- Email: [email protected]
Establishing IR in Emerging Countries—A Skill Development Initiative
GLOBAL PERSPECTIVES
Establishing IR in Emerging Countries—A Skill Development Initiative Sanjiv Sharma, MD, and Kartik Ganga, MD ABSTRACT Integrating interventional radiology (IR) into clinical practice faces challenges in emerging countries in Asia and Africa. Overcoming them requires innovative solutions customized to local needs. After an in-depth gap analysis of these challenges, we began an organized skill development initiative in late 2015 offering radiologists and their supporting staff fully paid scholarships for IR training. Its concept, structure, and progress are reported here. This initiative covered 8 countries, IR specialists (n ¼ 51), senior residents (n ¼ 24), and 15 educational events (training institute [n ¼ 3]; participating countries [n ¼ 12]). This initiative is intended to develop a global network of trained personnel who can support IR programs in challenging locations of emerging countries.
ABBREVIATIONS BAE ¼ bronchial artery embolization, IAEA ¼ International Atomic Energy Agency, IR ¼ interventional radiology
Integrating interventional radiology (IR) into clinical practice remains a big challenge in emerging countries in Asia and Africa. Although IR has changed clinical medicine worldwide, the benefits of these advances have not percolated to the mainstream practice of medicine in these locations. Emerging countries have much to benefit from IR. With burgeoning population levels and an inability to afford expensive health care, overburdened hospitals are struggling to meet the health care needs of a vast portion of this vulnerable population. Judicious use of IR can reduce the cost of disease management and hospital stay because it is a less invasive form of treatment and can positively influence the health economics in these regions. This impact can be assessed by the number of patients that can be treated rapidly by a minimally invasive IR procedure. For example, tuberculosis-related hemoptysis is common within emerging countries. Bronchial artery embolization (BAE) is effective in controlling hemorrhage and costs an average of US$125–$200 (in a community tertiarycare hospital such as ours) compared with surgical management which is much more expensive and has higher morbidity and mortality. Beyond the cost and morbidity, the loss in terms
From the Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, Ansari Nagar, Delhi 110092, India. Received October 12, 2018; final revision received December 21, 2018; accepted December 24, 2018. Address correspondence to S.S.; E-mail: [email protected] Neither of the authors has identified a conflict of interest. © SIR, 2019 J Vasc Interv Radiol 2019; 30:956–960 https://doi.org/10.1016/j.jvir.2018.12.728
of man-hours of labor and productive work is substantial if BAE is not performed or is unsuccessful. The subjects are often the breadwinners of the family, and that adds to the cost as well. Moreover, patients have an average hospital stay of up to 24 hours after BAE and return to resuming an active lifestyle and work much sooner than they would after surgery. This is especially relevant in overburdened and overcrowded hospital environments. Despite these advantages, IR has failed to establish itself as a clinical discipline or have any major impact on health care delivery in these regions. The potential impact of IR is blunted and offset by a host of obstacles and local challenges (Table 1). Overcoming these challenges requires practical and innovative solutions that are customized to local needs. A multidimensional holistic approach is required to address the complex issues and ensure gainful utilization and integration of IR techniques into treatment algorithms. Over the past many decades, there has been little progress in this regard despite sporadic efforts by local administrative bodies and national and international societies, bodies, and organizations. We began an organized initiative to address this challenge in late 2015 after frequent individual requests for help from selected interested radiologists from these regions and an indepth gap analysis of the challenges. The concept, structure, and progress of this initiative are summarized below.
SKILL DEVELOPMENT INITIATIVE—THE VISION A structured approach was devised for this initiative (Fig 1). A local talent pool of interested radiologists from countries
Volume 30 ▪ Number 6 ▪ June ▪ 2019
957
Table 1. Challenges Facing IR in Emerging Countries Social Challenges Lack of access to health care Overburdened hospitals Manpower Affordability Transportation Hostile geography
Infrastructure Challenges
Logistical Challenges
Administrative and Regulatory/ Legal Challenges
Awareness and integration of IR into treatment algorithms Dearth of talent pool and learning or training opportunities Creating optimal practicing environment
Challenge of imaging equipment availability, maintenance Availability, affordability, and matching of IR hardware to suit local needs
Incorporation of IR into clinical practice as a national agenda International frameworks National frameworks Institutional frameworks Recognition as a specialty by national medical council or designated administrative authority
Fig 1. Concept of the Skill Development Initiative.
with access and will to travel to our center were identified (Fig 2). They were offered observerships and short-term training courses to develop IR skills in our center (Fig 3). The average duration of this training was 3 months. Attendees were also provided with logistic and financial support during their training period (up to US$500/month toward stay and reimbursement of observership fee of up to US$200 per month) as well as education materials (books such as the Handbook of Interventional Radiologic Procedures by Kandarpa and Machan and copies of established management protocols published by established societies such as Society of Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe), and samples of consumable materials for starting an IR practice. Emphasis
was placed on teaching and building standards for the ethical practice of IR. Training was focused on imparting skills in disease-specific IR procedures that were relevant to their native regions. Trainees were treated as fellows in the department, and skill development was overseen by senior faculty staff of the department. However, no exitlevel examination was conducted at the completion of training. We plan to introduce an objective evaluation at the end of training from 2019 onward. We are currently designing a survey from among the trainees who have gone back to their native hospitals and started a specialty practice after training with us in order to objectify the impact of training on the practice of IR in their native hospitals. The focus was on imparting skills in basic nonvascular IR procedures, such as abscess drainages, percutaneous
958 ▪ Establishing IR in Emerging Countries
Sharma and Ganga ▪ JVIR
Fig 2. Countries participating in the Skill Development Initiative (map for illustrative purposes only; not to scale/accurate).
Fig 3. Observers from Myanmar and Mongolia with the department staff.
transhepatic biliary drainages, percutaneous nephrostomies, and biopsies and fine needle aspirations for tissue diagnosis, as well as high-impact vascular procedures, such as BAE, uterine artery embolization, basic vascular recanalization procedures, thrombolysis in acute limb ischemia, and management of bleeding emergencies and vascular trauma. Training was tailored to suit the requirements of the trainees. Trainees were introduced to industry representatives to facilitate procurement of equipment and consumables in their countries. They were encouraged to work with their clinical colleagues to foster better interdepartmental cooperation and sharing of equipment. On return to their native countries, they were encouraged to start an IR practice and were supported in decision making and procedure planning by regular communication via various channels, including telephone, Whatsapp, and e-mail on a regular basis. At appropriate intervals, their skills were reinforced by conducting CME programs and workshops in their native environments. Periodic updates were provided by invitations to scientific conferences held in our center. This initiative was able to motivate the formation of national IR societies in Nepal, Sri Lanka, Bangladesh, and Nigeria (Fig 4). As part of this initiative, web-based educational events were also conducted to enhance the outreach and its penetration.
These web-based platforms act as “force multipliers” allowing for wider participation. These events included virtual lectures and CME programs for audiences in Asia and Africa (transmitted live to up to 56 countries via a commercial network) for wider participation. For example, the recent CME program on vascular access, angiographic techniques, and management of the puncture site was transmitted live to 14 centers in India and 26 counties in the Asia-Pacific region. At another level, this initiative reached out to various medical colleges with poor IR utilization with the intention of providing senior residents in radiology with a short stint in an established IR department (Table 2). The objective was to enhance awareness about IR among radiology residents to encourage them to take it up as a career, as well as to provide them with a first-hand learning experience to acquire basic IR skills and opportunities to network with experienced interventional radiologists and possible future mentors. The participation and role of an experienced teaching faculty, both in house and national or international visiting professors, has been the key to the success of this program. These individuals act as global ambassadors for IR and play an enormous role in both inspiring and imparting knowledge to the budding specialists as well as act as role models for them. The volunteer faculty members (n ¼ 16) from India, USA, China, Germany, and UK delivered lectures and conducted workshops both at the established center of excellence and in the working environments of the trainees and observers (Table 2). There were several logistical and financial challenges to getting this program off the ground. The trainees had to pay for their overseas travel and observership fee to the center of learning and incurred other expenditures associated with a short term stay in a foreign country. These were substantial. These issues were mitigated by offering the trainees
Volume 30 ▪ Number 6 ▪ June ▪ 2019
959
well as virtual CMEs from our center transmitted live to audiences in various countries.
OVERCOMING ADMINISTRATIVE AND REGULATORY OR LEGAL CHALLENGES
Fig 4. An outreach program in Colombo, Sri Lanka, in 2016 during which the Sri Lankan Forum of Interventional Radiology was formally launched. Table 2. Results of the Skill Development Initiative Number of countries involved in observership and training programs (Bangladesh, Bhutan, Mongolia, Ethiopia, Myanmar, Nepal, Nigeria, and Sri Lanka)
8
Number of countries who participated in educational events
14
Number of international IR specialists trained
51
Number of international conferences in New Delhi
3
Number of educational events in other countries Sri Lanka
6
Nepal
2
Mongolia Bangladesh
2 1
Nigeria and Ethiopia via virtual CME
1
Number of expert faculty involved in teaching/training initiatives Number of lectures delivered by expert faculty Number of senior residents with short-term rotation in IR
Interventional radiology is variously recognized as a subspecialty of diagnostic radiology or as a distinct clinical specialty in some countries, owing to the differences in country-specific regulations. Interaction between interventional radiologists, professional societies, governments, and health agencies is necessary to ensure the recognition of IR as a distinct clinical specialty in Asia and Africa. The lack of a framework limits the professional bodies in this task. To assist in this endeavor, we began a collaboration with the International Atomic Energy Agency (IAEA) to prepare a document outlining the relevance of IR in clinical medicine and methods of establishing it in emerging countries. An IAEA expert group was established in 2015 and IR experts from various continents met at its headquarters in Vienna to help create a comprehensive report entitled “The Needs of IR in Emerging World Countries.” The report is currently in press as an IAEA publication and should be available on its website in due course. This document will aid governments in establishing IR as a distinct specialty within the existing health care system and lay groundwork for legal sanctity of the specialty and dedicated governmental support.
SKILL DEVELOPMENT INITIATIVE—THE FUTURE
16 640 24
financial aid for full board accommodation and observership fees; the financial and logistical support for the initiative was generously provided by the Society for Image-Guided Therapies. In the first phase of this initiative, we focused on the countries that agreed to participate in this initiative (Fig 2). Since this initiative was established, 51 specialists from these countries have received observerships in IR procedures. We encouraged the participating countries to send a team including radiologist, technologist, and nursing staff to help them establish a comprehensive IR team in their hospitals. This initiative offered them a unique opportunity to learn as a team and become the trainers of tomorrow. We have also so far conducted 15 educational events to international audiences in their native and foreign locations to cement the growth of this initiative (Table 2). These have included international educational events at our center to large audiences from Asia and Africa, regional meetings, and workshops in participating countries to impart skills at local levels as
Consolidating gains from these efforts may allow expanded support and sustained programs that may reach larger audiences. Professional networking for interventional radiologists, especially the next generation of trainees, may create sustaining mentorships, consultative relationships, online discussions, in-house training programs, optional observerships, and expanded clinical programs. This may further provide guiding insight into national and international differences for IR training and new practice building. For example, following these training initiatives, the 2 largest hospitals in Sri Lanka, Myanmar, Nepal, Bangladesh, and Nigeria have now started dedicated IR programs. Radiologists trained under this initiative are now performing basic and some advanced image-guided therapies in these hospitals. These hospitals have now become nodal centers for training local specialists in IR and have been conducting CME programs under supervision of our initiative. As an example, we recently conducted an outreach program in Candy and Colombo in Sri Lanka under this initiative in May 2018 that also included live workshops with advanced endovascular procedures, including below-the-knee revascularization and intracranial aneurysm coiling among others, performed by local Sri Lankan physicians who were trained in Delhi under the initiative. The workshops were conducted under supervision of the visiting faculty. These were the first
960 ▪ Establishing IR in Emerging Countries
successful live workshops conducted in native environments of observers that included performance of cases by the local specialists trained under this initiative. The success of this initiative at our center has established the feasibility of this concept, and the outcomes have established the necessity for its continuation. Collaborating with national and international centers of excellence and setting up more training centers are among the next objectives. These will serve as force multipliers to enlarge the number of budding IR specialists—and patients—who might benefit from broad-spectrum IR care. Social and regulatory challenges can be overcome by better coordination and cooperation between IR professional organizations and governments along with the support of organizations such the IAEA. Large international IR societies need to lend their experience and organization to help support this cause. Teaching programs and skill development initiatives that do away with the bureaucratic hurdles and those that provide generous assistance to trainees should be encouraged. Problems with availability of IR equipment should be
Sharma and Ganga ▪ JVIR
addressed by encouraging and fostering indigenization and locoregional development of such technologies. Until IR gets incorporated and integrated into regional health care systems and university teaching programs, the nascent regional IR community needs the support of international IR organizations. They can contribute by organizing and supporting programs such as this initiative. There is strong logic in the adage that “Together Everyone Achieves More.” Our specialty shares natural collegial bonds that should be harnessed to help each other grow rather than wait for external governmental agencies to leapfrog administrative and financial red tape and sluggishness. There is little doubt that IR can significantly and positively alter patients’ healthrelated quality of life. We are constantly striving to expand our network by inviting more institutions and individuals to collaborate and participate in this initiative. This initiative has contributed toward bridging the gap and developing a global network of trained IR personnel who can support IR programs everywhere, even in the challenging locations of emerging countries.
Establishing IR in Emerging Countries—A Skill Development Initiative Sanjiv Sharma, MD, and Kartik Ganga, MD ABSTRACT Integrating interventional radiology (IR) into clinical practice faces challenges in emerging countries in Asia and Africa. Overcoming them requires innovative solutions customized to local needs. After an in-depth gap analysis of these challenges, we began an organized skill development initiative in late 2015 offering radiologists and their supporting staff fully paid scholarships for IR training. Its concept, structure, and progress are reported here. This initiative covered 8 countries, IR specialists (n ¼ 51), senior residents (n ¼ 24), and 15 educational events (training institute [n ¼ 3]; participating countries [n ¼ 12]). This initiative is intended to develop a global network of trained personnel who can support IR programs in challenging locations of emerging countries.
ABBREVIATIONS BAE ¼ bronchial artery embolization, IAEA ¼ International Atomic Energy Agency, IR ¼ interventional radiology
Integrating interventional radiology (IR) into clinical practice remains a big challenge in emerging countries in Asia and Africa. Although IR has changed clinical medicine worldwide, the benefits of these advances have not percolated to the mainstream practice of medicine in these locations. Emerging countries have much to benefit from IR. With burgeoning population levels and an inability to afford expensive health care, overburdened hospitals are struggling to meet the health care needs of a vast portion of this vulnerable population. Judicious use of IR can reduce the cost of disease management and hospital stay because it is a less invasive form of treatment and can positively influence the health economics in these regions. This impact can be assessed by the number of patients that can be treated rapidly by a minimally invasive IR procedure. For example, tuberculosis-related hemoptysis is common within emerging countries. Bronchial artery embolization (BAE) is effective in controlling hemorrhage and costs an average of US$125–$200 (in a community tertiarycare hospital such as ours) compared with surgical management which is much more expensive and has higher morbidity and mortality. Beyond the cost and morbidity, the loss in terms
From the Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, Ansari Nagar, Delhi 110092, India. Received October 12, 2018; final revision received December 21, 2018; accepted December 24, 2018. Address correspondence to S.S.; E-mail: [email protected] Neither of the authors has identified a conflict of interest. © SIR, 2019 J Vasc Interv Radiol 2019; 30:956–960 https://doi.org/10.1016/j.jvir.2018.12.728
of man-hours of labor and productive work is substantial if BAE is not performed or is unsuccessful. The subjects are often the breadwinners of the family, and that adds to the cost as well. Moreover, patients have an average hospital stay of up to 24 hours after BAE and return to resuming an active lifestyle and work much sooner than they would after surgery. This is especially relevant in overburdened and overcrowded hospital environments. Despite these advantages, IR has failed to establish itself as a clinical discipline or have any major impact on health care delivery in these regions. The potential impact of IR is blunted and offset by a host of obstacles and local challenges (Table 1). Overcoming these challenges requires practical and innovative solutions that are customized to local needs. A multidimensional holistic approach is required to address the complex issues and ensure gainful utilization and integration of IR techniques into treatment algorithms. Over the past many decades, there has been little progress in this regard despite sporadic efforts by local administrative bodies and national and international societies, bodies, and organizations. We began an organized initiative to address this challenge in late 2015 after frequent individual requests for help from selected interested radiologists from these regions and an indepth gap analysis of the challenges. The concept, structure, and progress of this initiative are summarized below.
SKILL DEVELOPMENT INITIATIVE—THE VISION A structured approach was devised for this initiative (Fig 1). A local talent pool of interested radiologists from countries
Volume 30 ▪ Number 6 ▪ June ▪ 2019
957
Table 1. Challenges Facing IR in Emerging Countries Social Challenges Lack of access to health care Overburdened hospitals Manpower Affordability Transportation Hostile geography
Infrastructure Challenges
Logistical Challenges
Administrative and Regulatory/ Legal Challenges
Awareness and integration of IR into treatment algorithms Dearth of talent pool and learning or training opportunities Creating optimal practicing environment
Challenge of imaging equipment availability, maintenance Availability, affordability, and matching of IR hardware to suit local needs
Incorporation of IR into clinical practice as a national agenda International frameworks National frameworks Institutional frameworks Recognition as a specialty by national medical council or designated administrative authority
Fig 1. Concept of the Skill Development Initiative.
with access and will to travel to our center were identified (Fig 2). They were offered observerships and short-term training courses to develop IR skills in our center (Fig 3). The average duration of this training was 3 months. Attendees were also provided with logistic and financial support during their training period (up to US$500/month toward stay and reimbursement of observership fee of up to US$200 per month) as well as education materials (books such as the Handbook of Interventional Radiologic Procedures by Kandarpa and Machan and copies of established management protocols published by established societies such as Society of Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe), and samples of consumable materials for starting an IR practice. Emphasis
was placed on teaching and building standards for the ethical practice of IR. Training was focused on imparting skills in disease-specific IR procedures that were relevant to their native regions. Trainees were treated as fellows in the department, and skill development was overseen by senior faculty staff of the department. However, no exitlevel examination was conducted at the completion of training. We plan to introduce an objective evaluation at the end of training from 2019 onward. We are currently designing a survey from among the trainees who have gone back to their native hospitals and started a specialty practice after training with us in order to objectify the impact of training on the practice of IR in their native hospitals. The focus was on imparting skills in basic nonvascular IR procedures, such as abscess drainages, percutaneous
958 ▪ Establishing IR in Emerging Countries
Sharma and Ganga ▪ JVIR
Fig 2. Countries participating in the Skill Development Initiative (map for illustrative purposes only; not to scale/accurate).
Fig 3. Observers from Myanmar and Mongolia with the department staff.
transhepatic biliary drainages, percutaneous nephrostomies, and biopsies and fine needle aspirations for tissue diagnosis, as well as high-impact vascular procedures, such as BAE, uterine artery embolization, basic vascular recanalization procedures, thrombolysis in acute limb ischemia, and management of bleeding emergencies and vascular trauma. Training was tailored to suit the requirements of the trainees. Trainees were introduced to industry representatives to facilitate procurement of equipment and consumables in their countries. They were encouraged to work with their clinical colleagues to foster better interdepartmental cooperation and sharing of equipment. On return to their native countries, they were encouraged to start an IR practice and were supported in decision making and procedure planning by regular communication via various channels, including telephone, Whatsapp, and e-mail on a regular basis. At appropriate intervals, their skills were reinforced by conducting CME programs and workshops in their native environments. Periodic updates were provided by invitations to scientific conferences held in our center. This initiative was able to motivate the formation of national IR societies in Nepal, Sri Lanka, Bangladesh, and Nigeria (Fig 4). As part of this initiative, web-based educational events were also conducted to enhance the outreach and its penetration.
These web-based platforms act as “force multipliers” allowing for wider participation. These events included virtual lectures and CME programs for audiences in Asia and Africa (transmitted live to up to 56 countries via a commercial network) for wider participation. For example, the recent CME program on vascular access, angiographic techniques, and management of the puncture site was transmitted live to 14 centers in India and 26 counties in the Asia-Pacific region. At another level, this initiative reached out to various medical colleges with poor IR utilization with the intention of providing senior residents in radiology with a short stint in an established IR department (Table 2). The objective was to enhance awareness about IR among radiology residents to encourage them to take it up as a career, as well as to provide them with a first-hand learning experience to acquire basic IR skills and opportunities to network with experienced interventional radiologists and possible future mentors. The participation and role of an experienced teaching faculty, both in house and national or international visiting professors, has been the key to the success of this program. These individuals act as global ambassadors for IR and play an enormous role in both inspiring and imparting knowledge to the budding specialists as well as act as role models for them. The volunteer faculty members (n ¼ 16) from India, USA, China, Germany, and UK delivered lectures and conducted workshops both at the established center of excellence and in the working environments of the trainees and observers (Table 2). There were several logistical and financial challenges to getting this program off the ground. The trainees had to pay for their overseas travel and observership fee to the center of learning and incurred other expenditures associated with a short term stay in a foreign country. These were substantial. These issues were mitigated by offering the trainees
Volume 30 ▪ Number 6 ▪ June ▪ 2019
959
well as virtual CMEs from our center transmitted live to audiences in various countries.
OVERCOMING ADMINISTRATIVE AND REGULATORY OR LEGAL CHALLENGES
Fig 4. An outreach program in Colombo, Sri Lanka, in 2016 during which the Sri Lankan Forum of Interventional Radiology was formally launched. Table 2. Results of the Skill Development Initiative Number of countries involved in observership and training programs (Bangladesh, Bhutan, Mongolia, Ethiopia, Myanmar, Nepal, Nigeria, and Sri Lanka)
8
Number of countries who participated in educational events
14
Number of international IR specialists trained
51
Number of international conferences in New Delhi
3
Number of educational events in other countries Sri Lanka
6
Nepal
2
Mongolia Bangladesh
2 1
Nigeria and Ethiopia via virtual CME
1
Number of expert faculty involved in teaching/training initiatives Number of lectures delivered by expert faculty Number of senior residents with short-term rotation in IR
Interventional radiology is variously recognized as a subspecialty of diagnostic radiology or as a distinct clinical specialty in some countries, owing to the differences in country-specific regulations. Interaction between interventional radiologists, professional societies, governments, and health agencies is necessary to ensure the recognition of IR as a distinct clinical specialty in Asia and Africa. The lack of a framework limits the professional bodies in this task. To assist in this endeavor, we began a collaboration with the International Atomic Energy Agency (IAEA) to prepare a document outlining the relevance of IR in clinical medicine and methods of establishing it in emerging countries. An IAEA expert group was established in 2015 and IR experts from various continents met at its headquarters in Vienna to help create a comprehensive report entitled “The Needs of IR in Emerging World Countries.” The report is currently in press as an IAEA publication and should be available on its website in due course. This document will aid governments in establishing IR as a distinct specialty within the existing health care system and lay groundwork for legal sanctity of the specialty and dedicated governmental support.
SKILL DEVELOPMENT INITIATIVE—THE FUTURE
16 640 24
financial aid for full board accommodation and observership fees; the financial and logistical support for the initiative was generously provided by the Society for Image-Guided Therapies. In the first phase of this initiative, we focused on the countries that agreed to participate in this initiative (Fig 2). Since this initiative was established, 51 specialists from these countries have received observerships in IR procedures. We encouraged the participating countries to send a team including radiologist, technologist, and nursing staff to help them establish a comprehensive IR team in their hospitals. This initiative offered them a unique opportunity to learn as a team and become the trainers of tomorrow. We have also so far conducted 15 educational events to international audiences in their native and foreign locations to cement the growth of this initiative (Table 2). These have included international educational events at our center to large audiences from Asia and Africa, regional meetings, and workshops in participating countries to impart skills at local levels as
Consolidating gains from these efforts may allow expanded support and sustained programs that may reach larger audiences. Professional networking for interventional radiologists, especially the next generation of trainees, may create sustaining mentorships, consultative relationships, online discussions, in-house training programs, optional observerships, and expanded clinical programs. This may further provide guiding insight into national and international differences for IR training and new practice building. For example, following these training initiatives, the 2 largest hospitals in Sri Lanka, Myanmar, Nepal, Bangladesh, and Nigeria have now started dedicated IR programs. Radiologists trained under this initiative are now performing basic and some advanced image-guided therapies in these hospitals. These hospitals have now become nodal centers for training local specialists in IR and have been conducting CME programs under supervision of our initiative. As an example, we recently conducted an outreach program in Candy and Colombo in Sri Lanka under this initiative in May 2018 that also included live workshops with advanced endovascular procedures, including below-the-knee revascularization and intracranial aneurysm coiling among others, performed by local Sri Lankan physicians who were trained in Delhi under the initiative. The workshops were conducted under supervision of the visiting faculty. These were the first
960 ▪ Establishing IR in Emerging Countries
successful live workshops conducted in native environments of observers that included performance of cases by the local specialists trained under this initiative. The success of this initiative at our center has established the feasibility of this concept, and the outcomes have established the necessity for its continuation. Collaborating with national and international centers of excellence and setting up more training centers are among the next objectives. These will serve as force multipliers to enlarge the number of budding IR specialists—and patients—who might benefit from broad-spectrum IR care. Social and regulatory challenges can be overcome by better coordination and cooperation between IR professional organizations and governments along with the support of organizations such the IAEA. Large international IR societies need to lend their experience and organization to help support this cause. Teaching programs and skill development initiatives that do away with the bureaucratic hurdles and those that provide generous assistance to trainees should be encouraged. Problems with availability of IR equipment should be
Sharma and Ganga ▪ JVIR
addressed by encouraging and fostering indigenization and locoregional development of such technologies. Until IR gets incorporated and integrated into regional health care systems and university teaching programs, the nascent regional IR community needs the support of international IR organizations. They can contribute by organizing and supporting programs such as this initiative. There is strong logic in the adage that “Together Everyone Achieves More.” Our specialty shares natural collegial bonds that should be harnessed to help each other grow rather than wait for external governmental agencies to leapfrog administrative and financial red tape and sluggishness. There is little doubt that IR can significantly and positively alter patients’ healthrelated quality of life. We are constantly striving to expand our network by inviting more institutions and individuals to collaborate and participate in this initiative. This initiative has contributed toward bridging the gap and developing a global network of trained IR personnel who can support IR programs everywhere, even in the challenging locations of emerging countries.