Shocked and inspired: reflections on radiology in Tanzania

TanzaniaWinners of the 2013 BIR/Philips Student Bursary award, Faye Morrissey and Saima Dalvi, share their eye-opening experience in the radiology department of a hospital in Tanzania.

In the third year of our Diagnostic Radiography degree at the University of Derby we had the opportunity to undertake a 3-week elective placement. We decided to travel to Arusha in Tanzania to work in the radiology department of a regional government hospital. This motivated us through a challenging year as we had something to look forward to at the start of our final year of university. We chose this elective as we felt it was important to experience healthcare delivery in a developing country. We were delighted and very grateful when we won the BIR/Philips Student Bursary, which helped us make the experience possible. Having organised this placement through a company called Work the World we flew to Africa at the start of September 2014 and could never have imagined the challenges that were to lie ahead.

Tanzania 2The placement itself was an incredible eye opener. Practice in Tanzania is so vastly different to the UK. We were challenged both mentally and emotionally each day. Our radiography skills were pushed to the limit as we were expected to provide quality diagnostic images with technology we had never even experienced before. We strongly believe that going back to basics in this way has made us better radiographers and changed our perspective of what it means to be a professional in the healthcare setting.

Upon arrival in the imaging department we were shocked to discover that the hospital had run out of X-ray film. The department had already been waiting a week and a half for a delivery of new film and the staff were still unsure of its exact arrival date. To us this was beyond imaginable as we could not have even dreamt that this issue could arise in healthcare! For 2 weeks patients were denied imaging. Staff were forced to send patients to private hospitals where examinations cost six times as much. The large majority of patients we encountered had struggled to afford an X-ray at the government hospital we visited therefore the chances of them accessing private healthcare were extremely slim.

Tanzania 4After our first day in the hospital, we quickly realised that most patients and staff back home (ourselves included) fail to appreciate the harsh realities of global healthcare delivery. Many people argue that the NHS is “failing”, the truth is we are now extremely thankful for the luxuries we have. We feel as though our elective has changed our view of the world. Being surrounded by extreme poverty and the difficulties it brings, we now truly appreciate what it means to live in a country with government-funded healthcare and education.

Aside from the hospital placement, our experience in Tanzania as a country was unforgettable. We were fortunate enough to experience African culture through activities in our free time. We went canoeing, experienced an African painting class, shopped in local markets, visited a cultural heritage museum and even went on a safari to the Serengeti! One weekend, we hiked to a waterfall through the villages. The scenery was breathtakingly beautiful and allowed an insight into the lifestyle and culture of the local people.

We spent time visiting local orphanages and a school. Watching, playing with and talking to these children was incredibly inspiring. Although they have so little, their outlook on life remains positive and their ambition to fulfil their dreams was infectious. Visiting St Jude’s school helped us to understand and appreciate the everyday lives of the patients we encountered and the struggles they face in order to survive.Tanzania 3

At times we found radiography in Tanzania to be morally incorrect, however, we quickly realised that trying to change practice would have been both inappropriate and unachievable. Overall the experience provided an enormous appreciation for the radiography training we have received in the UK as we learnt to accept that practice in Tanzania will always be incomparable to radiography here at home.

Read more about Work the World or St Jude’s school.

Is the NHS failing to leverage transformation from technology?

Adam Hill.2jpgThe NHS spends a great deal on IT but rarely embraces the service redesign opportunities this offers. Dr Adam Hill, Chief Medical Officer at Sectra, explores how this could change.

The NHS spends significant sums on its valuable IT infrastructure. But despite this investment, our health service often fails to embrace the service redesign opportunities this technology presents, with major deployments still often layered onto existing services.

Redesigning services can dramatically improve care and save substantial amounts of money. Yet missed opportunities mean that we have under-utilised assets, and all this in an era of more for less.

The real opportunity to reshape the delivery of clinical services hand in hand with the deployment of IT programmes can be seen by taking a glance at the recent history of diagnostic services within the NHS. Radiology and pathology are both service delivery specialities within modern day medicine. Consultants from neither speciality have their name above a patient’s bed, but both are mission critical diagnostic specialities, and the bedrock upon which modern day healthcare is based.

One of these specialities has already managed to embrace technology at a remarkable pace. The other has very effectively embarked on service redesign. Yet neither has achieved both—something that must happen in future in order to maximise benefits for patients, enabling a shift to a new era in which cost-effective health outcomes are commissioned.

Radiology and pathology: two sides of the diagnostic coin
Radiology has shifted to digital very rapidly in the NHS. The National Programme for IT (NPfIT) accelerated coverage of picture archiving and communication systems (PACS) to in excess of 95% within 18 months. Despite widely publicised criticism, NPfIT revolutionised the delivery of imaging diagnostic services in the UK. However, the potential to reduce inequality of care provision and improve cost-effective outcomes have been less successfully realised, ultimately impacting upon professional working conditions.

Not only does service redesign impact the health of our population at risk, but it can have any number of indirect benefits. As just one example, it could mean freeing up and consolidating vastly under-utilised real estate in the NHS. Clinicians providing a diagnostic service with a digital workflow can arguably report from an office, a hot-desk reporting hub, from home or whilst on the move with equal fidelity. But radiology is yet to really harness this opportunity.

Pathology, in contrast, has undergone a significant service redesign following the Carter Review in 2008, focused on reducing costs by 20%. However, this diagnostic service has failed to realise the impact upon equality of outcomes and cost reduction that come with implementing a digital workflow, despite the widely held anticipation that pathology will soon be the next big digitisation in healthcare.

IT infrastructure deployment can re-vision service delivery
Embracing IT infrastructure at the same time as the service redesign opportunities that new deployments offer can unlock the potential to transition clinical care provision from centralised environments, through to decentralised models and distributed networks of care.

In diagnostic services, this would mean the ability to balance workloads across a region. It would give hospitals anywhere in a region the ability to access clinicians with the right skillsets to prepare a specimen, perform an examination or report a finding.

Modern PACS systems are cross-enterprise document sharing, or XDS , enabled. They can allow federation of workflow across a region, something that has previously been balkanised by different PACS vendors. This workload balancing can allow hospitals to meet ever stringent service level agreements, whilst improving specialist job satisfaction.

Joining up tasks to join up care
Put simply the tasks of IT implementation and service redesign are currently decoupled. It is very infrequent that a hospital looks for IT to support a service transformation programme. It is equally rare that hospitals will use the deployment of an IT infrastructure project as an opportunity for service redesign to unlock efficiency savings.

We must now move away from a situation where IT is simply layered onto the existing healthcare service as a result of analysing current workflow to inform IT architecture.

The focus must now be on the use of IT to support hospitals and the people within them, whether that is the clinician, the radiology service manager, the CEO, the chief financial officer or the patient.

Innovators will embrace the opportunity to use IT to redesign healthcare, achieving affordable health outcomes today; the risk of being a late adopter is that cost efficiencies are not realised until much later, failing patients that can’t wait for our health system to meet their needs tomorrow.

*Radiology Information System/Picture Archiving and Communication System

About Dr Adam Hill

Adam is a dual-qualified Clinician and Mechanical Engineer, previously having co-founded and led a successful university-based research centre at the interface of both disciplines. Adam’s expertise is in the research, development and optimisation of medical technologies and healthcare services, with over 100 publications and 8 academic awards in the last 15 years.

Having learnt the fundamentals of his clinical trade in the NHS, Adam passed through the Royal Military Academy, Sandhurst, before serving as the doctor to the Household Cavalry Mounted Regiment. Upon retiring his commission, Adam held technical and commercial leadership positions within start-up companies spanning service delivery, skills development and, most recently, technology incubation, before working as a Management Consultant with international clients in the Lifescience and Healthcare industries. During the term of our most recent coalition Government, Adam has provided thought-leadership, advice and content to a handful of its initiatives and programmes.

Adam’s current interests include unlocking the value of networked services, believing that the whole is greater than the sum of its parts; the primacy of imaging in the realisation of personalised medicine; and powering efficiencies in care delivery through standardisation.

Sectra has a rapidly growing share of the RIS/PACS* market the UK, a powerful product portfolio, and a world-class research and development centre at the University of Linköping; these are our foundation, our building blocks and our brain trust with which we can design, develop and deploy solutions to the most complex of problems challenging our NHS customers today.