SCoR Talk


Thursday, August 29, 2013

These are the radiographers to admire

kim balsdon

Kim Balsdon and her supervisor

Kimberley Balsdon, joint winner of the SCoR 2012/13 Work the World competition, shares the highs and lows of her time working at the Ocean Road Cancer Institute in Dar Es Salaam, Tanzania...

Immobilisation, permanent marks, infection control, linear accelerators, patient care, IMRT, IGRT... All what we know as radiotherapy... But my four-week experience in the Ocean Road Cancer Institute in Dar Es Salaam was very different to that experienced in the UK.

The equipment

With two colbalt-60 machines to cope with the entire population of Tanzania – 46.22 million – the department is more than overstretched; treating up to 150 patients a day with staff sometimes working from seven in the morning up until two the following morning.

The colbalt-60 machines are battered and a bit worse for wear with one of the sources taking three times longer than the other to treat; it needs replacing, but sadly they just don’t have the funding.

This machine also had a hole in its head where it has been crashed into some steps when auto-set was being used and the cameras weren’t being paid attention to. These cameras are now not in use and are broken. The simulator they have is relatively new, but again broken so only used for ‘special’ cases – those they do not treat on a day-to-day basis.

Equipment remains unfixed and then just deteriorates further as there is no money or specialised staff to maintain them – they are not even checked monthly or yearly, let alone daily.

With equipment this basic you can see that the techniques we use to treat cancers such as cervical would be near impossible to carry out. This is the most common cancer in Tanzania and nearly always the patient was late stage so any treatment would be deemed palliative here in the UK.

The set-up

The treatment given in most centres in the UK would be a four field brick, but at this institute they use nothing more than a 15cm x 15cm anterior and posterior parallel opposed pair.

This field arrangement was used for most treatments; a parallel opposed pair comprised of either laterals or an anterior and posterior. Most cancers, apart from breast (the second most common cancer that I saw) were treated using the same field arrangement as we do – a tangential pair.

I saw more child cases out there than I have in the UK which too, very sadly, were palliative – brain tumours, lymphomas and xeroma pigmentosa. Often for these they just treated using a direct anterior or posterior field.

Immobilisation consisted of a simple headrest but comfort was not really a consideration. No tattoos or permanent marks, just plasters stuck on around the field edge – which would be put on incorrectly by nurses once patients were off the bed or would fall off in the wash and then be stuck back on by the patient in the wrong position.

With no planning it was not an exact procedure like we know, with a few millimetres tolerance, plasters were aligned with the field edges and that was that! And for cervix patients, there were no plasters; the cancer was so common that staff would just use the same surface markings to align the field on every patient.

People, passion and ambition

A few cases I saw really hit me hard and I will never forget them... A young child suffering from a rare disease was having very palliative treatment – a direct anterior field to the face. The child’s face was covered in tumours. There were deep lesions over the scalp, and the youngster’s nose was non-existent as it had been eaten by tumour. The left eye was completely diseased, and the child’s mouth filled with ulcerative tumour.

The mother still had hope that her little one was going to be cured and was going to live her childhood and grow up to be an adult. This was sadder still. I helped this small child receive treatment and a few days later handed over a packet of stickers. The child beamed with happiness! I have never seen a little one so happy after receiving such a simple thing – something we’d take for granted.

All of the above may sound awful, but what these guys are doing is amazing for what they have! Yes, their treatments are basic, but with the equipment they have it’s the best they can offer; 30 or 40 years ago the profession in the UK was probably in a similar position.

The staff have so much passion and enthusiasm for ‘their people’, they just want to help them all. They all have big plans for the department and what they want to see happen. A couple are seeking government funding to start a charity for their head and neck patients.

Another wants to start up a road-show to educate people and doctors around the country about health and cancer. They are setting up another centre in the north of Tanzania for all those patients who have to travel long distances for treatment, hoping to increase awareness and provide a better service to a larger number of people.

And there is even talk of a linear accelerator in the department in the near future if funding is granted (the every-other-day power cuts will have to be sorted first). All they need is the funding and the knowledge to start all this off.

I admire these staff. They’re keen and they want to learn everything they can, they want to do and be better – they just haven’t the support to get there yet.

It’s been such an eye-opening experience and I am keeping in touch with some of the staff out there. In a few years time I’d love to hear how they have developed their hospital, but I will have to wait and see. I will never forget the four weeks I spent in this department! And I will not be complaining about the NHS any time in the near future.


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