Low Cost Digital Radiology
Two-thirds of the world’s population do not have access to basic medical imaging services. There is an acute need for diagnostic imaging among primary care providers to facilitate accurate and rapid diagnosis of trauma and infectious disease.
In the case of trauma, medical imaging expedites treatment and recovery so that patients can return to home and work more quickly and with better health outcomes, In the case of infectious disease, medical imaging facilitates an efficient triage of patients among scarce medical resources and rapid diagnosis results in more effective therapeutic response.
Primary care radiology addresses: Trauma; Infection (including Tuberculosis); Parasites and the complications of AIDS; Cancer in many variations; Intestinal obstruction and other abdominal problems.
The most serious needs are in small, remote institutions (first referral clinics or hospitals). These are frequently neglected by the national authorities and often forgotten by the outside world. There are deep gaps in safety, quality and quantity of services between tertiary hospitals and these small, remote first referral hospitals.
Approximately 80,000 x-ray units are needed worldwide to meet the demand in these remote locations. Some of the obstacles to their deployment include: limited public health care funds which are focused on immediate needs (not medical infrastructure investment); high cost of equipment, lack of trained personnel, operational support and costs (training, service and consumables) and limited availability of physicians and health care professionals to provide x-ray services on a timely and affordable basis; frequently, health care resources are directed to those who can pay, leaving even less services available for the general population.
In 2006 as part of the Biomedical Engineering program at Northwestern University, a group of five students were studying at the University of Cape Town, South Africa. They were to evaluate digital retrofit opportunities for a low cost X-Ray system, WHIS-RAD that was approved by the World Health Organization in 1993 (link to report), and was being promoted and deployed by Rotary Clubs in low resource communities. As the former manager of Humanitarian Programs at Rotary International, I was a strong advocate for these systems and helped to promote deployments in first referral hospitals and low income clinics in developing countries, including Zimbabwe. The client for this particular study was Rotary International. The students realized that there was a tremendous need for low cost X-Ray machines, especially in the underserved Township communities around Cape Town. In fact, this system was designed originally by Dr. Philip E.S. Palmer who was the Chief Medical Officer for the Western Cape and became an advisor to this program (link to obituary on Palmer).
The five students confirmed the need for such low cost radiology systems, and that by substituting a computed radiology imaging system by retrofitting the standard film system patient care would be improved and costs of operation would be substantially reduced (link to report Integrated Digital X-Ray System for the WHIS-RAD).
Based on the significance of this report a new organization, World Health Imaging Alliance was formed (link to brochure). This Alliance included Northwestern University McCormick School of Engineering and Applied Science, Kellogg School of Management, Feinberg School of Medicine, University of Cape Town School of Biomedical Engineering, University of Cape Town School of Public Health, Rotary Clubs in the US (District 6440), South Africa, Guatemala, World Resources Chicago, SEDECAL (manufacturer of WHIS-RAD systems), Carestream, Kodak, General Electric, McDermott, Will & Emery, LLC, Groote Schuur Hospital (Cape Town), South Africa Ministry of Health, Health Department of Western Cape, Health Department of Cape Town, Ministry of Health of Guatemala, Health Department of Guatemala City, Universidad Francisco Marroquin, Motorola.
From 2006-2009 WHIA installed digital WHIS-RAD systems in Crossroads Township Community Health Clinic, Cape Town; Clanwilliams Hospital, Clanwilliams, Western Cape; Guatemala City Municipal Clinic; Obras Sociales Del Santo Hermano Pedro, Antigua, Guatemala.
WHIA was transferred to a major donor for the promise of a $1 million contribution. The organization was changed to the World Health Imaging, Telemedicine and Informatics Alliance in 2009. In 2012 the name was changed again to Health Green. Due to some issues the donor had with the US Securities and Exchange Commission, WHITIA and Health Green were closed in 2013.
Rotary Clubs in the Chicagoland area (District 6440) revived the original intent of deploying low cost x-rays – digital WHIS-RAD systems to Guatemala. They started a new organization called Rotary District 6440 HealthRays ( https://healthrays.info/about/) They have committed to raising $2.5 million to deploy 29 X-Ray units in Guatemala. They have already completed 14 in the following sites: Mixco, El Amparo, El Paraiso, Livingston, Villa Canales, Faijanes, Palencia, Gualan, Nahula, DAC, Chupol, CAIMI San Cristobal de Alta Verapaz, Villa Nueva, Escuintla. 3-4 million Guatemalans will have access to digital X-ray technology for the first time!
