The following interview was conducted by LIN’s Research Associate Sydney Kambalikena (SK) with Mr. John Manda (JM). Mr. Manda works at Mzuzu Central Hospital, Radiology Department.

SK: What is your job title, and can you describe what you do in your daily work?

JM: I am a radiographer. I take images for patients using X-ray machines for the purposes of diagnosing various diseases. We are now in a digital world and things have changed. At first, we had analogue system where we would take images, produce films and those had to be taken to the doctors. But now, we have transformed to digital system in which we are using Computerised Radiography (CR) where PACS (Picture Archive and Communication System) comes in. With PACS, once an image is taken, we process and digitise it and send it through a system which is interconnected to the whole hospital and the image goes to the server. There are many outlet points in this hospital where people can log in and view the images without having the patients physically carry the radiographs.

SK: How long have you been using the PACS and the electronic data system?

JM: It could be between 4-5 years now.

SK: What do you think about the system?

JM: I find it helpful because it has reduced the waiting time for patients. It’s more convenient because apart from patients not taking longer time on the waiting line, the system has high quality images as compared to the analogue. The processing itself is very unique in the sense that it just requires manipulation of the image right on the computer. You can manipulate the image and make it clear. In the past when we would repeat taking X-rays but that is history now.

SK: What do you dislike about it? If you could suggest areas for improvement, what could they be?

JM: The batteries have drained so if there is blackout, the system will shut down and when you try to restart it, it requires an IT expert to come and configure the system. The batteries for the backup power have to be replaced.

There is a limited capacity of number of pictures it can keep. Sometimes it happens that we need some pictures of about 2 years ago but we can’t access them.

We have limited ports where people can view the images. For example, eye department and antenatal have no ports and have to rely on radiography department to view images. They have to come to our department and we need to give them space to view the image.

In one room, we have the port that is working but we have another independent X-ray machine. If an integrated system can be put in place, so that other systems we have, including the Ultrasound machine, it can be better.

SK: Has the introduction of PACS changed the way you do your work? What is the biggest difference you have observed or experienced?

JM: Yes, it has changed the way I do my work. The biggest difference is that we stopped manual processing of the images where after taking an X-ray, we take the image, go into the dark room, process it and take another film, put in and then switch on the processes, mix 3 types of chemicals, clean the processors almost every week …all that is history now. That is the greatest difference I have noted. It’s been a very big difference.

SK: The other difference that I can capture from your earlier comments is that you don’t need to organise multiple session with patients to take X-rays as was the case before.

JM: For example, we use high exposures according to the part to take an X-ray on, sometimes it may come out too dark or too bright. With the old system, we needed to repeat the process with the patient. With the PACS, even if a picture is too bright or too dark, you can just adjust it and make it appropriate to still get the required information.

Another thing is storage space. We have more than 100 patients per day and we had to find space to store all their files. With the PACS, we don’t worry about this anymore. Looking for the X-ray files used to be an exhausting work. Now, we just punch in a name of a patient and we have the files ready. Archiving of the images has been so easier than the previous one.

SK: Do you have anything else you would like to say?

JM: Like I said, this system is very good and it has really helped. Maybe we might be the first one in this country who have completely migrated from analogue to digital. It has really been a good system and I wouldn’t imagine going back to the manual system.

SK: If I go around, are you sure I wouldn’t find patients carrying radiographs?

JM: You won’t. The only thing you can discover is that some people can be referred and we use compact disks (CDs). What we do is that we export the images to the CDs.

SK: Does that mean they have to pay?

JM: No, they don’t pay. They just bring their blank CDs and we copy the images into the CDs and they take the images like that.

SK: Thank you for granting me the opportunity to have an interview with you.

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