Improving access to imaging in The Gambia

Today, we talk to Dr Ed Lightfoot, who is currently volunteering in The Gambia as part of our collaboration with the Medical Research Council (MRC) clinic, to improve access to imaging in the country.

In this interview, Ed shares his thoughts on the assignment and the experience working with sonographers in the MRC clinic, and Consultants in Edward Francis Small Teaching Hospital.

Tell us a bit about yourself

Hi! My name is Ed Lightfoot, and I’m currently between my ST4 and ST5 years of Clinical Radiology training at the Leeds & West Yorkshire Radiology Academy. When I’m in my usual training post I’m developing a subspecialty interest in Head & Neck, as well as Infectious disease and chest radiology, but I’m currently on an Out Of Program Experience working with Worldwide Radiology in The Gambia.

Why have you decided to volunteer with Worldwide Radiology?

Ever since beginning my medical studies I have been interested in global health. During my post-foundation years I worked with a small charity helping to provide healthcare to rural areas in Zambia.

This further increased my interest, but in accepting my training post in Clinical Radiology I worried that my days of volunteering in low resource countries might be behind me as I hadn’t heard of any radiologist volunteering abroad before.

During my first years, and after some detailed google searching I came across a some power point slides of a lecture that Liz had delivered some years before which included her contact details, and took a chance at emailing her.

To my surprise she replied and seemed pleased that a junior radiology trainee had taken an interest. After some years of training and getting my FRCR exams completed the timing lined up perfectly.

The opportunity to take my new training on the road and help provide services to a country with limited radiology provision was too exciting to pass up.

What are you hoping to achieve while in The Gambia?

My placement in The Gambia is the first one organised by Worldwide Radiology and certainly the first one by a UK radiologist still in training.

This means that I’m mostly here as a fact-finding exercise to identify the areas where Worldwide Radiology can best focus their efforts to improve radiology provision.

I’m working closely with sonographers in both the Medical Research Council (MRC) clinic, and the Consultants in Edward Francis Small Teaching Hospital, both to help deliver services, but also to help train both imaging and other clinical staff.

How is it going so far?

As expected, things are very different from working as a radiology registrar back in Yorkshire! It took me a few weeks to find my feet and settle into a new country, but things are certainly moving in the right direction.

I’ve started to identify areas where Worldwide Radiology might be able to have a real positive impact: even something as basic as providing training in radiation safety could have longstanding impact on local practice and therefore radiology provision in The Gambia as a whole.

On a personal level, I have felt hugely welcome in both the MRC and EFSTH departments, and feel that I am genuinely helping both departments in the time I’m here.

What challenges have you identified so far?

My time in The Gambia is split between the MRC clinic and the Edward Francis Small Teaching Hospital, and both have very different challenges.

The MRC clinic is a modern facility with a relatively western-style system in place for patient care. They have electronic medical records and a simple PACS for reviewing plain film radiographs.

The staff here are dedicated, keen to learn and competent, but are all relatively junior and seem to have appreciated some training and guidance, even when its coming from someone who’s still a registrar!

EFSTH on the other hand has several consultant radiologists, and have a visiting Professor of Radiology helping to develop their services. However the infrastructure here is less than ideal.

All radiographs are analogue, printed on cellulose film and carried with the patients leading to significant film degradation.

X-rays are being dried in the hot air coming out of the air conditioner

They have a 2-slice CT scanner but this is often out-of-action due to difficulty in getting adequate maintenance, and similarly their mammography unit and a 0.35T MRI scanner have not been in working condition for several years.

What have you achieved so far?

On initially reading this question I panicked a little, as it’s really quite difficult to pinpoint a tangible outcome! However looking back at the past 2 months, I have helped the sonography staff in the MRC improve their ability and confidence in scanning and reporting.

I’ve provided training to the clinical staff to improve the clinical history provided which has vastly improved the reports we’re able to give back – a win-win situation as the clinical staff have found the new reports to be much more clinically useful.

Furthermore, we’ve made changes to the plain film processing algorithm to improve the quality of plain film provision.

Ed draining an abscess in the leg of a patient with the help of a hand held ultrasound probe, avoiding the need for surgery.

On a personal note, I’ve found the past two months to be incredibly rewarding. Coming from a relatively “protected” training scheme, to being the radiology opinion to a whole clinic has been a significant step up in responsibility, and was initially quite daunting but has been incredibly empowering as I enter my final year of training.

Also, I have done more ultrasound scans in the past month than I have in 4 years! Ultimately I’m only one third of the way through my time here, and I’m excited to see what else we can achieve!