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Single point of failure

Life with a broken X-ray machine at CURE Malawi

Story by CURE International September 5th, 2017

On June 6th, CURE Malawi’s X-ray digitizer broke down...

...rendering the X-ray machine useless. Almost a month later, the machine was still down and affected the hospital in many ways—some obvious, others not as much. In the words of Malawian X-ray Assistant Thomas Kamanga, “It’s been like going to the garden without a hoe.” While the staff struggled to repair the machine, patients were sent to nearby public and private hospitals for X-rays.

Patients are loaded into an ambulance to be taken for X-rays at other local hospitals

Jon Edwards, CURE’s Biomedical Engineer, took the lead on trying to fix the X-ray machine. After struggling with the lack of resources online, he finally pinned down the problem as a faulty board in the X-ray digitizer, the machine that converts the analog plate to a digital image. The X-ray machine itself was still functional, but useless without a way to process the image.

Jon Edwards, CURE’s Biomedical Engineer
“It’s a waiting game, all about waiting… From the beginning, we tried to go back to the old film system, and that machine hasn’t run for almost three and a half years. It needed an overhaul and cleaning, so we stripped it down, rebuilt it, and put it back together... and then something else blew—a part that’s not available here, so that’s being sent from the US as well. In the meantime, we have no backup system.”
Jon Edwards, Biomedical Engineer
Jon Edwards looks in the maintenance shed for parts for an analog X-ray film developer

While Jon worked to fix the analog machine, the rest of the hospital struggled. Often, our weekly clinic patients need X-rays in order to see what is wrong and make plans for their operation. The lack of a working X-ray machine on-site caused massive delays and lots of extra work.

Dr. Kawonga struggles to put X-rays back into an envelope. At the time he was exasperated; many unnecessary X-rays were accidentally taken.
Dr. Siwicka talks to each of the patients to discover who needs X-rays so they can be sent for X-rays before clinic
Nurse Tileke tries to sort through files to find the correct X-ray. Previously, doctors could easily access the digital files.
Dr. Siwicka holds up an X-ray. Improperly processed, the child needed to be sent back for a second X-ray.
“It’s really difficult. We’re sending our patients to different hospitals… so much time is wasted. Providing care here for our patients, we waste a lot of time going to the different hospitals to do the X-rays. It’s hard as nurses. Even here, if you have two nurses on duty, it means one nurse is spending a lot of time taking patients to get X-rays while the other struggles to care for the patients well.”
Paul Nyson, Nurse
Nurses Paul Nyson and Mukonde Malijani hold up X-rays

Queen Elizabeth Central Hospital generously allowed CURE to use their X-ray machine, but because of their already-busy radiology department and the breakdown of another hospital’s X-ray machine, we were only allowed to use it on specific days. Yohane, below, was unable to get his X-ray the day before and had to be rushed first thing Wednesday morning before surgery, causing a delay in operations.

Yohane rides in the ambulance to Queen Elizabeth Central Hospital to have an X-ray before his operation
Still early in the day, the radiology department was fortunately empty when we arrived to take Yohane's X-rays
Thomas Kamanga explains to Yohane’s mom that the X-ray machine isn’t working. He needed to find Queen's technician to get it working again.
We inadvertently came when they were changing the processing chemicals in the analog X-ray machine, another delay
Thomas Kamanga laughs with the staff at Queens while he waits for Yohane’s second X-ray to be processed
Later in the day, the queue for the X-ray room is longer. Fortunately, on this particular day they let the children from CURE go first.
Children wait outside to be led to the X-ray room. Often, the guardian has to carry a casted child if they are small enough.
Grace came in for the Tuesday clinic and had to wait until Wednesday to have her X-ray
“When we take our patients [to Queen's], it’s us who have to do the X-rays, so normally when we go there they tell us to wait till they’ve finished their work, so we are there for long hours. When we are X-raying patients who are going to the operating room on Monday morning, we need to do the X-rays on Sunday. We start X-raying from 4:00pm up to 10:30 in the night. So this makes our work to be very tough and tiresome.”
Thomas Kamanga, X-ray Assistant
Thomas Kamanga, X-ray Assistant

Patients who have had operations need to have post-op X-rays taken. Unfortunately, for kids like Sati, below, this means transportation in the ambulance—a painful journey just two days after surgery.

Sati and about eight other kids load into the ambulance to be transferred to Queen Elizabeth Central Hospital for X-rays
Sati’s granny, Edina, holds up her casted leg while she waits. “My granddaughter was in so much pain," she says.
“My husband and I have always had a good experience taking our children to CURE’s private clinic. Recently, our 17-month-old daughter needed a chest X-ray. Unfortunately, the X-ray machine was broken so we had to go to the public hospital. With such a young child, X-rays are never a pleasant experience, but it would have been much less stressful to be able to take her to a familiar location where we trust the doctors. We got the services we needed at the public hospital after waiting for two hours, but we would much rather have remained at CURE and hope to be able to do so if needed in the future.”

“By having no X-ray machine here we have lost a lot of revenue [from our private practice], revenue which we need to run our charitable pediatric ward. Now, our clinics have been affected and we’re losing out a lot. We need this problem to be solved once and for all.”
Thomas Kamanga, X-ray Assistant
Stanley Mndoli, X-ray Technician, gets a call while working on X-rays at Queen's to come back to CURE to do tests for a private patient
Dr. Barbara checks Liana’s daughter’s X-ray

On July 13th, an analog X-ray film developer arrived from Lilongwe. Jon Edwards and the team at CURE Malawi managed to get the machine up and running. Although the digitizer, which enables us to convert the film to digital images, was still down, having access to the X-ray machine was a massive improvement for the hospital.

Yohane is the test patient for the new X-ray set up. He is the first patient to have his post-op X-ray taken at CURE in over a month.
“We are very happy now that we don’t have to go back and forth to Queen's anymore. A good job well done."
Stanley Mndoli, X-ray Technician
Stanley Mndoli inspects Yohane’s post-op X-rays, the test subject for the new analog developer

Although the X-ray saga is (hopefully) nearing its end, this sort of breakdown is a regular reality of hospital life in Malawi and other CURE hospitals. A few months ago, one of the C-arms (an in-theater X-ray machine) broke down, causing delays in operations and a lot of hassle. There are other “single points of failure,” as Jon Edwards calls them, where, if an expensive piece of medical equipment breaks down, there is no backup. Until last July, we had only one autoclave to sterilize surgical tools, and other areas such as the laboratory are still vulnerable without backup machines.

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Footnote: Story and photos by Avanell Brock
Blantyre, Malawi