Practicing medicine is hard enough under the best circumstances, with state of the art facilities and the latest in equipment and technology. But imagine trying to treat patients at the largest hospital in the country when the electricity goes out on average 10 times a day, or without a reliable telephone or water system. That’s what faces doctors at the University of Ibadan, which has the largest hospital in Nigeria.
Physicians at the University College Hospital, Ibadan are among the most experienced and talented clinicians in the world, but they struggle to overcome these obstacles. A particular challenge is radiology and medical imaging. Radiology, by its nature, requires sophisticated and expensive equipment—CT scanners, MRI machines and computer systems that need reliable power, routine quality control and maintenance.
Thanks to an NIH grant (NIH/NINDS Grant #1R25NS080949 and NIH/FIC Grant #5R24TW008878), a group of physicians and researchers from the United States is working with doctors in Ibadan to help them improve their medical imaging systems. In turn, the team from Nigeria is teaching them about listening to their patients, and doing more with less.Steffen Sammet, associate professor of radiology and medical physics at the University of Chicago Medicine, recently joined researchers from Northwestern University and Lurie Children’s Hospital of Chicago for a trip to Ibadan, part of an ongoing exchange program to help improve imaging capabilities for treating stroke and epilepsy in Nigeria. The trip followed a month-long visit to Chicago by the team from Ibadan that coincided with the Radiological Society of North America’s annual meeting in December.
Sammet said that the biggest challenge his partners from Ibadan face is finding high-functioning technical equipment for imaging that can work within the confines of the sometimes unreliable infrastructure. For instance, they can’t use an MRI machine with high-powered 1.5 or 3 Tesla magnets that are common in the US because the power often goes down. So on the most recent trip, he and his colleagues helped them set up a technique called diffusion imaging that can work even with lower-field magnets and still generate high-quality images of stroke in the brain.
They also helped establish quality control practices to make sure the state-of-the-art equipment they did have—like a 64-slice CT scanner—stayed in working condition, and developed a new picture archiving and communication system, or PACS, that can store digital images and prevent data loss during the frequent power outages.
Besides the obvious technical hurdles, Sammet said the infrastructure also disrupted the workflow of moving patients around and getting them to the right place to perform the required scans quickly.
“This was for me one of the striking things,” he said. “Things don’t move as quickly as we would like to have it here. When a patient comes in here, a few seconds later he’s already under a scanner on the gurney. Everybody knows where the patient is because we have barcodes and electronics records. They just don’t have that.”
Sammet said that the staff at the hospital in Ibadan often carry three different cell phones in case one or the other network goes down. Sometimes they have to employ water carriers when the plumbing system malfunctions. But despite these problems, though, it still works.
“They find always a way around, and this was impressive for me,” he said. “They never give up, so they always move forward. They always had the mindset that we have to do it, and they will do it.”
The exchange has been a two-way street, with Sammet and his colleagues learning from how the doctors in Ibadan compensate without the luxury (or crutch) of expensive, high-tech equipment: namely by talking to their patients, listening and building empathy to understand what’s going on.
“It’s pretty amazing how accomplished they are, and how much medical knowledge they have just by looking at the patient,” Sammet said. “They do the same things we do with an exam, talking to the patient, grabbing the hand, touching the patient, and realizing there is something wrong. You can still do medicine without the high end equipment we have.”