Malawi earns first-ever doctor to major in Nuclear Medicine

By Duncan Mlanjira

Mangochi District Hospital’s Dr. Jeffrey Jooma has made history by becoming the first Malawian Nuclear Medicine, the medical imaging speciality which involves using radioactive substances (radiopharmaceuticals) and special imaging equipment in the diagnosis, staging and treatment of various cancerous and non-cancerous diseases. 

He attained this rare qualification at the college of nuclear physicians (FCNP) of South Africa, where he is still there pursuing a Master’s in Medicine with the university of Stellenbosch in Cape Town, graduating in December 2019.

Asked where he will be practising this new speciality he has gained, Dr. Jooma says the long-term objective of the government is to establish a nuclear medicine department at the cancer centre in Lilongwe. 

“In the current economic climate, setting this up may be challenging but the chance to lobby different international organisations for assistance exists and coupled with the positive support from the Ministry of Health will also be key to this. 

“Overall, there is a need to improve the availability and accessibility of quality medical imaging in Malawi in both public and private sectors or we shall be left behind by the rest of the world.”

Single photon emission computed tomography

He explained that nuclear medicine gives information on different functions in the body. 

“Nuclear medicine imaging and radiology, which gives information on human anatomy, are not mutually exclusive and nuclear medicine physicians and radiologists work together to achieve comprehensive medical imaging. 

“The imaging equipment used in nuclear medicine are the SPECT (single photon emission computed tomography) and PET (positron emission tomography) cameras with attached CT scans.

Positron emission tomography

“Where treatment is concerned, radiopharmaceuticals form part of the treatment options for many diseases such as overactive thyroid glands, thyroid cancer, prostate cancer, neuroendocrine tumours, childhood cancers like neuroblastoma, various joint diseases as well as palliation of bone pain in patients with cancers that have spread to bone, among others.”

He explained that the main group of patients that need nuclear medicine imaging are patients who have been diagnosed with cancers such as lymphoma, breast, prostate, lung, thyroid cancer etc in whom the burden of disease needs to be quantified so that the patient gets the appropriate form of treatment. 

“Many different types of scans are done by nuclear medicine before the patient gets treatment, including bone scans, which look for spread of cancers to bone, nuclear medicine GFR studies, which quantify how well the patients kidneys work and heart studies, which quantify how well the heart works as a pump etc. 

“These scans are part of the international standard of care for patients before they receive any chemotherapy or radiotherapy which would potentially have undesired effects on these organs. 

“Away from cancer, other kinds of scans that are done include scans looking for blood clots in the lungs, especially in pregnant patients or women who have just delivered, aiding in assessing causes of jaundice in new-born babies, investigating kidney obstruction, looking for infection that is not clinically obvious etc. 

“Nuclear medicine imaging has an application in essentially all organs in the body with new applications being internationally recommended all the time,” said Dr. Jooma, who is an alumnus of the College of Medicine, University of Malawi where he attained Bachelor of Medicine, Bachelor of Surgery (MBBS).

Since he is still in South Africa, serving my clinical time at Tygerberg Hospital in Cape Town and will be back in Malawi in 2020, he is technically still attached to Mangochi District Hospital as his duty station.

Where Dr. Jooma is currently doing clinicals

Mangochi District Hospital will always hold a special place in my heart. However, upon my return to Malawi, it is expected that I will be re-posted to be part of the staff for the cancer centre that is being constructed in Lilongwe.

“There is currently a lot of research being done using nuclear medicine imaging in areas such as pulmonary TB with the aim of improving treatment protocols. These research projects could have significant impact on how we manage TB, a disease with a high burden in Malawi and the rest of Africa.”

The hospital that remains close to his heart

Asked what are the highlights of his career apart from this new achievement, Dr. Jooma said: “In the realm of medicine, my career is still in its infancy. 

“However, my previous work with Mangochi DHO gives me particular pride. During my time there I was voted the best district medical officer of the south eastern zone based on performance assessments. 

“I was heavily involved in maternal and child health, particularly active in the Mangochi DHO fistula prevention and treatment programs with our health partners such as AMREF. 

“More recently, my research abstract on vascular prosthetic graft infections was voted the best abstract from the Africa region at the European association of nuclear medicine congress in 2018.”

University of Stellenbosch in Cape Town

What prompted you to go for this nuclear medicine? “Two things, interest and need. 

“Nuclear medicine is an ever-evolving medical speciality world over, incorporated in clinical guidelines of best clinical practice. 

“Being able to visualise body functions that are taught during undergraduate training using nuclear medicine techniques is simply amazing. 

“Where need is concerned, the Ministry of Health, after much consultation with expert’s world over, realised that there was a need to roll out nuclear medicine services as part of a comprehensive cancer centre package. 

“Nuclear medicine may be in its infancy in Africa, but our fellow African countries have been quick to realise the potential and build capacity in this field. 

“A good number of our surrounding countries such as Tanzania, Zambia and Zimbabwe just to mention a few, now have established functional nuclear medicine departments as part of their cancer hospitals.”

Is this now the ceiling, will you go for another if an opportunity arises? “The beauty of medicine is there is never a ceiling. 

“There is always room for growth within ones chosen speciality such as in the form of a PHD. Another master’s degree is also a possibility. In the interest of continued self-improvement as well as continued capacity building, should the opportunity arise I would definitely consider it.”

Nurse preparing patient for CT scan

To the aspiring medical students, Dr. Jooma says the medical profession is a calling and requires dedication and many sacrifices. 

“The decision to become a medical professional should never be taken lightly and always do your due diligence before committing yourself. When done for the correct reasons, medicine is a wonderful and rewarding career with endless possibilities.

“To current medical students, well done on the journey so far. At some point in your training the academic expectations may weigh you down you or you will be disappointed in yourself but always remember that nothing worth doing is meant to be easy. 

“Even when in the lows of a valley tell the dream that you are chasing that you are still on the way! Only through a valley can we get to a peak, keep believing in yourself.”