Anne G. Osborn ASNR International Outreach Professorship to South Africa

Suyash Mohan, MD, PDCC
ASNR Visiting Professor, Cape Town, South Africa, June 2018
Assistant Professor of Radiology and Neurosurgery
Director, Neuroradiology Clinical Research Division
Department of Radiology, Division of Neuroradiology
Perelman School of medicine at the University of Pennsylvania
Philadelphia, PA-19104

In the fall of last year, I was delighted to get the email notification from Dr. Walter Kucharczyk, ASNR International Collaboration Committee Chair, that I was selected to be the Anne G. Osborn ASNR Outreach Professor to South Africa.  The planning for the trip started very early when I first met with the liaison person for South Africa, Dr. Leon J van Rensburg, Congress Chair, Radiological Society of South Africa (RSSA) during last year’s RSNA. He was very meticulous in outlining details of the program and explaining that I will be serving one week each at two premier South African institutions, University of Cape Town (Groote Schuur Hospital) and University of Stellenbosch (Tygerberg Academic Hospital).

He connected me with my very gracious Cape Town hosts, Prof. Sally Candy and Prof. Steve Benningfield, at University of Cape Town/Groote Schuur Hospital and Prof. Richard Pitcher and Dr. Christelle Ackermann at University of Stellenbosch/Tygerberg Hospital.

My first week was spent at University of Cape Town, Groote Schuur Hospital.  Set against the magnificent slopes of Devil’s Peak in Cape Town, South Africa, the University of Cape Town (UCT) was founded in 1829 and is the oldest university in the country. The grandeur of both the landscape and architecture have earned the university much recognition as one of the most beautiful campuses in the world.

Groote Schuur Hospital is a large, tertiary care, government-funded, teaching hospital of the University of Cape Town’s medical school, founded in 1938 and is famous for being the institution where the first human-to-human heart transplant took place, conducted by UCT surgeon Christiaan Barnard on the patient Louis Washkansky.

My first week was spent at Groote Schuur Hospital where a typical day would start with a morning didactic lecture from 8:00 AM to 9:00 AM. From 9:00 AM to 10:30 AM, I would spend time in the CT or MRI reading rooms, reading out live neuroradiology cases with registrars (what we would call residents here in the US), and case based workstation teaching. Then we reviewed interesting overnight cases in an “Interesting Case Conference” from 10:30 to noon, followed by a second didactic lecture from 12:00 noon to 1:00 PM. There was usually a departmental lunch with all trainees and consultant radiologists, (what we call as attendings) from 1:00 to 1:30 PM. Then the afternoon was spent reviewing cases and workstation teaching in the CT or MRI reading rooms.

Tuesday morning, we attended multidisciplinary pediatric radiology conference at the only dedicated children’s hospital in sub-Saharan Africa, the Red Cross Children’s Hospital (RCCH). It is one of a few children’s hospitals in the Southern hemisphere, with academic links to the University of Cape Town and University of Stellenbosch and is regarded as South Africa’s leading center for post-graduate specialist pediatric medical and surgical training, home for the only radiology fellowship program in Pediatric Radiology in all of South Africa.

On Wednesday, we participated in multidisciplinary neurology-neurosurgery conference with discussion on several interesting cases.

During my first week, I delivered the following lectures.

1. Bugs and thugs of the neck: Acute and deep space infections
2. Next generation (neuro-oncologic) imaging: Radiogenomics, Biomarkers and Response Assessment
3. Your brain on drugs. Neuroimaging of toxic encephalopathies
4. Approach to bilateral Thalamic lesions
5. Approach to bilateral Basal Ganglia lesions
6. Overdiagnosis and Radiolgists: ‘Harm in the Pursuit of Health’
7. An algorithmic approach to adult brain tumors

Some specific topics discussed during these read out sessions and case conferences were:

• How to read MRI of the temporo-mandibular joint (TMJ)?
• Approach to a CT scan of the neck.
• Systematic approach to brain MRI
• How to describe spinal degenerative disease using the right lexicon?
• Perceptual/cognitive errors and blind spots, etc.

I spent my second week at Stellenbosch University/Tygerberg Hospital which is the oldest extant university in Sub-Saharan Africa alongside the University of Cape Town which received full university status on the same day in 1918. The schedule was pretty similar as in my first week with a morning didactic, followed by workstation teaching/reviewing real-time live cases in the reading room, interesting case conference and a second didactic at noon.

In my second week I gave the following didactic lectures.

1. Core CNS infections
2. Mentoring in Academic Radiology: Why it matters and keys to satisfaction
3. Maxillofacial trauma: Practical Tips
4. Non traumatic neurologic emergencies of brain and spine
5. 2016 WHO Classification of Brain Tumors: State-of-the-Art Imaging Update
6. Evolving landscape of post therapy brain tumor imaging

In between these 2 weeks, we spent a few days at the world famous Kruger National Park, which is one of the largest game reserves in Africa and one of the largest national parks in the world! It covers an area of 19,485 square kilometers (7,523 sq mi), spans 3 countries, South Africa, Mozambique and Zimbabwe and extends 220 miles from north to south and 40 miles from east to west. We stayed at the Skukuza Rest Camp, in Skukuza, the capital city of Kruger National Park. It is the largest rest camp in South Africa and also the largest rest camp in the Kruger National Park. On day one we drove to Lower Sabie, along the banks of the Sabie River, one of the few perennial rivers that flows through the Kruger National Park, watching the endless procession of animals coming to drink at the Sabie River. On day two, we covered the northern part of the park, the Satara Rest Camp and on our last day we did Paul Kruger and Berg-en-daal, towards the southeast. The sunset safari was an amazing experience. All the Big Five game animals. “Lion, Elephant, Leopard, Buffalo and Rhino”, are found at Kruger National Park, and it has more species of large mammals (at least 147) than any other African game reserve.

Skukuza, Kruger National Park, South Africa

We also visited Table Mountain which is a flat-topped mountain “high hill, flat and square like a table”, a prominent tourist attraction in Cape Town.

 

We also visited Cape of Good Hope very close to the southern tip of Africa and saw the oceanic meeting point of the Atlantic and Indian Oceans.

On our way back we spent time at the Boulders Beach, home of African penguins.

We also had the opportunity to experience the vibrant flavors of South Africa in one of the popular waterfront Karibu African restaurant.

We got back to Philadelphia after spending a truly memorable visit to the two premier institutions of South Africa, University of Cape Town/Groote Schuur Hospital and Stellenbosch University/Tygerberg Hospital, and visiting the world famous Kruger National Park.

I was amazed to see the wealth of clinical material, spectrum of pathology, knowledge of the registrars (residents) who were all very smart, well trained, and eager to learn and the dedicated consultants (faculty) at these places. Sharing my experience and teaching them was pure joy! Everyone was so welcoming and the warmth I received was truly awe-inspiring.

I am still connected to several faculty and registrars and in fact did a webinar to all Radiological Society of South Africa (RSSA) members as a national broadcast last week on August 28, 2018, with two other such webinars already scheduled for the near future.

I am also closely working with one of the young faculty at Stellenbosch University in establishing a formalized mentorship program and perhaps a joint Radiology CME with RSSA in future.

I am extremely grateful to American Society of Neuroradiology (ASNR), Dr. Kucharczyk and Dr. Rensburg for organizing and facilitating the program, and Dr. Anne Osborn (one of my role models) for supporting this incredible outreach professorship to promote neuroradiology throughout the world.

This unique and highly rewarding experience will be one of my most cherished memories as a radiologist. I recommend a trip to South Africa and the amazing Safari experience (Kruger National Park – “the real deal”) to all my friends and colleagues.

I would also like to take this opportunity to thank Dr. Laurie Loevner, Chief of Neuroradiology here at Penn and the 2nd past president of ASNR for her mentorship and our Department Chair Dr. Mitchell Schnall for giving me the time and allowing me to represent Penn Radiology in South Africa.

My gratitude also goes, most of all, to my most welcoming and gracious South African hosts.

With sincere regards.

Suyash Mohan