Slave Castle

There are a few places on our lovely planet that sit in silent testimony to the horrors man can inflict upon his fellow man, and I had the honor and privilege to visit such a place today. I write this with difficulty, but it must be written. What I’ve felt today must rival what one feels at a concentration camp (I’ve yet to visit one, but I must). There is nothing but sadness at this place, the knowledge of just how low humanity can sink, how evil can take over a good man’s soul.
We left early this morning for a three-hour drive from Accra in a VERY small Hyundai, over relatively good roads. The trip was uneventful, except for being stopped by the Ghanaian Police who warned Alfred, our driver, not to stop for bandits who are dressed in the uniforms of the Ghanaian Police. Got that? The scenery en route was fascinating. I have tried to take photos of the street scenes here, but I simply cannot do it justice. Picture block after block after block, mile after mile after mile, of unfinished storefronts, tables, booths, piles of coconuts, larger piles of coconut shells, smoked fish, every manner of electronics from at least 30 years ago, car parts, tires, motorcycle parts, ornate caskets, statuary, pretty much anything and everything. And every manner of vehicle, from a few Mercedes and even a Lexus GX to little carts pulled by a motorcycle chassis. And people. More people per square foot than I have ever seen in my life. Today, many were in their Sunday Best, and there were several outdoor church services to be found by the roadside. Ghana is majority Protestant, and the people are quite religious.
We arrived at Cape Coast, and with the aid of my Cities2Go app (like I know where I am in Ghana), we found the Castle, one of several on the Ghanaian shore (once called the Gold Coast) that was the center of the African slave trade. You can look up the numbers; they are mind-numbing. Millions of slaves passed through these forts/castles on their way to the New World. Many died here, mainly from disease, many more died en route. Some chose to throw themselves into the ocean from the ship, and as there were a number of them chained together, that created a similar deadly choice for all. Perhaps it was better that way. 

It should be made clear that both Europeans and Africans were involved in the slave trade. Raids were conducted into a good part of Western Africa and human beings who were just minding their own business were captured and delivered to the slavers. Prisoners of tribal wars got sent off to slavery. The sordid list goes on. No party, save the victims themselves, were innocent in this horror. And it should also be mentioned that a majority of these tortured souls were sent to nations other than the United Stated. In fact, about 40% went to Brazil alone, and today, this is the nation with the second-highest number of people from African extraction. There’s a lot of guilt and a lot of blame to go around.

This is a shot from within the Male Dungeon. There were multiple chambers here, each holding something like 200 men, without room to lay down, with no toilet, and with water and food delivered once a day. The three window openings provided what little ventilation was to be found.

Here is the walled-up original “Door of No Return” through which the slaves passed through to reach an underground tunnel leading to the port at the base of the castle. They never saw daylight from the time they arrived here until they reached the New World. If they were alive when they got there.

The “Door of No Return” was recut into wall here, and those of African descent whose ancestors left from this place may request a “Door of Return” ceremony to mark the occasion of their visit, and bring things full circle.

You’ll be happy to know that while slaves suffered and died below, the various Governors (this place was built/rebuilt/run/owned at various points by the Swedes, the Dutch, the Portuguese, and the British) lounged in this lovely room with cool sea-breezes that drowned out the stench of death coming from the dungeons.

My readers know I am not a big fan of the current occupant, but it was fitting and proper that the Obama’s visited here in 2009 and placed this plaque:
Mrs. Obama, in fact, found that her ancestors did indeed pass through this horrible place en route to America. 
A few years ago, I was in Germany, and had the opportunity to visit Hitler’s podium on the Zeppelin review stand in Nuremberg. You’ve seen the stands in newsreels from the end of the war, when the Allies shot the swastika off the top of it. I stood there and felt some small glimmer of the triumph of good over evil. Hitler died a nasty death, and the parts of my family that left for America survived. Up yours, Herr Shickelgruber. I guess the Castle has a happy ending as well, but it’s hard to see it standing in the dungeons where men and women were held like animals, where many died like animals. Our guide, Sebastian, put it thus: “The only way this could have happened was for those in power to stop seeing their captives as human.” I have no better answer. But at lunch, our driver, Alfred asked this, “How could religious people do this? How could they go to the church on the grounds and then do this to people?” To that, I have no answer.
The profound sadness the Castle inspires is not pleasant, but something I think all must experience. I leave here changed a bit, a little older, a little wiser, a lot sadder. We have not learned the lessons we should have from all this. The Castle ceased warehousing people in the early 1800’s, but slavery continued, and sadly still does to this very day. Not 150 years later, the Holocaust not only enslaved people, but deliberately slaughtered them as well.
But here I am in Ghana, a proud, free nation that remembers this shameful past, but goes on with life, building and growing. Maybe that is the answer after all. 
Go on with life. Forgive. But don’t forget. Don’t EVER forget…

via Blogger http://ift.tt/2e2ryji October 30, 2016 at 06:39PM

Weekend Update

I have a short report covering the past couple of days’ activities, but despite the relative brevity, you may rest assured that things remain busy here in Accra!

On Thursday, Ben had asked me to look into sending exams back to the modalities in case something needed to be printed from the console and not PACS. (Brian continues to make progress in DICOM printing from Merge PACS; there is still a contrast issue with the printed films.) While I was able to find the mechanism to do this, the transmissions did not go through completely, and I think this indicates a problem with the configuration on the modality end.  However, the CT and MRI both have functions that query the PACS, which would accomplish the same thing we are attempting. I’ll test the function if I can ever get some time on the scanner!
                    
In and among that bit of tail-chasing, I was able to spend some time with the residents. A FEW are still using the Query function rather than the worklist, and several were logged in with a generic ID. I cautioned Ben and the resident that this could lead to a number of problems in the future and strongly advised that the generic sign-on not be used except in very extreme circumstances. (I was thrilled to discover the generic login and password on the backgrounds of most of the workstations!) And I made another little discovery…One of the monitors, a 30″ consumer-grade HP, was set for a lower-than-optimal resolution. I grabbed the mouse and set it to the proper, higher resolution…and I was then schooled by the resident…”Doc, many thought the icons were too small at the high resolution, so we run it at low resolution to make the icons bigger…” I’m going to have to see if I can buck this trend, as the low-res causes us to lose some of the drop-downs off the lower edge of the screen. That’s not a reasonable trade. Keep in mind, many/most of the stations are running on one monitor. There are several Barco’s in the waiting, but their workstations lack power-supplies, which are coming. Apparently on a slow boat!

Friday was a bit more frustrating. We had meetings scheduled with various people critical to the project, but many had other obligations, and we did a bit of hurry-up-and-wait. The meetings ultimately did occur, and we had good discussions. There appears to be an in-house team developing a RIS-like program for another division, which hopefully can be adapted and interfaced to PACS. I’m to cast eyes on that on Monday.

One high point was my first lecture here at Korle Bu, an introductory talk about PET/CT, delivered to an apt (and awake!) audience of Nuclear Medicine residents, and many folks from RT as well. You have to keep in mind that the NM residency program is completely separate from Radiology, and these kids have not been exposed to CT. Still, they grasped the concepts readily, and asked some very astute questions. And they even laughed politely at my feeble attempts at humor…  While I think there is only a small chance of PET/CT coming here in the near-future, I believe everyone needs to be aware of its capabilities and know when sending the patient off to South Africa (where the closest PET/CT lives) might be worthwhile. And who knows? Maybe some very nice scanner company will donate one to this very busy (and worthy) Oncology site. Oh, and we’ll have a cyclotron on the side with that, please. (Please?)

Finally for Friday, what I thought would have been an easy task turned difficult. You might recall that I mentioned putting the Merge client on the residents’ laptops. Well, a couple of them have Macbooks, and I was asked if I could make the Windows/Java-based program work. But of course! I replied naively… Well, the Macs in question are Macbook Air’s with 128 Gb SSD’s. Oops. I’m having one of the residents try to clear 50 Gb off of her drive (she had exactly 2.5 Gb free) and I’ll try to do the most minimal Windows 7 installation possible. If that doesn’t work, I’ve found a reference to creating a bootable Win7 (or any Windoze) runtime external USB disk, and maybe that will work. This is one I might have to dump on Ben.

We are playing tourist for the weekend. We went to the Big Mall, as nice and modern as any in the States, and then had drinks and dinner at the Bojo Beach Resort, a rustic but still quite beautiful site:

Tomorrow we are off to the slave-trader castles at Cape Coast.

I suddenly realize that my time here is more than half over, and I still haven’t accomplished all I came to do. So for Monday through Thursday, here’s my agenda:

  1. Spend more time with the residents, smoothing out their Merge experience
  2. Give more lectures to NM and Radiology residents
  3. Connect the NM gamma camera, a 2005 Siemens e.cam, to Merge PACS
  4. Work on the Macintosh problem above.
I could spend another 2 weeks on those alone. I also come to realize, however, that I’ll probably not have much reason to be asked back here, as by the time I would return, the staff will be better versed in the PACS than I am, and could probably teach me how to use it. I’m hoping there will be many more sites, assisted by Rad-Aid, that install Merge PACS, and I would love to be on site at go-live! I’m ready, willing, and able! That’s the joy of working part-time, right? 
In the meantime, I bid you good night from Accra. 

via Blogger http://ift.tt/2dZ13uV October 29, 2016 at 06:41PM

Preliminary Status

This morning, I spent an hour demonstrating Merge PACS to the residents and those attendings who were able to, well, attend. I went over some basics of the PACS, as well as a few of the more powerful tools, and everyone seemed to grasp very quickly what I had to offer. In particular, in working with several residents in CT and MRI, I found ALL were using the worklists as I had suggested. Wonderful!!! I was able to show those in the CT reading room the ease with with they could create 3D renderings. We tried this with both thin and thick data, and of course the thins gave the best result.

While watching the workflow, it became apparent that the residents aren’t the ones (generally) who mark the studies as “Read”, but rather the attending does so after review. I was able to make a button (a macro, really) that mimics the “Click study Read and go to Next” Checkmark, but marks the study as in “Preliminary” status instead. I think this fits the way things are done here. The only downside is that each individual user has to place this on the client under their own login, but that’s not too much of a problem.

Things are shaping up!

In the meantime, here are a few more shots of Korle Bu Teaching Hospital and environs:

Chest Clinic

Main Entrance (under renovation)

National Cardiothoracic Center

ATM “Farm” on Korle Bu Campus

Street scene outside the gates

via Blogger http://ift.tt/2eH704e October 26, 2016 at 06:37PM

Monday, Monday…

Korle Bu Courtyard

Our first daily report from Korle Bu!

We had a very good first day! (Well, Erin was under the weather in the morning, perhaps a reaction to her anti-malarial, but she recovered quickly and joined us after lunch.) We had a significant amount of hurry-up-and-wait in the morning. Ben, Mack (PACS/IT), Brian, and I made the trip back and forth to the Nuclear Medicine department several times, waiting on those we needed to see. We finally did connect later in the day. More on that shortly.

While not in transit, Brian and I spent the morning in the reading room with Ben and Dr. B., one of the residents. We were able to solve a few problems, and at least understand several more. Brian had mentioned the problem of multiple clicks required to close a study and mark it as read, and his discovery of the “check mark” button that would do this in one click. (One of those things we AMICAS users have known for years!) When working with Dr. B, we found that his checkmark was greyed out. After some experimentation and observation, we found that the button does NOT function if the study was opened via query and not from a worklist. Which brings us to the problem of them actually USING a worklist. Merge PACS has VERY powerful worklist creation capability. Basically, if you can conceive of how a worklist should look, it can be created. The downside is that as compared to the later versions 6.x, which we are still on back home, the level of complexity in crafting the darn things has increased considerably. I need to have a word with my friends at Merge on that! However, I think I have the hang of the new approach, and I was able to create a simple worklist, “Today’s Studies” without too many glitches.

I worked with Dr. B. for about an hour, showing him some of the tools within the Merge Halo Viewer, and he caught on very quickly. I think similar sessions with one or two of the residents (and attendings, and clinicians, and anyone else) would work best rather than try to answer everyone’s questions in a larger group. I would like to concentrate particularly on creating departmental worklists and more individualized hanging protocols. That could take my entire two weeks in and of itself.

I spent some time trying to install the Merge PACS client on Dr. B’s Windows 10 laptop, but without success. I was able to download an MSI from my server back home in Columbia, and I’ll try that tomorrow. Apparently no one has had any trouble with Win 7, and I was able to load Merge 7 onto my Mac running Win10 in Parallels, so it CAN be done.

Now, Erin will tell everyone about the developments within the Radiography Department, which I think are very exciting!

Erin: Very exciting. Thanks guys for making sure I as alright this morning. I am feeling so much better. I met Dr. O who is the Radiography Program Director and we had a great discussion. I donated the textbooks I had brought with me. I will be lecturing the Radiography students tomorrow at 9am on what our Radiography program is like in the States. Also, Dr. O is charged with trying to start more Radiography programs all over Ghana. I learned a lot about the status of radiographers in Ghana and will be lucky to speak to students tomorrow. I told Dr. O that it would be nice to have both of our sets of students interact with each other in the near future. I feel that we could all learn a lot from each other. Maybe even create “sister” programs with each other. Dr. O stated that he is trying to attend the RAD-AID conference on Nov. 5, which Brian and I will be attending also. I was intrigued to learn how similar our Radiography programs actually are. Hopefully the beginning of a wonderful relationship.

Me: I’ll close with a paragraph about our meeting (finally!) with one of the Radiation Therapy Docs. The two NM physicians are out this week, I believe, but may be back next week. I’ll be giving a talk to the NM residents on Friday. We discussed connecting NM to the Merge PACS, which she generally favored, particularly after we were able to get the client up and running on a laptop and demonstrate its capabilities. She had NEVER seen the PACS in action and was most impressed. (This thing sells itself!) We will, of course, need to defer to the NM Head of Department for approval before proceeding, but the actual connection should be straightforward. (Which I say whilst crossing mhy fingers.) We discussed as well a problem RT has had with importing planning CT’s into their TDS planning system,

OK, just one more little paragraph….Never commission someone who was once paid by the word…

The topic of rapid delivery of reports arose at several junctures. Without a functioning RIS, there are very limited options. Merge PACS does have a comment field built into the order window, and a separate voice-clip property. We use the latter to provide instant gratification for the ER docs, and it could work here. There may be a way to use a “print to DICOM” program to load the resident’s typed reports into the PACS as a separate series in the exam. It’s not optimal but… More on this as we go. Tomorrow we have a meeting with the residents…I’m not sure if I am to lecture them on PACS or on one of the other topics I’ve brought with, but we’ll see. In the meantime, Me ma wo adwo!

Brian: Migaso

Ben: You want to try some Twi already yeah.😉

Me: Did I say it right???😃

Ben:: You mean, did you post it right? Yeah, you did! Will be glad to hear you say that out loud!…😊

Me: I’ll need coaching or Mack will laugh at my Southern Accented Twi!

More to come….

via Blogger http://ift.tt/2eB0fhw October 24, 2016 at 07:05PM

A Quiet Day In Accra

Just a brief note…I spent most of the day at Dean’s Guest House, getting over jet-lag, and talking with my team members. Brian, radiologically-trained PACS administrator, has been here a week, and has had great discussions with the folks at Korle Bu. He’s made significant progress on a number of issues. Tomorrow, Erin, Radiology and NM technology educator , and I dive in and offer expertise where we can. My jobs will include working with Radiology residents, and with the Nuclear Medicine Department, primarily to get them more comfortable with their Merge PACS, and also to give a few lectures and work with them in any way the proves helpful. I’m hoping as well to be able to connect their gamma camera to PACS. Wish me luck!

Tonight, we went downtown to eat with Nathan, a former member of the Korle Bu staff Brian had come to know on a previous visit. The restaurant was fine (we had pizza of all things) but the cab ride from the ‘burbs (I think…I’m not very familiar with the town as yet) was fascinating. And frightening. And amazing. I’m reminded somewhat of Lima, Peru, where the traffic was actually much worse. There, stop-signs are treated as suggestions, and traffic-lights are ignored completely. Here in Accra, these things are obeyed, but traffic is still very wild. Merging is an exercise in combined trust, timing, and terror, but somehow between judicious use of horn and gas (and rarely the brakes), everyone gets where they are going.

Accra by night strikes me as somewhat similar to many towns in the Caribbean, but much larger, with more buildings, some very new and modern, some not so much. But what stands out to me more than anything else is the number of people on the sidewalks, on the streets, milling about. I’m sure they all have a purpose in mind, but I’ve never seen so many people just…there. It’s almost unnerving.  I’m sure I’ll understand the culture more by the time I return home.

In the meantime, may I wish you Me ma wo adwo, a good evening, in Twi, (the primary local, though unofficial, language here in Ghana.)

via Blogger http://ift.tt/2eXyRyz October 23, 2016 at 06:31PM

Agfa F***s Up

I am on the e-mail list for Agfa’s Daily Blog Update, and it often contains interesting information. But imagine my surprise when THIS came through this morning:

I immediately clutched my pearls to my ample bosom and experienced a bad case of the vapors. Such language!

Agfa immediately sent out an apology:

Our sincere apologies are in order. The first article in our daily blog update today was not appropriate. We strive to bring you a wide selection of relevant articles from around the web to promote thought, present new ideas, and offer insights into the ever-changing world of eHealth and Digital Imaging. We messed up today and let an inappropriate article slip through. We have removed it from our blog, but unfortunately, could not remove it from your inbox.

Can we thank all those who brought this to our attention and please continue to read our blog updates on a regular basis.

Please accept our apologies.

No harm done, guys. But no doubt, someone is going to get fired. At least no one said, “Pu**y”.

via Blogger http://ift.tt/2eFXfET October 19, 2016 at 11:09AM

Directions…

Wow. It’s been three months since I last checked in with you, my loyal readers. All 3 of you. As you might guess from reading my ranting over the past 11-plus years, I’ve been in the midst of a dilemma,  in this case trying to figure out what my future should hold. There are many directions to go, many options to consider, and many needs to satisfy. But I think I’ve got it. Finally.

To be totally honest, my basic instinct was to retire completely at the end of the year. Which was my intention last year, but somehow I stayed on. And I will indeed continue to work for another year, although I’ll cut back my weeks even more; in 2016, I will have worked 26 weeks, but in 2017, I’m planning on being in the saddle for only 22 weeks. That’s enough, I think. Rest assured, however, I’ll have my phone on and operational 24/7, so no one need worry about reaching me. No, I don’t charge for that extra service…

So why was this decision so hard? Do it or don’t, right? Well, it’s complicated, and there are many factors involved. Of all of them, the financial aspects are the most straight forward. Continuing to work keeps my (markedly lowered) salary coming in, and my health insurance is provided. Since Dalai, Jr. has a $36,000/year drug habit, that drug being Remicade, insurance is quite nice to have, and even our rather high-deductible plan would set me back almost as much as the Remicade if I were paying for it directly out of my pocket. No brainers, there.

Then there’s the mental stimulation. Being at the PACS station does keep me on my toes, with little time to squander on foolishness like blogs. Hopefully, with the downsized work-year, I’ll be a bit better. A three month hiatus is inexcusable.

And I must add that Mrs. Dalai was quite encouraging…of me getting my saffron-robed backside out of the house. “For better or worse, but not for lunch!” as she says. Quite often, in fact.

There were some negatives, of course. Here, I must be careful in my wording. If you choose to read between the lines, I cannot be responsible for what you assume I’m saying. Capisce? Much of my hesitation revolved around numbers. Mainly numbers of exams, read and unread, daily variance in consumptions of the numbers, numbers of things on exams I did not find, numbers of times I could not complete my interpretation of an exam all at once due numbers of others coming in my office, numbers of patients reading their own reports, etc., etc. Some of these problematic numbers could be cured by throwing greater numbers at them, but greater numbers come with greater costs, and in essence, this is not an option for the for the foreseeable future. So, I could either embrace the numbers or reject them. For one more (reduced) year, I’ll suck it up. After that…we’ll see.

You might recall my earlier post about Rad-Aid wherein I mentioned a chance to go to Ghana. I couldn’t make that trip, but I was given another chance to go, and so I shall! Watch this space for updates from Africa. My task (as team leader, no less, being the only physician on this particular expedition) is multifold. First and foremost, I will try to help with the local PACS, which thanks to a generous donation by IBM/Merge, is the same as our system. Actually, it’s a version ahead of ours, so I’ve had to try to learn that one a bit sooner than I had planned. Fortunately, the viewer component is pretty similar, but the worklist page is much more complex, allowing construction of some rather amazing worklists. I’ll still declare Merge PACS to be one of the more usable out there, and I’m sure the physicians in Accra can by now use it about as well as I can. But their system lacks one element, a RIS. As luck would have it, I gave this problem some thought when we put in our AMICAS PACS years ago, in this post from January, 2006, 10 (yes, TEN) years ago. My solution was to use PACSGear to scan a paper report and send the image to PACS as another series in the particular exam. One could also use one of several software apps out there (I cited Print2PACS back then) that would do the same thing with a digital document. Those ideas might work. It seems though that the residents in Ghana actually type their reports into a different computer, so I’m wondering if they could instead type into the PACS comment field. Much will become apparent when I’m on site. In the meantime, any ideas on this are welcome.

Rad-Aid is exploring a flying hospital concept, using not a 747, but an airship!

Sign me up for the first flight…

Let me end on a happy note. I had the opportunity to speak with a bunch of pre-meds at an event last week. Yes, that’s a good thing! These particular pre-meds were members of an honor-society, and were the cream of the crop. Based on some of my past experiences, remote and recent, I had expected a bunch of arrogant, socially-inept snowflakes, bleary-eyed from 20-hour days of study. I couldn’t have been more wrong. These kids (indulge me, I’m old) were enthusiastic, yes, but they were curious and introspective, well-informed, and interested in just what it is radiologists do. They had the proper balance of intelligence and humility. Their MCAT scores are no doubt high, but they maintain their humanity. In other words, they GET it. They have the instinct to be fine physicians, those to whom I would send my family and friends.

I feel more optimistic about the future of medicine than I have in a very long time.

One of those kids might become my doctor some day soon. Hopefully one of them will go into gerontology.

via Blogger http://ift.tt/2dDgdKy October 04, 2016 at 10:45PM