At that time, nobody was able to perform US exams or was at least aware of the benefits of diagnostic ultrasound. Since medical personnel in this area are scarce, the program was organized to include not only MDs but also Assistant Medical Officers, Clinical Officers, Radiographers, and Nurses. Care was taken to give them basic information about anatomy and pathology, as well as on-the-job ultrasound education. The official languages in Zanzibar Archipelago are Kiswahili and English. English is the official school language starting from the second grade.

Implementing the program (2006-2011):

The WMC “ultrasound training program” started in 2006 at the Chake-Chake Hospital in the middle of Pemba Island, which is the second largest isle of the Zanzibar Archipelago. When the program started, there was no radiologist performing US examinations in the public hospitals of the Archipelago and only X-ray equipment was available. The program lasted 5 years and included basic and advanced courses. Courses in sonography conducted by European experts were scheduled every 4 months for 2 consecutive weeks each time. During each course 24 hours of lectures and 36 hours of hands-on scanning was planned. The trainees performed sonographic examinations on outpatients and inpatients under the supervision of the teacher/tutor. At the beginning of each course the trainees received a multiple-choice entrance test with the purpose of evaluating their basic knowledge. At the end of every course the trainee’s proficiency was assessed with a multiple-choice test and a practical test conducted on patients. The trainees admitted to the following course should have reached a minimum score on both tests. The results obtained at the end of the first year of the program were impressive and were published in the American Journal of Roentgenology in 2007 (doi: 10.2214/AJR.07.2202).

The program continues (2011 and thereafter):

After this successful first experience, the project restarted in 2011 at Mnazi-Moja Hospital located in Unguja Island, which is the largest isle of the Archipelago. The attendees of the 2006-2011 program with the highest performance were trained to become trainers themselves and able to supervise the trainees and to give classes, supported by the WMC team. The local trainers included Dr. Khadija Suleiman Said, who is an OB/GYN specialist and the local representative and supervisor of the WMC and Mr Khamis Abraham and Mr Mahmoud Badru who are both radiographers as well as the local coordinators of the WMC. Currently, one of the three annual courses is held by them, therefore the ultrasound training program has almost reached the self-maintenance phase. Moreover, they are tutors for the on-job training of participants between course and responsible for a written report of all activities related to the program, including the number and quality of US examinations performed by the trainees.    

In 2011, the first memorandum of understanding between the WMC and the Ministry of Health of Zanzibar Archipelago was signed. In June 2022, the fourth agreement was signed for the 2023-2025 edition of the ultrasound training program. Participants to the ultrasound courses were selected by Dr. Khadija Suleiman Said, Mr Khamis Abraham and Mr Mahmoud Badru. Younger participants working for a public hospital with fluency in English were the preferred applicants.  Half of the seats were reserved for health personnel living and working on Pemba Island. Since the signing of the first memorandum of understanding all course attendees get an official diploma and are qualified as sonographers.

Over the years several sonographers have been trained by WMC and are capable of performing high-quality diagnostic ultrasound examinations in Zanzibar Archipelago.

2023-2025 edition of the program:

In January 2023 the fourth edition of the program started at Mnazi-Moja hospital with twenty participants selected. This time Richard Barr, Professor of Radiology at Northeast Ohio Medical University, and Leslie Scoutt, Professor of Diagnostic Radiology at Yale School of Medicine, joined us, at their own expense, to give lectures and hands-on training.

This is their report of the experience:

“Drs. Leslie Scoutt and Richard Barr were asked if we wanted to participate by Dr. Ferraioli and Dr. Meloni.  We both are very dedicated to ultrasound education and were happy to say yes.  When we arrived at Stone Town in Zanzibar, everyone was very friendly and inviting.  The students were so energetic, committed and eager to learn.  We were privileged to spend 5 days with the students at the very beginning of their 3-year course. We spent the mornings working alongside Drs. Ferraioli and Meloni as well as the local faculty providing didactic lectures reviewing basic US principles and scanning techniques, how to use the ultrasound machine, as well as the anatomy and some basic pathology in the abdomen, pelvis and breast. This was followed by several hours of hands on scanning each day. The students were very, very attentive, and all were taking notes as we were giving lectures and asked many questions.  They especially wanted to do hands on training. They themselves,were the models, and it was so impressive to see what an excellent job they did helping each other learn as they grasped concepts and identified the anatomy.  Even though the ultrasound equipment they had to use was old and of limited quality, that did not stop the students from learning or diminish their enthusiasm and effort!  We are happy to report that they all showed significant improvement in their final exam!

Outside of class, everyone at Stone Town was very helpful and we felt completely safe while there.  It is a very beautiful area with lots of history, and when we weren’t teaching, we had a lovely time learning about the local history and culture as we explored the area.

We are looking forward to following the students throughout their three-year course and helping them to become accomplished and certified ultrasound practitioners. We believe that medical care in the area will be significantly impacted by this group of health care professionals as they become competent in diagnostic ultrasound, and we understand that they have been specifically chosen from over 100 applicants such that they will practice throughout the Zanzibar Archipelago. Moreover, we are incredibly impressed by what this program has already accomplished. We taught alongside several local faculty who already have been trained through this program. They have become so adept that they are now themselves excellent teachers and respected local faculty. We anticipate that many of these current students will also become teachers and continue to train others to follow in their footsteps, making this a truly sustainable health care initiative with the goal of exponentially helping others to provide the best possible health care throughout the Zanzibar health care system.  We are excited that the Ministry of Health is supporting this initiative, and honored that we were invited to participate in such a well-organized program that has already demonstrated such excellent results”.

Local benefits linked to the program and comments:

The 2022 Tanzania Zanzibar Census reports that there are 1,889,773 inhabitants in the region, and about half of them live in rural areas (https://www.nbs.go.tz/index.php/en/). There are well-equipped and well-staffed tertiary hospitals in mainland Tanzania, however the costs for travelling might be unaffordable for most of the population living in Zanzibar Archipelago. Currently ultrasound examinations are performed by sonographers trained by the WMC program, and the ultrasound facility at Mnazi-Moja hospital in Unguja Island is open 24/7 all year round. The Ministry of Health has acknowledged the importance of having efficient and effective ultrasound services by establishing the “sonographer” position that is given to the personnel trained by the WMC. Sonographers receive a better wage, and their working time is dedicated exclusively to US exams. The presence of US facilities has dramatically reduced the number of diagnostic errors and has led to an overall improvement of the quality of the healthcare delivered in Zanzibar Archipelago. There are now 24 sonographers actively working in this region. All of them were trained by the WMC.

The WMC ultrasound training program, which is free of charge for the participants, is devoted at spreading knowledge and expertise, fulfilling the WHO aims in this field. We strongly feel that a long-term US training under expert’s supervision can achieve amazing results even starting from the scratch in areas with limited resources.

Maria Franca Meloni, MD, President of the World Medical Colours (WMC)

Giovanna Ferraioli, MD, Secretary of the World Medical Colours (WMC)