Between June 14th and August 16th 2015 I took part in the Engineering World Health Summer Institute. This was an opportunity to study and work in Northern Tanzania, and to put my engineering skills to use with hospital equipment. The first month was education and training, followed by one month working in a hospital repairing equipment and conducting assessments.
The program sets out to tackle some of the issues that come with the masses of mainly donated, often inappropriate equipment flowing into less economically developed countries like Tanzania. This is an issue I first became interested in specifically after it was a recurring theme at an IET conference on affordable healthcare technology that I attended in 2014. Having previously worked with Engineers Without Borders UK and for a design consultancy developing medical devices, it was an appropriate step to combine the two specialisms.
For the first month I lived and studied in the town of Usa River. Each afternoon, Monday through Thursday I participated in lectures and laboratory sessions run by Engineering World Health staff at the Training Centre for Development Cooperation. These provided an overview of the most common medical equipment found in developing countries. Because most equipment is donated, it comes from a range of locations and time periods, and the course sensibly focussed on the general operating principles and universal troubleshooting techniques. EWH are experts in this field, having produced a large amount of academic research with Duke University.
In the mornings I had language tuition in Swahili. In Tanzania, English is used for secondary and further education, as well as scientific work, but almost all everyday life is conducted in Swahili. This was initially a major point of apprehension for me: I learned French and German at school but never particularly excelled nor enjoyed the lessons. Fortunately I found learning Swahili to be a completely different experience, primarily because every new piece of vocabulary and grammar made my everyday life easier, whether interacting with staff at the centre or with my homestay family. It also proved invaluable during the second month hospital placement. This positive experience has definitely changed my outlook on learning new languages and working in countries where English isn’t widely spoken.
On Fridays during the first month I worked at Mt. Meru hospital in Arusha, under the guidance of the Engineering World Health Instructors. This drove home the challenge: broken equipment with no service manuals, mismatched power supplies, no spare parts. It was here that I repaired my first pieces of equipment: blood pressure cuffs; a wheelchair and an operating table. In particular the operating table was characteristic of the repairs we would undertake in the second month. A lot of messy disassembly of the hydraulics to work out the underlying principles was step one. Once the problem was identified we had to come up with a solution with what we had access to. Eventually after much experimenting car brake fluid proved a suitable replacement for hydraulics and we were able to repair the bed.
During the second month I worked full time at Mawenzi Regional Referral Hospital in the city of Moshi. Here my main responsibilities were to maintain and repair equipment, conduct an inventory and to complete needs assessments. My partner and I decided to also produce a report for the hospital management and Engineering World Health as we identified many areas where small improvements could be made with significant results.
In total we worked on 52 pieces of equipment. 40 pieces of equipment were repaired and 12 were not repaired. Repaired equipment included an oxygen concentrator, suction machines, nebulizers, blood pressure machines and a centrifuge. The majority of repairs were mechanical and some were electrical. We also produced an inventory of 198 pieces of equipment, covering most of the hospital.
One of the key challenges was negotiating the hospital management structure and bureaucracy, in order to gain access to broken equipment. As the hospital has many volunteer medical students who generally are there to learn, there is a dim view of what volunteers can accomplish and building trust was essential. This was a key reason why the Swahili lessons were so helpful. At the start of the first week we were able to introduce ourselves at the clinical meeting in Swahili, which built a huge amount of good will. We also learned quickly that authority was very important at the hospital and asking the right people was essential, though often difficult.
We made many fixes, but one of the more complex was an oxygen concentrator. We received a broken oxygen concentrator which could switch on, but ran very loudly. Typically in a western hospital an oxygen analyser would be available to test the machine, but we obviously did not have one and needed to improvise a solution. We used a glass bottle as a fixed volume of gas and timed how long a lit candle would burn, first with regular air and then with the outlet gas from the concentrator. As the candle burned far longer in the outlet gas, this indicated that the concentrator was working, albeit noisily. We identified the issue was a missing sound suppressor from one of the inlets. With no spare parts available we were able to jury rig one using a small medicine bottle packed with gauze, with rubber tubing expoxied as inlets and outlets. Consultation with the doctors established this was suitable and we were able to return the machine to service. Most repairs continued along similar lines.
We recognised many of the difficulties we had were also applicable to the engineering technician at the hospital, and had potentially simple solutions. As we were keen to document our work, we chose to produce a report. We presented our findings and key recommendations at a meeting with the biomedical engineer, doctor-in-charge, supplies officer, head matron and head administrator. If you’re interested in reading the full report please get in touch.
The experience of working with Engineering World Health and at Mawenzi Regional Referral Hospital was extremely valuable. My knowledge of hospital equipment and their workings has deepened, giving me a much better understanding of their operating principles. Seeing how the machines failed once taken out of pristine hospitals brought home the considerations needed when designing systems for developing countries, and this is something I will take forward into future design work. I am in the process of applying to become a coordinator on the same program next summer, which if successful will be the first paid engineering for international development work I have undertaken after 4 years of volunteering.
In the long term I hope to work on the design of medical equipment with developing countries in mind, where the experience of the Summer Institute will be invaluable.