By: Rati Bishnoi, Special Projects Intern
Two reasons—a lack of spare parts and too few highly trained technicians—are often cited as the causes of large numbers of out-of-service laboratory and medical equipment across the developing world. As a result of broken equipment, already burdened health systems find it increasingly challenging to accurately diagnose and treat patients.
This obstacle is particularly alarming as 2015, the deadline for achieving the Millennium Development Goals (MDGs), looms on the horizon. Strong, functioning health systems are essential to reaching the MDGs, and MDG 5 in particular. With this in mind, Duke University researchers from Robert Malkin’s Developing World Healthcare Technology Laboratory set out to better understand the problem of unused or underutilized medical equipment in developing countries.
Researchers found that the problem of broken equipment had much less to do with hard-to-find parts and much more to do with gaps in basic knowledge to repair equipment than previously thought. Specifically, researchers studied 2,849 equipment repair requests, most of which were for out-of-service medical equipment, from 60 resource-poor hospitals in eleven African, European, Asian, and Central American countries. Nearly three-quarters, or 72 percent, of the medical devices were successfully repaired without importing spare parts, and 99 percent of successful repairs required knowledge related to one of six technical areas: electrical, mechanical, power supply, plumbing, motors, and installation or user training. In particular, a majority of repairs (66 percent) required only basic knowledge of the six domains as demonstrated by 107 specific skills. According to the researchers, this was “far less knowledge than that required of a biomedical engineer or biomedical engineering technician.”
Armed with these new insights, the Developing World Healthcare Technology Laboratory partnered with Engineering World Health and developed a curriculum for biomedical technician that is now being implemented in Ghana, Rwanda, Honduras, and Cambodia. The three-year Biomedical Equipment Technician (BMET) program, which is funded by the GE Foundation, pairs classroom instruction with periods of experiential learning and promotes the long-term objective of increasing the “in-country capacity for the maintenance and repair of medical equipment.” For example, at Korle Bu Teaching Hospital in Accra, where the BMET program is offered with the help of the Ghanaian ministries of health and education, sessions focus on repairing and maintaining:
- Sterilization, suction, and blood pressure machines;
- Oxygen and respiratory systems, ventilators, and anesthesia machines;
- Cardiac and monitoring systems;
- X-ray equipment and peripherals;
- Clinical laboratory equipment; and
- Other equipment, such as generators.
To improve effectiveness, the curriculum also reflects the general experience level of participating technicians. For example, the training courses offered in Ghana and Honduras are more advanced because most technicians already possess some training, while those in Rwanda are given introductory training as well. In addition, newer iterations of the program offer courses in the afternoons, evenings, and weekends to accommodate the schedules of practicing technicians.
The BMET trainings are also enhancing the ability of technicians to improve newborn health. For example, in a training offered in Honduras last month, students were taught about fixing infant incubators, infant warmers, and bili lights. The session also provided instruction on technical vocabulary specific to neonatal equipment and interpreting medical equipment manuals.
Although the number of students so far is small, the BMET program is critical for saving lives and improving health now and in the future. Ultimately, the training seeks to help establish a cadre of technicians, who can create learning networks and professional associations to keep building capacity and knowledge. The innovation and information-sharing demonstrated by the BMET program is a profound demonstration of the power of investing in capacity-building, and of the resulting returns for communities and nations that deserve quality health care.
Flickr photo by: MikeBlyth