Imaging in Developing Countries

Special Interest Group

I recently returned from a five week ‘working holiday’ on the island of St Helena in the South Atlantic Ocean. It is a beautiful sub tropical island with an ideal climate and a whole lot to recommend it but sadly no beaches. It is the second most remote inhabited island in the world and the people are an eclectic mix with a very interesting history. The population of the island is 5000 approximately.

While there my mission was to improve the quality of the imaging service. The present service is provided by two nurses (June and Maureen) who have had some training in the production of images.

There is a hospital staffed by four doctors and a selection of nurses. There is a laboratory, physiotherapy and dental service but a very poor imaging service which depends on an AMX4 mobile machine and a bench top processor. I attempted to help the two nurses learn the rudiments of x-ray production, some information on processing and its idiosyncrasies together with some tuition on basic technique. The island being small (47sq miles) the speed limit is 30mph so high speed impact injuries are non existent. The approximate workload breaks down to chests 40%; Spines 23%; extremities 30% and the remainder pelvis/ abdomen/skull.

I observed that the two biggest problems related to exposure and positioning.

The mobile machine is good but output is limited. Grid cassettes are in use for spine, pelvis etc but there is a problem when a patient has a BMI over 28. Exposure latitude was also severely compromised by the film screen combination. Compounding this was the lack of underpinning knowledge on the part of the nurses which, as you can imagine, makes it incredibly difficult to get exposures right.

Positioning – well to radiographers this is second nature. Once again though when your primary job is nursing and care of the patient, and when your knowledge of radiography is limited, it is difficult to get it right. Their biggest problem was their inability to discern whether the image they produced was adequate, inadequate or totally unacceptable. In order to alleviate this problem I took a dual approach. I had with me a large number of digital images so was able to demonstrate what a good image looked like. I then selected a large number of previous images from the film store and we analysed them using the broad headings of ‘image quality’ and ‘exposure’ and deciding what (if anything) was wrong and how to fix it.

At the end of the five weeks there appeared to be an improvement in image quality but there is no doubt in my mind that quality will deteriorate after three or four weeks due to lack of knowledge from a radiographic standpoint.

There is also a small ultrasound machine in the department. This provides a limited service and is operated by June as well as by the doctors. It appears to be mostly used for gynaecological purposes.

My conclusion at the end of the time there was that a radiographer was/is badly needed on the island. This individual would need to have a good knowledge of radiography (no automatic exposures!), ability to use screens and film as well as knowledge of automatic processing. He or she would also need knowledge of ultrasound as well as the ability to teach both modalities.

Radiographer Needed in St Helena!

Margaret Mulligan recently spent 5 weeks working in an x-ray department in St Helena. Here she recounts her experiences, and appeals for a radiographer to work there for a year.

The island does not have an airport so to get there requires a minimum four day trip – by air to Ascension Island and two and a half days by ship from there so getting there is an adventure in itself and a pleasant one at that. I carried with me an actinic marker – a gift from SoR to the darkroom on the island - so thank you to those concerned.

If anyone is interested feel free to email me for more information – it would be a lovely place for a year or so. It is a paid position incidentally!!

Margaret Mulligan (