Imaging in Developing Countries

Special Interest Group

Visits to St James Mission Hospital, Lesotho

Much remains to be achieved, particularly with regard to training, and we hope it will be possible to build further on the work done. The warmth and friendliness of staff and local people, and the beauty of this remote part of Lesotho, made our time at St James an unforgettable experience.

Following an appeal for volunteer radiographers, three members of the IDCSIG, Angela Ramsay, Hilary Noakes and Julia Williams, have undertaken placements at this hospital situated in mountainous countryside in Lesotho, Southern Africa. Angela was the first to go, in November 2006, with Hilary following in December. Julia vistied most recently in February/March 2007.

St James Hospital was built in 1963, to bring medical services to a scattered population of mainly subsistence farmers. It has around 60 beds, though generally no more than 20 inpatients. There are at present three doctors, one from the UK and two from the Democratic Republic of Congo. Because of the isolated position, staff live on site in the small houses provided. There is mains electricity and a back-up generator but no land telephone line.

There are outpatient and maternity services, pharmacy, pathology, theatre, x-ray and ultrasound facilities. Many patients are suffering from TB and a number are being treated for HIV/AIDS. Caesarean sections are performed and minor injuries are treated. More serious cases are transferred to the capital, Maseru (three hours drive away, partly on dirt roads). Patients have to pay for each investigation or treatment. Travel in the area is mainly on foot or on horseback and many patients walk long distances to the hospital. Pregnant women are encouraged to come and stay in a special shelter as their delivery time approaches.

The hospital has an established x-ray room and darkroom. There is a Korean mobile x-ray machine, but kept in a fixed position 150cm from an upright chest stand; the tube head can be rotated for a horizontal beam or to be vertical to the couch. The couch has no wheels nor bucky, but can be moved fairly easily. There is a light beam diaphragm and collimation is possible. Processing is by wet developing in a standard series of tanks, but washing is done in a separate sink, and drying by handheld hairdrier – all very time-consuming.

St James Mission Hospital

A pelvis X-ray covered in static marks

Currently there is no qualified radiographer. X-rays have been taken by other staff, e.g. an assistant nurse or a pharmacy technician, depending on availability.

Most of the doctors’ requests are for chest x-rays; many patients have TB and embark on drug therapy on their first visit. There are a number of trauma cases, e.g. falls from horses, or the results of fighting.

The dark room

Our work was on three fronts:

1. Improving the set-up in the department: clearing and cleaning the darkroom and processing tanks, ensuring the chemicals were up to strength, and preparing replenisher; sorting cassettes, discarding the poor ones; developing an exposure chart and overhauling the film filing system. Angela – the first to arrive – brought a selection of grids and some new cassettes, foam pads, and lead rubber strips, and Hilary made a sandbag. The department already had plenty of in-date film and chemicals, lead coats, safelights and several charts and textbooks on processing and positioning.

2. Providing a better and more continuous service while we were there.

3. Providing training to local staff – but they were already hard pressed in their existing duties and could not easily find sufficient time to learn a range of new skills.

The x-ray unit

The hospital also has a fairly modern Siemens ultrasound machine that the doctors use to look at pregnancies, though it is programmed to examine the whole range of organs.

Angela and Hilary’s Report

Julia’s Report

I volunteered to work at St. James' Mission Hospital, Mantsonyane, Lesotho, from 24th February to 24th March 2007. This is a short account of my experience.

In spite of the extreme poverty and desperate illness, I fell in love with Africa almost as soon as I arrived. Despite the cruel hand that has been dealt them, the people of Lesotho remain unremittingly cheerful and immensely proud.

St. James' Hospital is in an extremely remote location in the Highlands and, as a consequence, the X-ray Department is very primitive. The equipment is ancient and the darkroom has to be seen to be believed. Good X-rays were difficult to achieve but not impossible. Wet developing and drying the films with a hairdryer was time consuming but surprisingly effective.

I attended the church services, participated in ward rounds, visited outlying clinics and helped reduce fractures - skill mix in the extreme!

Angela had covered the basics and Hilary had taken things forward. I too stressed the need for good darkroom practice and taught basic X-ray positioning technique as well as giving a talk to the hospital staff about radiation harm and its effects.

I did see an improvement but unless the untrained staff are taught basic background knowledge, it is difficult to see how things can improve for the long term. Although I was made to feel extremely welcome, I am under no illusion that I have left a lasting legacy. Hopefully there is some small improvement and we all leave a little bit of ourselves behind.

Visiting St. James' Hospital on an ad hoc basis serves to make us feel good about ourselves but we only change things for the better temporarily. There is indeed much "goodwill and commitment" and further volunteers are waiting to help.

However, for the project to be sustainable and if we are to achieve results more quickly in creating a better X-ray service for the people of Mantsonyane, we need to become more organized and give future visits more thought.

That said, it is an amazing place with fantastic people. My life has changed for the better, having been there. I feel privileged and very grateful to have been given the opportunity to visit such a wonderful place.