Why computed tomography is needed in Papua New Guinea.

EDITORIAL Why computed tomography is needed in Papua New Guinea Computed tomography (CT) was introduced in the 1970s and rapidly transformed diagnostic imaging, especially in neurology and neurosurgery. Direct images of brain pathology could be seen and therapy could be precisely directed to the pathology. As a result of more accurate diagnosis, the mortality of various conditions began to fall. For instance, the mortality of brain abscess fell from >40% before CT to approximately 10% following its introduction (1,2), and the mortality from severe head injuries fell from 60-80% to 20-30% in specialized centres (3,4). The priorities of health care for Papua New Guinea (PNG) are preventive health and primary health care. However, specialist medical services are also a necessity. There are well-organized specialist services in the hospitals of PNG and this results in improved health outcomes for many PNG citizens. PNG has self-sufficiency in the training of medical and surgical specialists. The first author (WMK) is the first national surgeon to train and qualify in neurosurgery. Many brain disorders can potentially be treated in PNG (5), but the absence of CT scanning makes this very difficult. There are strong arguments for the acquisition of CT imaging for the Port Moresby General Hospital (PMGH), which is the principal referral centre for neurological disorders in Papua New Guinea. The people of PNG are becoming increasingly aware of health issues and what treatments are available internationally and increasingly are demanding access to CT. The risk of litigation may also increase without the support of CT-guided diagnosis. The sole CT scanner for PNG is a private scanner in Port Moresby but this is clearly inadequate to meet the health needs of the whole population. It is inaccessible to most patients because of distance and cost. We have seen many families borrowing heavily and entire villages using valuable income to pay for a private CT scan. It is also impractical and dangerous to transport sick patients from PMGH to another hospital for CT scanning. CT scanning and now magnetic resonance imaging (MRI) are the key to modern diagnosis and treatment in neurosurgery and neurology. Most pathology in the brain is not adequately diagnosed by the present diagnostic modalities in PNG such as ultrasound, plain X-rays and angiography. CT scan is required to diagnose life-threatening mass lesions such as abscess, haemorrhage and tumour. These lesions can then be treated by the appropriate surgery. Neurosurgery is …