Changing the Global Health Model

For the radiology residents at the Hôpital de l'Universite d'Etat d'Haiti in Port-au-Prince, Haiti, support from volunteers is critical to the success of their program. They lack everything from an organized curriculum and working technology to mentorship from attending physicians—all things that are taken for granted in U.S. programs.

Through its global health program, Columbia’s Department of Radiology has provided critical aid to the Haitian residency for more than three years. In collaboration with RAD-AID International, members of the department have travelled to Haiti multiple times to provide on-site education and support for the Haitian residents in the form of lectures, organized conferences, and hands-on training.

Now, thanks to fourth-year radiology resident Michael Chervonski, MD, and third-year radiology resident Andrew Liu, MD, the Haitian residents receive weekly lectures as well. These lectures are delivered remotely through the video conferencing platform Zoom, with a live resident available to present cases, answer questions, and open topics for discussion.

“This is traditionally what radiology residents in the U.S. receive for their radiology training,” says Dr. Liu. “Besides the clinical responsibilities, we get these regular lectures every day.”

In fact, lectures are a cornerstone of medical residencies in the U.S., a forum for attending physicians to pass knowledge onto trainees and share information about specific cases. In low-resource countries like Haiti, this kind of organized curriculum is often non-existent.

“We are really blessed with both our exposure to complex disease entities and to knowledge and mentorship from people who have been trained by people before them,” Dr. Liu says. “It's really up to people in more developed countries to provide the knowledge and expertise to help resource-poor countries.”

But when Dr. Chervonski, Program Director of RAD-AID Haiti, took on the Haiti global health program, he immediately saw that there were limitations to the traditional global-health model, where groups from high-resource countries travel to low-resource countries for a week at a time.

“The teaching program relied almost entirely on flying volunteer teams to Haiti,” Dr. Chervonski explains. “The resources and effort that goes into these trips don’t allow us to teach sustainably. We’d teach for about 12 hours in any given week-long trip, two or three times per year. In contrast, Columbia residents have lectures every day, often three times a day, all year round."

After two trips, Dr. Chervonski decided to try something different. With the support of residency director Elise Desperito, MD, he began broadcasting periodic lectures to the residents in 2018, during months when trips were not happening.

The lectures were a success. They have also enabled the program to continue despite travel restrictions that were imposed by Columbia Radiology last fall, due to political unrest.

This academic year, the Haiti program is not only entirely remote, but Dr. Liu has transformed the lectures into an interactive experience. Daily lectures at Columbia are now recorded, and selected lectures are broadcast each week to Haiti through Zoom. In addition, a Columbia radiology resident is available live throughout the broadcast to present cases, answer questions, and pause the lecture for comments. 

For the residents in Port-au-Prince, who are accustomed to self-guided learning, the lectures have provided invaluable training. “They are really appreciative, especially with everything else that's happening in their country,” Dr. Liu says. “Some of the comments were that this has been one of the best, most positive things that's been happening for them.”

Eventually, both Dr. Chervonski and Dr. Liu envision a global program in Haiti that combines the weekly lectures with periodic week-long trips. “These trips are actually beneficial for our own residents, because they get to experience the reality of practicing radiology in a resource-poor setting,” Liu says. He believes the trips will become even more meaningful when Columbia’s residents already have developed relationships with the Haitian residents through the Zoom lectures.

In addition to selecting lectures to broadcast and creating a schedule for Columbia residents to present them, Dr. Liu is finding ways to measure their effectiveness. He writes up test questions for the Haitian residents to answer before and after the lecture, which he hopes will eventually provide a quantitative gauge of how effective they have been. He is also keeping a journal where he records challenges he’s faced and improvements that have been made along the way. All this is in the hopes of helping people apply this idea in other situations.

“You could do this anywhere,” Dr. Liu says.