What is the condition of the equipment well meaning donors have sent to mission hospitals or that hospitals have purchased? Estimates vary from 40 to 90 % of medical equipment shipped to hospitals in developing countries is inoperative at any given time, some of which has never worked after arrival.
WHO has documented that 50% of medical equipment (in developing countries) is not in use Found in: * Maintenance of Hospital Equipment, 21st Meeting of PAHO Executive Committee of the Directing Council, Washington D.C., 9-10 December 1993, SPP21/4, 8 November 1993 * Investing in Health, World Development Report 1993, chapter 6 on Health Inputs, p 134-155, World Bank, 1993 * Health Care Equipment: A WHO Perspective, by A. Issakov, in Medical Devices: International Perspectives on Health and Safety, edited by C.W.D. van Gruting, p. 3-5, Elsevier, 1994 * Service and Maintenance in Developing Countries, by A. Issakov, in Medical Devices: International Perspectives on Health and Safety, edited by C.W.D. van Gruting, p. 21-38, Elsevier, 1994 * Better Health in Africa: Experience and Lessons Learned, chapter 7 on Infrastructure and Equipment, p. 98-108, World Bank, 1994"
Some of the reasons that at least 50% of equipment is inoperative Lack of maintenance Lack of spare parts Equipment is too sophisticated Medical staff do not know how to use it Equipment shipped in as-is condition and not properly prepared for use overseas
Lack of Maintenance: E-mail received April 28, 2008 My name is Andreas Andoko. I'm the superintendent of the Imanuel Baptist Hospital in Bandar Lampung, Indonesia. As a former missionary hospital we have many medical equipments that weve had since the hospital was founded. Many of them discontinued (taken out of service) since: (1) we couldn't repair (2) we couldn't find the spare parts (3) Buying new is too expensive for us. Because of this our medical services to the public has to decrease. In Indonesia more than fifty former missionary of Christian hospital that have same problem with us.
Mother hand venting her child Upstairs is room full of inoperative ventilators
Lack of Spare Parts: E-mail received April 28, 2008 (less than one month ago) My name is Andreas Andoko. I'm the superintendent of the Imanuel Baptist Hospital in Bandar Lampung, Indonesia. As a former missionary hospital we have many medical equipments that weve had since the hospital was founded. Many of them discontinued (taken out of service) since: (1) we couldn't repair or (2) we couldn't find the spare parts (3) Buying new is too expensive for us. Because of (the above) our medical services to the public has to decrease. In Indonesia more than fifty former missionary of Christian hospital that have same problem with us.
Difficulty finding and purchasing repair parts Acquiring parts is the number one difficulty all developing world technicians face Example: My name is Carlos Amaral. I am biomedical engineer from Mercy Ships. We are starting one project to train and support West African Hospitals in the biomedical field. One of the ideas is to help with the acquisition of parts. Could International Aid help us to purchase such items?
Not knowing how to use it New x-ray machine-has never been used. Why? Staff received no training on how to use it
Not knowing how to use it: A very nice ultrasound that has never been used. Why? Staff received no training on how to use it
Equipment shipped As-is When new or used medical equipment is sent to a mission hospital without checking it out to make sure everything works Equipment shipped without making all necessary repairs Equipment shipped without preparing it to work on the electrical power in that country Equipment left for the hospital to figure out installation requirements and other details on their own.
Medical Equipment Training Empowering Nationals to Help Their Own Communities Teaching valuable skills to improve healthcare Empowering healthcare facilities with self-sustainable solutions Providing instructors to teach electronics and medical equipment repair to hospital maintenance workers Providing tools, test equipment and service manuals
Course Outline Mod 1 & 2 MODULE I IA – Maintenance Management –Maintenance Philosophy –Planned Preventive Maintenance –Inventory Control –Electrical Safety Practices –Standards and Regulations –Networking IB – DC Electricity –Magnetism –Electrical Circuits –Ohms Law –DC Components –Troubleshooting Theory IC – Equipment Troubleshooting I –BP Apparatus –Sterilizers –Microscopes –Suction Pumps –Oxygen Equipment MODULE II IIA – Shop Practice Hand Tools, Care and Safe Use Soldering and Desoldering Welding Shop Safety IIB – AC Electricity AC Waveforms AC Test Equipment Voltage Dividers Power Calculations AC Components Transformers AC Power Production & Delivery IIC – Equipment Troubleshooting II Eye Equipment Dental Equipment Respirators and Ventilators
Course Outline Mod 3 & 4 MODULE III III A – Medical Education Anatomy & Physiology Medical Terminology III B – Solid State Devices Diodes Transistors Amplifiers Vacuum Tubes Reading/Extracting Circuit Diagrams III C – Equipment Troubleshooting III Electrosurgical Units Physical Therapy Equipment MODULE IV IV A – Radiation Theory & Practices Radiation Safety X-Ray Physics Film Production & Developing X-Ray Quality Control IV B – Circuit Reading & Troubleshooting Circuit Reading Troubleshooting Build Power Supply IV C – Equipment Troubleshooting IV Mobile and Stationary X-Ray Machines Single phase, 3 phase & high frequency generators High Voltage Transformers X-ray Tubes and Collimators Tables and tube stands V D – Instructor Training Writing Lesson Objectives Using Audio Visual Materials Conducting Evaluations
Course Outline Mod 5 & 6 MODULE V V A – Basic Laboratory Technology Role of Laboratory in Diagnosis Blood & Body Fluids Blood Typing V B – Motors, AC and DC Common Problems and Solutions Control Systems V C – Digital Fundamentals Logic Gates Microprocessors Microcontrollers V E – Equipment Troubleshooting V General Laboratory Equipment Colorimeters Spectro and Flame Photometers Centrifuges Autoanalyzers MODULE VI VI A – Biomed Computer Applications Electronics Workbench Software Hospital Equip. Management programs On-line Courses Internet Search Techniques for technical information VI B – Advanced Troubleshooting Electrocardiographs Cardiac Monitors DC Defibrillators Patient Care Equipment Pulse Oximeters VI C – Equipment Troubleshooting VI Diagnostic Ultrasound Monitors Fetal Monitoring VI D – Supervised Work Experience Medical Computer Technology Cardiac equipment
Ghana How did we get there? - MET program began in Ghana in 1998 What have we accomplished? - 140 students have participated -86 students have graduated -11 th class will begin June 2 (45 students approved) - 13 countries benefiting to date (Cameroon, Chad, Dem Rep of Congo, Ethiopia, Ghana, Kenya, Liberia, Nigeria, Sierra Leone, Togo, Uganda, United Kingdom and Zimbabwe) - 4 graduates have participated as instructors -Will be certified by Ghana Education Service in July 2008 Active areas for IA
Honduras How did we get there? - MET began as a Development Project after Hurricane Mitch What have we accomplished? - All lectures and training materials are in Spanish - 111 students have participated - 72 students have graduated -New class of 23 students began May 5 Active areas for IA
India How did we get there? - Rotary International Matching Grant What have we accomplished? - Program ran from 1999 to 2000 - 19 students enrolled - 10 hospitals benefited in India - 21 hospitals benefited in Nepal Active areas for IA
Indonesia How did we get there? - In response to Dec 2004 Earthquake and Tsunami What have we accomplished? - Medical Equipment Service Center opened Nov 2005 -MET training began September 2006 -All lectures and training materials in Indonesian Bahasa -57 students participated Active areas for IA
Kosovo How did we get there? - MET began in 2001 after NATO bombing What have we accomplished? - New training facility set up and equipped - All materials translated into Albanian - 45 students participated - 43 students graduated - 6 hospitals received new biomed workshops Active areas for IA
Philippines How did we get there - 2001 Rotary Foundation 3-H grant What have we accomplished? - 192 students participated - 47 students graduated - 26 students enrolled in MET Extension - 3 colleges now use MET curriculum for training programs - Certified by Technical Education & Skills Development Authority Active areas for IA
Correspondence Courses - 7 students enrolled - 4 countries benefiting Chile Guatemala Haiti India -Conducted via e-mail and ftp file transfer
MET Global Impact Kosovo Honduras Ghana Indonesia Philippines India 540 Students have participated 248 Technicians graduated from MET course 312 Hospitals have in-house biomed technicians 26 Countries have benefited Guatemala Chili Haiti
NEED TRAINING TECHNICIANS TRAINING ADMINISTRATORS
Advanced Medical Equipment Management A Program for Health Reform A Presentation to CCIH May 25, 2008
The Need Hospital operations not working at peak efficiency levels Dependence on foreign consultants & repair services Drain on foreign currencies Compromises quality & effectiveness of healthcare
A Proposed Solution to Improve Hospital Productivity & Cost Efficiencies… International Aids Advanced Medical Equipment Management Program To improve health care delivery through professional equipment management for medical equipment
Hospital Equipment Management Training One Year – Learn & Do Quarterly 1 week learning events 4 Modules (one per quarter) In partnership with World Health Organization and Pan American Health Organization
Support Systems Equipment Inventory System Preventive Maintenance System Equipment Management Info System Equipment & Technology Acquisition System
Process 2-3 year process Assessment & Inventory Baselines Training Events (MET & AMEM) Systems Development /Installation Establish Repair Centers Evaluation (Measurable Results)
Benefits 1.Increased saved lives from proper equipment operations 2.Cost Savings from more efficient equipment operations for allocation to Primary Health Care 3.Sustainable Operations 4.Professionalized hospital equipment management
NEED TRAINING TECHNICIANS TRAINING ADMINISTRATORS FUTURE DIRECTION
How is International Aid planning to build Biomed capacity worldwide? Spread Biomed training faster and farther Institutionalization – Partner with public universities and technical schools Such instructors are already trained in pedagogy and electronics Focus training on teaching biomed applications Curriculum-In-A-Box (for trained instructors) Sustainability – Tuition funded: Partner schools will offer the course as a part of their regular curriculum
2009-11 Plans Honduras Ghana Indonesia Philippines Advanced Medical Equipment Management (AMEM) training planned for Ghana, Honduras and the Philippines New MET program planned for East Africa (Uganda or Kenya) and South America East Africa South America
Other Possibilities Haiti Indonesia China PCUSA & MBF – Interested in Haiti MET 80 Catholic hospitals and 60 Protestant hospitals want Indonesia MET China Medical Foundation interested in MET Iraq MET - on hold until security improves Iraq