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In early June, radiologist Eva Nabawanuka had a patient with a ruptured liver tumor. The patient was young but bleeding out — and needed to be urgently treated. 

Based out of Uganda’s largest public hospital and teaching facility, Mulago National Referral Hospital, Nabawanuka was able to stop the bleeding by performing an embolization, a common medical procedure within interventional radiology (IR), a subspecialty of radiology that uses image-guided, minimally invasive procedures.

Until recently, there wasn’t a single interventional radiologist in Uganda’s public hospitals. But Nabawanuka has spent the past two years training to become one through a program led by Fabian Laage Gaupp, assistant professor of radiology and biomedical imaging at Yale School of Medicine (YSM), and his collaborators at Road2IR, an international consortium of physicians, nurses, technologists, and trainees working together to bring minimally invasive, image-guided procedures to East Africa and beyond.

In August, Nabawanuka and her fellow trainees, Alex Mugisha and Sam Bugeza, graduated from the program at Mulago Hospital.

The first graduating class of Road2IR in Uganda, with Fabian Laage Gaupp and Janice Newsome

The first graduating class of Road2IR in Uganda, along with Yale radiologist Fabian Laage Gaupp (center) and co-director of the Uganda program, Janice Newsome (top left) of Emory University School of Medicine.

“That young man, prior to us being here, would have had no chance at all,” said Nabawanuka, now an interventional radiologist at Mulago Hospital. “He would have had to wait for surgery, and yet he was unstable for it. That’s a life saved because we are here.”

Surgery meets radiology 

Through outreach and education, Road2IR builds self-sustaining training programs to expand access to life-saving procedures in resource-limited settings. Launched in 2018, Road2IR started as a collaborative effort between Tanzania’s Muhimbili University of Health and Allied Sciences (MUHAS), YSM’s Department of Radiology and Biomedical Imaging, Emory University’s Department of Radiology and Imaging Sciences, and several other partner institutions.

Despite a population of nearly 60 million, Tanzania had no interventional radiologists until Road2IR started its pilot project in the country. IR provides image-guided, minimally invasive therapeutic and diagnostic procedures for countless medical conditions, from traumatic injuries and infections to cancer and vascular diseases.

“It’s kind of a mix of surgery and radiology,” said Laage Gaupp, one of the founding members of Road2IR and director of its program in Uganda. “We use imaging, including X-ray, ultrasound, and CT scans, to make procedures less invasive and use small needles and catheters to really get anywhere in the body. With that, we can make procedures a lot less risky, and we can allow patients to go home the same day and just make procedures safer and better.”

Team of doctors performing a surgical procedure

Image-guided sclerotherapy of a vascular malformation being performed by the Ugandan Road2IR team together with Dr. Marie-Charlotte Hessler, visiting interventional radiologist from France (right). 

Many low and middle-income countries still lack access to interventional procedures, despite the well-established benefits of IR, making essential, even lifesaving, treatment options unavailable to millions of people around the world.   

The Road2IR training program has helped to close that gap in Dar es Salaam, the largest city in Tanzania. The program was officially certified by the Tanzanian government in 2019, and MUHAS now offers a Master of Science (M.S.) in IR

The M.S. program is structured as a two-year long training program with three trainees — all of whom have already completed a residency in diagnostic radiology — graduating per year. Participants take part in both in-person, hands-on training and undergo regular exams. The course is taught by volunteer teams of U.S.-based IR physicians, nurses, and technologists who train the fellows in two-week increments at least once per month. In addition to teaching fellows, visiting teams also train local nurses and technologists in IR

Since the launch of the pilot program in October 2018, 19 radiologists have graduated from the program in Tanzania, in addition to 11 nurses and technologists. More than 100 teaching teams have travelled to the country so far.

“When we started the program, the question was, essentially, do we try to bring people here to the U.S. to train, or do we do the training there?” said Laage Gaupp, also program director of YSM’s interventional radiology residency program and an affiliated faculty member with the Yale Institute for Global Health. “Both of these approaches have some advantages and disadvantages. But we felt overall that doing the training there would have a higher guarantee that we’re actually graduating people who stay there and serve their own population.” By Meg Dalton, Yale News

 
 

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