Global support bolsters WHO's educational plan

Support from national radiological societies, international associations, and subspecialty groups is helping the World Health Organization meet its goal of improving diagnostic imaging facilities in developing countries.

Plans to set up regional centers of excellence for education and training, produce updated information on basic imaging, and translate WHO manuals into different languages are under way. Collaboration among organizations has made this progress possible, said Dr. Harald Østensen, coordinator of the WHO's Team of Diagnostic Imaging and Laboratory Technology.

WHO initiatives to assist radiology services in developing nations remain focused on "training the trainers," providing high-quality, relevant, and accessible education for local medical staff. In line with this policy, the WHO has supported the establishment of the East, Central, and Southern Africa Centre of Excellence for Education and Training in Diagnostic Imaging at the University of Nairobi.

Center staff invited 23 government-selected senior radiographers from across Kenya to the first training course on practical quality assurance in March. It is hoped that those who attended the course will develop and implement what they learned by setting up QA training in their own regions. Radiographers who attended the inaugural Nairobi course also received instruction in plain-film pattern recognition to help improve diagnostic decision-making in hospitals and clinics where no radiologist is available.

"In most of sub-Saharan Africa, there are radiologists only in the capital city and two or three major cities," Østensen said. "Most of these are working (or mainly working) for private enterprises. So there are very few in government hospitals, and outside these sites there are hardly any."

The WHO is negotiating to establish a similar center of excellence in French-speaking Africa in collaboration with the French national radiological society, although no decision has been made on the location. A third center planned for the Pacific region is expected to be up and running by the end of 2003. Discussions are under way with the Royal Australian and New Zealand College of Radiologists and include radiographers working in the region.

"We cannot do anything from our side if there is no possibility of working very closely with local, eager experts," Østensen said. "We have to find these people, and that is not always easy. In a lot of the countries and areas that we want to support, there are so few people working in diagnostic imaging that they have no time to take part in education and training."

An ongoing program to replace outdated WHO imaging publications with current versions is also progressing. The first of these updated publications, "Pattern Recognition in Diagnostic Imaging and Quality Assurance Workbook for Radiographers and Radiological Technologists," became available last year, while the "WHO Manual on Diagnostic Imaging: Radiographic Anatomy and Interpretation of the Musculoskeletal System" is expected to be published this month.

Another publication, "Diagnostic Imaging: What Is It? When and How to Use It Where Resources Are Limited," has been translated into a number of Southeast Asian languages. The WHO's regional office for the Western Pacific arranged the translation process with sponsorship from Østensen's group. Anyone wishing to translate WHO imaging publications at their own expense will be given permission to do so, subject to written agreement with the WHO and assurance that the finished work will have no commercial value.

Planned translations of all WHO manuals into French and Spanish, however, will be funded mainly from Geneva. The WHO's Global Steering Group for Education and Training in Diagnostic Imaging will cover some of the expenses for this work.

"All activities, including the publication of documents, are financed by the WHO regular budget, which is extremely small. Our field of work does not easily attract donors, although we are working intensively on it," Østensen said. "The translation of these documents will need a lot more money, but we are always hopeful."

Østensen remains optimistic that radiological education programs will continue to advance, noting the apparent willingness of international radiological societies to offer assistance and expertise. Members of the Global Steering Group, who meet annually at the RSNA meeting and may also meet at another other major international radiological conference, have helped provide the contacts needed to realize projects in developing countries, he said.