Emory Report

May 4, 1998

 Volume 50, No. 31


Sprawls helps developing
countries achieve healthy images

Seeing is believing-and in medicine, "seeing" can mean the difference between life and death. X-rays and all sorts of other imaging procedures are allowing doctors to "see" from without more clearly and diagnose more accurately what ails within.

But doctors in less developed areas of the world often lack the training and equipment to properly image patients and make complete diagnoses. Helping these doctors "see" more clearly has become a life's passion for Perry Sprawls.

After 36 years as a medical physicist in the School of Medicine, in 1997 Sprawls requested a half-time appointment so he could concentrate more fully on improving the practice of medicine in developing nations. Patients, doctors and scientists in India, China, Brazil, Estonia, Panama and Malaysia have already benefited from Sprawls' determined efforts.

During his years as a full-time professor in the department of radiology and as director of the department's division of radiological sciences, Sprawls became an internationally recognized authority in the field of medical imaging. His renown in diagnostic quality improvement in radiology was the reason health care agencies and institutions from around the world began seeking his expertise.

He now works to help health care systems in developing countries put in place programs and procedures to improve the quality of medical imaging. This often involves the training of medical personnel, creating quality assurance programs and developing infrastructures to support quality improvements. The ultimate goal is to help doctors make the best diagnoses.

"An effective diagnosis is one that can detect a disease, such as cancer, at an early stage-when there is the best chance of effective treatment and patient survival," Sprawls said. "This is very dependent on the quality of the diagnostic imaging process."

Sprawls has found that approaches to imaging improvement vary in developing countries according to national economy, organization of the health care delivery system, types of medical and medical science education and political factors. In Estonia, for example, the health care system has been emerging from Soviet domination since the country's independence in 1991.

"In the former Soviet Union we are trying to develop a new approach to the concept of quality," Sprawls said. "We are trying to foster the notion that quality is less a bureaucratic requirement and more a professional and social responsibility. This is a paradigm shift that takes time to develop in some societies.

"There are advantages to working with smaller countries such as Estonia, Panama and Malaysia, in that we have a better chance of affecting national policy and programs with respect to quality issues. The larger and more populous countries such as India and China, however, offer the opportunity to reach more people. Still, the full implementation of quality improvement procedures will require extensive national efforts. In the larger countries, we are working more toward the development of pilot programs and demonstration projects in selected areas."

Sprawls' most ambitious program to date is in China at Xian Medical University. Several years ago he worked with the university president and faculty to identify needs that might be met through cooperative efforts with Emory; one of those specific needs was for physicians trained in medical imaging diagnostic procedures. This resulted in the development of the Emory University-Xian Medical University Cooperative Program in Medical Imaging Education, a unique model in which about 12 top Chinese students are selected to pursue intensive training in radiology during their final year of medical study.

Two classes have graduated and a third will graduate in July. According to a recent report by Ren Humin, president of Xian University and a major supporter of the program, graduates are in high demand throughout China. Sprawls personally teaches each class in Xian, and several of his Emory colleagues have taught in Xian and provided special training for Xian faculty who have visited Emory.

Sprawls is involved in three other projects aimed at improving the quality of medical care around the world. He directs the College of Medical Physics at an intensive training institute in Trieste, Italy, sponsored by UNESCO (United Nations Educational, Scientific and Cultural Organization). Physicians and medical scientists gather at the institute for special training that allows them to update their skills and bring new knowledge back to colleagues in their home countries.

In addition, the family-sponsored Sprawls Educational Foundation makes grants to provide educational materials, instructional media and equipment for programs in developing countries-all to support training in contemporary diagnostic imaging methods and quality improvement techniques. The foundation has planted seeds for future growth in more than 20 countries.

Several years ago Sprawls developed a partnership program in which medical scientists in the United States partner with a developing nation to provide resources and collaborative support. About 25 active partnerships are now in existence. Sprawls has also begun traveling on the information superhighway-he is developing an Internet-based program to support the personal on-site work he is pursuing in remote and not-so-remote corners of the world.

-Lorri Preston

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