CCIH Biomed Capacity Building for Mission hospitals

2. CCIH Biomed Capacity Building for Mission hospitals

3. NEED

4. 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.

5. WHO has documented that “50% of medical equipment(in developing countries) is not in use” Found in: *        Maintenance of Hospital Equipment, 21st Meeting of PAHOExecutive Committee of the Directing Council, Washington D.C., 9-10December 1993, SPP21/4, 8 November 1993*        Investing in Health, World Development Report 1993, chapter 6on Health Inputs, p 134-155, World Bank, 1993*        Health Care Equipment: A WHO Perspective, by A. Issakov, inMedical Devices: International Perspectives on Health and Safety, editedby 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"

6. 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

7. 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 we’ve 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.”

8. Mother hand venting her child Upstairs is room full of inoperative ventilators

9. 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 we’ve 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.”

10. 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?

11. Not knowing how to use it New x-ray machine-has never been used. Why? Staff received no training on how to use it

12. 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

13. 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.

14. NEED TRAINING TECHNICIANS

15. Medical Equipment TrainingEmpowering Nationals to Help Their Own Communities Providing tools, test equipment and service manuals Providing instructors to teach electronics and medical equipment repair to hospital maintenance workers Empowering healthcare facilities with self-sustainable solutions Teaching valuable skills to improve healthcare

16. Course Outline Mod 1 & 2 • 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 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

17. 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

18. 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

19. Active areas for IA 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 • 11th 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

20. 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

21. 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 India

22. 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 Indonesia

23. 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

24. 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

25. Correspondence Courses • - 7 students enrolled • 4 countries benefiting • Chile • Guatemala • Haiti • India • Conducted via e-mail and ftp file transfer

26. MET Global Impact Kosovo Ghana Haiti Honduras Philippines Guatemala Chili India Indonesia 540 Students have participated 248 Technicians graduated from MET course 312 Hospitals have in-house biomed technicians 26 Countries have benefited

27. NEED TRAINING TECHNICIANS TRAINING ADMINISTRATORS

28. Advanced Medical Equipment Management A Presentation to CCIH May 25, 2008 A Program for Health Reform

30. 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

31. A Proposed Solution to Improve Hospital Productivity & Cost Efficiencies… International Aid’s Advanced Medical Equipment Management Program To improve health care delivery through professional equipment management for medical equipment

32. 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

33. Support Systems • Equipment Inventory System • Preventive Maintenance System • Equipment Management Info System • Equipment & Technology Acquisition System

34. Process • 2-3 year process • Assessment & Inventory • Baselines • Training Events (MET & AMEM) • Systems Development /Installation • Establish Repair Centers • Evaluation (Measurable Results)

35. Benefits • Increased saved lives from proper equipment operations • Cost Savings from more efficient equipment operations for allocation to Primary Health Care • Sustainable Operations • Professionalized hospital equipment management

36. FUTURE DIRECTION NEED TRAINING TECHNICIANS TRAINING ADMINISTRATORS

37. 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

38. 2009-11 Plans Honduras Ghana East Africa Philippines South America Indonesia • 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

39. Other Possibilities Iraq China Haiti Indonesia • 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

40. QUESTIONS ?