Thursday, April 3, 2014

When eliminating film is not necessarily the best solution.

During my recent humanitarian trip to Nicaragua, sponsored by Rotary International, we built a library and feeding center. While there I also visited the local children’s hospital in the city of Chinandega. It was good to see the impact on patient care we had made on a previous trip by bringing in equipment, such as oximeters and other life-saving devices, to help care for these very tiny premature babies.
I typically also visit the radiology department to find out if I can learn anything. They just had received a nice refurbished CR system with an X-ray table, and with having the room newly painted, and air conditioning installed, it looked really nice.

Feeding 900 children, one at the time
However, I noticed on the table next to the CR computer an appointment book listing all of the patients that were imaged. It seems it is difficult to get people to let go of their old practices. Even though there was a mini-PACS and patient management module available, for them, there is nothing better than paper. The exams were identified as “exam1,” “exam2” etc. and the appointment book served as an index.

If patients are deemed to be in a critical condition, they travel by ambulance to the Nicaraguan capital, Managua. In the past, they would send the film with the patients. In this case, even though a film printer was provided with the system, it is unused. It seems they needed its power conditioner somewhere else, so the printer is not operational anymore. The primary image exchange from this system was intended to be paper using a small desktop printer, however, after the print cartridge ran out, this too is no longer used. While burning the image on a CD is an option, there is apparently no budget for supplies such as print cartridges and CDs.

So, the bottom line is that a year ago, before the CR system was installed, critical patients would go with the analogue film to the main hospital. Today, the analogue processor is gone, and there is no means for getting the digital images out of the PC to go with the patient. I resisted the urge to run to the local supply store and buy a stack of CD’s and/or a printer cartridge, however that would only have been good for as long as they lasted. The hospital has to learn how to implement digital technology in a sustainable manner.

This is only one example of the trial and error that takes place in aiding developing countries. That is why it is critical to travel and find out the local needs instead of throwing technology at these regions. That does not only apply to medical devices, but equally to any other areas as well. This year I visited a library that was built by another non-government organization next to a school we had started several years ago. The library was very well equipped, with books, a computer, big screen TV with a DVD, and even a copy machine. Too bad there was no electricity to use any of these new gadgets, nor has the education ministry provided anyone to staff the library.

I estimate that about 50 percent of all relief money is spent without doing the necessary homework and follow up and is thereby wasted. This is by no means meant to discourage participating or contributing to these causes, just make sure you do your homework and pick the right projects and organizations. We have been very fortunate to be able to sponsor the construction of several small clinics and classrooms in this area with a high success rate for sustainability. It takes work, visits and local follow up to make it a success.


  1. Very interesting blog, I can relate to few encounters myself in the past in India. In my view we have to introduce the latest technologies as concept to the local tech brains and allow them the innovate a method to implement these concepts with local available technologies.

    I can give you and example, When the concept of Teleradiology was flurishing in West during early 2000, with technolgies like DICOM, COMPRESSION, ISDN, VPN, Diagnostic Quality Monitors where as in Rural India we hardly had DICOM enabled Modalties and not even dialup internet.

    But the concept of Teleradiology was badly needed in these parts of world. So we manged to understand the COncept and implemented a solution. We used Analog Films (cT/X-ray), digitised using a good quality Digital Camera, Lightbox and Tripod - captured JPEG images, upload these images to the Radiologist via a Peer to Peer dialup connection (ftp / 33 Kbps). On the Radiologist side we used Irfanview to view the images and report. A call was made to the Physician to communicate the reports.

    Now in India, 2014 people use Cloud, mobile phones based viewers for Teleradiology, but it took a decade to go through this transformation. I see your encouter is very similar to ours a decade back.

    History repeats in places like Africa, looks like an intersting place to travel and provide our innovations.

  2. Thank you very much for sharing interesting stuff.keep sharing more updates
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