Monday, July 30, 2012

Turbo Clinic: the pilot

Patrick, the IU house resident carptenter, with his rendition of our digital photography frame.

Today's Monday morning ride to Turbo Clinic, one of the AMPATH clinics located outside the city, was my first trip west of Eldoret.  We drove about 40 minutes toward the Ugandan border, on a newly paved highway, a full two lanes wide, with no potholes or ditches to be found.  Full of hulking Mercedes tractor trailors, as well as the requisite cyclists, mo- peds, pedestrians, peddlers, cattle, dogs, and children, all shuffling past each other in a game of leapfrog, it was a chaotic scene. The reason the beautifully smooth road exists, I learned, is that this is a major trade route stemming from Mombasa, stretching across Kenya and continuing through Uganda. 

We arrived at the clinic virtually unanounced, given the logistics of getting multiple people in one place at one time, getting the frame completed, and securing a driver.  We simply showed up and asked for the person in charge.  Greeted by one of the local AMPATH physicians, we explained the concept, a brain- child of Dr. Marc Kohli and Dr. Joseph Mamlin.

Several conventional chest radiographs are taken at these outlying clinic sites each day.  Barriers to getting a chest film from these outlying clinics read by a radiologist are myriad:

1. There is a sole film, property of the patient.
2. These films have previously been transported to Moi Teaching and Referrral for interpretation.
3. Films are lost along the way, or are sometimes not interpreted.
4. If all goes well, the clinician may receive a report on the x-ray in about a week. 

Our proposed system of taking digital photos of these radiographs aims to accomplish the following:

1. Preserve image quality so that it remains interpretable as normal or abnormal, similar to the system used at the University of MD.
2. A digital copy of the radiograph will always be accessible, and may serve as a baseline study for future comparison.
3. Films do not need to leave the clinic, and are therefore less likely to be lost.
4. Interpretation may occur with a quicker turn around time, improving TB and HIV/ AIDS related care, as well as public health surrounding these issues.
5. Films may be read at any time of day with password access to the online PACS, and may be read remotely at MTRH or even state-side.

The purpose of the actual wooden frame is to provide a consistent camera- to- radiograph distance and consistent image quality, regardless of the operator.  The meeting consisted of a full demonstration for the medical officer, the site manager at AMPATH, one of the physicians, and the radiographer.  The memory card from the camera will be couriered biweekly at minimum, so that Kelvin, the PACS manager, may upload them for interpretation. 

It is an experiment with many moving parts, but I'm hopeful it is a step in the right direction toward equalizing the level of care that patients receive throughout the AMPATH system.    

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