Global health and health care practice in developing countries has long been one of my passions. I spent a large part of my childhood In India, where I experienced health care as a patient. In Bogota, Columbia, before entering medical school, I volunteered at a visiting health clinic; during my final school year, I spent a month at a teaching hospital there as well. I went on to get an MPH with a focus on tropical medicine at the same time as my MD degree. More recently, as an IR-in-training, I have been trying to discover ways to bridge the gap between IR, a resource- and technology-intensive specialty, and health care in the developing world—which is often practiced in settings where resources and technology are limited.
Last year, I learned from a fellow resident about the tremendous work SIR has done with RAD-AID (rad-aid.org), an international organization dedicated to improving radiology resources in developing countries around the world. The resident had participated in a RAD-AID DR outreach program in Guyana, an experience he said was incredibly rewarding.
That fall, I was fortunate enough to receive generous funding via SIR’s RAD-AID Global Ambassador Award. Working with my program director, Senta Berggruen, MD, I secured a position on a RAD-AID medical team traveling to Vietnam in March 2019.
The team, led by RAD-AID IR Director Andrew Kesselman, MD, and Hyukjun Yoon, MD, also included transplant hepatologist Elizabeth Zheng, MD. We planned a total of 5 days working at two different sites in central Vietnam.
We spent the first two days at Da Nang General Hospital. With a population of 1.2 million, Da Nang is the third-largest city in Vietnam and is rapidly growing and industrializing, and Da Nang General serves as its primary public hospital.
Our first day included meeting with the IR and diagnostic radiology staff. Dr. Nguyen Phuong, a diagnostic radiology attending, helped facilitate our visit. After meeting with the radiology staff we were briefed on IR cases for the day. The equipment included an angio suite that was shared with cardiology. The cases were mostly TACE procedures for HCC and colon cancer. Few venous or nonvascular IR cases were performed. I assisted while Drs. Kesselman and Yoon participated in procedures and trained the hospital’s IR attendings in best techniques. Although the procedures at the hospital were performed by attendings who had no subspecialty training in IR, the sheer volume of TACE cases had honed their skill. Our team took the opportunity to share our skills and knowledge with them.
The next day, our team performed ultrasound- and CT-guided biopsies, both of which were new skills for the hospital’s staff. Later that afternoon, our team gave multiple lectures on RAD-AID’s interventional radiology programs, as well as nonvascular IR procedures, venous interventions and liver transplant in the United States, along with the role of IR in the transplant team.
Our remaining 3 days were spent in Hue, approximately 2 hours north of Da Nang. Hue University of Medicine and Pharmacy is one of the largest medical schools in Vietnam. Dr. Trong Binh Le, a fellowship-trained IR who was our host at Hue University Hospital (HUH), had only recently returned to Hue after completing his training in South Korea.
Our first day at HUH consisted of organizing an IR symposium for the faculty, residents and medical students. We also organized a simulation lab using the equipment we brought: an endovascular simulator, ultrasound models for biopsies, and plastic models to practice deploying IVC filters and stents. The next two days at HUH consisted of rounding on our patients, consulting with other services, and performing a variety of nonvascular procedures with residents and attendings, including ultrasound-guided biopsy, nephrostomy tube placement and CT-guided biopsy.
Even though IR is a small department at their hospital, the HUH residents’ and students’ enthusiasm was apparent in the simulation lab. They repeatedly asked me to explain how our training model works, and I was happy to share my excitement for the future of IR with them. Roles for residents traveling to Vietnam in the future could include giving didactics on how our residency and fellowship model is structured as well as educational lectures aimed at trainees. There is an opportunity to lay the groundwork for educating trainees on pre- and postprocedure management, sterile technique and radiation safety.
The time I spent in Da Nang and Hue was invaluable not only for the experience of learning how IR is practiced in settings outside the developed world but also for the connections I formed with our IR colleagues in Vietnam. Our passion and dedication to IR is common ground for forging lasting relationships. My experience has convinced me to return to Vietnam as an IR attending in the near future to teach the skills I will acquire in my fellowship training.
I am grateful to SIR and RAD-AID for creating this amazing opportunity.
