Teaching and Learning in Ethiopia

Alexis Taylor Smith is a sonographer, a teacher, a mentor, a patient advocate, a team player and now, thanks to a life-changing two weeks in Addis Ababa, Ethiopia, she's an ultrasonographer with a global fan club.

Alexis joined Emory Radiology's Gayatri Joshi, MD, FAIUM, FSRU, professor in the Division of Emergency and Trauma Imaging and medical director of ultrasound; Leann Linam, professor in the Division of Pediatric Imaging; and Chief Resident Christian Gomez, MD, for two weeks in Ethiopia earlier this year as part of the Global Health Radiology Scholars Program. Alexis was chosen from an impressive pool of applicants - all Emory Radiology sonographers who wanted to share their expertise as sonographers with the radiologists and radiology residents training at Black Lion Hospital in Addis Ababa. A scholarship provided by the Emory Sonographer Global  Health Scholarship Program covered Alexis' travel expenses. 

Dr. Joshi says having an ultrasonographer on the team makes a big difference for their colleagues at Black Lion Hospital. "There are no dedicated sonographers in Ethiopia. The physicians ARE the sonographers. They scan the patients themselves and then write up their findings, so proficiency in scanning is of the utmost importance."

Dr. Joshi also explains that ultrasound is the imaging workhorse at Black Lion Hospital. "Black Lion does not currently have a functioning MRI and many patients cannot afford CT, so many clinical questions must be solved by ultrasound." 

The team emphasized hands-on learning for the Black Lion doctors and trainees; brief lectures previewed the diagnostic techniques the Black Lion radiologists would then employ during outpatient clinics and inpatient rounds.

Alexis embraced the challenge. "During the trip, I led lectures and hands-on workshops in abdominal ultrasound with a focus on Doppler and carotid ultrasound." I also did a brief lecture on pelvic imaging. I assisted with live patient scanning, helping guide residents through protocols, image acquisition, and interpretation. It was rewarding to support and learn from the local radiology team as we shared our techniques and adjusted to their equipment and resources. I also assisted with the breast biopsy lab led by Dr. Joshi and Dr. Gomez."

Drs. Joshi and Linam have traveled to Addis Ababa many times and enjoy warm working relationships with their colleagues at Addis Ababa University and Black Lion Hospital. As first-timers, Alexis and Chief Resident Christian Gomez prepped by learning about Black Lion Hospital and how to provide medical care in a resource-limited environment.

Not only did they plan lectures and demonstrations, they also collected medical supplies to donate to Black Lion Hospital. Their procurement skills resulted in a new dilemma: how to haul 10 suitcases full of medical supplies plus their own belongings through the airports. The answer? Cheerfully.

Delivery logistics sorted, the team then had to sort and organize the supplies at Black Lion. Dr. Joshi enjoyed showing off the medical supplies she and the team neatly organized in an old emergency department room repurposed for storage. The supplies included soap, gloves, masks, gowns, ultrasound gel, biopsy and procedural supplies, sterilizing wipes, and, thanks to a grant from Hologic, several breast biopsy devices for Black Lion’s new breast imaging center. 

Alexis boarded the plane with hopeful expectations. "I expected to contribute educationally and offer support through clinical training. But more than anything, I wanted to approach the experience with humility and an open heart. I anticipated differences in technology and workflow, and I was curious to see how they adapted with limited resources. I also hoped to form meaningful connections and grow both professionally and personally."

She accomplished all that and more.

One of the most meaningful moments, Alexis says, "Was witnessing how genuinely appreciative the radiology residents were during the workshops. Their warmth, curiosity, and eagerness to learn made every interaction feel special. I’ll never forget the look on one resident’s face after I shared a small scanning tip they lit up with so much joy when they applied it and saw a beautiful image appear on the screen. It was such a powerful reminder that even the smallest pieces of knowledge can spark confidence and inspiration. That moment stayed with me and it reminded me why I love ultrasound work and how impactful it is to connect with others through teaching and shared purpose."

For fourth-year diagnostic radiology resident Fiza  Khan, MD, the month-long rotation in Ethiopia felt deeply validating. For four years, she and her classmate Zofia Lasiecka, MD, worked to establish the Global Health Track for Emory Radiology's Diagnostic Radiology Residency program. As recipients of the department's 2021 Adopt-A-Resident Grant, the two residents worked with faculty mentors Hernan Bello, MD, and Jay Shah, MD, to create the track, which includes an option for completing a rotation in a resource-limited partner location like Black Lion Hospital in Ethiopia's capitol city of Addis Ababa.

Dr. Khan says, "The month-long immersive experience at Black Lion Hospital was truly eye-opening. During my time there, I gained a deep appreciation for the impact of diagnostic radiology and the crucial need for interventional radiology on a global scale. It was remarkable to witness the work ethics and resourcefulness of my local colleagues on the ground, considering the resource-limited environment they worked in. This experience has only reinforced my commitment to improving health care access and quality in underserved areas. I am eagerly looking forward to continuing this bilateral educational experience and contributing towards identifying the need for interventional radiology and establishing a sustainable program."

Dr. Zofia Lasiecka devoted much time teaching the residents and fellows at Black Lion Hospital about cranial and spinal ultrasound thanks to a mini-grant awarded to her by Emory Radiology's Global Health Committee. Dr. Lasiecka's efforts included scanning the tiniest patients in the neonatal intensive care unit (NICU). 

The trip marked the first time an Emory Radiology Global Health Residency Scholars Program (RGHRSP) team traveled abroad since the start of the COVID-19 pandemic and only the second time a clinical staff member participated. A scholarship program launched in 2018 by Gayatri Joshi, MD, associate professor and co-chair of the RGHRSP, helps cover the staff member's travel costs. After a competitive application process during the fall of 2023, the program committee selected Annie Goodwin, RDMS (AB)(OB), level II sonographer at Emory University Hospital Midtown, to join the team for the February 2024 trip.

One of the many benefits of the partnership with Black Lion Hospital is co-learning, which Annie really appreciated. "During my time there, I helped the residents with scanning techniques and image optimization. Ultrasound is the workhorse of the radiology department at Black Lion Hospital and they depend on it heavily. The residents are so smart and have so much knowledge about ultrasound, but as a sonographer, I was able to share some of my techniques I have learned throughout the years and I was able to learn so much from them as well."

When asked about her favorite part of the trip, she doesn't miss a beat. "My favorite part of the trip was learning about the residents, their stories, and getting to know them. Each of the residents are so special and smart; they will all make great radiologists! I am glad that I was able to share the knowledge that I have and hopefully impact them as much as they impacted me."

Dr. Alex Bode, a fourth-year interventional radiology resident and an Emory Radiology chief resident, also received a mini-grant to support a teaching project. Funded by the School of Medicine's Global Health Residency Scholars Program, Dr. Bode's mini-grant focused on teaching ultrasound image-guided procedures such as biopsies and drains. The grant helped purchase supplies needed to create phantoms, or stand-ins for organs and body parts so the residents could practice the techniques Dr. Bode demonstrated.  

During this year's trip, the first since the start of the COVID-19 pandemic, the Emory team brought with them eight large suitcases. Each was stuffed with medical supplies Dr. Gayatri Joshi, associate professor and co-chair of the scholars program, had been stockpiling over the past year or two.

"If we've experienced shortages in medical supplies over the past few years because of the pandemic and shipping disruptions, imagine what Black Lion Hospital has experienced," says Dr. Joshi.

"There are significant disparities in health resources and health outcomes in underrepresented and underserved communities, which may be in our backyard or thousands of miles away on the global front. This is particularly true in Africa, Ethiopia included. Each year I do my best to collect supplies with help from colleagues at all Emory sites. Because of the pandemic and recent political instability in Ethiopia, we have not been able to go to Ethiopia since 2019. So for this year’s trip, I had been collecting supplies for about four years."

The supplies came from Emory and from private practice hospitals in the Atlanta area, as well as a generous donation through a grant program with Hologic. The team lugged nine large suitcases filled with supplies to Ethiopia.

"It was a lot of work, but incredibly fulfilling," says Dr. Joshi.

Resident Update: Fiza Khan, DO, now is a clinical assistant professor and interventional radiologist in the Department of Radiology at the University of Cincinnati. Zofia Lasiecka, MD, is an assistant professor in the Division of Neuroradiology in the Department of Radiology at Emory University. Alex Bode, MD, is completing an interventional radiology fellowship with Emory Radiology.