A trip to Haiti shows the challenges and potential rewards of providing sustainable medical aid.
A mobile C-arm was the last thing I expected to see in a border town in Haiti. It was donated from overseas and tragically collecting dust. Our host at the medical center said the machine had never been used in the years since it was received. She wasn't even sure if it was functional.
One enterprising resident in our group found the instruction manual and got the fluoroscope humming. We donned the donated lead aprons and scanned random objects to test out the unit. It was ready for use, but we weren’t sure when the need for the equipment would arise. As it turned out, it didn’t take long.
I believe that’s our attending’s hand we imaged.
One rainy night, the wail of ambulances tore into the evening. A taxi truck had careened off a mountain pass, causing eight fatalities and sending twelve patients to our clinic for triaging. Unfortunately for Haitians, this is not an uncommon occurrence. Dangerous roads and unrestrained passengers in overloaded vehicles lead to frequent and devastating traumas. We saw the toll that these unsafe conditions have on the Haitian people, and we realized how woefully under-equipped we were as health care providers working in a resource-poor environment.
Injuries included a severed ear, an open distal tibia fracture-dislocation, and various other fractures. All of these patients would have received imaging services if the facilities had been available. We had to transport many patients to a hospital in Port-au-Prince, over an hour away, either because advanced treatment was necessary or we simply could not determine the extent of injuries with the equipment we had.
Haitian taxis consist of repurposed pickups and dump trucks. The vehicles are frequently even more overloaded than what you see here.
How many patients did we image that day? One, thanks to the fluoroscope. We used it to diagnose an ulnar styloid fracture, saving the patient a trip to Port-au-Prince. Although the fluoroscope possibly contributed to the power loss we experienced that night, we carried on with head lamps as usual.
What did it take for a single patient to get one imaging study? Donated equipment, curious medical personnel, occasional electricity, and just enough luck to bring these elements together. Well then, what would it take to make medical imaging consistently available for people who need it? Not lots of random pieces of equipment and lots of medical service trips and lots of luck. It just doesn't scale that way.
Looking out from our medical center in Fond Parisien, Haiti.
In Haiti, I saw that a sustainable solution requires getting the right knowledge and resources to the right people, but to do so can carry significant challenges. For instance, ensuring that the permanent staff at the clinic were comfortable using the fluoroscope to diagnose disease would have required radiology education considerably beyond the scope of our trip. Alternatively, relocating the machine to another center that could use it more effectively would have posed dangers in transport.
It seems that a fluoroscope donated overseas that then languishes in storage is an embodiment of honorable intentions overcome by inadequate execution. On the other hand, it represents an opportunity to identify and address gaps that prevent proper utilization of such resources, with the hope that one day, access to medical imaging will not seem so out of place in Haiti.
By Henry Y. Chou, department of radiology at Indiana University School of Medicine