A Life of Service-Dec2009

Helmut Diefenthal, M.D., shown in his home in Minneapolis, is training Tanzanians to be radiologists.

Photo by Janna Netland Lover

Back to Table of Contents | December 2009

Face to Face

A Life of Service

Helmut Diefenthal, M.D., set out to be of service. Along the way, he brought radiology to a nation.

By Carmen Peota

On October 7, 85-year-old Helmut Diefenthal, M.D., and his wife, Rotraut, closed up their cozy south Minneapolis home and boarded a plane bound for Tanzania. It’s a routine the couple has been performing for the past two decades since Diefenthal retired from teaching and practicing radiology at the University of Minnesota and Veterans Affairs Medical Center.

That these octogenarians will spend the next 10 months working full time at a hospital on the slopes of Mount Kilimanjaro is remarkable. That in their retirement years they have brought radiology to Tanzania is even more so.

Yet to the Diefenthals, this trip is just one more leg of a globe-trotting lifestyle that began in Germany in 1943, when Helmut, the son of a Jewish father and Lutheran mother, was drafted into the German Army and sent to the Russian front to work as a medic. During two miserable winters spent caring for typhus patients, he began to bargain with God. “Seeing all the misery and death,” he says, “I made a promise that if I ever survived the war and the Nazis, I’d use my life and talent in service.”

Unlike some who make a deal with the divine and then forget it, Diefenthal has spent his life making good on that promise. In fact, it’s been the organizing principle for it.

On a Mission

When World War II ended, Diefenthal returned to Germany. He graduated in the first medical school class at the Free University in Berlin in 1949, went into internal medicine, married Rotraut in 1953, and approached the German Institute for Medical Missions about going overseas. In 1956, the couple was sent to Malaysia, which might have remained their home, had Helmut not spoken frankly about the prevalence of hookworm disease in the country. Unhappy with his comments in a newspaper article, the Malaysian government asked him not to return when his four-year term was up.

In 1961, the Diefenthals were dispatched to a one-doctor hospital in the remote Pare Mountains in northeastern Tanzania. There, they learned of a Minnesota missionary’s plans to build a modern medical center near the base of Mount Kilimanjaro. Diefenthal wanted to be part of it. He realized that the center would need specialists of all types and that the one specialty they didn’t have was radiology. “They couldn’t afford one at missionary prices,” he says. He decided to get trained and ended up doing a residency in radiology at the University of Minnesota.

By 1971, Diefenthal was back in Tanzania, this time working as a radiologist at the new Kilimanjaro Christian Medical Center (KCMC) in Moshi, a city of about 200,000 near the famous mountain. But the Diefenthals were not yet to settle into life in Africa. After only a few years, they returned to Minnesota to send their four children to college. Diefenthal took a faculty position at the University of Minnesota, where for the next 16 years, he built a network of friends and colleagues who started to share his vision for bringing radiology to East Africa.

John Knoedler, M.D., now a radiologist at St. Paul Radiology, was one of those who was impressed with what Diefenthal had done and wanted to do in Africa. So in 1987, when his former teacher asked him to help start a foundation, Knoedler didn’t hesitate to say yes. The idea was that the East Africa Medical Assistance Foundation would tap Diefenthal’s Minnesota network to provide money, equipment, and volunteers to help bring radiology services and training to Tanzania (see “The Minnesota-Moshi Connection”).

The foundation was launched in 1988 as Diefenthal, at age 65, headed back to Africa to work as a staff radiologist at KCMC, which by then was a 500-bed tertiary-care hospital.

A New Model of Education

Diefenthal was well-aware that the goal of bringing radiology to Tanzania, a country of more than 40 million people, would not be easy to achieve. With only a handful of radiologists in the entire country, few Tanzanians had access to even basic X-rays. And although there was a need for radiologists, few physicians wanted to go into the specialty. “Radiology is a very desired specialty here, but over there, no, because radiology requires equipment that’s expensive,” Diefenthal explains. As a result, the few radiologists in Tanzania were concentrated in the nation’s two largest cities, Dar es Salaam and Arusha, where there was equipment and opportunity for private practice with paying patients.

The Minnesota-Moshi Connection

Like many who have gotten involved with the East Africa Medical Assistance Foundation, Park Nicollet radiologist James Halverson, M.D., did so because he got to know Helmut Diefenthal, M.D., when he was a resident at the University of Minnesota.

Now president of the foundation, Halverson oversees the 501c3 that has grown from a small organization run by volunteers that raised $30,000 or so a year to a more mature and sophisticated one with professional staff, a board of 14, and a goal of raising several million dollars for a cancer center at the Kilimanjaro Christian Medical Center (KCMC).

Over the years, the foundation has sent X-ray film and equipment to Africa; provided scholarships for Tanzanian students and U.S. residents; bought books, cameras, projectors, and computers for and sent volunteers to set up a medical library; and built a dormitory for residents. Recently, someone donated an almost-new mammography machine. Someone else from a church in Stillwater picked it up and delivered it to a warehouse in Fridley, where it was packed and shipped by a nonprofit called Global Health Ministries. “We all have connections that we try to leverage,” Halverson says.

Board members have served as examiners and teachers for the KCMC trainees. They’ve solicited funds, equipment, and time from their colleagues, churches, and friends. Recently, the foundation raised the money and found the technical experts to establish a repair department at the hospital to fix the broken machines that have accumulated there over the years. The one thing the foundation does not do, however, is provide salary support to Diefenthal, who’s managed to be self-supporting for more than 20 years.

Now the foundation is attempting its biggest effort yet—building a cancer center at KCMC. “We’d like the government to provide the bricks and mortar,” Halverson says. The foundation would raise money for the equipment. Board members are currently in talks with the International Atomic Energy Commission about the regulatory issues related to nuclear medicine that would need to be addressed.—C.P.

For more information about the East Africa Medical Assistance Foundation, go to www.eastafricafoundation.org.

Bringing in radiologists from other countries was impractical. If they stayed long-term, they’d fall behind technologically and put their careers in jeopardy. If they stayed only a few months, they wouldn’t have time to learn the language and cultural and medical differences to make them really effective. In addition, the Tanzanian government required that physicians be licensed there, a process that takes six months or more.

Recognizing these issues, Diefenthal came up with the idea of training Tanzania’s midlevel providers. Called assistant medical officers (AMOs), they are the main providers of primary care in the country and are employed by district hospitals in the smaller towns scattered throughout the country. Following three years of clinical training, five years of clinical experience, and two years of AMO training, AMOs earn the title of “doctor” and can then make diagnoses, prescribe drugs, and perform routine surgical procedures. Diefenthal’s idea was to train them in radiology. Because they’d be sponsored by the hospitals that employed them, the AMOs would return to those smaller hospitals and towns upon finishing the program, rather than head to the larger cities.

Diefenthal submitted a plan for a two-year AMO training program in radiology to the Ministry of Health. His curriculum was accepted, and in 1993 Diefenthal found himself in charge of the Kilimanjaro School of Radiology, Tanzania’s first radiology training program. The school has since added a four-year residency in diagnostic radiology for physicians and a short course in obstetric radiology for midwives. Thus far, the programs have graduated 11 M.D. radiologists and 62 AMO radiologists, which means that half of Tanzania’s 127 districts (comparable to counties in the United States) are now served by radiologists trained by Diefenthal.

Diefenthal readily admits that the instruction at KCMC is somewhat different than what might be found in the United States. For one thing, they need to prepare students to work on older, less-expensive equipment—the kind they’ll likely have access to in their hospitals. They have to teach students to recognize and correct the technical errors the equipment might cause. They have to teach the radiological features of diseases that are commonly seen in Africa. And they have to encourage residents to use ultrasound to do what MRI and CT might do elsewhere. For example, they use ultrasound to look for foreign bodies, retinal detachment, and tumors in the eye and to assess cardiac function by measuring hepatic veins. “In some ways, with ultrasound they’re ahead of us,” says Knoedler, who has served as a board examiner for the trainees. Although they don’t do MRIs or nuclear medicine, and their ability to do interventional radiology is limited, “they’re good radiologists,” he says.

Remarkable at Any Age

Inspired in part by Diefenthal, the American College of Radiology (ACR) has launched an international outreach program and has begun providing travel grants for residents to go overseas and experience how radiology is practiced in developing countries. In addition to gaining an appreciation for the challenges, “they gain an understanding of the imagination necessary for practicing in developing countries,” says Brad Short, senior director of member services for the ACR and head of the ACR foundation’s international efforts.

Those who go to Tanzania get an added benefit—they meet Diefenthal. “I think almost everyone I’ve spoken to who had the great experience of either meeting him or practicing with him has walked away changed by the experience largely as a result of his inspiration and dedication to improving health care in developing countries,” Short says. “You see how old he is, how dedicated he is, and you can’t help think, if he can do it, maybe I can, too.”

University of Minnesota radiology resident Naomi Mraz, M.D., who spent a month at KCMC, had a chance to witness Diefenthal’s dedication. She wrote in a report on her experience: “Dr. Diefenthal works tirelessly to provide quality service to referring clinicians, including same-day performance and reporting of all studies, daily interactive clinical rounds, and regularly asking clinicians, ‘What else can radiology do to improve our services to you?’”

Juggling patient service with running three radiology training programs, Diefenthal carries a load that would be heavy for a person of any age. At 85, he still works 11 hours a day, seven days a week, helping his staff read X-rays, ultrasounds, echocardiograms, and CTs done at the hospital; giving lectures; and coordinating the work of the stream of volunteers who now spend a month or two at the hospital. He’s also building a digital library of radiographic images. (When students graduate, they get a CD containing the images.) “When most people go and work with him, they’re beat by the end of the day,” Knoedler says.

Yet Diefenthal clearly is a willing worker. “I will stay there as long as the Lord, the Tanzanian government, and the hospital administration allow,” he says, admitting that he doesn’t know how long that will be.