PAIRS 2023: “[Opening] the gate” to IR in the Middle East and North Africa

Rana Tarek M Khafagy

Rana Tarek M Khafagy is a consultant interventional radiologist based at Ain Shams University Hospital (Cairo, Egypt). In her capacity as head of the Pan Arab Interventional Radiology Society (PAIRS) residents, fellows and students (RFS) section committee, she sat down with Interventional News at the PAIRS annual meeting (11–14 February, Dubai, UAE) to discuss her journey into interventional radiology (IR), and how it is for those in training now, both in her home country and across the Middle East-North Africa (MENA) region.

“At my institution, we have one department, radiology and IR […] During your residency and fellowship you are obliged to do rotations in [diagnostic and IR],” Khafagy explained, setting the scene for the discussion. However, she went on, “when I entered in 2014, the IR department was not open to [all] the residents and fellows. There were no females at that time in the IR unit—I had wanted to have training at the IR unit since my first year in residency, however only a few male seniors agreed to help me. I used to finish my daywork duties in the department then go and stay there [and observe].”

The significance of being a woman in IR in the MENA region

Khafagy proceeded to recount how most of those in the IR unit at the time thought that “she [would] get bored and leave,” but, as is evident now given her position, she did not. “Most of the consultants were not accepting females in the unit,” she elaborated, describing the situation as “very challenging”. Khafagy believes that this is due to stereotyping women as unable to cope with the stress of a specialty like IR and the on-calls that they bring, and as too squeamish to deal with blood. “However, to be honest,” she conceded, “I did meet some male consultants who supported me, including my mentor.”

In 2021, “me and another woman in my class the first [women] to be consultants at the IR unit,” Khafagy shared. “Our presence as residents and fellows and now consultants has encouraged many females after us to join the IR unit and has helped to open the gate to them—if you were to come to the department now you would see a lot of women training at the IR unit.” Khafagy illustrated how much of the initial negativity towards female interventional radiologists at her hospital has dissipated since—women are now “welcomed” and “no one is offending [us], no one is avoiding [us]”.

On the subject of the IR procedures that she specialises in, Khafagy emphasised the importance of being skilled in all of them, not only in women’s health-related procedures. For example, she does prostate artery embolization, and bronchial artery embolization, presenting on the latter at PAIRS 2023. However—and this is a point that was echoed in an information session later on during the meeting, on routes into IR in the MENA region—there is a particular demand in the region, given the religious and cultural environment, for female interventional radiologists, as female patients often require their doctor to be a woman. Therefore, women’s health procedures, such as uterine fibroid embolization make up more of a female interventional radiologist’s caseload than they do a male’s in the region.

Training in IR in the MENA region

Khafagy then moved on to discuss her role in PAIRS’ RFS section—“ the team is very active and there are also many females on the team.” Team members are “mainly from Egypt, Saudi Arabia, also from Algeria, Syria, Qatar, UAE and Morocco—many countries,” she detailed. There are even members involved in the section’s activities despite currently being based outside of the MENA region—“the UK, USA, Canada and Germany,” she added.

This prompted the question of whether she had spent time during her training outside of Egypt—“I spent a few months in the UK,” she replied. Contextualising this fact, she explained that it is “not that common to do fellowships abroad in Egypt” but more common in Saudi Arabia and the UAE. “Officially, in the UAE they do not have an IR training programme. So they have to go abroad, do their training and come back as a consultant.” The implications of this reality were addressed in the aforementioned information session—attendees expressed their concern that interventional radiologists-in-training often leave the region for an IR programme and do not return. Khafagy shed further light on this subject, clarifying that it is mainly in Saudi Arabia and Egypt, of all the MENA countries, that trainees embark on IR training.

Khafagy then segued into addressing awareness of her specialty in the MENA region—”Maybe five, six years ago, if you asked medical students [in the region] if they knew anything about IR, they would definitely say no. As for now, I cannot say that everyone knows about it, but I believe they have heard about it. And this is very important regardless of the specialty they will go into eventually —they need to know about IR so they can refer patients.” The progress towards more widespread recognition of IR in the MENA region is, in part, due to the efforts of PAIRS , who “had a vision” that involved a focus on “promotion” of IR. An example of this is the ‘I am PAIRS’ campaign done in several Middle Eastern countries, for which Khafagy is a regional leader in Egypt, she shared. This has centred around gathering students at a dedicated event “so that [medical students would know about [IR]”. Many of the students were “amazed, giving very good feedback,” Khafagy supplemented.

PAIRS’s residents, students and fellows focus

The inspiration for tailored RFS initiatives came from “peers at the Society of Interventional Radiology [SIR] and Cardiovascular Interventional Radiological Society of Europe [CIRSE],” Khafagy went on to say. The committee itself started as “just a little chat”—with Ayah Megahed (Yale New Haven Hospital, Bridgeport, USA). “She is a colleague of mine training in the USA and she is working for the SIR RFS. She said to me, why do we not have something like this for PAIRS?” Khafagy relayed by way of an origin story for the section. They agreed that the concept had “very good potential,” given the success of the US and European counterparts. “Being interested in working with the juniors and as a regional leader in Egypt of ‘I am PAIRS’, I spoke to Ayman Al Sibaie [Rashid Hospital, Dubai, UAE], the president of PAIRS and Karim Abd El Tawab [also Ain Shams University Hospital], the secretary,” Khafagy recounted, the PAIRS board was supportive and thus the PAIRS RFS section came into being. “I led it when I was a fellow and still [am leading it],” she added.

“Our vision, which is matching with PAIRS’s vision ‘Investing in Youth’ is mainly to increase awareness of IR among students and to support the residents and fellows because in a lot of countries, they are also involved in diagnostic work […] so we are working to encourage them [towards IR],” Khafagy summarised. Also of central importance to her though, as reflected throughout the discussion, is boosting the image of women in IR in the MENA region. She celebrated the fact that the section members say they “see many females presenting—this enhances their vision of females being able to [work in IR].” The goal is to continue what the section has achieved to date with supporting the students and juniors, Khafagy concluded.


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