Guyana Journal

Columbia Radiology at Georgetown Public Hospital Corporation

Since 2019, residents and attendings from Columbia Radiology have provided on-site support for the radiology residency at Georgetown Public Hospital Corporation in Georgetown, Guyana. The program relies heavily on RAD-AID volunteers to provide resident education and assist with read-outs. Columbia Radiology is an official chapter of RAD-AID International, with Guyana as a primary area of focus.

September 8 - 15, 2023

Georgetown, Guyana: Diagnostic Radiology Residency Program Director and abdominal radiologist Jasnit Makkar, MD, travelled to Guyana with chief residents Collin Edwards, MD, and Alana Fruauff, MD. This was Columbia Radiology's third trip to Georgetown Public Hospital Corporation to provide support for the the hospital's Radiology Residency. 

L to R: Christopher Chang, MD (University of Illinois, Chicago anesthesia); Jasnit Makkar, MD; Alana Fruauff, MD; Collin Edwards, MD; Christopher Harnain (Weill Cornell Medicine, interventional radiology), Linda MacDonald (mammography technologist, Victoria, Canada)

September 15, 2023

Journal entry by Alana Fruauff, MD

After spending a week with the radiology residents and attendings in Guyana, I couldn’t help but feel astonished by the resilience of the radiologists (both residents and attendings), who must deal with many more obstacles and challenges than most American residents will encounter throughout their training.

The Guyanese radiology residency is still a very new program with only two classes of residents having graduated thus far. This means that there is still a large shortage of attending radiologists practicing in the country. As a result, the in-house attending radiologists are stretched thin and cannot dedicate as much time as necessary for direct supervision or teaching of the residents. Furthermore, funding for the program is limited, which means residents have access to fewer valuable educational resources. Residents must really advocate for their education and pursue supplementary resources on their own.

Additionally, the working environment and conditions are suboptimal for efficiency. Fewer working monitors and a lack of a voice dictation system means residents and attendings alike are hindered by technical limitations.

Third-year resident Collin Edwards, MD, reviews cases with a Guyanese radiology resident.

Despite all these obstacles and limitations, Guyana has gone from having no radiology residency program at all to building a very capable one in just a few short years. This is no easy feat, even in the most ideal circumstances. This is a testament to the work ethic and determination of the radiologists there. The radiologists never complained or made excuses. Instead, they are focused on ways to keep making improvements.

Throughout our time in Guyana, the residents and attendings were constantly expressing how grateful they were that we had chosen to volunteer with them and their program. They truly valued having extra radiologists available to provide in-person read outs and teaching sessions.

Jasnit Makkar, MD, gives a conference to the radiology residents at Georgetown Public Hospital Corporation.

While they couldn’t thank us enough, we couldn’t help but feel like we were the ones who should be thanking them. They had done such a remarkable job building this program from the bottom up. We had learned so much from them and their determination and resilience. After a week in Guyana, I was proud of the progress we had made, but I wished we had more time in the country to continue our work.

Columbia Radiology with Georgetown Public Hospital radiology residents on the final day of the trip. Columbia Radiology is an official chapter of RAD-AID International.

December 3 - 10, 2022

Georgetown, Guyana: Musculoskeletal radiologist Zohaib Ahmad, MD, third-year radiology resident Edwin Mathieu, MD, and second year radiology resident Connie Liou, MD, travelled to Georgetown, Guyana, to provide on-site support for the Georgetown Public Hospital Corporation Radiology Residency.

L to R: Zohaib Ahmad, MD; Edwin Mathieu, MD; Connie Liou, MD

Saturday Night, December 3rd

Journal entries by Zohaib Ahmad, MD

We arrived close to midnight. When we walked through the doors to the outside, there was that exciting feeling of walking into the cool night surrounded by a crowd of people waiting for family members or friends arriving from abroad. After a little back and forth, I found our driver, Bailey, a nice tall man who pointed out the cricket stadium as we drove past. Bailey dropped us off at Project Dawn, the gated clinic with boarding rooms, at midnight. We each received a key to our rooms, where we had two twin beds, a desk, a dresser, our own bathroom, and a loaf of bread on top of the minifridge.

Sunday, December 4th

One by one, we stumbled into the common area. Angelita, one of the registrars, had signed us up for the Essequibo River Tour. There was just the slight issue of it being at 7:00 AM. Julian, the radiology chief resident, picked us up at 6:20 along with Wynton, a senior resident from Indiana University who is also staying at Project Dawn. Like everyone we meet in Guyana, Julian is a kind man with a wry sense of humor. We crammed into the shuttle with some other tourists and drove an hour to Parika. Along the way, our tour guide mentioned the broken Queen Victoria statue in front of the judiciary building in Georgetown. He remarked that the Guyanese thought that they really should not cover up their colonial past, but while they were having that debate, the statue lost a hand. We stopped for coffee and chicken balls, a fried chicken breakfast food. African, native, Hispanic, and Indian cultures in Guyana are integrated due to the British colonial need for indentured servants in the late 19th and early 20th centuries. This is evident in the food; at the small corner shops, you can buy fried creole food or daal over rice. The small shack where we stopped had a halal sign. It wasn’t a separate culture food: it was all Guyanese food.

We finally made it to Parika, where we started second-guessing our life choices while waiting at the dock. The boats were much smaller than we imagined and had that ready-to-fall-apart-with-a-slight-wave look. But that daring side of my brain took over and I encouraged Edwin and Connie along with each of their unsteady steps. As the largest river in Guyana, the Essequibo River boasts multiple large islands separated by long stretches of waves, heavy winds and rain. I actually enjoyed the boat and was surprisingly able to nap during these interludes, much to the joy of Edwin, Connie, and their cameras.

Fort Island was one of the early Dutch settlements with a fort that protected trade and goods from other colonial powers. Bartica is a city at the fork in the river that has a burgeoning boardwalk area. Baracara Falls unexpectedly required us to wade through ankle-high waters to a pleasant waterfall (cool to the feet). Sloth Island was a disappointment due to lack of sloths.

It then took us an hour by boat and then an hour by shuttle in dense traffic to return to the tour guide offices where Julian picked us up. He drove us to the mall down the street from Project Dawn, where we had an array of options including Pizza hut, Mexican food, and even “New York Style” chicken and rice. Connie and I opted for the tropical chicken bowl, while Edwin and Wynton chose German food. We returned to Project Dawn, ate, and quickly went to our much needed beds.

Monday, December 5th

The shuttle arrived five minutes earlier than expected. Of course, I had only one shoe on when I heard the honk outside. This is when we first caught sight of the goats on the gravel and mud road and started discussing our favorite goat dishes much to Connie’s distaste. The shuttle stopped at the nurses’ boarding house to drop off the overnight nurses. And then we arrived at the Georgetown Public Hospital. The hospital is made up of multiple buildings with blue and red roofs contrasted by white walls. Wynton led us through a back way into the main building, down a long corridor, a left turn to pass the diabetic foot center, another left into radiology, and then a last left into the reading room. Cheerful as always, Edwin wished “good morning” to each patient sitting in the hall and received a “good morning” in return.

Residents in reading room

The reading room is a long narrow room with a shelf along the wall opposite from the door which holds seven workstations. Two lead cabinets serve as portals through the wall into the ultrasound room and the fluoroscopy room, and this is the main method of communication— through the wall. The doctors reading are residents and registrars who are recently graduated residents. There is also a radiologist from China who reads studies as well. We spent the day observing the workflow and helping out with any questions they had. As a musculoskeletal radiology specialist, I was asked to help out with a knee ultrasound. Edwin and Connie helped the residents look at CTs. There's an overnight resident who goes over their cases in the morning, either with a registrar or a doctor in the USA over a web conference. The day residents read CT cases as they come in (a MRI machine is supposed to be installed in the coming year), the indications being written, sometimes messily, on a piece of paper that gets messaged from the tech over WhatsApp. One resident does fluoroscopy cases in the morning, consisting of upper GI and esophograms, usually looking for post-operative leaks. Another resident is on ultrasound, scanning patients on their own in the morning, and doing portable inpatient ultrasounds in the afternoon.

At 11 AM, they asked me if I could give a lecture, and I gave a talk on shoulder trauma. We then went out to lunch, where the residents treated us to daal over rice and mutton from Shanta. It was delicious. One thing I want to emphasize is how hospitable and kind everyone is. They insist on paying for everything and making sure we are well fed.

The day ended around 4 PM. We asked the shuttle driver to stop for groceries, and we picked up some essentials and a delicious Guyanese punch drink call Topco. We returned home realizing that what they said was true; this is not a city where you can walk outside unescorted, especially at night. We stayed in and played some games, and then called it a night.

Tuesday, December 6th

Breakfast with the residents consisted of bake and saltfish, a delicious spiced fish inside a golden fried sweet dough that Connie called a donut. We started to get into the hang of the daily workflow and how we could best help. Things can be very hectic in the reading room, and we quickly realized that we really had to be a part of the cases rather than waiting on the sidelines. I fit lectures in whenever there was a little downtime. The residents seem incredibly grateful to have a MSK specialist amongst them as they are seeing more and more volume in MSK X-ray, CT, and ultrasound.

Wednesday, December 7th

The PACS (Ambra) stopped working sometime in the morning, and I was able to fit in a case conference. More importantly, they provided some fantastic fish for lunch, one my favorite dishes on the trip. In the afternoon, I was able to do a knee ultrasound workshop with the resident Devendra serving as a model patient.

I must emphasize how smart, keen, and sharp these residents are. They see the smallest finding, create great differentials, contain such eagerness to learn, and they are such a kind and helpful group of people. When I say they are a true joy to teach, I mean it more than I have ever had before.

For dinner, Edwin, Connie, and I ventured with a taxi to an Indian restaurant, Aagman, where we had a sweet evening together.

Thursday, December 8th

Thursday was the day of a joint radiology-orthopedic surgery resident lecture, where I discussed tendinous and ligamentous shoulder injury, especially appearance on ultrasound and MRI. It seems orthopedic surgery is eager to order more shoulder ultrasounds for their patients. I was, as were all the residents and registrars, happy that I gave a shoulder ultrasound workshop that afternoon with one of the administrators, Nirmala, and Connie as my model patients.

Throughout these days, Edwin and Connie admirably discussed cases and helped the residents to the best of their abilities. That evening Lissa, a family medicine fellow from Ottawa also staying at Project Dawn, joined us to play more games. We were later joined by Amadu, a pediatric cardiologist from Suriname, and had a great time talking into the evening. Edwin and Connie have been amazing residents to bring along. They have been teaching non-stop and really put their all into helping out in the reading room. Also, they are great fun to dorm with. I will say, if you need someone for charades, pick Edwin.

Friday, December 9th

Friday was bittersweet as we knew it was our last day. A lot of the registrars were out for their graduation ceremony, so I stepped in to read out the overnight resident, Devendra. That evening, the residents Julian, Roscoe, and Devina took us to the sea-wall. Guyana was originally a Dutch colony before changing hands to the French and then the British. The Dutch made this low-lying city safe from flooding by constructing a wall by the ocean and trenches along all the roads. However, this created limited space for a beach, which was small and relatively underdeveloped. A couple of competing luxury hotels stood by the beach. We walked around this boardwalk area and then went to the Christmas village on Main street. As all the departments of the University of Guyana had their graduation that day, a lot of people were out in their graduation robes with professional photographers. There was a Santa and his elves roaming around, and a lot of people had set up stalls selling rum cake, wine, a sherry drink that made your mouth red, and decorations. We returned to Project Dawn, where Amadu had taken out El Dorado Rum, supposedly the best rum according to the Guyanese. He had also brought us roti and chicken from the street, which was delicious.

Saturday, December 10th

The three of us took our time waking up as we were exhausted from the week. Samantha, one of the registrars, was kind enough to take us out to lunch at a Bar and Grill called Kosmos. We said our goodbyes and returned to Project Dawn, where we watched the Quarterfinal FIFA world cup matches, packed, and waited for Bailey to take us to the airport.

I really will miss this country. I hope to return soon, not just to teach, but to see and talk with these lovely people that I was so privileged to meet. Out of everything, the kindness of everyone will stick with me. I hope to return and hope to run into them at conferences. And most of all, I want to do everything in my power to help them that much more.