ON a morning three weeks ago Ivy, who only wanted to be identified by her first name, accompanied her 22-year-old nephew, wracked by pains in his feet, to the Spanish Town hospital. The doctor who examined him sent him to the x-ray department but the machine had broken down.

"I took my nephew to be x-rayed in the morning and they said the machine was not working. But in the evening, the machine was fixed and he was able to get his feet x-rayed," Ivy told the Sunday Observer.

Kingston Public Hospital

Ivy's nephew was lucky. Scores of sick persons, desperately in need of x-rays, ultrasound and fluoroscopic examinations, go to the Kingston Public (KPH) and Spanish Town hospitals in vain or must delay treatment for protracted periods because specialised x-ray units have broken down and need to be refurbished or replaced.

Most cannot afford private rates and so have no choice but to wait, even at risk to their health.
"Many of the patients can't afford to go anywhere else so you find that they keep coming back to find out when the machine will be working," said a KPH official who asked not to be identified.

In the case of the KPH, the English-speaking Caribbean's largest medical facility, only three of the hospital's 10 machines were in operation at Sunday Observer press time.
"Plain x-rays of the chest, hand and foot are basically all the KPH can offer at this time," the spokesman said.

At the busy Spanish Town hospital in the St Catherine capital, the situation is worse, with all of the four x-ray units now needing to be replaced .

"Right now we have just one machine that is functional in the x-ray unit. Our ultrasound unit does not function, nor does the fluoroscopic machine," complained Pauline Reid, the chief executive officer at the hospital. "The impact on patient care is that patients have to be sent to the private facilities to have these tests done and this is more costly to them."

Catherine Gregory, the regional director of the South Eastern Regional Health Authority (SERA), admitted that the authorities were aware of the situation, based on a recent survey carried out, by principal medical physicist Dr Colin Miller, on the status of the diagnostic radiographic units in the region.

The hospitals in SERA are KPH, Victoria Jubilee, Sir John Golding, the National Chest Hospital, the Spanish Town Hospital, the Linstead Hospital, the Princess Margaret Hospital, Bellevue and the Bustamante Children's Hospital.

Miller found that of the 31 pieces of X-ray radiographic equipment at the hospitals within the South Eastern region, seven machines at KPH and four at the Spanish Town Hospital needed replacement. In addition, an ultrasound unit at the Bustamante Children's Hospital also needed to be replaced, Gregory said.

Fluoroscopic machines are especially in demand by patients who have had to be waiting since September last year for barium meal and barium enema procedures, or had been forced to face higher costs elsewhere.

Inspite of the difficulties at the KPH, last year the facility still processed an estimated 36,000 inpatients and outpatients from clinics at the hospital, health centres and prisons in and around Kingston and St Andrew.

The Spanish Town hospital was able to deal with less than a half of the procedures it could have handled if its four machines were in operation. Last year, a total of 22,598 persons were seen in the x-ray department from health centres in St Catherine and Clarendon.
"From the records, we could have dealt with another 28,000 or so patients if the machines were all functioning," Reid added.

The demand for x-ray services, and fluoroscopic machines, in particular, is being pushed by Jamaica's high rate of breast cancer, for which mammograms are seen as one of the top preventative measures. The KPH is the cheapest place to have the procedure done.

X-ray fees at the KPH last year were as low as a third of what private institutions were charging for similar services: $1,500 for a barium enema compared with $6,000 elsewhere; $1,500 for a mammogram, against the Cancer Society's fee of $2,000, and higher on the open market.

Once again, the shortage of funds to purchase the expensive machines has emerged as the main obstacle. A new fluoroscopic machine costs an estimated US$270,000, while an ultrasound machine costs US$120,000. An x-ray unit costs approximately US$120,000.
"To find US$250,000 up front is not very easy," SERA's Gregory moaned.

And given the state employment freeze, the region did not expect to get the bio medical staff needed for critical maintenance of the equipment.
"As it is now, this maintenance is contracted out to persons from whom we buy the equipment. We had a preventative maintenance schedule for these machines but due to lack of finances some of them were not renewed," she said.

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