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Problem Malawi has one of the world's highest rates of human immunodeficiency virus (HIV) infection (10.6%), and southern Malawi, where Thyolo district is located, bears the highest burden in the country (14.5%). Tuberculosis, common among HIV-infected people, requires radiologic diagnosis, yet Malawi has no radiologists in public service. This hinders rapid and accurate diagnosis and increases morbidity and mortality. Approach Medecins Sans Frontieres, in collaboration with Malawi's Ministry of Health, implemented teleradiology in Thyolo district to assist clinical staff in radiologic image interpretation and diagnosis. Local setting Thyolo district's 600 000 inhabitants are mostly subsistence-level or migrant farmers living in extreme poverty. Health facilities' include one public hospital and 38 primary health centres. Understaffing and the absence of a radiologist make the diagnosis of tuberculosis difficult in a population where this disease affects 66% of patients with HIV infection. Relevant changes From September 2010-2011, 159 images (from 158 patients) were reviewed by teleradiology. Teleradiology changed patient management in 36 cases (23.5%). Two (1.3%) of them were cases of pulmonary tuberculosis not previously suspected by clinical staff. In addition, the radiologist's review corrected the misdiagnosis of tuberculosis and averted inappropriate treatment in 16 patients (10.5%). Lessons learnt Teleradiology can improve tuberculosis diagnosis and case management, especially if criteria to identify the patients most suitable for referral are developed and the radiologist is conversant with local resources and health problems. Designating a clinical focal point for teleradiology ensures sustainability. Staff need time to adapt to a new teleradiology programme. [TEXT NOT REPRODUCIBLE IN ASCII.] Faisabilite de l'utilisation de la teleradiologie pour ameliorer le depistage et la gestion des cas de tuberculose dans un hopital de district au Malawi Probleme Le Malawi connait l'un des taux les plus eleves au monde d'infection par le virus de l'immu nodeficience humaine (VIH) (10,6%), et le Sud du Malawi, ou se trouve le district deThyolo, porte le fardeau le plus lourd du pays (14,5%). La tuberculose, freq uente chez les personnes infectees par le VIH, necessite un diagnostic radiologique. Pourtant, le Malawi ne dispose pas de radiologues dans le secteur public. Cela empeche un diagnostic rapide et precis et accroit la morbidite et la mortalite. Approche Medecins Sans Frontieres, en collaboration avec le ministere de la Sante du Malawi, a mis en oeuvre un service de teleradiologie dans le district de Thyolo, pour aider le personnel clinique a interpreter les images radiologiques et a etablir un diagnostic. Environnement local Les 600 000 habitants du district de Thyolo sont, pour la plupart, des agriculteurs disposant du minimum vital, ou des migrants vivant dans l'extreme pauvrete. Les etablissements sanitaires se composent d'un hopital public et de 38 centres de sante primaires. Le manque de personnel et l'absence de radiologues rendent le diagnostic de la tuberculose difficile dans une population ou cette maladie affecte 66% des patients atteints de l'infection par le VIH. Changements significatifs De septembre 2010 a 2011, 159 images (de 158 patients) ont ete examinees par teleradiologie. La teleradiologie a change la prise en charge de 36 patients (23,5% des cas). Deux (1,3%) d'entre eux etaient des cas de tuberculose pulmonaire que le personnel dinique ne soupconnait pas auparavant. En outre, l'examen du radiologue a corrige un diagnostic de tuberculose errone et evite un traitement inapproprie chez 16 patients (10,5%). Lecons tirees La teleradiologie peut ameliorer le diagnostic et la gestion des cas de tuberculose, en particulier si des criteres d'identification sont developpes pour les patients les plus adaptes a une orientation vers des centres specialises, et que le radiologue connait bien les ressources et les problemes de sante Iocaux. Designer un point de convergence clinique pour la teleradiologie assure la perennite du projet. Le personnel a besoin de temps pour s'adapter a un nouveau programme de teleradiologie. [TEXT NOT REPRODUCIBLE IN ASCII.] La viabilidad de las radiologias a distancia para mejorar el diagnostico de la tuberculosis y la gestion de los casos en un hospital de distrito en Malawi Situacion Malawi presenta una de las tasas mas altas (10,6%) de infeccion por el virus de la inmunodeficiencia humana (VlH) del mundo, y el sur de Malawi, donde se encuentra el distrito de Thyolo, es la zona mas afectada del pais (14,5%). La tuberculosis, muy habitual entre los infectados por el VlH, requiere un diagnostico radiologico, pero Malawi no tiene radiologos en su servicio publico, Io que impide diagnosticar la enfermedad de manera rapida y exacta y aumenta la morbilidad y la mortalidad. Enfoque Medecins sans Frontieres, en colaboracion con el Ministerio de Sanidad de Malawi, han aplicado la radiologia a distancia en el distrito de Thyolo para ayudar ai personal clinico en la interpretacion de imagenes radiologicas y el diagnostico. Marco regional La mayoria de los 600 000 habitantes del distrito de Thyolo apenas pueden sustentarse o son granjeros inmigrantes que viven en la pobreza extrema. Las instalaciones sanitarias incluyen un hospital publico y 38 centros de atencion primaria. La escasez de personal y la ausencia de un radiologo dificultan el diagnostico de la tuberculosis en una poblacion en la que dicha enfermedad afecta al 66% de los pacientes infectados por el VIH. Cambios importantes Por medio de la radiologia a distancia se examinaron 159 imagenes (provenientes de 158 pacientes) desde septiembre de 2010 a 2011. La radiologia a distancia supuso un cambio en la gestion de 36 casos (23,5%). Dos de ellos (1,3%) resultaron ser casos de tuberculosis pulmonar de la que el personal clinico no habia sospechado antes. Ademas, el examen dei radiologo corrigio el error de diagnostico de la tuberculosis y evito un tratamiento inadecuado en 16 pacientes (10,5%). Lecciones aprendidas La radiologia a distancia puede mejorar el diagnostico de la tuberculosis y la gestion de los casos, en especial cuando se han desarrollado criterios para identificar a los pacientes mas adecuados para derivarlos a un especialista y el radiologo esta versado en los recursos Iocales y los problemas sanitarios. La designacion de un centro clinico de coordinacion para la radiologia a distancia garantiza la sostenibilidad. El personal necesita tiempo para adaptarse al programa nuevo de radiologia a distancia., Background Approximately 600 000 people inhabit Thyolo district in southern Malawi. Most are subsistence-level or migrant farmers who live in extreme poverty and have very little formal education. (1,2) Thyolo [...]

Abstract Background Community learning and e-mentoring, learning methods used in higher education, are not used to any extent in residency education. Yet both have the potential to enhance resident learning and, in the case of community learning, introduce residents to basic lifelong learning skills. We set out to determine whether residents participating in an Internet based e-mentoring program would, with appropriate facilitation, form a community of learners (CoL) and hold regular community meetings. We also determined resident and faculty perceptions of CoL and Internet sessions as effective learning experiences. Methods A six-month e-mentoring pilot was offered to 10 Radiology residents in the Aga Khan University Postgraduate Medical Education Program in Nairobi, Kenya (AKUHN) with a Professor of Radiology, located at University of Virginia, USA, acting as the e-mentor. Monthly Internet case-based teaching sessions were facilitated by the e-mentor. In addition, residents were coached by a community facilitator to form CoL and collectively work through clinical cases at weekly face-to-face CoL sessions. Event logs described observed resident activity at CoL sessions; exit survey and interviews were used to elicit perceptions of CoL and Internet sessions as effective learning experiences. Results Resident adoption of CoL behaviors was observed, including self-regulation, peer mentoring and collaborative problem solving. Analysis revealed high resident enthusiasm and value for CoL. Surveys and interviews indicated high levels of acceptance of Internet learning experiences, although there was room for improvement in audio-visual transmission technologies. Faculty indicated there was a need for a larger multi-specialty study. Conclusions The pilot demonstrated resident acceptance of community building and collaborative learning as valued learning experiences, addressing one barrier to its formal adoption in residency education curricula. It also highlighted the potential of e-mentoring as a means of expanding faculty and teaching materials in residency programs in developing countries.