Michael Abrahams | We need more CT and MRI machines now

Recently, someone sent me a social media post by our Minister of Health and Wellness, Dr Christopher Tufton, and asked me to verify the information given there. It was a tweet lauding our government and the strides it has made in improving radiology services in the public health sector. However, the first bit of information caught my ire. It stated that in 2015, there were zero MRIs in the public health system. The claim disturbed me because it is inaccurate.

Multiple colleagues at Kingston Public Hospital (KPH) have confirmed that an MRI machine has been at that institution from before 2015, at least as far back as 2010. One of my colleagues told me they recall an MRI machine being at KPH when they returned to Jamaica in 2014 after studying overseas. What the minister did not tell us, is that there has been no MRI service at KPH, the largest multidisciplinary hospital in the government health service, as well as our largest trauma centre, for many years, dating back to before the COVID-19 pandemic. The cessation of this service happened under his watch.

The state of the radiological services in our public hospitals has concerned me for years. My greatest concern is that Bustamante Hospital for Children (BHC), the only children’s hospital in the English-speaking Caribbean, has never had a CT or MRI machine. The Ministry of Health in the previous administration did not provide the hospital with these machines, and this administration has not either. Why is it a big deal? It is a big deal because having at least one CT machine on the hospital compound has the potential to save the life of a child who is critically ill and needs timely intervention.

Picture this scenario. A child is rushed to the hospital, unconscious after sustaining a head injury in a motor vehicle accident. Imaging the child’s brain is essential in such a situation, and a CT machine is the ideal tool. It can detect injuries that other imaging modalities, such as ultrasound scans and conventional X-rays, would not reliably identify. It can provide information regarding the presence, severity and location of injuries, which is essential in guiding appropriate management which could be life-saving.

VITAL

A CT scan is, therefore, vital in such a situation. However, BHC does not have a CT machine. So, in such a scenario, an ambulance has to be identified to transport the child off the compound, and one may not be available at that time. A nurse also has to travel with the child in the ambulance. There is already a nursing shortage, so taking a nurse off the compound may further compromise the care of inpatients who had been under her care. A doctor may also need to accompany the patient, which means taking them out of the intensive care unit or wherever else they have been assigned. The child must then be taken to and placed in the vehicle. Following this, the ambulance will need to navigate through traffic, which may be significant, depending on the time of day, and drive on our pothole-laden roads en route to the facility where the examination will be performed. On arrival, the patient has to be removed from the vehicle, taken into the institution, placed into the machine, have the procedure done, taken out of the machine, put back into the ambulance, which will then negotiate traffic on the way back to the hospital, where the child is removed from the vehicle and taken to a ward, the intensive care unit or operating theatre. Depending on the nature and severity of the child’s condition, they may need to travel with oxygen, and colleagues have informed me of instances where the oxygen being inhaled by the child has run out before they received the scan.

NO-BRAINER

It is a no-brainer why a CT machine should be on site at the hospital. For several years, I have been asking why this has not been done, and I have yet to receive a rational reason. The CT scan was invented in 1971, more than five decades ago. It is not exactly new technology. The authorities have had more than enough time to sort this out. There is also no shortage of machines. Within a one-mile radius of my practice, there are at least eight locations, all private institutions, that house CT or MRI machines or both.

So why subject a seriously ill child to the inconvenience of having to be transported to and from an outside facility when the examination could be performed in-house? I do not understand it. The fact that there is still no MRI service at KPH also perplexes me. While fact-checking for this article, more than one colleague who has had decades of experience working at KPH told me of instances where private entities attempted to donate MRI machines to the hospital, but their efforts were unsuccessful. Cornwall Regional Hospital (CRH) does not have an MRI machine either. CRH and KPH are the two Type A hospitals in the government system, multidisciplinary hospitals that provide services for all medical specialities and serve as referral centres for the island. The fact these institutions have no functioning MRI service is, in my opinion, unacceptable. Needless to say, Spanish Town Hospital, the country’s largest Type B hospital, like BHC, has neither a CT nor an MRI machine.

A consultant paediatrician at BHC told me that when they inquired about when the hospital will be getting a CT machine, a senior official at the Ministry of Health and Wellness told her it would be “soon”. How about “ASAP?” This is 2025. It is about time the hospital has a CT machine so that the children there in need of such examinations will not have to be carted around town in their debilitated states. It would also be appropriate for the MRI service at KPH to be sorted out expeditiously. The Jamaican people deserve better.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams