CR in Haiti: Durability and Sustainability
Stephen NeushulIn the wake of the January 2010 earthquake in Haiti, multiple aid groups rushed to the country to provide housing and medical care for the estimated 1.5 to 1.8 million residents displaced by the natural disaster. One such group was Health4Haiti, which had established a presence in the country several years before and had been building a clinic in the city of Gonaives when the earthquake struck; before long, the organization put out a routine call seeking specifications for radiography equipment to be deployed there. A response soon came from iCRco (Torrance, California), a developer and manufacturer of CR and DR solutions. “When the disaster in Haiti first happened, I knew I wanted to help,” Stephen Neushul, CEO, says. “We had tried to send over some equipment initially, but at the time, nobody wanted it. When an old dealer of ours, Shane Anderson, reached out about trying to help Health4Haiti, it was very encouraging.” Neushul responded to the organization’s call to recommend that Health4Haiti choose CR over conventional (analog) radiography; this would enable the organization to perform imaging at higher quality levels without the additional costs associated with film and darkrooms. John Smith, MD, president of Health4Haiti, recalls, “We were trying to get things lined up for a darkroom and called for information; iCRco recommended that we go digital so we wouldn’t have to have a darkroom, film, and the chemicals.” iCRco went a step further, donating two of its iCR3600 CR systems to the organization. “I believe that our machine is perfect for this setting,” Neushul says. “If you’re in Haiti, without consistent power and without a lot of access to service personnel, this is the machine for you. It’s one moving part, and the plates don’t go bad.” Engineering to Last Matt Changala, director of engineering for iCRco, notes that many CR systems are designed so that the plate is handled with every scan, leading to wear and tear that eventually requires the plate to be replaced. “The plate is like anything else. If you bend it enough times, it will begin to break down,” he notes. The iCR3600 was designed with a single moving part; the phosphor plate never leaves the cassette, and the company says that users can anticipate getting 300,000 images out of a single plate. “We designed our system so that the plate is never handled,” Changala says, noting that many CR systems require plates to be run through rollers in the CR reader. “In addition to ensuring that the plate lasts longer, the design minimizes the chances that the plate will be dropped or damaged,” he adds. Neushul notes that one iCRco site in Argentina recently produced its 600,000th image using the company’s CR equipment—without a single plate replacement. “People have yet to make the distinction between everyday and industrial-grade technology in our industry, but it’s really important,” he says. He offers an analogy: “There’s industrial-grade printing and then there’s desktop printing. A desktop printer couldn’t produce 10,000 documents a day. It would break. Our CR system is an industrial-grade machine that can run all day, day in and day out,” he says. Evolving Needs Two years after the magnitude 7.0 earthquake devastated much of Haiti, the focus for aid groups has shifted from immediate triage of the injured to long-term sustainability in the community. “This clinic serves about 20,000 people in the city, and our goal is to make it self-sustaining,” Smith notes. “The staff is actually seeing patients there year-round, as opposed to just a couple of weeks a year.” Neushul notes that a market without easy access to the kind of service personnel or biomedical teams available in the United States requires durable technology, which is why the company chose to send the iCR3600 units (which use True Flat Scan Path technology to ensure detector durability). “For Haiti, or anywhere that’s remote, our machines are going to do very well,” he says. “They can do 300 patients a day, and the plates will hold up; the flat scan technology doesn’t have the series of gears, belts, and motors that can cause maintenance issues.” Smith observes that in order for Health4Haiti’s Gonaives clinic to be self-sustaining in the future, it will have to begin making money at some point—and that imaging equipment, in Haiti as in the United States, has a role to play in ensuring its sustainability. “We can find equipment and supplies to be donated, and we have enough money to buy medicines, so we are able to keep the clinic in medical supplies,” he says, “but there are salaries to pay—we opened with a physician and a couple of nurses. With a radiography machine running, the clinic can make revenue off of that, because physicians from other parts of the city will send patients to the clinic for imaging. Our hope is that the systems donated by iCRco will go a long way toward making this clinic self-sufficient.” Cat Vasko is editor of and associate editor of Radiology Business Journal.