Report of Outreach Professor Wade H.M. Wong, D.O

ASNR Visiting Professorship: South Africa, June 2015
Wade H.M. Wong, D.O., FACR, FAOCR
Professor Emeritus
Interventional Neuroradiology
University of California, San Diego

I was fortunate to be selected as the 2015 Outreach Professor to South Africa for the ASNR. I spent a week at each of two very well respected Radiology teaching institutions in June of 2015:

University of Pretoria	Professor Zarina Lockhat, Chair
University of the Witswatersrand	Professor Victor Mngomezulu, Chair

Both institutions are comprised of a number of government hospitals catering to all segments of society, but largely to the indigent. The number of patients seen by these hospitals is staggering. One hospital in the Witswatersrand system was converted from a former Army Base into a 2,000 bed hospital. Like the rest of the hospitals imaging capabilities were limited, having a single CT scanner and a single MRI at each location. All of the staff Radiologists were generalists, some with special interests learned on the job. Fellowship training is rare to non existent in South Africa.

I presented two to three formal lectures per day and some additional teaching cases on the fly at readouts or between interventional cases. There were between 40 to 50 residents (“Registrars”) and staff at each of the lectures. Most of the residents were a bit shy when it came to taking unknowns, but I did get to do some serious board coaching by the end of each week. The lectures and case presentations were so well appreciated that I thought they might not let me return home.

The remainder of the time was largely spent in the interventional suite as the bulk of my background is neurointerventional. I discovered that, while there is an effort to coil cerebral aneurysms, that work is done as a sidelight by a limited number of adventuresome general body interventionalists who have rather limited neuro background and technical skills. (They did the best with what they could with the skills and the equipment that they had.)

There was no acute stroke program, no cancer interventional program, and absolutely no interventional spine/pain work. That gave me an opportunity to do a good deal of coaching when it came to aneurysm treatment, and I was able to introduce several new procedures including Inferior Petrosal Vein Sampling, Kyphoplasty, Celiac Plexus blockades, Hypogastric Plexus Blockades, Spinal Joint Blockades. (I was fortunate to be able to obtain support from Medtronic-Kyphon on a moment’s notice for a number of procedures).

I spent a few afternoons at the MRI readouts where I had an opportunity to do some small group case-by-case teaching with residents. The pathology was diverse with a heavy emphasis on AIDS-related diseases, including TB. The attitude toward cancer pain was that some pain was naturally expected, and that those would die soon so heroic measures were not of concern. I talked at length about palliative interventional procedures whenever a scan of a cancer patient was reviewed…from sympathetic blockades to augmentation to RF and Cryoablation…potentially novel concepts to excite the staff and residents.

The hospitality of the staff was exceptional. They had arranged a driver to pick me up at the airport, take me to the hospital and back to my hotel each day and eventually back to the airport. Everything was exceedingly timely and punctual. That same driver acted as my tour guide on the weekends so I was able to take in some special sites such as the Leseedy Cultural Center, The Cradle of Humankind, The archeological caves of “Little Foot” (the missing link between apes and humans), the Cullinen Diamond Mines, the Voortrecker Museum, Freedom Park, Union Buildings, and the Apartheid Museum.

High Fiving a 30 foot tall statue of Nelson Mandela at Union Park, Pretoria
(an Illusion with the statue in the background)