When Dr. Kristen DeStigter, chief of radiology at University of Vermont Lamer School of Medicine, speaks about the needless maternity deaths she saw in the 1980s as part of a research team in Kenya, she does so with insight and just a trace of outrage.
In an opening day virtual 2020 RSNA session on Sunday morning, she presented compelling evidence about the need for, and the payoff in, improving imaging services in low- to low-middle income countries. The overriding theme in her presentation, titled “The Power of Radiology to Drive Collective Action and Transform Global Health,” was that imaging practitioners must take the lead in this effort.
“What we saw over and over was devastating,” DeStigter recalled. “Evaluating pregnant women with ultrasound … complications like obstructive labor due to twins and breech presentation, knowing that without the proper care, women who couldn’t transport to the hospital 14 hours away were likely to die. I carried this with me for many years. To save women’s lives, I co-founded the organization Imaging the World (ITW).”
The lack of basic imaging in low medical resource areas amounts to radiology's "wicked problem." — a term used in planning and policy to describe complex social and economic challenges. There is a disproportionately high burden of disease in low resource areas, especially in Sub-Saharan Africa.
"Without access to imaging services, effective health care is not achievable," she told the audience. "This is a call to action to begin to address this problem."
DeStigter cited data sources from such groups as the UN Humans Rights Council, The World Bank, and the comprehensive Global Burden of Disease study released this year by the Institute of Health Metrics and Evaluation at the University of Washington, noting that in many worldwide health policy planning policies, imaging is barely mentioned.
“So why do we care that imaging is not included in the plans of the world stage?” she asked. “Because these are the guidelines that get incorporated in a country’s national health services strategic plan where it becomes policy and gets budgeted.”
DeStigter said ITW recently reviewed 79 health national health plans of low-income countries. Only 12 countries mentioned imaging or radiology. Only six plans mentioned radiology workforce, and only four mention imaging outcomes.
Current efforts typically face myriad problems. Equipment is often purchased in low-income countries without consulting physicians. Service programs are not included, warranties are often expired before equipment is installed, adequate training is not provided, and it is not unusual for the wrong kind of equipment to be delivered. In one instance, a donated ultrasound machine was installed and blew out the entire power supply for a village; the equipment was never used.
A big part of the solutions is collaboration through organizations such as RSNA to educate and advocate worldwide with health ministries, DeStigter said.
In her work with ITW, portable ultrasound, with its low power needs and relative ease of use, has effectively improved imaging services. Among the ITW outcomes DeStigter cited in their efforts in Uganda and Malawi, including:
1: A 25 percent change in medical management from basic scan finding.
2: Reliable obstetric sweeps for accurate dating and identification of complications.
3: A 70 percent increase in both routine antenatal visits and skilled deliveries as a result of scan “magnet effect”.
4: Successful workforce development — ten advanced imaging non-M.D. degrees and six M.D. degrees in the past ten years.
5: Almost one million patient, family, and community beneficiaries over ten years.
“There are many great efforts, too numerous to mention, by stakeholders around the world who want to raise imaging services,” DeStigter concluded. “We have an obligation to improve equitable access to radiology service for all people … There is incredible skill, talent, and passion in our radiology community. And there is goodwill, and there is empathy, and there is hope."