and Teefey all clearly remember one such case.

A 22-year-old man came to Mulago National Hospital with filariasis, a parasitic and infectious tropical disease transmitted by mosquitoes. "He presented with a scrotum the size of a basketball," Dr. Mullan said. "He was 22 and this had been going on since age 3, but he did not have access to medical care so he suffered for a very long time."

Dr. Dogra pointed to another case that he said epitomizes the unfortunate outcomes of a lack of medical care in impoverished countries.

"A young woman had a Cesarean section and due to poor hygiene got an infection," said Dr. Dogra. "She had an abscess but limited resources meant they couldn't find it right away. Her survival chance is dismal, yet here in the U.S., a simple exam could have found the abscess and it would have been taken care of."

Equipment Donations, Return Visits Planned

These cases not only illustrate the great need for teaching in Uganda but also emphasize the need to work towards attaining additional updated equipment for the hospitals, said Dr. Teefey. She noted that since the IVP team returned to the United States, donation of two ultrasound scanners has been arranged. In addition, Michael Kawooya, M.M.Ch.B., M.Med. (Rad), president of the Pan African Congress of Radiology and Imaging, visited the Mallinckrodt Institute of Radiology following RSNA 2007 and interventional equipment was gathered for him to take back to Uganda.

Noting that a physician experienced in musculoskeletal ultrasound was requested when the IVP team was named, Dr. Teefey said she performed hands-on teaching and patient examinations in addition to giving lectures. The experience was incredibly rewarding and she feels honored to have been chosen, she said.

Dr. Dogra expressed the same sentiment.

"I always wanted to devote my time to share my expertise with less privileged nations," he said. "While I was in Uganda, I felt that they needed a lot of basic knowledge, so I gave a 2-hour lecture on ultrasound physics. I think they learned a lot and I learned from them as well.”

Dr. Dogra said the trip made him "very humble," adding that he wants to keep helping his fellow radiologists in Uganda.

"I have sent a good deal of books to them on ultrasound and CT," he said. "They don’t have the high technology there. I feel that we need to put our money where our mouths are and help countries like that. We are trying to make a list of things they need because whatever we don’t use is absolutely good for them."

Drs. Dogra, Mullan and Teefey all said that they are very grateful for the opportunity given to them by RSNA to go to Uganda. Each hopes for an opportunity to return, either through the IVP program or on their own.

"This trip was more than a professional trip," said Dr. Teefey. "New found friendships were developed that will almost certainly last a lifetime."

Established in 1986, the RSNA International Visiting Professor Program annually sends teams of North American professors to lecture at national radiology society meetings and visit with radiology residency training programs at selected host institutions in developing nations. The goal is to foster teaching and a cultural exchange between radiology departments in the U.S. and those in other countries. The RSNA Committee on International Relations and Education administers the program.

In 2007, RSNA also sent visiting professors to Algeria, Honduras and Mexico. In 2008, IVP teams will go to China, Nigeria, Vietnam and Mexico. Other recent trips have included Chile, India, Malaysia, Lithuania, Sri Lanka, Thailand and Brazil.

(a) Vikram Dogra, M.D. (second from top), assisted in clinical interpretation of CT scans during the Uganda trip.

(b) Sherry Teefey, M.D. (second from left), demonstrated musculoskeletal ultrasound.

(c) The International Visiting Professors with participants in an ultrasound refresher pre-course, offered as part of the Pan African Congress of Radiology and Imaging in Kampala, Uganda.