ASNR Visiting Professorship to South Africa, August 2016
Jeff L. Creasy, M.D. FACR
Professor, Department of Radiology and Radiological Sciences
Section Head of Neuoradiology
This August I was honored to be selected as the ASNR Visiting Professor to South Africa for 2016. My time in South Africa consisted of one week at each of the following three teaching institutions with radiology training programs:
|University of the Free State, Bloemfontein||Prof Coert de Vries|
|University of Stellenbosch, Tygerberg||Prof Richard Pitcher|
|University of Cape Town/Groote Schuur||Dr Sally Candy|
All three of these primary teaching hospitals largely serve the indigent, or those who are without “medical aid” (what we would call medical insurance.)
As there are only two radiology fellowship programs in all of South Africa, one in pediatric radiology and one in interventional radiology, most of the consulting radiologists I met (we call them attendings) who had fellowship training obtained it outside of South Africa. Every consultant I met had one or multiple areas of specific interest. Those with a primary interest in neuroradiology and equivalent training had a level of expertise and knowledge commensurate with attendings I routinely work with at Vanderbilt.
Each institution had one day each week set aside as an academic day, during which multiple lecturers were given by registrars (what we would call residents) on anatomy, unknown cases, specific disease entities, approach to a given clinical problem, or their own research. It would be unusual for a large number of lectures to be given in a week by the consulting staff. However, as a visiting professor, over the course of each week, I was able to present 10-12 didactic lectures on topics ranging from the routine (sinus CT, facial fractures, basics of stereotaxis) to the more cutting edge (MR and CT perfusion, DTI and tractography, fMRI). I also gave several hours of unknown case presentations at each site. One evening in Stellenbosch, I gave a webinar on DTI and tractography that over 70 radiologists around the country were able to login to watch my PowerPoint presentation and hear my audio lecture in real-time. Afterwards, they were able to submit questions to me by text messaging. A similar system was used to transmit some of the lectures I gave at Stellenbosch to UCT, and vice versa.
I found the registrars to have an impressive knowledge base. They performed as well on routine and difficult unknown cases as my own residents and fellows. Everyone demonstrated a very significant work ethic, and enthusiastically supplemented any lack in clinical material or hardware with extensive reading and personal study. They were so eager to learn, that at times I felt like they were pulling the knowledge out of me.
When I wasn’t lecturing, I spent the balance of each day with the registrars at their CT or MR reading stations, just as I would in my home institution. We evaluated each case as it came to the workstation, which often led to additional discussions of technology, protocols, or approach to disease.
The mix of cases had a much higher percentage of HIV/AIDS patients than I see in the US, with an associated high incidence of intracranial, spinal, and extra-CNS tuberculosis. There were significant numbers of parasitic infections, especially neurocysticercosis and echinococcus. The amount of trauma was not unusual, but rather the nature of the traumatic cases, as there were “bike spoke” injuries and “group assaults” that I had not previously seen.
Outside the academic centers, I was able to visit the Anglo-Boar War Museum in Bloomfontein; experience a South African cookout or braai; tour the Cape Winelands; ride the cable car up Table Mountain; and take the Cape Point tour to the Cape of Good Hope. After my three weeks were completed, I went on a two-day wildlife safari at a private game park east of Port Elizabeth.
This experience was excellent, rewarding, and very satisfying. I had the privilege of being exposed to a new, beautiful country, with amazing, talented and hospitable people. My hosts and I were able to learn about each other’s health care system, and I was able to see firsthand how quality radiology education looks in a setting outside of the United States.