Monday, December 11, 2017

Day 2 – The Real Work Begins

Susan Sotardi
Fellow, Neuroradiology at MGH
PGY7

Day 2 – The Real Work Begins 

Day 2
I arrived at Black Lion Hospital at 730am with Issack, MR technologist and my colleague from RadAid. I immediately went to the reading room, and Issack started work in the MR suite. The morning readout session was filled with cases that are unusual in the US, a 10 year-old child with nasopharyngeal carcinoma, a 35 year-old man with disseminated tuberculosis. After the readout with the attendings, several residents on their neuroradiology rotation asked me to sit with them to review cases. We discussed the findings and their interpretation. I pointed out anatomy and explained my thought process. I found the residents to be extremely competent and eager to learn.

At noon, I joined Issack in the MR suite for a training session with the MR technologists. The technologists were also very knowledgeable and excited to learn physics. Issack lectured about MR physics and image optimization. I fielded questions about the clinical implications of the studies. The technologists had many questions, such as what MR sequences are helpful for different diseases and when should gadolinium be used for MRI. I realized then that gadolinium contrast costs around $125 USD, which is the entire life-savings for many patients. Often in the US, we don’t think twice about giving contrast agents; but in this situation, the decision needed to be entirely justified.

Around 1pm, I gave my first lecture to the residents, focusing on pediatric head trauma. Residents took cases and descried the findings and clinical implications, similar to residents in the US. I returned to the reading room for the afternoon session and looked at cases with residents until around 6pm.

In the evening, Issack and I met over coffee to discuss our respective days and the information we had learned. By piecing together multiple perspectives, we learned that several MRI coils were not working and that the MR machine had not been serviced in months. The technologists didn’t even have a working metal detector. In fact, the MR machine sold to Black Lion did not have a formal service contract with the vendor, which is a standard aspect of sales negotiations in the US. This contract is a critical component to the maintenance of the machine. This million dollar machine, one of a handful of MR machines in a country of 100 million people, is slowly falling apart. We emailed Dr. Mollura (CEO of RadAid) to update him on our findings. I was shocked to learn that this situation is a frequent occurrence in the developing world, where contract negotiations fail to encompass the long-term needs of the infrastructure.  

Susan gives her first lecture at Black Lion Hospital.