Tuesday, September 16, 2014

Orthopedics without X-ray

Empty Xray waiting area
Kid with broken arm
Bill looking at Xray after reduced with Ultrasound

The important chemicals
Xray showing fracture seen on US
We run out of things and make substitutions daily here at Kudjip.  Whether it is a medicine, an IV fluid, a laboratory test, gauze, gloves, even no water - we are constantly figuring how to make do with what we have.  Recently, the shortages have carried over to X-rays.  Taking an X-ray requires not only someone who knows how to position the patient for the X-ray, but a machine that can take the X-ray, film to put the X-ray on, and chemicals to develop the X-ray.  If any one of these pieces are missing, X-ray doesn't happen.  Recently, we ran out of chemicals, or very short of chemicals.  We were down to our last bottle and weren't sure when the next bottle would come.  A bottle usually lasts us 4 days at our normal rate of ordering X-rays.

2 of our Xray guys
US showing fracture
So as we have known we are running low, we have been trying to limit the number of x-rays that we are doing.  Trying to treat the things we can treat without actually getting the X-ray.  If someone has a cough, instead of getting an X-ray to see if they have pneumonia, we make a clinical decision and treat accordingly.  Instead of doing an X-ray to see if they have fluid in their lung in pulmonary tuberculosis, I have taken them to the US room and done an ultrasound to look instead.

Ultrasound looking for fracture
The ultrasound has also become helpful in orthopedic cases.  You can see bones quite nicely on ultrasound and in this shortage of X-rays, we have taken to using the ultrasound to try and determine if there is a fracture or not.  If there is one, the ultrasound can help us determine if it is aligned correctly or not and then after trying to straighten the bones, we can look again to see if we got the bones in the right position or not.  It isn't perfect, but without X-ray, it is a great option.   We recently got a few bottles of chemicals, so we have been able to test our ultrasound methods and found that we did a pretty good job even without X-ray.  Maybe we should use ultrasound more often.