MSF

Médecins Sans Frontières/Doctors without Borders

Project identified by Savvas Andronikou

Tele-reading

 The WFPI is collaborating with MSF to provide pediatric imaging telereporters to support MSF’s global telemedicine network, using platforms and technology already set up in project sites.

Four WFPI volunteers are enlisted on the Collegium Telemedicus platform. Well over 100 radiographs have been read to date, with subsequent exchange occurring on some cases. Projects covered are in the CAR, Tajikistan, Malawi and Cambodia. The platform is rudimentary, but works. Quality is highly variable.

See WFPI's mini-symposium, "Outreach in the Developing World" for articles on MSF's tele-radiological history and quality assurance/lessons learnt. 

Discussions are underway with MSF's diagnostic imaging network for expanding WFPI's support. Our strong tuberculosis focus dovetails with MSF's massive TB drive: see here for MSF's TB overview, associated literature and films 

  

Click on the image to find out more about MSF's drug-resistant TB manifesto, signed by WFPI 


Other MSF work

MSF sends doctors to South Africa for HIV training where pediatric imaging sessions are delivered by the WFPI.

The WFPI's Outreach Leader, Savvas Andronikou, assists in the production of MSF diagnostic guidelines and recently co-authored an article on a quality assessment of X-rays interpreted via tele-radiology for MSF, accepted for publication in the Journal of Telemedicine and Telecare. Two "Seven Minute Snippets" (short videos) on the interpretation of pediatric tuberculosis CXR films were co-produced with MSF in South Africa: see here

Khayelitsha

Khayelitsha, Western Cape, South Africa


Project identified by Savvas Andronikou MD and the South African Society of Pediatric Imaging (SASPI)

Project start-up

WFPI began tele-reading chest and other plain X-rays  for Khayeltisha Hospital, Western Cape, South Africa, in July 2012. Starting with 5 South African readers, the team reached  50 volunteer tele-readers worldwide and has read over 500 X-rays to date. Radiographs are digital, converted to JPEG. Their quality is adequat for interpretation.

Image left: Dr Harlem Gongxeca, a SASPI member and practicing pediatric radiologist in South Africa who voluntarily tele-reads for Khayelitsha and the WFPI 

Project roll-out: ups & downs!

The project wound down in early 2013 following the departure of the onsite technician (responsible for referring films to WFPI). It re-started in September 2013, with a transfer of tele-reading from WFPI to Stanford University Hospital, USA, as part of WFPI's drive to set up partnerships between facilities in lower resource and modern medical settings. Referrals come from the facility's clinicians as opposed to the technician team, resulting in a reduced flow of problem cases only: an excellent development which avoids WFPI substitution of basic imaging services and places us in a role of "provider of expert second opinions".

The activity flow has been through further stops and starts since. Each clinician needs internet access for tele-platform use, which has proven problematic.

The WFPI-Stanford tele-support role has been confirmed for the time being; the Red Cross Memorial Children's Hospital and WFPI will provide onsite lectures and training to strengthen pediatric imaging knowledge.

 Project backround: click here

ONSITE TRAINING

Savvas Andronikou delivered an on-site training session for non-radiologists in October 2012 and January 2013. The visits proved useful for exposing problems and re-orientating the WFPI’s work accordingly  and reinforced the necessity to back up WFPI tele-reading with training and education. Some can be delivered online, but onsite visits are key to success.

Project reports: click here


AUDIT & EVALUATION

WFPI has published an audit and sustainability evaluation of its tele-reading for Khayelitsha in WFPI's mini-symposium, "Outreach in Developing Countries": click here.

 

 

IGICH

Indira Ghandi Institute of Child Health, Bangalore, India

Project identified by Drs. Catherine Owens & Samantha Sonnappa, GOSH, UK. IGICH lead: Dr. Ramesh. WFPI project lead: Dr. Cicero Silva

A WFPI tele-reading project is underway in the IGICH, a 250 bed children hospital supported by UNICEF and WHO. The hospital's radiology department performs an average of 1000 X-rays, 500 US and 150 CT scans per month with only one radiologist onsite.

The WFPI's tele-reading platform, developed by the WFPI's Telecommunications Committee, was ready for use in early 2014 and the project is now underway.  


Progress report, 4th August 2014

Total of 31 cases, most chest CTs, a few abdominal CTs and a few head CTs.
Time range study reaches WFPI coordinator -> report is fed into software: 0 to 4 days, mean 1.8 day, median 2 days (that does not exclude weekends - i.e. if a study is received on a Saturday and reported on a Monday we consider 2 days time range).
Findings in most patients: suspicious for tuberculosis or fungal disease.
Volunteers reporting: Ahmed Aadil, Jon Brandon, Sarah Desoky, Pacharn Preeyacha, Cicero Silva

Click here 

for more information on the IGICH

     
Dr. Ramesh, radiologist, IGICH 
              
 
Dr. Cicero Silva, WFPI coordinator (Yale, USA)


Malawi

Project identified by Savvas Andronikou and Arthur Daire

In July 2014 WFPI undertook an exploratory outreach mission to teach and determine pediatric radiology needs in different environments in Malawi. The visit rolled out with to providing tele-reading support for pediatric imaging and paving the way for future teaching and training visits.

A member of the South African Pediatric Imaging Society and a WFPI tele-reader volunteer,
Dr. Tracy Kilborn (Red Cross War Memorial Children’s Hospital, Cape Town) volunteered for the trip. Her geographical proximity and experience with endemic diseases, equipment constraints and environmental limitations leave her well equipped for regional outreach.

The trip covered 4 different health facilities in Malawi

  • Queen Elizabeth Hospital, Blantyre
  • Chiradzulu District Hospital - MSF AIDS-HIV project
  • Kamuzu Central Hospital, Lilongwe
  • Pothawira Haven, Salima

Dr. Tracy Kilborn with Dr. Peter Maseko, Pothawaria Haven Salima, Malawi

Queen Elizabeth Hospital Blantrye offers 300 Pediatric beds and conducts 100,000 Pediatric reviews per year in A/E with 20,000 Pediatric admissions per year. A 0.75T open magnet, installed by Johns Hopkins as a research magnet, is used by the hospital. A CT machine purchased 4 years ago is in storage while waiting for a room to be built. The sole MoH radiologist is stretched to support radiography and ultrasound as well as MRI.  

Right: Dr Arthur Dale, MoH radiologist, Queen Elizabth Hospital Blantyre

Below: Paediatric Ward, Queen Elisabeth Hospital, Blantyre


Teaching activities in Blantyre and at Kamauzu Central Hospital in Lilongwe included lectures to the paediatric and paediatric surgical staff on:

  • Approach to a paediatric CXR,
  • Approach to a paediatric AXR, 
  • Imaging of neonatal GI emergencies, 
  • Imaging of non-accidental injuries, 
  • Basic approach to nuclear medicine in renal disorders

along with teaching paediatric ultrasound techniques to sonographers, consultations on complex medical and surgical cases and engaging in discussions on CXR technique with radiographers.

Among the conclusions of the trip: Point of Care (PoC) ultrasound in all the facilities visited would be of immense relevance and value.

At Pothawira Haven, Salima, Dr. Peter Maseko (image left), 4 nurses and an occasional volunteering medical student run a clinic that sees 200-300 patients a day. Pothawira also supports 110 orphans, all of whom live at and are schooled at the Haven. The entire project is funded through donations. WFPI delivered a new portable ultrasound machine, donated to Pothawira by Dr. Kristen DeStiger of Imaging the World. Accompanied by a radiologist resident from Lilongze, Dr. Pamela Gunde (image below) and with excited orphans queueing up as teaching material, the ultrasound training at the clinic began. After 2 days, the two physicians could competently scan pediatric heads, chests, abdomens and look for pericardial effusions. 

 

WFPI hopes to partner with Imaging the World in its future Malawi project so as to move PoC ultrasound forward in Pothawira Haven and elsewhere.

More on WFPI's volume sweep ultrasound research here




 


 Chiradzulu District Hospital, where suspicions run deep that Childhood TB is severely underdiagnosed
 Happy volunteers for the ultrasound training...! 
 Kamuzu Central Hospital, Lilongwe



Central Europe

WFPI in Central and Eastern Europe

 

 

The WFPI is looking to expand its pediatric imaging support to Central and Eastern Europe. Future projects are likely to draw on health facilities forming part of the CEEPUS network (Central Europe Exchange Programme for University Studies) which links up facilities with each othere and partner facilities in Western Europe.

The WFPI would offer tele-reading support for facilities lacking pediatric imaging expertise, tied into existing educational and training programs run by CEEPUS.

This project is under development - we will post more details as our plans take shape

MAP: the CEEPUS network. Click here for more project information (slow file to open)

 

WATCH THIS SPACE!!

Click here
for a project start-up form submitted by
Clinical Hospital of Tetovo, Macedonia 

Zdravstveni Centar Studenica, Serbia
A CEEPUS member and possible WFPI project site