Interventional radiology services in Sudan

The rapid advancement of the interventional radiology field, raise awareness of the importance of minimally invasive procedures which provided by IR and interventionist among the medical students, residents and specialists.

Advanced training in vascular IR should be available in Sudan Medical Specialization Board (SMSB).

Health insurance should cover the entire of IR procedures.

By Osama Kamel

Nagameldein, Almoalem Medical City,

MD clinical radiology (University of Khartoum),

Fellowship in Interventional Radiology (Malaysia)

E-mail: osamak33@gmail.com

Introduction

Sudan was the largest country by area in Africa and the Arab League until the secession of South Sudan in 2011, since which both titles have been held by Algeria. Its capital city is Khartoum and its most populous city is Omdurman (part of the metropolitan area of Khartoum). It has a population of 45.7 million people as of 2022 and occupies 1,886,068 square kilometers (728,215 square miles).

The World Health Organization (WHO) estimates the number of physicians (per 1,000 people) in Sudan was 0.262 as of 2017, which is far less than the average number of other Arab and worldwide developed countries as shown in Fig A. There is no official released data about the work force of radiologists in Sudan. However, on personal connection and estimation, there are 577 radiologists registered at Sudan Medical Council, and less than 250 radiologists practicing in the country. And there are seven interventional radiologists (IRs) registered at Sudan Medical Council but just four IRs currently practicing in the country.

General radiology training In Sudan

Diagnostic radiology as postgraduate medical training in Sudan is under Sudan Medical Specialization Board (SMSB). The SMSB was established in 1995 by Presidential Decree under the Sudan Medical Specialization Act (1995). The SMSB is
the sole professional training body in the Republic of Sudan mandated to manage and deliver medical and health specialty programmes in the country which is providing 35 specialties since its establishment in 1995.

Radiology training In Sudan started at the University of Khartoum in 1992, but the program did not shift to be under SMSB regulations until 2003, when SMSB became the official governmental body responsible for the selection of candidates, training programs, and exams (3). However, most of the training centers belong to private sector due to well-equipped radiology departments compared with the governmental healthcare institutions.

Since the training started under the regulations of SMSB, approximately 275 physicians have finished their training and have been certified by the board. The process of radiology training starts with a selection exam that determines the candidates who will enter the 4-year training program, which consists of clinical radiological
rotations in different hospitals. The assessment of trainees is based on continuous log book evaluation and two exams, one after finishing the first year and a final exam at the end of the fourth year. The number of radiology trainees accepted is increasing yearly as it started by 10 trainees in 2003 and is currently 30 trainees in average.
Such increase in number of trainees depends on the accreditation of new centers for training and maintaining the accreditations of the old ones.

Figure A: Sudan - Physicians (per 1,000 people)

Physicians (per 1,000 people) in Sudan were 0.262 as of 2017. Its highest value over the past 57 years
was 0.407 in 2015, while its lowest value was 0.030 in 1960.

Definition: Physicians include generalist and specialist medical practitioners.

Source: World Health Organization's Global Health Workforce Statistics, OECD, supplemented by
country data.

Interventional radiology practice In Sudan

The IR services are available only in Khartoum, the capital city of Sudan. Only four IRs are currently working in Sudan (Khartoum), so the rural areas are suffering from the lack of this type of services. As there is no IR training fellowship in Sudan - all IRs currently working have been trained in Malaysia, Jordan and Thailand.

Most of the basic interventional procedures such as biopsies and drainage are performed by the diagnostic radiologists. Some other procedures like percutaneous insertion of nephrostomy tubes and tunneled dialysis catheters are performed by urologists and vascular surgeons, respectively. There are three dedicated IR suites, that are available for interventional procedures. The first two IR suites are private established in 2016, the third one is governmental and established in Suba teaching hospital in 2021.

Difficulties facing the IR services in Sudan

There are several significant difficulties that must be overcomed to safely and practically implement and sustain IR service in Sudan. These difficulties include infrastructure and relevant logistics, social and financial difficulties. The vascular IR services are available in only one governmental institution (Suba teaching hospital) which is essentially not equipped with enough advanced imaging modalities due to funding issues.

Second, all IR services concentrated in the center of Khartoum (that means this services even not available in peripheral areas in the capital of Sudan (Khartoum).

Third, the high cost of the IR procedures, which are very costly in comparison to the average Sudanese income with no health insurance companies covering IR procedures in their plans due to which both physicians and patients are forced to choose more conventional, but more invasive options.

Fourth, there is lack of professional awareness among different physicians about the advantages of IR and its role in the management of various clinical conditions with minimally invasive techniques. For example, management of bleeding due to uterine fibroid and avoidance of subsequent hysterectomy.

The fifth difficulty is the number of available trained IRs, which is less than in any other Arab countries due to unavailable training program and immigration of radiologists to work abroad especially in the Gulf countries. Although there is governmental fund for improving the department of radiology equipment including IR in one of the biggest governmental hospitals, there is no available national plan for expanding IR service in Sudan.

Finally, the unstable political situation is the main stumbling block.

Proposals for the future

All governmental and private efforts should co-operate to overcome the difficulties facing the minimally invasive IR services in Sudan, which include:

1) Advanced training in vascular IR should be available in SMSB.

2) The rapid advancement of the IR field. Raise awareness of importance of minimally invasive procedures which are provided by IR and interventionist among the medical students, residents and specialists.

3) The ministry of health should support the governmental IR suites with the expensive consumable material to minimize the cost of the IR procedures.

4) Health insurance should cover the entire of IR procedures.

5) Co-operation with the international health organizations and big companies to support the interventional services in Sudan.