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now I'm going to hand over to Doctor. You could sues the founder of Worldwide radiology and based in Liverpool and works is a trial clinical traffic of medicine and effects disease radiologist, which in itself is a very interesting title and are also joining US life from Malawi. Adding to the the international nature of this program today is Doctor carrying Kit Kuti, who's a consultant, pediatric radiologist working in the College of Medicine in Malawi. You get just just a highlight. I guess how great it is that, you know, despite all of the negatives that we've had in the last 14 months or so with the pandemic, and that there are some benefits in being able to kind of welcome an international delegation today and on. Thank you so much for joining us. A. Hand it over to yourself, Doctor. You can thank you. Thank you very much. Let me just set up my screen share. Here we go. It's okay. Great. So thank you. Thank you so much. Now for the really kind invitation on down, I think. First of all, I should say thank you also very much for all Fring to wave your conference fees in, you know, in lieu of donations to our organization that incredibly generous. And I'm also very grateful to everybody in the audience who has taken up that initiative. And I just looked and you've raised nearly 400 lbs so far for us, which is amazing. So thank you very much. Um, my part of this talks going to be really brief because I would like the bulk of the talk to be from Malawi by Karen to give you a real flavor of life on the ground. Um, quick introduction. Yes. I work in Liverpool, interested in tropical and infectious diseases. I was once upon a time in interventional radiologist, fully trained fully fledged, uh, and then left and went to work to Ghana for three years in a teaching hospital. We're obviously some basic interventional skills were really useful, but not the rest on. Since then, I have sort of focused on the global health tropical medicine side of things. Now, now I'll ask the perfect question. The title of this. This talk was supposed to be how worldwide radiology is making a difference. Um, on. But when I was reflecting on what? You know how shall I introduce this? I actually thought it's too soon for us to really show you properly how we are making a difference. And when you set up an organization like hours and when you ask people to help you with this to raise funds, it's the question. You should always have it. The forefront of your mind, you know, Is this making a difference? How are we making a difference? So I changed the title now. Well, sorry is World Wonder ideology making a difference? And when you think about making a difference, that in itself it'll philosophical topic. But it's about making change on when you think about making a change. I think you can immediately understand how difficult it is to show that you are making meaningful change. I gather I didn't hear the whole previous talk, but I got that. It was about changing how you run your practice, how your specialty presents itself and making changes really hard and takes years and years and years to achieve. Um, when you then look at what is it that we're trying to change? It becomes somebody much easier because the change we want to make is related to the massive inequity and health provision that there is in the world. And if you focus that down to radiology, it is actually the case that more than half the world population nobody knows the exact finger, obviously, but it's more than half the world population have no access to any kind of imaging tests ever. They have no antenatal scans when they're in utero. No X rays when they break their legs, have no CT scans for trauma. And interventional radiology is way off the charts. And this is for the majority of the people that walk on the Earth today. So that's the problem. So that's a huge problem. And I think I can demonstrate that for you. What sorry in this graph, which was recently published in The Lancet Oncology Medical Imaging Report, which shows you the distribution off ideology, professionals, radiologists in the world. And you could always see the North Stars divide. Dark Green is where there are more than 100 radiologist per million people. The yellows are where there are fewer than 10 per million the gray areas of those where the infrastructure doesn't allow even collecting that data, and you can see how the inequity is distributed when it comes to radiologists. With that, then becomes no radiologist, no infrastructure. No, no, no. I could see for this for the for the specialty on It's a Baron Field. On top of that, in places where there is some provision, that provision is nearly always in large central cities. It's often private. It may be public, but then there's a few specialists there. But the majority of people actually don't live in that one particular city. Or if they do, they made. It may not be able to afford, even if they live right next to the hospital. So there is also very localized regional inequality. And this is a slide that I got from imaging the world, which is an organization that's focusing on expanding antenatal ultrasound. They can tell how they've made an impact that been going for 10 years, and they don't done some fantastic. Still, The other side of the problem is the, you know is that the world has said we we need to change this, you know, the the ratio the U. N. Is the UK has signed up to sustainable development goals. Uh, excuse me on the sustainable development. Calls are also about universal health coverage. Every person should have access to the full range of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care. That is, in a 50 page double it to document which shot. There is almost no mention of radiology, and yet we'll know that these things are not achievable if you don't have access to it. Least some basic imaging tests. Now, When I worked in Ghana 20 years ago, this would depress me terribly. I'm sitting there in my department and thinking, you know, 90% of the people in this country will never have access to this. It's not doable. Equipment is expensive. Staff is very few and far between. I found it sometimes quite obsessing and sad. Um, but in the last 10, 20 years, things have really changed. Um, and I'm really sorry. Um, on I'm a bit embarrassed to say that those changes have not been driven by the radiology community. They have been driven back cynical communities, the emergency medicine community who needed rapid access to imaging that has driven handheld ultrasound. Um, a I in tuberculosis. This is an example of a I being used to detect active tuberculosis and screening programs that that has been driven by the TB community. The mobile X ray equipment was originally developed by the American military because they wanted to be able to take X rays in battle zones. But the A I have been driven by the clinician's. The good thing is that that now means that that equipment exists on do that. We can now bring a sick services to the wider community, and I do think we can. We need to step up to the role and increase our involvement because this is an example off that imaging the world program. Where now do two portable equipment? Nurses and midwives in communities are being trained, properly trained to do upset your ultrasound, and similarly, you can now carry an X ray machine anywhere you like, basically set it up and start taking it right so briefly about the current projects that we started. We started three years ago on I'm I'm a co founder. I'm not the only founder. Um, we started by just setting up the charity that in itself takes time outlining our strategy, thinking about what it is we want to achieve and identifying some pilot projects. So we're about to start delivering a point of care ultrasound training program together with the university in Eastern Gonna where we will give you additions, a package of skills that is relevant to them when they are in a place where there is no radiology. We have, um, a neuro radiologists from this end working with radiologist in the hospital where I used to be, um, who now have a have a group of people working there large enough that they are beginning to think about subspecialty training, but they can't afford to do fellowships overseas. They learn skills that are not always relevant on they can't you know, a they got often there's no funding for them to go overseas, and also there are much too much needed in their own setting. So organizations like you know, the BSI are on day. European societies should start thinking about how can we help people to a credit in subspecialties in a way that is relevant to there an environment. So we're trying to work with that with the British Society of Neuro Radiology is Well, um, there's a training program in the research units of the MRC and the Gambia. They have a small clinic, and they need to not go for and radio for training on. The good thing of that is that we've managed to recruit a Nigerian on Do a Diaspora Gambian. So there are people who know the environment who understand the settings where they are part of our group of volunteers. Now on there is a senior training and leads who will be going out there for six months as an actor program experience to learn about what it's like to be doing radiology there we have several research collaborations. Research is really important to inform. Policy organizations like ours are never going to make the difference. Policymakers air going to make the difference, and we have to influence policy on if there are in the audience. Any people who speak French and are adventurous were about to advertise an opportunity to go to Madagascar for 4 to 6 weeks and toe work on a lymph node ultrasound project in bubonic plague. So once, yeah, but comes out to do apply. Um, and now you'll hear from Karen, who works on our college of Medicine collaboration project in Malawi. Normally, when I ask people from elsewhere to speak for my partners, I think it's really important as an audience. Here is the story from the other side because you know this. This can't be just us, you know, this is about this is about the other side. Um, I also thought it would be good, maybe, or there might be an interest in this audience to hear about what it's like to start taking part of making this part of your career. So actually last Karen to do this presentation because she's both employed by the College of Medicine in Malawi that there is no other radiologist where she works at the moment. So she knows the story as a clinician on the ground. But she also knows what it's like when you come from the UK, So she's going to talk a little bit about both what it's like there and what it was like for her and how you can make, um, you know, working with partners in country part of your career. Um, so that's the end of my introduction. Um, how are we making a difference? I think we've made a start on for me. That's actually a real achievement. And maybe five years from now, I'll come back and tell you a little bit more about, um, what the actual impact has bean of all these projects that we're now starting on for which we are, you know, we need help. We need funds. We need people to join us in this. So if you want to know anything, Mawr have a look at our website. We launched a new version yesterday. So any glaring errors with that, you know, on go also very happy for you to contact me in person and we'll have a coffee. Have a chat on Dyken. Tell you more about what we do. So thank you for the invite now and I'll hand over to Karen. Thank you, Liz. For that, we'll try and get Karen stuff connected now. Perfect. Thank you. Up there and again. Thanks so much again. I know you've mentioned there is with regard to the fundraising that we're doing today and some donations still coming in. So it's it's it's great to see that. And obviously, if you're inspired by watch your hearing now as well do I continue to give something to work. What are the, um and I think it's on its way. Conceive a slide scan everything. It's, um, present review. I don't know if you can changed the slide that the screen that you're sharing to the actual presentation, but it's just, uh yep, perfect. Okay, we'll let you take it away. I think you might be music car. It's three lines. As Lisa said, thanks very much for the invite. It's it's fantastic for us to be here for us to share experiences with you, particularly for me and from Malawi live and And I thought I'd start with perhaps a little bit of an introduction to my story just because I was off course. The medical student once and I always had a passion for global health, but it didn't quite know how to get there. I couldn't and visit it, and so I just Still, it might be worth giving a little bit of an insight. Stomach Korea, trajectory, how I ended up in Malawi, which is where I am at the moment in Africa and and then I wish to illustrate my experience here or life as a radiologist. here and in a low income setting through some cases, which I think you may find interesting. And so this is where my radiology career started off at. If you are based in the UK, then you may not. You know, some of these and buildings and scenes. This is liver pool, and that's where I trained in radiology and once a achieved my reality degree. I then went off to the Royal Children's Hospital in Melbourne, where I did my pediatric radiology fellowship. And then I returns to Liverpool, and then I worked. There is a consultant at all. They're a Children's hospital. But, you know, I always left lobe. Um, has always knew that I wanted to be involved on my first point of contact, was less actually who and then kind of introduce me also to this organization, which I'm sure that if you would have come across Doctors without Borders and I am, I starts to volunteer with MSF about nine years ago now and and it was actually one of their projects, which got to me in contact with Malawi to start off it. And this is what mellow it looks like on a map It's a landlocked country and in steps are in Africa. And, you know, I came here with MSF for a very short projects, left it and decided to come out here on a cell funded when you're sabbatical from my job but older. Hey, and while I was here, I learned something really interesting facts about Malawi, which I wanted to share. What you just to put you in the picture a little bit. And the population of malaria is about 19 million and growing fast, and one or two of the major problems, perhaps, are a very high infant mortality rate and life expectancy, as it is recorded at the moment average is about 50 years and the one of the greatest problems or disease burdens in malarious HIV AIDS and then, as is written here, the number of tablets living with the disease in 2015 as it was recorded then was already 980,000. And just to put you in the picture over 215 your case is a recorded daily and then HIV AIDS is is encountered in our daily practice the whole time. They say that about 70% off hospital beds in Malawi are occupied by patients inflicted by this disease, but there are other and disease burdens or disease problems here, which sort of are the most prominent. And these are just some of them diarrhea. And I try to say, Oh, I forgot fever, malaria, sister, Rabies and, of course, TV and and the way in which healthcare works years that's there are several points of contact for patients. So patients I represents to central hospitals, public hospitals like the one I am currently based that and regional facilities after the district's. There are also private clinics for the few that can afford it. And then and it is nice to know that the public sector has Kerry is a free service, and free medication is provided to patient's attending these areas. So became, you're honest and front admission went back and to Europe and then decided, You know, I just really wants to understand global health more. I need to spend more time there. For me, global health. This is like learning a language, you know, they say you have to well, to learn a language properly. A lot of people say, just moved to the country for Lee and Mercer Self there and this is what we decided to do is a family. And as you can see, we did not travel lights. But we came out here in September of last year, and the different thing this time was that and I came back not as a volunteer but as an employee off the College of Medicine of Malawi. And I have two primary rose. One is to disseminate and work on radiology education with in Malawi as a list A said. There is, I am in a resource. This is a resource, a constrained setting, not only because we don't have the high tech machinery that higher, easier settings like the US, like the UK have, but also there's a positive radiologist expertise. There are, I think, in country approximately five or ideologists, which is absolute crazy, isn't it? For the for the large population. So we came here in September, and this is the hospital I currently practicing. Um, it's called the Queen Elizabeth Central Hospital. It's based in Blantyre, which is one of the two biggest cities in Malawi, and, uh, it's a teaching hospital on they say it's It's one of it's, I think, now is largest hospital and and another fact associate it is that apparently there is the largest my nutrition ward here and huge teaching hospital affiliated closely with the College of Medicine. And this is just a few snapshots off the inside of the hospital. We are very privileged in on this hospital campus to the fact that we have some very strong affiliations with the hospital itself. And these are just some off the institutions affiliated with the Queen Elizabeth Central Hospital. And some provides specialist in a good hair carrot like the Mercy James Center for a Pediatric Surgery and Intensive Care, which was founded by and the raising Malawi information. And that's just across the roads. The Malawi and Liverpool Welcome Trust Research Center at the Blends Ahriman, Eric Project, John Hopkins. All of these different research centers have representation on campus, so geographically they're just across the road and, of course, is the College of Medicine and which makes the Queen Elizabeth Central Hospital very important. And would you go to the formation, the education off, upcoming medical professionals and because we are such an important presence with in Malawi and because of one of these researches and collaborations, and we also are heavily invested in, which is which is very lucky for us. So we recently had a CT bought for us by the ministry of hers in Malawi, and that's obviously is imaged on the left side of your screen. And then on the right side is something which is very exciting and obviously not the main stay in Africa. That's a portable MRI scan, but it just goes to show you how you know this connotation. People may have off. Of course, in Africa, your your imaging workforces, workhorses are extra, an artist owns, and often you are very lucky if you even have those in Africa. And but then you know, you just get the full span where and there's big institutions like the one I'm at at the moment, you know, you might even incomes reports of an MRI, and it may seem a little bit distorted and but, you know, carrier wise, it's also fantastic and revolutionary for us to to be even in country and such things over here. So, no, I wish to present you some interesting cases in which has helped us a lot with them, obviously understanding our patients better and in forming their management, but also us educationally and for research purposes. So these are three pictures off three conditions which you encounter in the higher is our center settings, but also we in the lower and middle income settings On the left is a true post aortic aneurysm in the middle, on a separate is carcinoma and on the right is a very sneaky C six slash seven. This thesis where you know you are reminded to look at your review areas in your lower cervical vertebra colon. So you see these cases, we see them also, some cases, some diagnosis, are encountered wherever you are placed in the world. But then there are some others which are quite specific or more prevalent than anyone where you're located in the world and those are the ones I'm not going to show you. Okay, this is a young patients 20 years old who came in with Focal neurology. We had a CT installed as I told you already. And so we put her through our CT scan because the clinical question that the refers had waas is this an ischemic stroke? Or is this a magic stroke? And as you can see, there is an interpreter of a hematoma. It's huge. There is midline on displacement mass effect. But you might be thinking, What's so special about this case, you know, interpret command. Hemotomas happened everywhere, But what is special is the fact that this is a 20 year old nontraumatic case, and the fact is that essential hypertension is huge in a place like Malawi, and and that is a huge risk factor for interpreting common hemotomas or intercranial hemotomas and which is what we're seeing here. In fact, the literature states that one in three of millions age 25 to 64 has hypertension. So I think for me, this case off course, I liked how radiologist can effects and head refers, manage their patients, but also on how important it is when you're practicing global. That's radiology. To truly understands the epidemiology on the context you are practicing in which is often very different. So what we have been trained in next again, another showcase from our recent CT and portfolio is this patient who you will see has a very complex fracture involving their facial goes and very complex factor for doing this. I go my, uh, amendable, and this was a case of trouble, and the game drama happens everywhere. But the prevalence off trauma in Malawi is incredibly high, and that is just one statistic, which is quoted by the malaria National Road Safety, cancer and often, road traffic accidents when they happen here are incredibly serious. It's not, you know, the mild bumper to bumper injury. It's usually a high impact drama, and therefore the prognosis off these patients is really quite poor most of the time. And then I think again, I think this to me is really important to know when you know when you're going to practice. Global has to know what to expect and the sort of cases we see here really do match very closely what you would encounter in a drama center anywhere else in the world. So the level of exposure off complexity and the kind of scenario we're all used to with the multi disciplinary discussions, that huge nature of radiology that also is very much president here again, just to more and, uh, examples of on the left, a liver laceration of confusion with a huge hemoperitoneum on the rights, a huge confusion on NASA rated kidney and again together with the CT, which has just been introduced here. And we know having much and better outcomes for these patients. Mango season, which is favored by all of us here tasting mangoes or a favorite and usually happens in November, December and it's all God's, but not because it's the usual problem of we would want to collect at the top of the tree to do not waste any of those mangoes. But the problem is that sometimes young Children lose their balance and then up with an injury which looks like this, and I think this case of it in a straight a couple of points. One is how obviously important X ray is, especially in a context like and Africa, or like a low middle income country setting a plane in a X ray like this justice so informative. There's the grocery displaced angulated supercomputer factor with unlikely neurovascular injury which needs to be tended to very urgently, and so this it's It's also very interesting to live the context because then you understand why we see so many superconductors in mango season. And so it definitely is a known phenomenon. Another really interesting case. Um, this was an early, uh, the lesson to presented with a back mass. So this is the patient lying pro, and you try to ask the patient, Of course, I don't speak to Chairman, which is the local language, but you you have translators abilities. How long has it been there? That is it painful. But also, what are these marks on the skin and those marks of the skin? Some of you may have incomes with this phenomenon are do two interventions from a tradition of the uterus up to 80% off the local population in Malawi, resorts to tradition and heaters and medicine. And as you see, it's a very high number. Several reasons for that one is no easy access to a hospital, and two is cost, and it might be easier or more straightforward to get treatment from a traditional dealer, then get on a van or the way to a hospital. And also it's it's a huge part of their culture. And but, you know, high population used medicine apart months for their basic cats. Gory needs. I think it's important to understand or know about this phenomenon because it kind of explains why patients present so late, which such gross presentations is compared to the same you know, condition in the UK, for example. And but it's also interesting and important to know, because some of the medicines used some of the techniques used by the healers themselves scores pathology. So I think it is very important to have a sense of culture sensitivity when practicing global have you have to truly understand your context to be able to understand patients like this. Just a little teaching point. Attention. A lot of you know, already the chest X ray belonging to this patient in the past in the upper middle zones of the left and hit me So Rex, not a lung problem, not a pleural problem. This was just a pacification from the overlying loss. So just an interesting education of X ray, which we got from this firm and which we use for teaching purposes here. So this is another patient with a similar condition that the same condition, actually. So this is also wrapped in my sarcoma patient will also presented very, very late, so these are actually wrapped in my circle for metastases, huge in the lung, but also in the mediastinum. As you see, the MEDIASTINUM is right. And and then I think this case I wanted to show you to again dry for the points off. It's extra an ultrasound, which really are the work horses over here in this loan income setting and ultrasound is just so much more available nowadays, isn't it? With the advent of portable ultrasound, which was so easily donated much more before the bone way, we can make diagnoses like this bladder primary wrapped in my sarcoma with lung metastases. This patient and um attempt was made to treat them or a pediatric oncology, and it with chemotherapy, unfortunately did not quite make it because of the late presentation. And this is just a snapshot off the sort of pediatric oncology epidemiology within relatively cancer is a problem everywhere in the world, but also in Malawi. And this is an approximate number off pediatric oncology cases here that we did with proximity 900 cases per annum and again, I can't stress enough how important it is to understand the epidemiology of the country. You are dealing with. You need to be armed with that information when he practiced in these settings. And this is just a Nexium sample off a study which was conducted here in Malawi, which are lines the prevalence is off. The various pediatric oncology is going on from that. Another interesting case to a different patients patients. One is in the top left corner patient tools in the bottoms, the right corner. And as you can see, these are patients with the same disease and huge kidneys by naturally. And this is a case of a Burkitt's and former incredibly common over here and has we have some very good results from the chemotherapy and from are fantastic pediatric oncology team here, Children around the world enjoy ingesting and inhaling foreign objects to no difference here and but in batteries are one example of that. The slight differences. I suppose that we see them much later here, and this is a patient with a consequence following a battery ingestion, and what you're seeing here is a diverticular from the upper thoracic esophagus, so same condition as what you guys would say in the higher income setting. But a slightly different presentation because of a different context. In this case of delayed clinical presentation, this was a very interesting case, and one which we again encounter very commonly. This is the brain CT scan off. A patient is eight years of age, and for anyone who's used to looking at brain CT scans, you notice that there's a whole load of extracts. UCSF's right and waning says too much CSF in this brain, not much parenchyma, which you're not meant to have in the developed or a developing brain. So this brain is very traffic and you are more likely to see this in the hiring comes setting in someone was maybe 80 so this becomes an eight year old brain, eight year old patients. But this patient was admitted with focal neurology on the left side, and what you would see on the image on the right side is that we have confirmation that there is an ischemic stroke in the right cerebral hemisphere. There's a wedge shaped, hypodense region geographic oh, affecting the cortex in the White matter, which fits for an ischemic stroke. But I think what's obviously we're all thinking at the moment is why I shouldn't eight year olds have any traffic brain on the stroke, and that leads to some to what is also very common encountered here. That's sickle cell anemia. And I think sickle cell anemia is one which sometimes it's very evident clinically on. The pediatricians pick up very fast, but sometimes it can be a little bit of a zit as a clinical diagnosis to make. And sometimes reality may be the one to suggest to the conditions actually test for a second. So and this is what happened in this patient. So this is her originally played a huge part in this patient's on chemical management, you know, Next, we have to think about infectious diseases. Each allergies and these three different pictures are Abnormalities are all caused by the same enemy we have here. And that s T V On the left is a huge to be obsessed in the middle or two. So, uh, abscesses and on the far right is a case of TB spondylitis, which skip lesions as you will see. And TB is a huge problem party because of HIV co infection. Um, Onda, Uh, yeah. One must also always think about TV in this context high prevalence. So this is just three different cases illustrating that disease which is just so prevalent in my sitting over here. No, this is not an advert. It's in. It does lead to a case. But these are pictures of Lake Malawi, which is absolutely gorgeous. But you know what lies beneath. And it's this Stan which, uh, harbors a disease are there is a a, uh, parasites, the schistosomiasis parasites. And we we do see that very, very often this is a fantastic paper from read a graphics which you may read if you wish to go. And but these are just some pictures off some cases we've had over and of some pictures quoted from the article, actually, but which we see very commonly over here. Top left is some classification in the urinary bladder ward. And then bottom is the cystic lesions, which you found. This filling defects in the bladder of the ureter and top right is actually picture from Aricept. To hear. A cystoscopy center is showing what these look like microscopy. So again, understanding your context why the villages around the lake might be more prevalent or might show this disease even more them in a clinical history and, you know, really ties into us as a clinical reader. Just what we do, Why it's so important to ask, where do you come from? You know, what is your occupation? And so she just oh, very prevalent years, huh? With see it and others much open systems. But genital urinary is the one which is most commonly seen over here. We have to speak about this guy is the awfulest mosquito. And I think every time I used to a nice still hear enough, Please. You think about malaria, don't you? Um, malaria still a huge problem in Malawi and the numbers off malaria cases have markedly decreased. And that's mainly is up to the fantastic publicas measures which have taken place in Malawi and also by the amazing population, which is taken up all of those public health measures. So bad nets and all sorts of other things. Mm. But this ties in with the part of the fascinating and concept of being here is a radiologist where you're not only you know and have been clinical service and all of that. But you're also part of research off emerging research and evidence based medicine where the bloods are malaria project in this context of doing so much work which accounts too cerebral malaria in Children. And this is what led up to us acquiring the sports of a memory. So, you know, your your career trajectory is a global has physician can really take you in directions, which you might don't expect them to take you in. And so this is malaria. And of course, it's sociology Aces of them here. This is my last slide on, but no, I didn't fix my animation pain, but, um, I heard this very concerned 80. See, you know any doctor who who texted me this this picture and said, What is going on? And and actually, you know, one of my prior mentors and educators, Doctor current is always taught us look at an image, not an isolation, but always try to look at it as though you're looking at a patient from the end of your bed. And the distribution off those punctate lesions is very interesting, isn't it? Quite uniform in size and distribution. But that's at the back. And then, you know, as a radiologist, you can also say to the clinician. What does the patient have? Anything on their heads that, you know, like a hat or something. And then they go, Oh, it must be the sediment in the style of hair. And that is what this this patient had so in take, um, thoughts. Where? And I think taking up a carrier in global health medicine radiology is fascinating. Living in a country like this is is I feel very privileged to do with that, and, uh, it's very interesting. Professionally, I would highly recommend it. And I think Secondly, there is a lot of relevance to home toe hiring, um, setting radiology or medicine. You know, with a global mobilization of people. Whatever you learn in global has medicine. Nowadays, you can also translate what is going on at home. In hiring comes settings. I think it's important for us to have a balanced view off. What's the workhorse modalities in a lower middle income setting are extra. An ultrasound dominates the field in the central hospitals. Like what I am in no off course, you more privileged, potentially two more refined imaging and the key concept off. How is any imaging intervention going to affect the patient's management is asking here as it is back home, I think, um, it is vital to be culturally sensitive. It is always imperative to be respectful wherever you are in the world. But when you were placed in such a difference environment, then this is especially important and, you know, look up the global have policies. Look up. What the targets for for the country are the national leads policies because it's so important to know what context you're practising in. And lastly, but not least, Li, if that is even a worried collaborations, are very, very important. And if it wasn't for an institution like definitely WR runs wide radiology, I would probably not be able to fully function here because you know, the support is needed the support on and complex cases which, of course, I'm not qualified to look it. Absolutely. Every complicated case there are qualified. Your radiologists and you can really supports me as well as in other fields, but also when it comes to education and interventions and we need the institutions and collaborations like the one with WW are to be able to advance over here to be able to been something sustainable to be able to train the trainers so and I cannot stress how important this link is, you know much. It is valued by all of us here. And that's the end of my talk with a bit of more propaganda for visiting the country. And thank you very much. Thank you. Um, just stuff the share again, but just to take down those lovely images, unfortunately. And so thank you so much for that great talk. Um, it was it didn't didn't interfere with the sound coming through, but they're waas. I could hear some animal noises in the background. Yeah, added to the texture of the top. Definitely. So there's a few questions coming in, and I guess it between don't think you're you're not music. You can speak away. There is. Well, I have a few questions I just pulled them to, you know? So the first one was I guess the picture of the portable ultrasound machine was one that kind of drew a questionnaire to Iran and wondering office. Obviously, whether portable ultrasound and extra services are things that should be prioritized at the moment, you know, getting on the ground over there are. Is there a way that we can kind of better think about getting resources to places like Malawi, you know, that are actually more useful? Yeah. The short on trees. Yes, I think I do think that needs prioritization. Um, but I think it goes hand in hand with, um, um, work at the central hospitals because the incrimination, like, in the Ugandan program, that thing other company runs for the organization, for the training, for the appropriate, you know, applications. Um, I think we need to also look at strengthening central services on experts sort of trainers. But it's absolutely the priority. Definitely. If we want to achieve, you know, wider access. Those two visit those two modalities must have on bequest in more for Karen. I guess it's been. And I guess I haven't been in ah, developing world before with regard to the language. People who would think about maybe going over there at some stage in their training are later on. How much is not having the local language barrier to carrying out your work there? Yeah, for me. And, uh, it, uh it doesn't limit my work quite so much in the sense that I'm lucky that in this context a lot of the population doesn't know what to speak English as well. And of course you do. And constipation's more from the bone. It's coming from the district and who don't speak English at all. But in that case, then everybody over here is just so friendly the nurses, theatrical professionals, the doctors and in translating. So you don't get a lot of support on the ground from a lot of people who are appreciating what you're doing here. And would you got some bridging that gap? So in my in my opinion and in my experience and I function as well as I do in the UK, for example, it doesn't give me as much as perhaps, when my think on, I guess the the other thing for a lot of our audience there kind of either senior medical students are junior doctors and maybe haven't even backed on the radiology training yet. Do you think that, you know, spending some time in these settings even before radiology training would be something worthwhile to do it kind of. I get guess as you were saying, Get in order like the language immerse yourself in the culture, least I would say, Yeah, I would say Absolutely, Yes. Um, I think I think as long as you understand, do that has part of, you know, a proper plan project or on an understanding that you're doing it to learn. I think I think we have to move away from medical electives and things. And I think the world is moving away from the idea that in elective is that you are actually going to save lives. Will do something. You know, I think the learning experience that that will give you is hugely valuable. You know, he might come back and realize this is not for me or I don't I don't want to do this, But actually, I think having a bit of clinical experience before you do the radiology is is really valuable. Yeah, that's good. I'll keep an eye on the chat here. Obviously, there's there's Unopen area there for people ask anymore questions that they have about the charity and work that's being done there. And so if there's any other questions, I pass them on to this. But thank you so much to to this and Karen for joining us today and really appreciate giving up your time to be here with us. Thank you for the invite. Thanks.