to be trained to take basic X-‐ray examinations without any real understanding of what they are doing or trying to
achieve. This obviously leads in some cases to very poor imaging and risks to the patient of being over irradiated. Fortunately Villa Maria has a very competent qualified radiographer, Adrian who is assisted by Tabitha in radiology.
I was able to communicate with Adrian, by e-‐mail, before my visit about the conditions there and the equipment
they needed. This proved invaluable as I could then establish exactly what was going to be of use to them. We soon
established that as they only had two X-‐ray cassettes (these hold the X-‐ray film) it was a priority source some more.
The majority of UK hospitals, if not all, now use digital imaging and so have had no need of cassettes for a number of
years. Therefore, I was a little concerned if I was going to be able to get hold of any. I put an appeal into a couple of
radiography magazines and was inundated with offers of help with equipment, amongst which was the offer of a
tabletop automatic X-‐ray film processor from Cirencester Hospital. I established with Adrian that this would be
useful, as they were wet developing films at present. I contacted the company X-‐ograph, who originally installed
it and they offered to uninstall it, service it and provide me with a tutorial on any common problems that may arise and how to fix them. They also did an excellent job of packing it ready for airfreight. This was all done free of
charge which was brilliant.My next challenge was to organise air freighting it there. Luckily Jim McWhirter has a contact in Uganda who is
extremely experienced in organising customs clearance at Entebbe. This was invaluable as I had previously been
told many horror stories of equipment being impounded for months there! I am very grateful to the Rotary Club of Whitchurch, Shropshire, who paid for the cost of air freighting the package to Uganda.
I arrived at Villa Maria on the 5th July with four large boxes and suitcases of equipment, including a light box,
ID camera, lead aprons, x-‐ray cassettes and various other equipment and books, which was all enthusiastically
received by the staff there. Adrian proceeded to show me the new X-‐ray machine, which had just been installed.
Unfortunately they were having problems with it as it was behaving erratically, not allowing exposure factors to
be set with any degree of accuracy. This coupled with the issues of wet developing made it very difficult to produce
diagnostic x-‐ray films, as a lot of it was down to guesswork – not a safe way to be using radiation! I therefore
suggested that the engineer was called back in to sort out the problems.
The wet developing that was being used was also causing problems, as over time the chemicals become “exhausted”
which leads to further drop in image quality. It is also quite a haphazard procedure as it relies on a certain degree
of skill when developing the films. It did take me back to my early days of training to be a radiographer at Aberystwyth hospital when we had to wet develop films during theatre procedures, a very nerve wracking experience!
The automatic processor arrived safely a few days later. Adrian and I set about the task of getting it set up in the
darkroom. This we did with the help of the plumber who connected it to the water supply for us. We had a few
minor issues with it but managed, with the help from radiographer colleagues on Facebook and a phone call to
X-‐ograph, to get it up and running successfully. This will give some standardisation to the production of diagnostic
films. Luckily there were not too many requests for X-‐ray and it was just accepted that we were out of action for the
Adrian and I also discussed other problems with the new equipment. The biggest one being that there was no
facility on the machine to do chest x-‐rays, which is by far the most common request. We went to the stores to
look at the old equipment to see if we could salvage anything suitable. Luckily things are not thrown away there.
We found two pieces of old equipment and with help from the maintenance man, managed to make a functioning
stand to hold the cassette for chest x-‐rays. It isn’t the most beautiful design but it solved the problem.
I was really struck by how difficult the radiographer’s job is there with the lack of resources and backup both
technically and clinically. There is a great deal of responsibility put upon the radiographer to comment/report
on images despite having no training to do so. This is due to a lack of training for the doctors in image interpretation
and the complete absence of radiologists. Adrian also undertook and reported on all the ultrasound scans.
The second week I was there we concentrated on carrying out the actual examinations, trying to emphasise
radiation protection and to establish an exposure chart to standardise the exposure factors. Whilst I was there
I also visited Kitovu Hospital to see their new purpose built Radiology Department. It is a lovely, spacious, light
filled building, with dedicated rooms for X-‐ray and Ultrasound. They are just waiting delivery of the new
equipment, which has been funded by a loan from Rotary Doctor Bank. Very impressively, they have also built
a large room to be used in the future for a CT scanner when funding becomes available.
I did manage some leisure activities whilst there ,including a visit to the Sesse Islands with the medical students
from Bristol University as well as other assorted ‘muzungus’. It proved to be a very enjoyable and entertaining
end to my visit.
I would like to thank everyone at Villa Maria Hospital for making me feel so welcome. I would also like to thank
everyone at the Rotary Doctor Bank for the support and encouragement given to me throughout the planning
of and during this visit.
Dr Rogers and me at Villa Maria
Mrs Teresa Dawkes is a radiographer in the Breast Screening Unit at the Countess of Chester Hospital. Teresa has visited Kisisi Hospital in Uganda on a previous occasion but this is the first time that she has volunteered with the Rotary Doctor Bank.
Teresa arrived in Uganda on 4th July and was met by Jim McWhirter and Rogers Kuyube, who took her to Villa Maria Hospital. Teresa has sent an automatic x-ray processor to the hospital which was surplus to requirements here in UK and was going to scrapped. The processor is now in use and there is already a marked improvement in the quality of the x-rays being developed when compared with the old manual system. Teresa is showing the staff modern techniques and teaching safety issues.
Here are copies of x-rays taken using the new processor and the old manual system.