Angkor Hospital for Children, Siem Reap, Cambodia
Angkor Hospital for Children (AHC) is a 103 bed charity pediatric hospital serving children affected by poverty and disease. Founded in 1999, the hospital has grown to include a 12 bed intensive care unit, a surgery program including open heart surgery cases assisted by visiting teams, the beginnings of a cancer care program, a neonatal ward and a newly renovated and expanded outpatient department. More information can be found at www.angkorhospital.org.
AHC’s two radiology modalities are X-ray and ultrasound (no CT scanner or MRI Machine. CT scans are occasionally obtained at other facilities in Siem Reap on an as needed basis.) The good quality images are done with a very simple mobile machine. A phosphor plate system is in place, thus X-Rays and descriptions can be reached from the ward. ACH uses SONIX SP (ultrasonix) ultrasound machine with three probes: C7-3/50 , L14-5/38 and PA4-2/20. Since its repair in early March 2014, the machine has ceased to function with Pulsed and Power Doppler. There are 15-20 ultrasound examinations/day, mainly severe soft tissue masses and eye injuries. There is no small convex probe. Generally speaking there are no normal finding, just severe pathologies. AGH has one radiologist and plans to add an additional physician to train as a pediatric radiologist. Since November 2014, WFPI has given opinions on 24 cases, largely on plain radiographs and contrast exams with only a couple of Ultrasound studies. Opinions were returned within 24 hours (often sooner).
Site coordinator: Dr. Seng Hap. WFPI coordinators and tele-readers: Drs. Veronica Donoghue and Eva Kis. Project identified by Dr. Catherine Owens/Royal College of Radiologists, UK
© Cambodia images: George Taylor
Other imaging interventions at Angkor Hospital for Children
WFPI is far from the only organization to offer assistance to this facility. AHC pediatric staff members are trained by ultrasound faculty at UMass Memorial Medical Center through onsite lectures and hands on training. UMass physicians travel to Siem Reap about 3-4 times per year for onsite education. Pediatric radiologist Dr. Joe Makris has been among them. See here for more.
Laos Friends Hospital for Children
[More specifically: ultrasound people in oct/November and both ultrasound/xray for Dec 5 to beginning of January. General job expectations are to teach, assist, mentor our xray/ultrasound technicians. LFHC hopes to start a full teaching program eventually and will be looking for help in its organization.]
Laos Friends Hospital for ChIldren opened its doors in Feburary 2015. Set up and supported by Friends Without a Border (as is Angkor Hosital for Children in Cambodia, above), LFHC is the first full-service pediatric hospital in northern Laos, offering inpatient & outpatient departments, 24 beds, emergency room, intensive care unit, operation theater, laboratory, pharmacy, radiology, lecture rooms & library to teach pediatric medicine to the future leaders of the hospital, kitchen & laundry for families visiting the hospital, and a vegetable garden to teach families how to prepare nutritious meals. See Friends Without a Border website (here) for more background information on the initiation of this new and much welcomed hospital.
As of mid-May 2015: LFHC offers a growing outpatient clinic seeing up to 100 patients per weekday, which includes approximately 5-10 ultrasounds and 5-10 radiographs per day. Any patient requiring inpatient care is immediately transferred next door to the adjacent Provincial Hospital which has its own radiology department. This Provincial Hospital department is staffed by approximately 6 radiographers who perform both the radiographs and ultrasounds. The ultrasounds are interpreted by the radiographer with an example image(s) often printed and sent with the patient including an interpretative hand-written note, while the X Rays are sent back with the patient to be interpreted by the ordering MD. This radiographer team has no specific pediatric radiology training, and the hospital has no onsite radiologist. Subspecialty pediatric care (CT scan, MRI) is only available - at a cost - in the capital of Vientane, 340 km and thirteen hours by vehicle away, despite government-provided health care for children under the age of 5. The transportation cost alone is prohibitive for many families in the region.
UPDATE NOV 2015: the hospital is rapidly growing:
+ Currently operate in outpatient and inpatient setting with approximately 5 Laotian MD’s seeing approximately 30-70 patients a day with the performance of approximately 2-10 radiological exams (combined radiographs and ultrasounds) per day
+ November 2015: scheduled opening of the ER
+ January 2016: scheduled opening of the ICU and operating room theater
• Continues to expand radiological services + Site visits for sonographers + Continuing RAD-AID support of PACS
RAD-AID's pediatric coordinator for Asia, Dr Michael Reiter, visited LFHC in May 2015 to assess future collaboration and support. Following the visit, Dr Reiter and LFHC's director, Dr. Nijssen-Jordan, contacted WFPI for tele-second opinions for LFHC's embyronic imaging department (the hospital does not have a radiologist hired yet to interpret the images for a newly installed US and portable radiography unit). First referral received on 23rd May, cases coming in since! We're happy to support this new hospital and all it is aiming to achieve.
Progress report, November 2015: 80+ cases referred to WFPI by LFCH via the tele-platform - the number of referrals for WFPI volunteer second opinions increased significantly from late November on. Most cases have been chest radiographs, also radiographs of skull, mandible, spine, leg, and abdomen, as well as one head CT. They raised diverse clinical questions, including queries on infection, heart failure, beriberi, storage disease, tuberculosis, sellar tumor, dental abscess, thalassemia and acute abdomen.
More information on this project and the pediatric imaging set up can be found here
Laos Friends Children's Hospital is looking for a volunteer Xray and US technician, visits in late 2015/early 2016 welcome. Contact us.
Bustamante Children's Hospital, Kingston, Jamaica
Bustamante Children's Hospital offers 283 beds, including 5 in the ICU. The hospital is usually overcrowded and has long waiting times for diagnostic and medical interventions as well as outpatient consultations. The Accident and Emergency department operates on a 24/7 basis and sees approximately 77,000 patients per year.
The imaging department serves an overwhelming number of about 4000 patients for examinations per month from all over the Island (the vast majority is outpatient). CT scans and MRIs are done on about 80 and 20 pediatric patients respectively per month. Update August 2015: 2 cases referred; MR brain and spine: tumor, multiple sclerosis. MRI machine broken down for many weeks.
In July 2015, Dr. Pamela D. Ketwaroo (Boston CHildren's, USA) visited Bustamante Hospital on behalf of WFPI. Here's what she reports:
On a fiery July afternoon in Kingston, Jamaica, my family and I were welcomed into Bustamante Children’s Hospital. Dr. Michelle-Ann Richards-Dawson, the senior medical officer, and Dr. Marcia Lawrence, the sole pediatric radiologist at Bustamante, met me with warmth and generosity that is so typical of Jamaica. I learned during my tour of the expansive and airy facilities that in the best of times, clinicians here rely primarily on radiographs, one ultrasound unit (which is shared with cardiology), and fluoroscopy. CT and MRI are available at Kingston Public Hospital, where both patients and Dr. Lawrence are transported to and fro for imaging and interpretation, respectively. They have made the best of a difficult situation, but with the more recent loss of their fluoroscopy unit as well, it made me wonder: what are some alternative ways to diagnose (and sometimes treat) pediatric GI emergencies without the benefit of fluoroscopy? In resource-limited settings, the lack of fluoroscopy is not so uncommon, and pediatric radiologists can be in the forefront of helping these patients. If we think creatively and draw upon collective experience, perhaps overcoming challenges like these will not be so overwhelming.
Image: L -> R, Dr. Marcia Lawrence, Dr. Richards-Dawson and Dr. Pamela Ketwaroo
Site coordinator: Dr. Marcia Lawrence. WFPI coordinator: Dr. Ramon Sanchez. Project identified by Dr. Ramon Sanchez and PAHO/WHO.
Click here for more information on Bustamante Hospital
Hospital de Cobán, Alta Varapaz, Guatemala
This hospital is the only third level hospital in the region. It offers 180 beds, 1 general radiologist, 1 U/S, an X-ray room, 1 portable X-ray. The site is non-digital. CT belongs to a large private group and cases are sent and read outside (external PACS). More details available here
Compute internet access is hampering the referral of images from Cobán: the team prefers to refer via mobile phone applications for now. (See below). Update May 2015: average of 1 referral received/month via WHATSAPP, combination of plain film cases, CT and MRI. More X Ray than anything else.
Site coordinator: Dr. José Pineda, WFPI coordinator: Ramon Sanchez. Project identified by Dr. Ramon Sanchez.
Centro de Salud Santa Clotilde (CSSC), Napo River, Peru.
This 30-bed hospital includes a general medical area, a labour and delivery room, an operating room, a clinic and a laboratory. The CSSC is the head of a network of 12 health facilities along 400km of the Napo River and serves 100+ villages and a population of over 20,000. In 2010 there were 15,000 outpatient visits and 903 admissions to the hospital with 62 deliveries and 71 surgeries. Patients unable to be treated at the CSSC are stabilized and transferred to Iquitos via a one day boat trip and if needed flown to Lima. The Centre offers 1 U/S machine and no X-ray machine (work in progress). Update May 2015:
4 cases referred; CT head, CT chest, XR chest, US fetus: varied pathology
Site coordinator: Dr. Brian Medernach, WFPI coordinator: Dr. Ramon Sanchez. Project identified by Dr. Ramon Sanchez
More images here
Following Dr. Aadil Ahmed's visit to Gaza in June 2013, WFPI is now providing tele-opinion support to Nasser Children's Hospital with extension to Rantissi Hospital planned. The team from SIDRA Medical and Research Centre, Doha Qatar, plan to join this tele-reading team; there are hopes for later onsite training. Update May 2015: 1 case referred; XR chest: surfactant deficiency. It is hard to maintain contact with this facility, especially given its "hot spot" location. WFPI remains on standby with its support.
CT, Rantissi Hospital, Gaza
Site coordinator: Dr. Hossam Ahmed ELNajili, WFPI coordinator: Dr. Aadil Ahmed. Project identified by Dr. Aadil Ahmed.
Wendy Fitzgerald Paediatric Hospital, Trinidad
This pediatric hospital, managed by a regional health authority, is part of the national health system. It is the only pediatric facility for 2 regions (out of 5) and offers 275 beds. There are 7 general radiologists on its staff. A new national children's hospital is under construction and will eventually offer all pediatric imaging services. The 9 year old 16 slice CT is in working order. Pediatric CTs and sonography are performed in a separate building in the nearby campus of the Eric Williams Medical Sciences Complex. There is a plain radiology unit in the emergency department of the Wendy Fitzwilliam Paediatric Hospital. Update May 2015: 1 case referred; XR pelvis: femoroacetabular impingement
Site coordinator: Dr. Paramanand Maharaj, WFPI coordinator: Dr. Ramon Sanchez. Project identified by Dr. Ramon Sanchez and PAHO/WHO.
Click here for more details