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C. W. Sperryn et al.
residency programmes as opposed to starting fellowship programmes, given the
small size of neuroradiology practice in the country, is one major factor. Another is
the paucity of Neuroradiologists, given the difculty of attracting internationally
fellowship-trained Kenyan Neuroradiologists, including Interventionists, back
to Kenya.
Nigeria
Nigeria is the largest and most populous country in Africa. As with many developing countries, the healthcare of the population is underserved with approximately
one doctor per 9000 population.
An even more acute shortage of radiologists means that most serve as generalists. Interventional radiology is provided by expat or visiting specialists.
Dr Aisha Umar completed her Neuroradiology fellowship in Zurich and became
the rst female neuroradiologist in Nigeria after her return in the early 2000s.
During her tenure at the biggest government hospital in the capital, National
Hospital (Abuja), she has provided both a comprehensive radiological service as
well as contributing extensively to teaching and training of residents.
Her inspiration to pursue neuroradiology stemmed from the desire to improve
the clinical outcome of her patients. Some of the drawbacks she identies are the
lack of resources, e.g. insufcient MRI scanners, underfunding for training, and
insufcient role models to inspire and guide future radiologists into the
subspeciality.
Having made a signicant positive impact over many years at both local and
national levels, she has transitioned to an administrative role in the hope that she
will be able to address at least some of the structural difculties affecting radiology
in Nigeria.
There are many challenges for female radiologists wishing to pursue subspecialisation in Nigeria and neighbouring countries. Dr Umar’s vision is directed at nding
workable and sustainable solutions by collaborating with other radiological communities in West Africa and further aeld.
Dr Phyllis Mezue (Fig.22.11) is a consultant Radiologist with an interest in
Head and neck, currently working with a globally established teleradiology provider. Prior to this, she worked in the UK National Health service.
She completed her radiology training in the United Kingdom. During her training, she had the opportunity to travel to Nigeria for an out-of-programme experience, which is where her passion for Neuroradiology and Head and Neck imaging
became established. She has been accepted into a 2-year Neuroradiology fellowship
programme in Canada and is looking forward to it.
22 Women in Neuroradiology inAfrica
Fig. 22.11 Dr Phyllis
Mezue
Somalia
241
In Somalia, in the eld of neuroradiology, women are underrepresented, with only
three female radiologists practising nationwide: Hamdi Mohamed Isse and Haliema
Abdullahi (Sahan Diagnostic Centre, Mogadishu), Degmo Ali Mohamed, (Hayat
Diagnostic Centre, Hargesia). There are no registered female neuroradiologists.
Despite this, female radiologists in Somalia frequently encounter and report on a
variety of neuroimaging cases using different modalities.
Common cases include neurodegenerative disorders, dementia, brain abscesses,
TB meningitis, and neoplasms such as meningiomas and glioblastomas. Additionally,
congenital anomalies are regularly encountered in practice.
Although there are no registered female neuroradiologists in the country at present, there is a growing interest in this speciality among female radiologists. We are
hopeful that in the coming years, Somalia will see the emergence of female neuroradiologists who will further advance the eld.
South Africa
In South Africa, women represent 31% of the radiology workforce. The South
African Society of Neuroradiology (SASNI) boasts 49 women members out of a
total of 129 members (38%). Women account for 50% of the SASNI leadership
242
C. W. Sperryn et al.
committee. These statistics parallel the global feminisation of medicine, though
they conceal the hurdles to subspeciality and advancement within the academic
hierarchy.
Subspeciality in diagnostic radiology remains uncommon in South Africa (as it
is in most subSaharan African countries). Most radiologists function as generalists,
reporting neuroimaging as part of their daily practice. Formal accredited postspecialisation programmes are costly and are not seen as a priority in a resource
constrained health care environment.
Historically, South African radiologists wishing to subspecialise in neuroradiology have done so in academic institutions in Canada and Australia, countries for
which additional local examinations are not a prerequisite for entry into a fellowship programme.
Notable exceptions in South Africa are the postgraduate diploma programmes in
interventional radiology (including neurointervention) set up at the University of
the Free State in 2002, the Diploma in Paediatric Radiology (which has a strong
emphasis on neuroradiology) at the Red Cross Children’s Hospital attached to the
University of Cape Town and the Fellowship in Neurointervention at Chris Hani
Baragwanath Hospital (CHBAH), attached to the University of the
Witwatersrand (WITS).
Paediatric Neuroradiology
The Paediatric radiology diploma programme was initiated by Prof. Tracy Kilborn
who completed her radiological training in the UK and returned in 2005, heading
the Radiology division at The Red Cross Children’s hospital from 2011–2022. Her
research interests include the imaging of paediatric CNS infection and neurooncology. Together with a small team of dedicated paediatric radiologists, including
Dr Nicky Wieselthaler, she has provided high level neuropaediatric training. To
date, ve female radiologists have graduated from this programme. Their expertise
is now spread throughout South Africa.
Dr Gopolang Mndebele (Fig.22.12) is the current head of the radiology unit at
the prestigious Nelson Mandela Children’s Hospital (NMCH). In her words, “This
role is not just a title but a platform for me to signicantly inuence the eld of
paediatric radiology and paediatric neuroradiology in particular.” The Children’s
Hospital provides quaternary medical services to both state and private patients,
dealing with complex and challenging cases that require the expertise it houses in
various departments.
She completed her radiology training at The University of Witwatersrand
University (WITS) and worked as a general radiologist at Chris Hani Baragwanath
Hospital (CHBAH)before joining the team at Nelson Mandela Children’s Hospital
in 2020. Her passion for paediatric imaging and neuroradiology led her to pursue a
fellowship in Paediatric Neuroradiology at The Hospital for Sick Children in
Toronto, which she completed in 2022.
22 Women in Neuroradiology inAfrica
Fig. 22.12 Dr Thandi
Buthelezi
243
She is a joint staff member at the Wits Diagnostic Radiology Department, supervising three radiology MMed registrars, participating in registrar lectures, and mentors two young radiology students.
One of the low points of her career has been recognising the lack of dedicated,
paediatric imaging services in South Africa. “It is disheartening that we cannot
meet this need due to the shortage of paediatric radiology trained personal.
However, this realization drives my passion for teaching even more and speaks to
my dream to one day pass the knowledge through a fellowship training program at
NMCH”—Dr Gopolang Mndebele.
University of Cape Town graduate, Prof Caroline Robson/Levitt obtained her
paediatric neuroradiology specialisation with a particular interest in head and neck
imaging in the US and has had an illustrious career at Boston Children’s Hospital
where she is now vice-chair of radiology.
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C. W. Sperryn et al.
Interventional Neuroradiology
Dr Sandra Basson is recognised as a pioneer in the discipline of neuroradiology,
particularly neurointervention in South Africa. Having qualied as a radiologist in
1989, she pursued a 6-month observership in neurointervention at UCLA.The unit
was at the forefront of detachable ballon development, evaluating the Guglielmi
detachable coil and the use of Onyx in the treatment of cerebral AVM.In her own
words: “these were exciting times.” Returning to South Africa, she accepted a con-
sultant position at the Universities of the Free State and Pretoria where she continued her diagnostic and interventional work.
Dr Thandi Eunice Buthelezi (Fig. 22.13), affectionately known as “Mumsy,”
stands as a trailblazer in the eld of neuroradiology and interventional neuroradiology (INR) in South Africa. She joined the INR team at Chris Hani Baragwanath
Hospital in June 2021 where she completed a Fellowship in Neuro-intervention. In
2024, she joined the South African Neuro-intervention Society (SANIS) becoming
the only registered active female member.
She credits her mentor Prof. Victor Mngomezulu for sparking her interest in
interventional neuroradiology. His patience, dedication, and meticulous approach to
INR cases were an inspiration in her passionate pursuit of the speciality. Prof. Samia
Fig. 22.13 Dr Boitumelo
Khoza
22
Women in Neuroradiology inAfrica
245
Amed from the University of Pretoria was one of few women in the eld of neurointervention at the time. The presence of another female at the table provided her
with a sense of comfort and inspiration, reinforcing her determination to succeed in
a male-dominated eld.
Dr Buthelezi has made signicant contributions to neuroradiology and INR in
South Africa. She has applied advanced knowledge to improve patient outcomes,
enhancing the quality of care in her practice. She is afliated with the University of
the Witwatersrand (WITS). Her teaching efforts, through multidisciplinary team
meetings and on-oor training sessions, demonstrate her commitment to skill transfer and education.
Her continued presence at the institution has sparked signicant interest in
Neurointervention, leading to a waiting list for the Neurointervention fellowship
programme. One of their current fellows is female, Dr Boitumelo Khoza (Fig.22.14),
which is a source of immense pride and a testament to the possibilities for others
like her.
One of Dr Buthelezi’s most signicant achievements is her role as a pioneer for
Black women in neuroradiology. Her success serves as a powerful example that
background does not limit potential. This realisation fuels her commitment to working in the public sector, ensuring that skilled healthcare is accessible to all, regardless of class.
Fig. 22.14 Dr Gopolang
Mndebele
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C. W. Sperryn et al.
Diagnostic Neuroradiology
In South Africa, in the eld of Neuroradiology, Professor Sally Candy (Fig.22.15)
as the rst chair of the South African Society of Neuroimaging is well known and
respected for her contributions to the discipline. She attributes her love of neuroradiology to her local mentor at Groote Schuur Hospital, Prof. Lenny Handler, but her
role model was the visionary Professor Anne Osborne whose frequent visits to Cape
Town inspired her to uproot her family to NewYork City in 2000/2001. Here she
completed fellowship training at the NewYork Presbyterian and Memorial Sloan
Kettering Hospitals.
As the clinical head of neuroradiology at Groote Schuur Hospital, Cape Town,
and an examiner at the Colleges of Medicine South Africa (CMSA), she has been
involved in the education and development of radiologists for over 20years. She
believes strongly in the importance of interdisciplinary cross pollination, ensuring
regular interdisciplinary meetings between the departments of radiology, oncology,
neurology, ophthalmology, neurosurgery, neuropathology, and neurointervention.
Her research has centred on neuroimaging of Tuberculosis and in HIV/AIDS.Her
wish is to have passed on an appreciation of the particularity of neuroimaging in the
Fig. 22.15 Prof Sally
Candy
Women in Neuroradiology inAfrica
22
247
South African context and hopes that she provides a positive academic role model
for her female trainees.
Dr Kathleen Jacobs (Fig. 22.16) completed her radiology training at the
University of Witwatersrand, Johannesburg in 2017 under the supervision of Victor
Mngomezulu and worked as a consultant at Chris Hani Baragwanath Hospital
(CHBAH), Soweto, before pursuing a 2-year Neuroradiology Fellowship at Foothills
Medical Centre/University of Calgary, in Canada, in 2019. Her motivation to complete subspeciality training was the desire to understand more about the complexities and intricacies of the central nervous system. Currently, she is a Clinical
Assistant Professor at the University of Calgary specialising in Head and Neck
imaging.
Dr Napo Kasirye-Mbugua (Fig.22.17) completed her radiology training at the
University of Cape Town in 2019 under the supervision of Prof. Sally Candy, whom
she credits for kindling her interest in neuroradiology. She worked as a general
radiologist in the private sector where she was exposed to increasing subspecialisation in clinical referral, prompting her decision to pursue a Neuroradiology
Fellowship. A 24-month stint at Foothills Medical Centre/University of Calgary has
increased her depth and understanding of CNS pathology, has expanded her research
Fig. 22.16 Dr Kathleen
Jacobs
248
Fig. 22.17 Dr Napo
Kasirye-Mbugua
C. W. Sperryn et al.
interests into Myelin Oligodendrocyte Glycoprotein Antibody associated Disease
(MOGAD) and given her the opportunity to present at international conferences.
While these (usually 24month) International Fellowship programmes have the
advantage of complete immersion in the sub-discipline, they are associated with
signicant nancial and social cost and are often not practical for many women with
families.
Dr Christelle Ackerman presently heads the Department of Radiology at
Tygerberg Hospital (Stellenbosch University). She is one of very few radiologists in
South Africa, and one of only two women, who have completed their PhD in neuroradiology. She is an inspirational teacher of the subspeciality and a long-standing
examiner of the Colleges of Medicine of South Africa (CMSA).
Internationally accredited conferences and, more recently, part-time diplomas in
neuroradiology (EDiNR) and paediatric neuroradiology (EDiPNR) offered by the
European Society of Neuroradiology (ESNR) have facilitated subspecialisation
without the disruption that full-time overseas study demands.
At present, 12 women members of the South African Society for Neuroimaging
(SASNI) hold diplomas in adult neuroradiology, including Kerryn Devy, Mariane
22 Women in Neuroradiology inAfrica
249
Kuehnast, and Jeanine Owen who hold key membership roles in the organisation.
Dr Christelle Ackerman is the only female member of SASNI with a diploma in
Head and Neck imaging.
Despite the increasing number of radiologists and subspeciality trained radiologists in South Africa, the challenge of a low ratio of radiologists per capita remains.
South Africa has a total of seven postgraduate medical training programmes. Upon
completion of registrar training, radiologists will hold a fellowship of the Colleges
of Medicine of South Africa (CMSA) and a Masters of Radiology (MMed). At present, 54% of all radiology trainees (residents) are women. The number or female
radiologists registered with the Health Professions Council of South Africa has
increased two-fold between 2002 and 2019 and the number is growing at an annual
rate of 14%.
The healthcare system in South Africa is divided into private and public sectors
with notable discrepancies in funding and the number of people accessing care. The
underfunded public sector serves a larger proportion (84%) of the population of
South Africa. This unfortunate discrepancy can result in delayed or absent access to
advanced imaging techniques and procedures, resulting in delayed diagnoses and
poor patient outcomes.
High patient loads and understaffed departments can result in frustration and
burnout, creating a problem of retention. “Brain drain” is a common issue faced by
many African countries as radiologists seek educational and or career opportunities
out of the African continent.
The radiological society of South Africa (RSSA) includes South African trained
radiologists but also radiologists from multiple countries in subSaharan Africa.
Together with SASNI and SANIS, they create forum for education, training, and
networking which opens doors for collaboration amongst radiologists based in
South African and internationally.
By identifying and acknowledging the role of women in radiology, we hope to
unveil the potential to which women can be elevated in a historically male dominated profession. We hope to provide mentors and positive role models for women
in training so that they can meet the realisation that “you belong in every room that
you are in” —Shond Rhimes.
Tanzania
Dr Ugumba Mussa Kwikima, (MD, MMed-Radiology, Msc-Neuroradiology)
(Fig.22.18) is a Neuroradiologist at Lugalo General Military Hospital and Honorary
Lecturer at Muhimbili University of Health and Allied Sciences, Dar es Salaam.
She completed her radiology residency at MUHA and her interest in neuroradiology was sparked by a visiting neuroradiologist, Dr Frank Minja. Originally of
Tanzanian origin, Dr Minja received under- and postgraduate training in the USA
and is attached to Emory University, Atlanta.