The ACR has always made it a mission to ensure radiologists have access to as many resources as possible to advance the specialty. This includes providing financial support for global travel to low- and medium-income countries in need of healthcare services. 

Since 2008, the Goldberg-Reeder Grant has offered ACR members a chance to make a difference in global health through funding for in-person visits to other countries. In August and September 2023, Darby Shuler, MD, traveled to Nicaragua through the grant program as an elective that counted towards residency graduation with One World Health — enabling her to pursue the interest in global health she discovered while in medical school. Shuler sat down with the ACR Bulletin to talk about her time in Nicaragua and the positive impact the Goldberg-Reeder Grant made possible.

How did you become interested in global health?

I became interested in global health pretty early, right as I was becoming interested in medicine. In high school, I was really involved with Model United Nations. We would meet and represent different countries and talk about world issues. I got to be on the World Health Organization committee for one year, and I got a lot of exposure to talking about global health issues through that. Then in college, as I started to think about a career path, I decided I wanted to go into medicine. 

I had some opportunities in college to work with teams, not within radiology but just in medicine in general, that were doing international work. As an undergraduate, I worked with some pediatric cardiologists who traveled to Ecuador, and they had set up a program that was providing pediatric cardiology care and surgeries in an area where they really didn't have that. It was something I had always been thinking about. 

But then in medical school, a lot of it is very focused on learning your general medical education and then the same for residency. So I was really excited this year to actually get to see what radiology looks like in the global health field, because the exposures I'd had before were a little more about general medicine and clinical medicine. It was good to see how radiology can be improved on a global health scale and how we can be useful in that setting.

It was good to see how radiology can be improved on a global health scale and how we can be useful in that setting.

How did you learn about the grant and why did it seem like a good opportunity to pursue your global health interests?

I found out about it a few weeks before the deadline. We’d had some residents who had traveled to Uganda from our institution, and they had applied and used it in the past. They mentioned it, and I said, “Oh, I haven't looked into that yet.” But I started reading about it and thought it could be a good fit to help supplement my experience. Hearing about it from past Goldberg-Reeder recipients motivated me.  

I learned that the grant was meant for radiology residents to help make global health experiences more accessible. All of that was appealing, because at that time I wasn't sure how I was going to go to another country for a month. It's an expensive process and a big time commitment. 

How did the grant help you accomplish your goals for working in Nicaragua?

I worked with an organization called One World Health, which at its core has always emphasized setting up a long-term relationship with local clinicians and empowering the local community to provide good healthcare services within their own community. From everything I learned and studied about a global health approach, it's important to do that so you're not just coming in and providing some short-term care and putting a Band-Aid on something that doesn’t last once you leave.

Working with local physicians and healthcare workers who wanted to help their own community and create a lasting impact, my goal was to see how they were doing that on the radiology side. I wanted to get a better feel about how they set up the clinics, how they expand the relationship between the international staff and the domestic staff, and how that all works. 

Salud Para El Mundo Diagnostic Center in Managua

I worked with the international staff that conduct site visits and provide site support from abroad and in person. I also worked closely with the local Nicaraguan Director of One World Health and with the radiology team at their main diagnostic center. They wanted me to see several of the other clinical sites that are available. 

They have eight clinics that provide care around Nicaragua, the main one being at the capital, so I spent the majority of my time there. We also got to visit a few other smaller clinics, which were several hours away. Having the grant helped with transportation and lodging, making it more accessible. I felt like it was a great month to get to see how everybody works together and what their long-term goals are, and their next steps and how they're going to expand care in their different clinics. 

Outside of work, were you able to explore the country and take in a new culture?

I was given a lot of opportunities to experience Nicaragua and enjoy it. Nicaraguans are very passionate about their country, and they're excited when you're excited to see and experience it. On a daily basis, the doctors were always giving me food recommendations of “you need to go eat this food, you need to try this, these are the national cuisines.” We made a list that I ticked off through the month.

On the weekends, there was time to visit other cities and experience the culture. I was fortunate to be there during their Independence Day and got to see some of the holiday celebrations, which were really interesting. 

I went to Granada, the oldest colonial city in Latin America, founded in 1524, which is about an hour and a half away from where I was staying. Throughout the Independence Day weekend, there were so many parades and celebrations. I saw a lot of the traditional dance scene, and I was able to take a cooking class to learn how to make some of that really good food I had gotten to try. 

It was an overall good, integrated experience to not only get to enjoy the culture, but also work with the organization and get a feel for radiology in that developing setting.

What were some of your key takeaways from your experience?

The biggest thing when working in global health is empowering the local community and understanding that long-term efforts are going to be best sustained by local physicians. It can be a complicated relationship when you have international providers trying to work with local providers and want to make sure everything flows in a good way. 

Being respectful, appreciative and supportive of the local staff and putting them first is one of the biggest reasons One World Health has been doing well with its clinics. It has international support staff, but the local director who is addressing everyday needs is Nicaraguan, and he is passionate about the community and provides care. International providers are there to supplement and help them and to address any questions we might be able to answer through our previous experience, but not to impose. It was rewarding to see and develop that kind of relationship. 

Then on the radiology side of it, just thinking also in terms of the resources available in the community, the main center where I worked had X-ray, mammogram and ultrasound equipment. But some of the smaller clinics had only ultrasound capacity. I got to work with the local team to evaluate logistics and what goes into thinking about expanding and adding services. Just thinking about that whole approach was another takeaway and a big learning point for me. 

Who would you recommend apply for the Goldberg-Reeder Grant? What advice would you give them?

Any residents who are interested in an international experience and seeing how they can apply radiology in a global health setting should consider this opportunity.

Go into the experience with an open mind. We had some orientations with the program leaders before I went, and they try and give you an idea of what it's going to be like. But even with that, still it's going to be different. 

It's good not to build up too many expectations. Just go in with an open approach to be there, be helpful and see where you can fit in. Come in first as a learner. That makes the local physicians more receptive to you and to how you can fit into their workflow. When you come in from a humble place as a learner, that facilitates the relationship — and your growth with the program.