Mulanje District (Government) Hospital (MDH)

The government hospital does not charge for services, and is much busier than the Mission Hospital. By coincidence Dr Ngalala (who comes from DRC) was at St James Hospital in Lesotho when we were there 2 years ago, he is now working here under UN auspices.

As at the Mission, there is a daily morning handover meeting.

X-ray staff

There are two trained radiographers. One has been qualified for five years, the other for one year. Together they cover out-of-hours. There is also a darkroom assistant who takes X-rays when the others are missing. The qualified staff earn almost 3 times as much as the darkroom assistant, who unfortunately does not yet hold the prerequisite school certificate, or he might also study for the qualification. Radiographers wear white coats.

X-ray room

There is a 2005 Philips machine, with fixed a fixed tube–bucky distance of 145cm. It is relatively new and accurate. Chests cannot be done outside the bucky or at a different distance and there is no AEC. A table can be wheeled into position, enabling shorter distances for extremities.

The control panel is very limited – kV and mAs can be selected; an incomplete exposure chart was available. A pair of lead screens protect the operator but staff did not have film badges.

There was a selection of fast and regular cassettes, and I was able to bring a few more fast ones.

I observed the machine being cleaned daily. Cleaning materials and gloves were available in the room in case of spills.

There was no means of marking names on films before processing. The request form was passed with the relevant cassette via the hatch into the darkroom, and the name copied onto the film with felt tip pen after processing.

There is also another X-ray machine, currently out of use.

Darkroom

This is kept in good order, clean and tidy. There is a Protec table-top processor, in good working order, with its own water supply and automatic replenishment.

There is a film file adjacent to the darkroom, also tidy and with filing up to date.

Ultrasound

The Japanese YEC YD 90000 machine was unreliable: some days it would stay on when switched on, others it would not and could not then be used. On these days, patients had to be sent (without assistance) to the Mission Hospital for their scans. MDH then paid the fee for the scan to MMH. The machine was just over a year old, and had been returned to the manufacturer within guarantee to be sorted out; soon after its return to MDH, just after the guarantee had expired, it began failing again.

Office

No computer and few reference books (they desperately need more reference material and I have suggested they contact WRETF for help). Patients’ details are entered into the ledger but exposures are not recorded. Patients brought request forms from clinicians. The form is returned to the clinician in the film envelope with the films, and the packets are returned to the X-ray dept for filing.

Conclusion

Following my visit I made a number of recommendations to both hospitals which I hope they will be able to act upon. I am particularly grateful to Cowles Chilingulo, a radiographer based in Blantyre, for arranging the visit.