In their efforts to improve cerebrovascular care on a global scale, Karol Budohoski, MD, and PGY-4 resident Sarah Nguyen, MD, have partnered with providers in Tanzania who are passionate about increasing access to cerebrovascular care—specifically stroke care. The two visited Tanzania in August of last year alongside the Tanzania Stroke Project team to
learn more about the current health system and training in Tanzania and to continue establishing a new stroke program. “We had several goals for this trip,” Dr. Nguyen shared, “but, most importantly, as we work with the Tanzanian government and the stakeholders at Muhimbili National Hospital and Muhimbili Orthopedic Institute, we want to make sure everyone has the same goals for building the program and bringing endovascular treatments for various cerebrovascular pathologies, including aneurysms, arteriovenous malformations, and strokes, to Tanzania.”
During the trip, the team reviewed Muhimbili National Hospital records and the stroke registry created by neurologist Sarah Matuja, MD, that collects data from 8 sites throughout Tanzania. “This information helps us understand the patient population that could potentially require treatment for stroke; it also gives us an idea of the potential cost burden related to equipment, people, facilities, and consumables so that the government is prepared to sustain this program once it has been established,” Dr. Budohoski said.
The team met with department heads and hospital management to outline a new standard operating procedure for patients who present with stroke-like symptoms and identify changes that need to be made to the current stroke referral system. “The stroke referral system has been basically nonexistent,” Dr. Nguyen shared, “so that’s something we’re focusing heavily on.” While the team was in Tanzania, they received referrals for two patients with stroke who would have been perfect candidates for thrombectomy to remove the blood clot, but both patients presented outside of the time frame for effective treatment. “I think there is a lack of awareness that treatment for stroke is even available in Tanzania,” Dr. Budohoski said, “so increasing the general population’s awareness of stroke symptoms and
the treatment options available is another piece of the puzzle as we build this program.” New standard operating procedures, a better referral system, and increased awareness will be key to making sure patients get proper imaging and treatment within the window for intervention.
“The greatest need is for stroke,” Dr. Budohoski said, “but we also have to build up the rest of the cerebrovascular program at the same time so that the providers there have the background to care for patients with stroke. We're developing a formalized curriculum for training neurointerventionalists in Tanzania that will become self-sustaining as providers develop their skills and then work with incoming trainees,” Dr. Budohoski said. With a formalized curriculum, Tanzania will become a hub for cerebrovascular care in East and Central Africa.
“I'm currently working on a master’s degree in medical education for health professionals,” Dr. Nguyen shared, “and I'm planning to complete an enfolded endovascular fellowship for my 7th year, so this was a great opportunity to do some detective work into how different education systems work and how things in Tanzania differ from the way we do them in our hospital. We're essentially building a vascular fellowship program, so we've also gotten to take a look at how the new program will fit into their current system of training. It’s been interesting how
closely our goals for the trip tied in with my classes on curriculum and program development. It's been a great real-world example of the things I'm learning.”
The team has begun training Tanzanian neurosurgeons, neurologists, and interventional radiologists in stroke and endovascular procedures, including stroke thrombectomy. “We have been trying to figure out the technical aspects of performing endovascular interventions,” Dr. Budohoski shared. “We’ve started with less complicated procedures like diagnostic angiograms so that the providers learn to recognize the different pathologies and learn the basic techniques of endovascular work.” During their visit, the team performed 5 surgeries on patients with cerebrovascular pathologies, including an infected aneurysm, an acutely ruptured aneurysm (the first to be treated in the country), a traumatic caroticocavernous fistula,
and 2 unruptured aneurysms. “We performed the cases alongside attending physicians, nurses, and techs who live and work in Tanzania, using their rooms and their equipment,” Dr. Nguyen said. “It was great for hands-on learning and giving the team there more experience with these techniques,” Dr. Nguyen said. All of the procedures went smoothly, and the team is excited to see the progress the program is already making.
“We want to increase the number of teams from different institutions around the world that can visit Tanzania to provide training,” Dr. Budohoski said. “The goal is to have a different team there for a week or two every month so that the trainees and fellows there receive extensive instruction but no one visiting institution is stretched too thin.” So far, the team has partnered with Faheem Sheriff, MD, at Texas Tech University in El Paso, Road2IR (which developed the interventional radiology program in Tanzania), and Mission Thrombectomy (an organization that prioritizes increasing access to thrombectomy around the world). “We’re excited to be working with these groups, especially Road2IR,” Dr. Nguyen said. “There was no interventional radiology program in Tanzania just a few years ago, so their team created this great fellowship training program there that's essentially self-sustaining now. We're working with them to set up the neurointerventional program in the same way.”
The program is still in its early stages, but they’re already making great progress. “I see this as a 5- or 10-year project,” Dr. Budohoski shared. “It'll take us a while to get the actual healthcare systems in place and have the patients coming through and presenting, and then it will take time to get the curriculum approved. And, of course, it'll take a while to get the first batch of
fully trained physicians who will be able to perform cerebrovascular procedures. When that first group is trained, we really hope it will pave the way for a self-sustaining program with the ability of graduated classes to train future providers.”
For Dr. Nguyen, much of the trip was focused on observing behind the scenes a completely different healthcare system. “They experience different barriers to access, and they have different resources and ways that their programs are currently managed,” Dr. Nguyen shared. “I don't know how many trainees get to see the inner workings of a completely different system. I'm familiar with the comprehensive stroke program we have at our hospital, and even though we're always improving, the program is very much settled, whereas in Tanzania, I get to watch how things are built from the ground up. Not only are we helping to establish this new program, but I’ve also gotten insight into the things they're doing in Tanzania that might help us to grow and improve our own systems and programs.” There's a huge need for this program, and there are many dedicated and motivated people in Tanzania who are doing everything they can to make this happen. “It's a privilege to see this in real time and to get to learn about everything that goes into it,” Dr. Nguyen said.