Medical device challenges and global priorities

Linnet, one of our Country Programmes Coordinators, travelled to the WHO in Geneva to attend the third Global Forum on Medical Devices. Here follows an account of her time there. 

The successful 3^rd World Health Organisation’s Global Forum on Medical Devices was held over three days in Geneva. It brought together over 600 delegates from around the world, including three THET representatives (Andrew Jones, Anna Worm and myself). The great thing about the forum is the variety of people who attend from Beninese biomedical engineers to representatives of UN agencies and the private sector all exploring how to improve the medical equipment ecosystem.

Anna ran an interactive workshop (Gradian Health and THET collaboration) on the role of BMETs in the Healthcare Technology Management lifecycle and presented new data that suggest the status of medical equipment in sub-Saharan Africa is more positive than most publications indicate. It was great to see so many backgrounds coming together to look at not just problems but solutions. The outcome of the workshop will be shared with the participants, and the presentation on African data is now available; click here to get a copy.

On Thursday, Andrew co-chaired two sessions, one on Human Resources and Medical Devices, where six abstracts were presented by LMIC representatives on collaboration and their experiences as BMETS in low resource settings and a plenary session with international partners sharing ideas and views.

Throughout the three days there were plenary sessions showing how the issue of medical devices is an intrinsic part of so many global health priorities from NCDs to Reproductive, Maternal Neonatal Child and Adolescent Health and looking at how medical device challenges effect these global priorities.

The collaborative feeling of the conference was reinforced by the messages from all corners of the world emphasising how we must all work together, from funders to government representatives, supranational organisations to the engineers on the ground, we all have a part to play. As one delegate from IFMBE (International Federation of Biological and Medical Engineers) said “partnerships are vital.” With so many challenges to overcome we need to all work together.

The global forum was a great chance to share experiences and lessons learnt from all over the world, and while each context faces its own challenges and different stakeholders have different priorities, there were great examples of innovations being showcased and it was clear that we could all take something from each other’s experiences. 

Linnet Griffith-Jones

Country Programmes Coordinator

THET 

Medical Equipment in Top Condition

Since 2011, THET with support from the UK Government’s Department for International Development (DFID) has been working with the Northern Technical College (NORTEC) to develop the first pre-service training course for Biomedical Engineering Technologists (BMETs).

In this blog, Chris Mol, a lecturer in Biomedical Engineering at NORTEC, celebrates the projects most recent successes and comments on the complexity of the tasks ahead.

At the end of 2016, our first cohort of Biomedical engineering technologists (BMET’s) in Zambia completed their final examinations. 

Every year from now on, some thirty new technologists will become available to improve the poor maintenance situation of the medical equipment in the country. We have also trained enough local BME lecturers to make this teaching program sustainable! Good reasons to be proud! Surely this will have a major impact on the availability of working medical equipment for patient diagnosis and treatment!

Well…maybe not. Whereas the presence of well-trained BMETs is a necessary condition, it may not be sufficient. When you think about it, what good can a BMET do in a hospital where a workshop or tools are extremely limited? Or where there is no substantial budget to purchase spare parts for repair? Or where spare parts purchasing procedures are so cumbersome that it may take up to one year to acquire these, even if a budget is allocated? Or where service and user manuals are available only in the Chinese language because they came as part of a business package and there are no regulations on local language documents? Or where donated equipment comes without adequate documentation and spare part provisions? Or where the local culture is to wait with repairing a piece of equipment until it is really broken, rather than doing preventive maintenance? Or where the status of the BMET is such that (s)he is supposed to sit in the cellar of the hospital, waiting for a phone call to come and fix a unit, rather than pro-actively managing the installed base of equipment in the hospital?

When you come close, the issue of good medical equipment appears to grow in complexity. Such is life! This is not a reason to despair and give up, but rather to remove our blinders and consider the total complexity (‘eco-system’) of the task at hand. 

Let’s appreciate the potentially limited but still crucial importance of our contributions and diligently hammer away at the next roadblock.  

Considering the crucial position of the Ministry of Health in managing local healthcare, support of local policy generation will be one of the focal points of our follow up actions. Another one will be to support process improvement activities in local hospitals and the support of a national BME Association to advance the profession. Only a broad and integral approach will, in the not too long  term, deliver bottom line value to the Zambian patients. Let’s do it!

Chris Mol
Lecturer in Biomedical Engineering
NORTEC, Zambia 

BMET training in Zambia: the money

As described in a previous blog, I am supported by THET to work at a Technical College in Zambia to train local students to become hospital equipment maintenance professionals. In this blog I want to share with you some of my experiences on what it means to be in what the ‘International Development’ world calls a ‘low resourced country’.

Training to become a Biomedical Technician is quite an expensive undertaking. The college is over 90% funded by the fees from students. The main fee is about 300 USD per term (900 USD/year).  On top of that come examination fees (100 USD/year) and housing fees (60 USD/term), for which you have a bed in a small room with two-four co-students plus some facilities. Altogether, that is quite a lot of money in a country where 60% of the population lives below the poverty line and 42% are considered to be in extreme poverty.

Chris Mol lecturing to BMET students.

Our BMET students are usually funded by their family. This includes not only parents, but also uncles, aunts and older brothers and sisters. It is very difficult for ‘older brothers’ with a reasonable income to save money or purchase a house while their (many) younger siblings still require education. These contributions are not considered a loan and won’t be paid back. Money is spent in the family where it is needed.

On top of family funding, many of our students have to work to earn money during their school terms as well as in between terms. The work they do is what they call piece work: washing cars, helping in building works, and whatever else they can find. The salary for this, as for gardeners and house maids, is in the order of 40 cents/hour, if you can find the work!

Students take notes during a lecture.

In this context it is not surprising that many students have little money left for anything that is not an absolute must. Most students do not have a computer and if they do, are dependent on the overloaded network at the college to get internet access. However, most of them do have a mobile phone which is frequently used. The cost of talking is about 10 cents per minute, but many schemes give cheaper access under certain conditions. Also, special offers for ongoing Facebook access are popular. 

Coming from a high resource country, it at first appears to be a good idea to help students by offering them loans to finance their studies or a computer, something that is currently not done by the government. But this becomes less attractive considering the near certainty that such loans will not be paid back, simply because students would not feel this as a strong moral obligation.  And a problem of gifts is to define where to begin and where to end and how to do this in a way that appears fair and does enable you to continue to be related to your environment in a ‘normal’ way.  The advice I am currently following is not to interfere in these matters and consider my teaching of the BMET course and the long-term improvements to healthcare graduates will make as the best contribution I can make.

Your comments are welcome at: chrisr.mol@gmail.com

Training the next generation of bio-meds

Chris Mol is a volunteer lecturer for THET’s BMET Programme. Here he describes his experience training the next generation of technologists in Zambia. 

I have now been working more than a year at, the Northern Technical College (NORTEC), in Ndola, Zambia. It has been an interesting year. This blog is to share my experiences and my enthusiasm for this attractive country and its friendly people as well as my findings on the world of medical equipment, which is so essential for modern healthcare.

This THET/DFID supported activity is based on a 2011 needs assessment in Zambian government hospitals which established that the medical equipment situation in the country was indeed quite poor.  Typically, only 50-65% of all medical equipment that is found in hospitals is functional. One of the root causes for this was found to be the absence of technical personnel who have been trained to repair medical equipment. No such training was available in the country.

Following up on this, THET has worked with the Ministry of Health as well as the Ministry of Education to set up a training course for Biomedical Equipment Technologists (BMETs). NORTEC, one of the leading Technology Colleges in Zambia, was selected as the training institute to implement this new curriculum. The BMET course is for a good part based on course modules that were already given at NORTEC, such as on electronics, mathematics, and computer skills. THET has supported NORTEC by installing a BMET workshop, acquiring 2^nd hand Medical Equipment for student practice, instruments/toolboxes and last but not least hiring and funding volunteer lecturers to present the Medical equipment specific lectures, this is where I come in.

NORTEC has now taken on 95 students, including 20 women, divided over the three years of the BMET curriculum. The first cohort will complete their studies at the end of 2016. THET is working with the Ministry of Health to ensure that new positions for BMETs will be created at the hospitals by 2017.

While working here at the College, visiting hospitals and talking to local experts, it has become clear to us that more needs to be done in the country to substantially improve the medical equipment situation. To have well-trained BMETs is certainly essential, but if the workshops at the hospital continue to be so poorly equipped, if the number of technical people in the hospital remains so limited (one technical person in a 700 bed hospital is common), if the procedures to purchase spare parts remain so cumbersome, only limited impact can be expected from well-trained BMETs.

Therefore, the THET focus is now moving from education only to also include hospital processes and decision making processes at the Ministry of Health. THET has acquired DFID funding to look further into these issues during 2016. It will be an interesting year. I will keep you posted. 

Working on equipment at Ndola Hospital, Zambia.