To the Editor,

In October 2018, a training program for Interventional Radiology (IR) was launched at Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania, creating the first accredited IR training program in East Africa. Teams composed of IR nurses, technologists, and faculty from North America have been training nurses, technologists, and residents/fellows, onsite [1]. One year post-implementation, we conducted a survey (Table 1) to assess awareness of local clinicians about the IR service, aiming to identify their specific needs and expectations to improve the service. In this letter, we briefly present our findings.

Table 1 Survey on awareness and needs of physicians regarding IR services at Muhimbili National Hospital
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The questionnaire was distributed among clinicians working at Muhimbili National Hospital (MNH), the main teaching hospital of MUHAS. The survey was self-administered, anonymous, voluntary, and filled in manually. It comprised nine multiple-choice and two open-format questions. 106 surveys were collected and 100 were considered for the analysis, covering one-third of doctors working at MNH. Six surveys could not be included due to missing and/or contradicting values. The data was analyzed using IBM® SPSS® Statistics.

Of the 100 respondents, 51 were attendings, 22 were residents, 27 were registrars and medical interns. 98% of clinicians were aware of the IR service at MNH, with the majority of physicians (84%) already referring patients to IR (Fig. 1). There was, however, consensus among most respondents (95%) that more information about these IR services was necessary for hospital staff and patients. This result was expected, as the program is new and the first of its kind in East Africa.

Fig. 1
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Number of referred cases

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Starting with non-vascular procedures, the IR curriculum has been designed to be extended to incorporate the often more complex vascular procedures by 2nd year of training [1]. The results show that the most commonly performed procedures to date are basic non-vascular procedures (Fig. 2). By February 2020, 336 procedures have been performed, 290 being non-vascular and 46 being vascular interventions (unpublished data). This is expected to change moving forward.

Fig. 2
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Demand of offered procedures

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Procedures are exclusively performed with Tanzanian trainees as the primary operator under supervision of visiting faculty. All trainees are IR fellows, who have completed their Master of Medicine in Radiology. The findings demonstrate that the overall rating of the procedural outcomes of IR procedures was between “good” and “very good”, confirming that the training model is successful.

Based upon suggestions made by responses to this survey, the MNH IR team is in discussions with the hepatology service to create a multidisciplinary team to screen patients at risk of hepatocellular carcinoma and then decide on what the most appropriate treatment would be. To this end, we are working to expand available IR services, including hepatic embolization and local thermal ablation.

Although current initiatives are somewhat stifled secondary to the current worldwide Covid-19 pandemic, we do plan to make other changes to satisfy the suggestions made. This includes building an IR page on the MNH website and initiating hospital wide teaching sessions to educate physicians and other healthcare providers about IR.

Given the location of MNH in the nation’s largest city and economic capital, these results may not be representative of the population throughout the rest of Tanzania. Additionally, not all departments were equally represented within the results. Considering these limitations, this study provides several important pieces of information. The results demonstrate that within its first year, the only IR service in Tanzania is known to most clinicians taking the survey. Moreover, the satisfaction regarding the procedural outcomes is between “good” and “very good”, emphasizing the great teaching progress that has been accomplished during this short period. The results provide an opportunity for further collaboration with other departments, implementing treatment guidelines and conducting research projects with the goal of improving patient care.