X-Ray

We've recently have two young mothers admitted with active tuberculosis. One lives here in town, and active TB was detected two days after she gave birth to her 5th child. Another woman from upriver came in to clinic with her 4 month old (her 4th child) and was diagnosed with active tuberculosis. All 9 children are PPD positive and need chest X-rays, as do the husbands and other family members. We need to know if these kids have active tuberculosis (which in children is sometimes asymptomatic), and the only way to know is based on chest X-rays. If we give them prophylaxis against tuberculosis and they have active tuberculosis, the bacteria will become resistant and transform the infection into a very hard to treat dilemma.

Do you know the diagnosis?

We do not have an X-ray machine here at Centro de Salud Santa Clotilde (CSSC). This is #1 on our needs list at the current time. We serve over 30,000 people along 250 miles of river. Our top three most common diagnosis here at CSSC are 1) infectious disease/parasites/abdominal pain, 2) respiratory infections like pneumonia, and 3) musculoskeletal complaints like fractures and trauma... most of which "require" an x-ray. It costs $100 per patient to go to Iquitos (on the fast public boat) for an Xray, most of which we end up covering because most of our population are subsistence farmers and don't have that amount of money.

Some families choose the "wait and see" approach to fractures in their children due to fear of the cost, and children end up with permanent disabilities. Without X-ray, we treat complex pneumonias including tuberculosis and attempt to put bone fractures back into place. We had a premature baby born with respiratory distress and after 10 days of no improvement she went to Iquitos and with a simple X-ray was diagnosed with a diaphragmatic hernia (intestines herniated into her lungs). Stranger things happen... we recently had a woman who swallowed a fish bone, but on evaluation we saw nothing in her throat. She admitted that it was no longer in her throat. On her second day here in the hospital, she was alert and talking, and we felt the fish bone starting to poke through the skin of her neck, and hours later she died. Maybe the X-ray would have detected the fish bone earlier and saved here life.

We have a long list of people who need X-rays, and we have rampant tuberculosis in the area, and we have a 35 bed hospital, and we have a fantastic radiologist at U of Michigan who reads all our X-rays (done in IQT)  for us, and we recently had a volunteer pulmonologist Dr. Wayne Farmer who gave two amazing talks on reading X-rays and tuberculosis, and we are living in the 21st Century. So why don't we have an X-ray machine? I ask myself this question almost daily. We are actually just $150,000 away from a portable digital X-ray machine, and have high hopes that the local government here will come thorough with funding next year, in collaboration with the local rotary club and maybe other generous donors. This will allow us to bring the X-ray machine to our 100 communities and formalize a tuberculosis program.