SUMMARY OF MEDICAL ENGINEERING IN AFRICA FORUM: REQUEST FOR VOLUNTEERS
The Forum was held in the excellent Calcot Manor Hotel Conference Centre courtesy of Richard Ball, Managing Director.
Thirty engineers, doctors and representatives from a couple of charities attended. The five speakers gave an insightful and varied view of problems they encountered whilst working in Africa, both from an engineer's and medical practitioner's perspective.
As the day progressed, there was plenty of opportunity for the attendees to discuss the issues raised; most of the assembled having had extensive experience of working on various projects in Africa.
A general theme emerged with a number of issues being highlighted by speakers and attendees; these can be categorised as follows:
1. Donations The shortage of equipment was generally not the problem; large quantities of equipment have been donated to African hospitals, however:
- It is often the wrong sort of equipment and is not suitable for the environment or skill levels of users, incorrect voltage etc.
- Equipment over-complicated and lacking spares
- Too many different types of equipment with no continuity
- No manuals / no spare parts
This was discussed at some length and WHO Guidelines for donations were mentioned http://www.who.int/hac/techguidance/pht/en/1_equipment%20donationbuletin82WHO.pdf
Hospitals are not in a position to refuse donations and find it very hard to ask for particular types of equipment. If they refuse a donation, the donor may perceive that they do not require help and will direct their activities elsewhere.
Two speakers highlighted this problem by showing photos of their store rooms packed with equipment which will never be used. One hospital had a large warehouse full of boxes of?. no-one knows what! As someone remarked, it was like the closing scene from Raiders of the Lost Ark when the Ark was boxed and hidden into a cavernous Government warehouse, presumably never to see the light of day again!
This raised another issue:
2. No Inventory Control or Planned Maintenance or Repair / Equipment Budget.
Most hospitals have no idea what equipment they have in stock, or its condition. Without inventory control there can be no collective plan for maintenance, provision of spares, training, manuals etc. Very few hospitals run computerised admin systems and purchasing involves a very torturous manual approach with many layers of control and management; which ultimately means that nothing gets purchased or, if it does, it arrives a year after the request. E.g. a tube for an anaesthetic machine - without which it won't work - could take months to replace; in which time the machine is unavailable for operators.
3. Quality of Tools - Quality of Cheap Imported Equipment.
Medical Engineer Dr. Keita (Ike) Ikeda also commented on the lack of decent tools to repair anything - citing that in Europe and America there are strict quality controls on all imports, but even then some of the imported Chinese tools are inferior. In Africa there are no controls on import at all, therefore Chinese manufacturers flood the markets with very inferior tools. Ike cited socket sets and spanners with 2mm variations and poor quality steel - this leads to bolt heads being stripped making repairs more difficult. Extension cables, plugs, power tools etc. are often very inferior and, at times, very dangerous.
Equipment sourced from emerging markets such as China and India is very often made out of cheap materials such as low grade plastics that fracture easily and are impossible to repair.
4. Lack of Money for Training Care.
Dr Lucy Obolensky gave a thought provoking lecture on her experiences with the Kenya Orthopaedic Project pointing out that the leading cause of death worldwide was trauma and not Aids, malaria or diarrhoea, although all of these receive more help from donor countries than provision of trauma care. Lucy found there was a considerable difference in the approach of the small local hospital she worked at, where they meticulously looked after their operating equipment, and the large Mombasa hospital where they did not bother fixing equipment.
5. Lack of Trained Staff and Medical Engineers
All speakers referred to the lack of trained engineers; there were several issues related to this that contributed to the problem.
- No budget within large state-run hospitals to train staff and no perception of need - if it doesn't work just leave it.
- Very few courses for engineers to take at local universities and a shortage of experienced medical engineers to teach students.
- European trained engineers prefer to leave their country to work in the US or Europe for more money, better facilities etc.
Conclusion and Proposals
Although the problems in Africa are immense they are not insurmountable.
1. African Governments must get more involved in equipping their state hospitals. Huge donations are given by the EU to countries such as Uganda - but the money often does not find its way into point of service healthcare.
2. Donors should try to talk to the countries Ministry of Health and involve them in the decision making. Donations must be targeted and donors must liaise with hospitals to discuss what they actually need, maintain and use. Often, training on use and maintenance is more useful than actual donations.
3. Supporting infrastructure is essential - reporting faults, equipment, inventories, effective sourcing of spares, training, making a small budget available for repairs etc.
4. Training - we discussed at some length the provision of training. Kyambogo University has asked the Amalthea Trust to support a training programme for medical engineers This has large benefits:
- Training locally will mean that more engineers will stay in the country - in particular as by sponsoring the course The Department of Health recognises the importance of providing posts for their own graduates.
- Initially, UK and US engineers will be required to provide practical training to the students. The Amlathea Trust is in negotiations with Kyambogo to support this over 3 years.
- If the Kyambogo University course is a success this could be replicated at other University / teaching hospitals across Africa.
- We discussed the provision of an NVQ type certification for the element of training provided by visiting technicians.
Database of Medical Engineers and Projects.
The Amalthea Trust would like to maintain a database of medical engineers willing to work in Africa, which could be used by doctors, charities etc. that require help. The database would also be useful for medical engineers travelling to a new country who need practical advice from people who know the environment and culture. Similar charities and hospitals can post requests for help for their particular projects.
The Amalthea Trust will actively encourage engineers to participate and support engineers with funds towards air fare and living expenses.