Those Underused PET Scanners
What must it take to get up to date health care for the sick of this country?
Two Positron Emission Tomorgraphy (PET) scanners, both donations, one bought through the goodness of Sri Lankans, and the other being part of the Saudi Governments funding of the Epilepsy Unit at the National Hospital, remain underused.
The scanner gifted to the Apeksha Hospital, also known as the Maharagama Cancer Hospital is used only to carry out CT scans, as is the one at the Epilepsy Unit.
While patients live in anxiety and hope of being cured, health officials and some of the medical fraternity have been dragging their feet in getting these two scanners up and running and used for the purpose they were obtained.
The donation to the Apkesha Hospital came about when the Dr. M S M Mohamed, Chairman of the Kadijah Foundation realized the hospital was treating patients without the aid of a PET scanner. He was at the hospital with his son who was battling cancer, and soon it became a dream for both father and son, to equip the hospital with a PET scanner.
His commitment resulted in the formation of a FightCancer Team. They gave themselves 9 months to raise the required Rs. 200 million to purchase the scanner. Their appeal, along with that of the Hospital’s Consultant Medical Director Dr. M Y K Wilfred brought an outpouring of donations from Sri Lankans of all walks of life and income levels and within just 100 days the bank account set up to collect the funds was overflowing. They raised Rs. 230 million.
Appealing for help to obtain a PET scanner, Dr. Wilfred said in a message at that time, “Unfortunately at present, we do not have the facilities for PET CT scan in our institute, which is an important need during the preliminary diagnosis followed by treatment.”
At present this particular scan is conducted only in one hospital in the country, a private one at that, in Colombo at a cost of Rs. 150,000. Money that a majority of patients could ill-afford.
Why is a PET scan so important? In the case of cancer, a PET scan shows up the cells as bright spots and helps the doctor see if the cancer has spread, if the treatment is effective and if there is a recurrence of cancer cells. This means that a patient would have more than one PET scan done while ill.
PET scans are also used to diagnose and manage disorders involving the central nervous system, including depression, epilepsy, head trauma and Alzheimers and Parkinsons.
While CT scans and MRI’s show up changes later, a PET scan is able to detect problems very early into a sickness giving patients the best chance of receiving proper care and treatment and ultimately their greatest chance at beating the illness.
Though ordinary Sri Lankans were able to raise Rs. 230 million for the Apeksha hospital PET scanner within a 100 days, the government opened the Letter of Credit (LoC), following the appointment of a tender committee and approval from Cabinet, more than a year later, informed sources who wished to remain anonymous, told Counterpoint. Finally, the much awaited scanner, a Siemens model, was purchased from the USA and arrived in Sri Lanka in December 2017. It was ready for use by April this year.
However, this crucial piece of machinery, one that would give a patient the best chance of survival, is yet to be used for the purpose it was bought. Instead, the hospital uses it to carry our CT scans.
Informed sources who spoke on condition of anonymity, told Counterpoint that the latest delay has been caused by the medical team chosen to be trained in using the scanner.
The scanner was bought in the USA, and the contract states training would be provided in the country of origin. With plans to having the scanner functional as soon as possible, the agents and others involved in securing the training had looked around for hospitals which had the same model as the one bought for Apeksha and found them in India and the UK as well. In fact, the UK hospital had offered to train the medical team in December 2017. However, sources say that two of the nine chosen for training, insisted that they be sent to the USA, resulting in a further delay in making the scanner operational and getting cancer patients the help they need. This meant another round of checking with hospitals that had the same model and willing to undertake the training. The authorities finally found a hospital, but the two week training will take place only on July 9. As our sources pointed out, accommodating the training involves the host hospital having to limit the use of the scanner for its own patients. Therefore, the earliest date available was in July.
While medical practitioners insist on their right to decide where they would obtain the training, cancer patients who cannot afford the Rs. 150,000 per scan charged by the private hospital that in Colombo too, continue to suffer.
Health Department officials declined to comment and instead provided Counterpoint with a press statement dated May 22, 2018, where Dr. Wilfred claims that the PET scanner is currently being used to carry out CT scans, and 390 such scans have been carried out so far. The statement further adds that DIMO, the local agents for the scanner, has obtained training from India for some of those who would be using the scanner. The others who are due to receive the training from the University of Minnesota in the USA are in the process of obtaining visas, and are scheduled to begin training on July 9. Meanwhile, the statement also states that the Minister of Health, Nutrition and Indigenous Medicine had approved Rs 38 million to obtain fludeoxyglucose (FDG) from India. The PET scanner is scheduled to begin operations towards the end of July and will carry out 10 such scans each week initially as approved by the Atomic Energy Authority according to the statement.
Meanwhile, the Apeksha’s MRI machine too is in disrepair, and Counterpoint learns, that patients are being sent to the National Hospital in Colombo twice a week for MRI’s. Dr. Wilfred, who confirmed this, added that he expects a new MRI will be purchased before the end of the year.
And what of the PET scanner at the Epilepsy Unit? This was a gift from the Saudi Government and had been installed nearly four years ago. However, the scanner cannot be used fully as it does not have a “Hot Lab.” Says Dharmakeerthi Epa, the General Secretary of the Radiological Technologists Union, the technical committee appointed to purchase the scanner for the Epilepsy Unit had not included members of their profession. With no such member to advise the committee, the Scanner had been purchased without a Hot Lab, essential to ensure the safety of the technicians when mixing the chemicals for the scanner. Epa states that at long last a Hot Lab is to be purchased, and is expected within the next two months.
It’s been nearly four years since the Epilepsy Unit received the scanner, and more than two years since the drive to raise funds for the Apeksha Hospital began. Touched by the need to alleviate the pain and suffering of the sick, ordinary citizens responded without a second thought and donated what they could.
But petty issues and official bureaucracy still keeps the sick waiting.