Standard skills, extraordinary reach

By Susan E. Sedory Holzer, MA, CAE
SIR Executive Director

By now, you should know that interventional radiologists apply the best of today’s medicine, bringing together physician insight, professional expertise and advanced image-guided technology to improve patient care. But did you also know that SIR members are committed to introducing the specialty’s standard skills to all the corners of the earth? The following is just one of many stories I hear from SIR members, all part of a truly extraordinary community making this happen.

Malawi is a landlocked country in southeast Africa that is bordered by Zambia to the northwest, Tanzania to the northeast and Mozambique on the east, south and west. Nicknamed "The Warm Heart of Africa,” it is among the world's least-developed countries. The country’s medical population suffers from tropical diseases, malaria and AIDS, which carry a high need for ultrasound (US)-guided biopsy and abscess drainage. Patients regularly die from drainable abscesses, obstructed kidneys and infected dialysis catheters.

Since many families and patients at the hospital are from remote villages, many spend their days and nights in family wards and around the hospital grounds.

Recently, Dr. Faiz D. Francis spent two weeks in Africa as a visiting interventional radiologist at the Queen Elizabeth Hospital at the University of Malawi College of Medicine in Blantyre. His goal? To introduce the potential of US-guided abscess drainage and other body interventions as an added skill of the young surgeons in training to improve the mortality and morbidity in this severely resource restricted country. 

Dr. Francis, second from left, with the surgical residents (registrars) Drs. Chimpanze, Wallinase and Malili after a day of IR teaching.

And he indeed succeeded. During a surgical IR rotation with surgical residents, he taught techniques in percutaneous procedures, including US-guided biopsy and abscess drainage, US-guided nephrostomy, US-guided cystic hygroma sclerosis and US/X-ray-guided tunneled dialysis catheter placement. Along with the visiting urologist, Dr. Montague, he performed a percutaneous nephrostomy with US guidance alone—a procedure rarely performed in Malawi despite great need—and possibly for the first time by an IR.

Dr. Francis is placing a tunneled dialysis catheter with US and X-ray guidance and is assisted by a medical technologist. (Photo consent obtained from patient.)

Francis, who was a fellow under SIR member/Dr. Matthew Johnson in interventional radiology at Indiana University School of Medicine, also connected resources-scarce Malawi with medical supplies from Cook Medical (thanks to Scott Tarrance, Michigan representative), which generously supplied Cook drainage tubes and Chiba needles used in teaching IR techniques. Francis’s ultimate goal is to sustain a pipeline of interventional supplies from Cook Medical Africa to the surgery department at Queen Elizabeth Hospital. 

Dr. Eric Borgstein, pictured with medical students, is holding medical equipment donated by Cook Medical. Borgstein is currently professor of surgery at the University of Malawi College of Medicine and consultant pediatric surgeon at Queen Elizabeth Central Hospital where he was instrumental in setting up its current surgical postgraduate training program.

In his own words, Francis said, “The world is a small village and we should be able to introduce interventional radiology standard skills to all corners of the earth. Physicians in Malawi are highly skilled and incredibly intelligent and have been performing advanced surgeries and providing exceptional care despite scarce resources. My contribution is minuscule compared to the years individuals have dedicated to medical care in Malawi, both from staff born in Malawi or elsewhere.”

Dr. Francis scanning a child in the ultrasound procedure room. (Photo consent obtained from mother.)

What an inspirational way to embody the kind of agile collaboration among patients, interventional radiologists, IR faculty members, mentors and industry representatives that defines the specialty of interventional radiology. It sounds simple: to bring standard IR skills to others. But what it creates is a grand and extraordinary opportunity for this global community.

Francis is an interventional radiologist with Eastpointe Radiologists; he practices at St. Joseph Mercy Oakland in Pontiac, Michigan. Through the mentorship of Dr. Terri Taylor (international Malaria expert from Michigan State University College of Osteopathic Medicine), Francis, as a second year radiology resident, had worked under Dr. Sam Kamponendi, the only radiologist at Queen Elizabeth Hospital and decided to return to the country after fellowship to help advance IR. drfdfrancis@gmail.com