Medical Imaging in Guyana, development and status

With a population, under 1 million, Guyana, according to the World Factbook (1), is the third smallest country in South America. Guyana was originally a Dutch colony in the 17th century, by 1815 had become a British possession. The abolition of slavery led to settlement of urban areas by former slaves and the importation of indentured servants from India to work the sugar plantations. Tropical rainforests cover over 80 percent, and its agricultural lands are fertile. A resulting ethno-cultural divide has persisted and has led to turbulent politics. Guyana achieved independence from the UK in 1966. In 1992, the country is first free and fair election since independence. The economy is growing; still at a high unemployment.


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https://journals.hioa.no/index.php/radopen/index The National Referral Hospital (level V) in Georgetown provides a wider range of diagnostic and specialist services, on both an in-patient and out-patient basis; plus psychiatric hospital; geriatric hospital, and also a children's rehabilitation center. The health sector is currently unable to offer certain sophisticated tertiary services, for which the required medical specialists are not available.
Medical imaging, especially X-ray based examinations and ultrasonography, is crucial in a variety of medical setting and at all major levels of health care. In public health and preventive medicine as well as in both curative and palliative care, effective decisions depend on correct diagnoses. Though medical/clinical judgment may be sufficient prior to treatment of many conditions, the use of diagnostic imaging services is paramount in confirming, correctly assessing and documenting courses of many diseases as well as in assessing responses to treatment.

The situation of radiographers
The University of Guyana Bachelors in Medical Imaging Degree program lasts 4 years. It has site classes as well as clinical attachments at the major hospitals in the capital city-Georgetown. The minimum admission is 10 students per year with roughly 15-20 students graduating per year. Almost off the teachers are from Guyana with occasional visiting lecturers and e-teaching sessions. Majority of the student body are Guyanese but there are students from the rest of the Caribbean because there are limited Medical Imaging schools in the region. Currently only Guyana, Trinidad and Jamaica have established programs. Cuba has a Radiography program but entirely in Spanish. Most of the privately own hospitals and healthcare facilities hire radiographers from India while the Government of Guyana has an agreement with the Government of Cuba to provide Cuban Radiographers to work in the public health sector. Either, Guyana radiographer's assistants/local "X-ray technicians" work independently or Cuban radiographers work in regional hospitals. In the later hospitals, there is usually a mix of Guyanese and Cuban/ Indian Radiographers. https://journals.hioa.no/index.php/radopen/index The first step in understanding "access to medical imaging" is understanding "availability." The Needs Assessment for Medical Devices is a technical review series report published by the WHO in 2011 (http://whqlibdoc.who.int/publications/2011/9789241501385_eng.pdf.) that outlines exactly how a country's Ministry of Health can calculate the gaps in access to medical device technology [20]. The situation of equipment outside of the capital-it is entirely film-screen-based. Almost all hospitals-both private and public-within the city either used computed or digital radiography. Within GPHC Cardiology and Radiology Departments, they have their respective servers and reading stations.
It has been suggested that 80-90% of the imaging need in a country as Guyana, can be met by X-ray, and ultrasound alone. X-rays are essential in the diagnosis and treatment for the large proportion of patients presenting with pulmonary or orthopedic conditions, among other things. This is true for acute conditions, such as pneumonia, pleural effusion, hemothorax, fractures, and osteomyelitis, as well as chronic ones, such as tuberculosis (TB), asthma, chronic obstructive pulmonary disease (COPD), and occupational lung disease.
A digital dental unit are located in the city. Several analog dental units are located in both private and public sectors. GPHC performs kidney transplant surgeries and hip and knee replacement through visiting teams, as well as coronary artery bypass and heart-valve replacement surgeries, through Caribbean Heart Institute and other visiting cardiologists. Even with substantial improvements in the health sector, the need for overseas treatment for some services might remain. The Ministry of Health provides financial assistance to patients requiring such treatment, priority be given to children whose condition can be A stress echocardiogram is a test done to assess how well the heart works under stress. The "stress" can be triggered by either exercise on a treadmill or a medicine called Dobutamine. Through these programs and more sub-specialty programs in the works, Guyana will be able to offer state of the art imaging services in the coming decades.
And while all programs have ensured their sustainability by training local professionals to teach and train other local professionals, a unique situation is being created where a developing country is learning to tackle developed world issues like advancing from analog technology to fully digital equipment. Guyana and many low to middle-income countries are tasked for adjusting to this improvement, while omitting initial steps developed countries had encountered while adapting to this transitory phase. Summing up,it's important that leaders are willing to share their knowledge and expertise. Guyana has signed onto to Sustainable Development Goals to end poverty by 2030. Amazing doctors in Guyana are willing to help and give guidance but sadly, it still is a lack of radiographers. Hopefully, the establishing of the local radiography society will ensure that resources and guidance are more easily available.