ASNR – Ethiopia
As the 2019 ASNR Outreach Professor to Ethiopia, I had the wonderful opportunity in October to join the Radiology Department for one week, in the College of Health Sciences of Addis Ababa University at the Black Lion Hospital. Although the hospital is the largest (800 beds) and relatively most advanced government hospital in the nation, with patients traveling from all over the country to receive care, resources are extremely limited. The buildings and grounds are worn and in some areas crumbling – quite literally. There is a single functioning CT scanner, a 1.5T MRI, and only one functioning x-ray unit. Fluoroscopy has not been available for many years. The hospital’s main diagnostic equipment is ultrasound, which of course is not of much utility in neuroradiology. Even then, ultrasound images cannot in general be easily saved/stored – they are looked at real time, and deleted.
The department trains about 40-50 radiology residents per year, as well as several fellows, including two in neuroradiology and two in pediatric radiology. Several of these fellows served as my daily hosts, including Dr. Fathia Omer, who drove me between the hospital and my hotel almost daily and made me feel right at home. She was the recipient of the 2019 Heidi Patriquin Award for International Education, and I had had the good fortune of making her acquaintance earlier the same year at the Society of Pediatric Radiology annual meeting, and we had stayed in touch prior to my arrival in Ethiopia.
In general, my schedule consisted of reviewing various interesting neuroradiology cases each morning with the trainees on neuroradiology rotation, who had previewed the cases the previous afternoon. The imaging files are viewed on a general DICOM viewer, as they do not have an efficient PACS system. I sometimes helped the residents with their typed reports (there are no dictaphones, nor software to support them). I then joined them in their readout with the neuroradiology fellows or faculty. I was very impressed by the residents’ eagerness and foundation of knowledge, especially given that their MRI scanner had been down for almost two years prior to my arrival! The seniors especially were very sharp, as they were preparing for their board exams – and were always hungry for more board reviews, which I of course provided. I also gave several lectures on pediatric neuroradiology topics (including pediatric brain tumors, congenital brain anomalies, and phakomatoses), as well as resident and fellow case conferences, including a preview of the RSNA 2019 “Diagnosis Live” for Neuroradiology.
I parted Black Lion Hospital with a small collection of advanced and atypical cases of TB, as this was clearly the most prevalent pathology. I also came across severely advanced pediatric brain tumors. Aside from didactics, I took the time to tour other portions of the medical complex, including a few vibrant visits to the ER and its very small reading room, staffed by a few radiology residents at a time.
The workday often started with a visit to the faculty break room, where various sweets and pastries would be offered, along with coffee/ tea. I cherished this sense of community, without the rushing commonly found in the U.S. Most days, I was accompanied by a few trainees and/or faculty for lunch at a local restaurant. I thoroughly enjoyed all my meals, always accompanied by wonderfully soft injera. I also attended a traditional dinner (with the famous honey wine) which included a variety of riveting cultural dances, graciously hosted by one of the neuroradiology faculty, Dr. Abebe Mekonnen.
Prior to my week of teaching in Addis, I toured northern Ethiopia, seeing the Blue Nile Falls near Bahir Dar, palaces and castles of Gondar, Gelada monkeys in the Simien Mountains, stele of Axum, and of course the rock-hewn churches of Lalibela. In Addis, we were fortunate to squeeze in a visit to the just opened to the public Unity Park.
I want to thank the Anne G. Osborn ASNR International Outreach Professorship Program, the ASNR International Outreach Committee, and Dr. Osborn for an invaluable and eye-opening experience. I hope to return in a few short years for an additional teaching experience!