Nuclear Medicine in a developing country

Namibia is a country with 1,8 million inhabitants, of whom the majority has limited access to first world facilities. Nevertheless, medical services of high standard are offered. A Nuclear Medicine Department was established at Windhoek Central Hospital in 1982. A nuclear physician, two nuclear medicine radiographers and a nursing sister staff the department. Equipment includes a Siemens Orbiter and an Elscint Apex SPX Helix gamma camera. Radiopharmaceuticals are obtained from suppliers in South Africa. Investigations performed include musculoskeletal, liver, hepatobiliary, thyroid, renal studies, ventilation perfusion lung scans as well as the following Nuclear Cardiology studies: Gated blood pool scans, Tc-99m pyrophosphate hot spot scans, Tl-201 myocardial perfusion studies, Tc-99m MIBI myocardial perfusion studies and Tl-201 rest-redistribution studies. Problems experienced at the Windhoek Nuclear Medicine department include: Lack of funding and high cost of equipment and radiopharmaceuticals, lack of understanding of Nuclear Medicine by the hospital management and health administrators, and difficulties in procuring short-lived radiopharmaceuticals. Furthermore, the absence of company representatives and spare parts in Namibia leads to loss of time whenever equipment needs to be repaired. Working as the only nuclear medicine physician in a country also poses major problems. Careful management of resources and information drives have helped to sustain the Nuclear Medicine service despite economic problems in the country. Installation of a tele-link between the department in Windhoek Hospital and Tygerberg Hospital in South Africa has greatly assisted to overcome the problem of isolation and lack of back up from fellow specialists. The IAEA has equipped both departments with Hermes workstations (Nuclear Diagnostics) and a tele-link is maintained via modem. The current software provided with the Hermes system is ideally suited to processing of data such as gated myocardial SPECT studies. Data from Windhoek can either be processed on-site and referred to Tygerberg for expert opinions, or be forwarded to Tygerberg for processing and reporting. The IAEA is currently assisting with training of further Nuclear Medicine staff (a medical doctor and a radiographer) for Namibia