|IAEA Technical Co-operation - A Partner in Development|
Enhancing the Quality of Health Care
ENHANCING THE QUALITY OF HEALTH CAREThe quality of health care is a universal concern for the global community. The medical diagnostics and treatment available for young people profoundly shape their quality of life, and may well influence their opportunities for future success. Communities and governments around the world strive to improve health care standards in order to provide a happier and more productive future for their citizens.
The IAEA's human health activities give top priority to the curative and palliative treatment of cancer and the establishment of comprehensive quality assurance programmes for radiation dosimetry. It also concentrates on the detection of diseases afflicting children, assessment of nutritional status and the planning and evaluation of applied nutrition programmes tailored to the needs of women and children. These activities span many disciplines - including radioimmunoassay, radiotherapy, radiopharmaceutical production, nutritional analysis, sterilization techniques for transplants and medical instruments and applications of nuclear medicine techniques and procedures.
Since 1980, activities to improve health through the application of radiation in medicine have expanded from 100 to 175 projects. During this period, US$47.4 million has been provided by the Agency to develop national capabilities through training, expert services and essential equipment to establish diagnostic and treatment facilities. This capacity is producing results: In Mongolia, 2,378 patients were treated during the first five months of operation of a new teletherapy facility at the State Oncological Research Center in Ulan Bator. By the close of 1997, Ghanaians will no longer have to seek cancer treatment relief in Europe or the Americas, thanks to the capability and commitment of the Atomic Energy Commission, the National Nuclear Research Institute and numerous other Ghanaian organizations.
It is a promise long in the making. Way back in 1960, the Canadian Government donated a cobalt machine to Ghana to be used for medical purposes. But the Government at the time couldn't provide the building to house it. Instead, the machine was donated to Nigeria's Lagos University Teaching Hospital. In 1975, Ghana again prepared to establish the facility, and the architectural drawings were completed. But again, a scarcity of funds kept the new medical centre from coming to fruition.
Now through a Model Project, the Agency and the Government have committed themselves to carrying through. And, while Ghanaian medics are abroad for training, the IAEA is providing a consultant radiotherapist who can begin cancer treatments and provide training to technicians currently working in the hospital.
Dr. John Amuasi is the Executive Secretary for the Ghana Atomic Energy Commission, one of two national organizations overseeing the establishment of the first of three new radiography centers. Dr. Amuasi explained the importance of the project to WREN Radio in the United Kingdom:
"I've been working at the nuclear medicine unit at Kolibu and seeing patients with cancer problems. We were able to scan patients using our gamma cameras, and therefore detect cancer. But then we were stuck as to how to give proper treatment. Now, the Agency has come to our rescue, providing us with a facility that can go on to treat patients. I think it's something to be excited about"
"Before, we were sending patients, that is those who could afford it, to Europe. Now we will have people trained to manage these patients locally. Ghanaian patients and people from outside will be flocking in for this treatment."
"IAEA's training component has allowed us to send four doctors to South Africa for training as radiographers. Last year, we sent two physicists to London for medical training. The doctors' training will take about 36 months to complete, the physicists', about a year. We expect them back home very soon to start treatments."
Strong Government support is a prerequisite for any successful development project. Ghana's Model Project has benefitted considerably from the involvement of the country's First Lady, Her Excellency Mrs. Nana Konadu Agyeman-Rawlings, who heads the project's National Co-ordinating Committee. Dr. Kwame Kyere, the Director of the National Nuclear Research Institute in Ghana, explains the importance of mobilizing broad based support at both high-levels and among popular organizations:
"The IAEA insists that the government give its solid and continuous commitment in Model Projects. In our case, the Minister for Finance, the Minister for Health and the Minister for Science and Technology all wrote to the Agency promising their commitment, and they have kept to it. Money was released on time; and that is why the project has been completed on time. Moreover, the commitment of the First Lady of Ghana has been tremendous."
"When the Model Project idea started, NGOs in Ghana were invited to serve on the national committee. The National Council on Women and Development campaigned strongly because it had the equipment to detect breast cancer, but not to cure it. They served on the committee, and their lobbying contributed much to the government's decision to allocate money. This project has gotten the whole population involved through various associations across the country."
Dr. Kyere provides another rationale for why Ghana was selected for the Model Project:
"Our country is sandwiched between three francophone neighbours, and none of us has had this kind of facility. But Ghana's nuclear medicine facilities had improved considerably, and our scientists have been working as IAEA experts in nuclear medicine, nuclear instrumentation and many other areas. I think the Agency was trying to complement what we've achieved by providing us with this facility, which we yearned for over 30 years."
Colombo, Sri Lanka.
Tissue banking isn't new to Sri Lanka, however. Nearly 20 years ago, Dr. Hudson Silva launched a campaign to preserve eyes donated by his patients so that others might see again. The tax-free charity that he set up, the Sri Lanka Eye Donation Society (widely known as the Eye Bank), has helped more than 10,000 Sri Lankans to regain their vision. Over the last 30 years, the bank has sent more than 30,000 sight-restoring corneas to eye surgeons in 60 countries. These have been delivered free of charge, but recipient institutions have made cash donations enabling the bank to thrive. Today, the Society has 325 branches around the country with the active involvement of 15,000 volunteers.
Given such a track record, and the fact that tissue banking is now a demonstrably viable technology, TC was fully confident about helping Sri Lanka set up the new facility, which is sited on land in a prime residential area provided by the Health Ministry. The Agency will contribute some US$375,000 over four years (1995-98). Apart from the governmental inputs, the Eye Bank and local charities will donate nearly US$150,000.
Oblation of one's body is inherent in Sri Lanka's religious-cultural traditions, so the Eye Bank has never been short of cornea donations. An average of 15 to 20 people per day are filling out the form for eye donation. About 15 percent of them are also willing to donate tissue. By autumn of 1996, some 90,000 registered donors had expressed their willingness to donate tissues.
Processing of "anmion" - the inner membrane of the placenta that cocoons the fetus- began in 1995. This thin, opaque material is immensely rich in hormones, but is usually thrown away after a baby is delivered. Pharmaceutical companies procure it from maternity hospitals to extract hormones, and it is also widely used to treat wounds and secondary burns. But the full range of its medical applications is still being explored.
The Colombo tissue bank has begun providing amnion to public and private hospitals. Its capacity to prepare, double package and irradiate amnion is about 350 pieces a month, while current local needs are estimated at 200 pieces. The rest is being sent abroad to meet urgent needs elsewhere. In time, the Bank will similarly process and store skin and bone tissues as well as brain and spinal cord membranes, intramuscular tissue, heart valves, arterial and cardiovascular graft material.
Apart from equipment, IAEA-TC is providing the expertise to establish a total quality assurance system for maintaining manufacturing practices at the highest international standards, as well as training of top staff to ensure that the activity is sustainable after the project ends. Thus far, TC has provided five training fellowships in Germany, India, Japan and the United Kingdom, as well as scientific visits abroad.
The bank will undoubtedly have tissue stocks in excess of the country's needs. Like the Eye Bank, it will respond to foreign requests, free of charge. While religious and cultural mores inhibit donation of body parts in some countries, a continuous demand for human tissues is projected within the Asia and Pacific Region and beyond.
The Sri Lanka Tissue Bank is a Model Project. As such it satisfies specific criteria such as environmental and economic sustainability and cost-effectiveness advantages over conventional approaches. It must also address priority needs of the country. Perhaps most importantly, it must receive solid support from national or local governments and communities.
The Model Project will increase the availability of human tissue grafts to victims of traumatic accidents, disease and congenital defects. The low income portion of the population, which currently has almost no access to such treatment, will benefit considerably. Sri Lanka currently spends an average of US$200,000 per year on imported tissue grafts. Savings of an equivalent amount can be expected as a direct economic benefit to the country, plus the invaluable benefits to international recipients of donated tissue for for transplantation.
Over the years the Agency has supported several modest-scale tissue banking facilities, but the Sri Lanka Eye Donation Society has the proven experience and international network to assure that the new facility will have significant impact both nationally and internationally.
As IAEA expert Dr. Norimah Yusof, said after visiting the facility last year, "With well trained and hard working staff under the clear vision of Dr. Hudson Silva, the Model Human Tissue Bank will soon become an excellent bank for the region, offering its facility for training of other operators. It will be able to provide training in procurement processing of bones and soft tissues as well as radiation sterilization of tissue products."
Cancer is a growing health problem around the world, and Colombia is no exception. In response to the increasing number of cancer cases in this South American country, the Agency has recently approved a TC project with the National Cancer Institute (INC) to extend brachytherapy services for cancer patients in the Bogota area. The project is replacing Ra-226 sources with more reliable Cs-137 sources, thereby making brachytherapy treatment safer and more widely available. Within this framework, the Agency has also provided INC with manual after-loading devices using Cs-137 and a storage safe for sources.