Radiology’s impact: Journey to Botswana offers lesson on the value of radiologists

Four weeks in Molepolole, Botswana, proved to be the experience of a lifetime for one Boston radiologist.

Sahil V. Mehta, MD, an interventional radiology fellow at Massachusetts General Hospital, said he was skeptical at first about the impact a single radiologist could have on day-to-day care in Botswana. But once he arrived, he gained a newfound respect for his own profession.

“I think as radiologists in the United States, there has been some marginalization of what we do,” Mehta told RadiologyBusiness.com. “And then when you get to a place where they haven’t had any radiologists, you realize just how valuable you can be.”

The journey begins

Mehta’s relationship with Botswana began over a year before he actually visited in person. When one of his former classmates, an infection disease specialist, began working at Scottish Livingstone Hospital in Molepolole, she realized the hospital had no radiology presence.

That classmate began reaching out to Mehta for assistance, and before long, a “full-time teleradiology link” was born. Months later, Mehta was on a plane, traveling the many miles between Boston and Botswana.  

Mehta said he was primarily there to assist the hospital’s medicine team, but once word spread that a radiologist had arrived, physicians from all of the other departments began seeking him out for help.

“It was a really interesting experience,” Mehta said. “As a radiologist, you really have a hand in all of these things and it's nice to be at a place where they can actually use you for all of these things. There are a lot of physicians that go over there and they can help out with their one specialty, but this was an opportunity to really go across many boundaries and help with everything.”

Mehta’s primary goal while in Botswana was educating the hospital’s other physicians. They understood radiology to a certain degree, but due to a lack of resources, their experience and skillset were limited. Mehta held daily workshops for both the hospital staff and other physicians from the area, focusing on ultrasound training and its ability to search for extrapulmonary tuberculosis.

Doing more with less

While working with the other physicians, Mehta noted that one of their biggest obstacles was a lack of basic supplies. Electricity was unreliable, paper towels were hard to find and, in one instance, a lack of gel had left ultrasound examinations backordered.

Luckily, Mehta said, he had grabbed a tube of gel from the pharmacy the day before he arrived.

“This hospital actually had ultrasound machines and they had a system in place to get ultrasounds, but the gel was such a limiting factor that they literally couldn’t do any ultrasounds for weeks before I got there,” Mehta said. “I expected there to be a lack of resources, but the fact that a lack of a simple resource could shut down an entire section of the hospital, that was what was really concerning in a lot of ways.”

Mehta also said the experience made him think about the waste he often sees in American healthcare.

“Whenever you come back from a resource-poor setting and come into a resource-heavy setting, that kind of stuff is always a little bit of a transition,” Mehta said. “You always think, ‘Wow, what could we do with literally 1/100th of what we have here if we had that in Botswana? How much of an impact could really be made?’”

A change of pace

[[{"fid":"20999","view_mode":"media_original","type":"media","attributes":{"height":1155,"width":800,"style":"width: 220px; height: 289px; border-width: 0px; border-style: solid; float: right; margin-left: 20px; margin-bottom: 10px;","alt":" - Botswana xray","title":"Botswana xray","class":"media-element file-media-original"}}]]In a way, his time abroad also made Mehta feel a bit like a time traveler. He said he was often reminded of stories his older professors had told him about the early days of radiology, before things grew so complex and radiologists started spending more and more time in front of a PACS workstation, away from the actual patients.

“I was at the bedside of every single patient, looking at x-rays and doing the ultrasounds,” Mehta said. “That’s obviously a huge paradigm shift from what we do today in radiology. I think that harked back to what we used to do in a lot of ways, what the profession used to be.”

Each time he looked at x-rays, Mehta knew he would be talking to that patient face to face, and he said he really enjoyed the change of pace.

“Actually seeing the patient and being in front of them makes such a huge difference when you’re interpreting,” Mehta said. “That’s hard to do in the way radiology is practiced today, but it’s not impossible to do—I do think there are areas where we could still do that. If radiologists are able to do that, it makes a huge difference with how we can help and also with how we are received by other clinicians.”

Mehta is back in the U.S. now, but those four weeks in Botswana will stay with him forever. He said he hopes more physicians go out of their way to travel abroad and provide care if they get the opportunity. However, he pointed out, only travel for the right reasons.

“It has to be a sustainable effort and shouldn’t be just a sort of medical tourism,” Mehta said. “Anytime you go, you have to be thinking, ‘How is this going to affect something long term?’”

Want to learn more about Mehta’s experience? He wrote about it in great detail for the Journal of the American College of Radiology.