CCIH

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CCIH Biomed Capacity Building for Mission
hospitals
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NEED
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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.

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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"

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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

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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.

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

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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?

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

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NEED
TRAINING TECHNICIANS
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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
Teaching valuable skills to improve healthcare
Empowering healthcare facilities with
self-sustainable solutions
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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

• 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

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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

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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

• 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

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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

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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

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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

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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

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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

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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

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Correspondence Courses

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

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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
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NEED
TRAINING TECHNICIANS
TRAINING ADMINISTRATORS
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Advanced Medical Equipment Management

• A Program for Health Reform

A Presentation to CCIH May 25, 2008
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(No Transcript)
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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

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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

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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

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Support Systems

• Equipment Inventory System
• Preventive Maintenance System
• Equipment Management Info System
• Equipment Technology Acquisition System

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Process

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

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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

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FUTURE DIRECTION
NEED
TRAINING TECHNICIANS
TRAINING ADMINISTRATORS
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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

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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
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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
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QUESTIONS
?
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