Imaging & Oncology - Society of Radiographers

Radiology in a developed country is challenging enough with its ever changing
technologies. Can it be implemented successfully in a developing country such as Haiti?
In 1997, Project Haiti of Saint Alphonsus Regional Medical Center in
Boise, Idaho, US was asked to assess the need for and possibility of
establishing radiology at Saint Damien’s Paediatric Hospital in Port au
Prince, Haiti. Formed in 1995, Project Haiti supports the medical needs of
Saint Damien’s Hospital. A refurbished mobile x-ray machine had already
been donated and shipped to Saint Damien’s.
consistent, high quality technology, running water, electricity, and access
to supplies and imaging equipment. At Saint Damien’s the basic needs
for radiology were elusive. Electricity was unreliable. Running water was
scarce and unsafe. Water was delivered to the well twice a day and stored
in buckets. The donated mobile was not working and beyond my skills to
repair. The darkroom was a closet consisting of four bare walls.
Was it functional? Was radiology needed, and if so, was it
possible?
As a radiographer I was asked to go to Haiti to assess the radiology
situation. It was an exciting and challenging opportunity and one for which I
thought I was emotionally and professionally prepared.
Facts
Haiti is a developing country in North America’s Caribbean with an
estimated population of 10 million 1 . Extreme poverty is widespread
throughout the tiny country. Around 80% of the population is below the
poverty line and only 50% is literate. The average life expectancy is 60
years for a man and 63 years for a woman. Infant mortality staggers at 52
deaths out of 1000 live births and half the deaths in one day are children
under the age of five. Tuberculosis, malnutrition and HIV are prevalent 1,2 .
Housing predominantly consists of dilapidated shacks without running
water, sewerage, or electricity. Very soon after arriving in Haiti I realised that
nothing can prepare one for this extreme poverty.
Background to Saint Damien’s Hospital, Haiti
In 1987, Father Rick Frechette, an American born Catholic priest, designed
Saint Damien’s hospice for the sick and dying children of his orphanage to
separate the dying children from those who had a chance of survival. Since
then, Saint Damien’s hospice has evolved into a fully-fledged paediatric
hospital (figure 1). Frustrated by the shortage of physicians in Haiti, Father
Frechette applied for and was accepted to medical school in the United States.
After obtaining his medical doctor degree in 1999, Fr/Dr Frechette returned to
Haiti permanently to practice medicine and to minister as a priest.
From Idaho to Haiti
The reality of Haiti was stark. My comfortable life was far removed as I saw
first hand poverty that was incomprehensible. As a radiographer at Saint
Alphonsus Regional Medical Centre in Boise, Idaho, I can rely on having
With modern technology unsupported, critical thinking skills momentarily
escaped me in the immensity of the challenge ahead. I questioned how
anything could be possible here, especially in radiology where a solid
infrastructure is needed and yet did not exist. My initial assessment was
bleak: radiology would not be possible at Saint Damien’s. Nevertheless,
the following day I travelled with a group of Saint Damien’s patients to a
clinic for radiographs. Some babies and children were accompanied by
parents so our medical transport in the back of a truck for 90 minutes in
the hot sun was stifling. Since Haiti has no solid medical structure as a
pay-for-service country, the clinic we were going to did not triage patients
by medical needs. They were triaged by economical means and paying
customers were x-rayed ahead of those without funds. Saint Damien’s runs
strictly on donations so the sick patients of Saint Damien’s were x-rayed last.
After four hours of waiting, our patients were finally addressed. One baby
was so sick I questioned if she would survive. She was cyanotic, and her
breathing shallow and congested. Her mother would pinch her, forcing her
to take a gasp of air. Radiographs confirmed her severe condition — double
pneumonia with cardiomegaly and tracheal shift. In a developed country she
would be in an intensive care unit. In Haiti she rode in a truck bed for an all
day excursion for a radiograph. In that moment my mindset changed to “we
will do everything possible to have radiology available at Saint Damien’s.”
“Paying customers
were x-rayed ahead of
those without funds”
IMAGING & ONCOLOGY 2013 { 63 }