Africa’s Medical Physics Workforce

Prof Chris Trauernicht - Tygerberg Hospital, Cape Town, South Africa

Could you tell us about Africa’s medical physics workforce?

When you ask a medical physicist what does he or she do, it’s kind of difficult to actually say what they do. So my typical answer is if you talk about treating cancer with radiation or any use of X-rays or radionuclides in the healthcare system, I can tell you a lot about the radiation, I can tell you very little about the patient. So it’s one of those healthcare professions that doesn’t really have direct patient contact but is absolutely crucial to deliver effective and safe radiotherapy.

As far as the medical physics workforce goes, in Africa medical physics is not well established on average. In the survey we did in 2020 there are about 1,041 medical physicists in Africa, around a quarter of those in imaging and nuclear medicine, and three-quarters for radiotherapy. To put that in perspective, Africa: 54 countries, 1.3 billion people. If you compare that with, say, Italy, a country of 60 million people, they have more physicists than the whole of Africa combined, medical physicists that is. So from the Federation of African Medical Physics Organisations we’ve been putting in some efforts to try and increase the visibility of medical physics, improve the workforce. So, for example, medical physicists should register with the Health Professions Council as health professionals. This only happens in a handful of countries in Africa, like five of them, and in the other almost 50 this doesn’t happen. So this is a problem because if you don’t know that medical physics exists then why would you appoint them?

So from the African Federation we’ve worked a bit on trying to establish an accreditation scheme and then register medical physicists with the professional development committee of the organisation to at least give them some status and some leverage to hopefully encourage them nationally to go back to their Healthcare Professions Councils and try and get the profession registered as professionals, as they should be.

What are the challenges pursuing this?

This is not something that gets done very quickly. If you need something to go into law it’s a process that takes a long time, it’s a process that has to be prepared very well. I’m from South Africa where we’re very fortunate, our society goes back to 1960, it’s one of the oldest in the world. We’ve had regulations, the Hazardous Substances Act in 1974; we’ve had a published Scope of Profession and so that’s great but it takes a lot of work to get there. So we’ve been encouraging from the Federation side to encourage members of countries who don’t have a national society to form national societies because Healthcare Professions Councils or Health Professions Councils will… you just have more clout with a Health Professions Council if you’re a society, a national society, rather than an individual saying, ‘Pick me! Pick me! I would like to be registered.’

So the challenges are on all fronts so where do I start? Not enough national societies; not enough regulations around the use of radiation; regulatory infrastructure is often lacking or non-existent in many African countries. The problems in Africa, there are so many problems that you’d rather employ three nurses or two doctors than what’s a medical physicist? He doesn’t even see patients.

So one of the big things that we have to deal with is just educate – we have to educate the funders that if you’re going to start a radiotherapy programme you’ve got to look at the human resources and you’ve got to do it properly. It’s not just, ‘We’re going to buy a linear accelerator,’ spend all that money and ta-da! It’s working. There’s a lot more to consider – apart from the infrastructure you have to consider the human resources and that includes medical physics. You have to consider consumables because those are also overlooked. You have to consider an adequate maintenance programme and everything that goes with it.

So challenges are all over the place and you do what you can do where you are. I don’t know if there’s much point in worrying about what you can’t control.

What message would you give to your colleagues in other countries?

Start with the low-hanging fruit. In Africa national societies would be very relevant, they are relatively simple to form and already that gives you a bit of a standing if it’s done in the proper way. Then engage the Health Professions Council to work on getting the physicists registered with the Health Professions Council. Figure out an accreditation scheme. We’ve got to desperately work on the medical physics education and training programmes, those are lacking quite badly in Africa.

I should maybe mention here the International Atomic Energy Agency has actually done a fantastic job as far as medical physics goes in Africa. They’ve invested a lot of money into medical physicists because obviously, the atomic bit, they’re very keen on having safe use of radiation. So for decades, actually, they have invested in medical physics in Africa, training quite a lot of medical physicists at different places. There is a curriculum out to harmonise curriculum for about ten years, the implementation is not uniform. So that’s another thing that really needs to be looked at is how do we actually get the academic and the clinical training done, not just in a few countries mainly in North Africa and some in Southern Africa and one or two in West Africa, Kenya is starting now which is great, but actually all over Africa.

Is there anything else you would like to add?

Is there anything else I’d like to add? One of the things that’s great about a conference like AORTIC is that it brings together so many role players in the oncology field. So as physicists we tend to be stuck in radiotherapy because that’s what we deal with but there is so much more to cancer care, to the challenge of cancer. So I think a conference like this is actually great for the networking, to meet other professionals, to hear what they’re doing, for some synergies that hopefully will develop along the way.

So the organisers have done a fantastic job, the venue is great, maybe a little far from downtown but that’s okay, they’ve organised transport. Hopefully we’ll see some very positive things coming up in the future.