Who says you need buckets of cash and huge government bureaucracies to make a profound difference in the standard of living for people in developing countries?
A handful of dedicated Duke undergraduate engineering students, with support from the GE Foundation, will later this year initiate an educational program in Rwanda that could have a significant impact on the health of this nation’s 8.5 million people.
Their approach doesn’t make use of the latest gee-whiz technology or the newest pharmaceuticals.
It’s a lot simpler than that.
Past and current Pratt School of Engineering students, guided by Robert Malkin, director of Duke-Engineering World Health, are in the final stages of developing a curriculum to teach local technicians how to repair and maintain existing equipment and those donated by GE.
While Rwanda is slowly emerging from the ravages of a devastating civil war, it still suffers from a severe lack of doctors, nurses and biomedical engineers to keep the health care system running. In fact, there isn't even a school to train biomedical engineers or biomedical engineering technicians in the country.
“In many health care settings in the developing world, a broken x-ray machine or ventilator can have a dramatic effect on the health of patients,” Malklin said. “And so conversely, making sure this equipment is functioning can often make the difference in whether or not a patient gets treated.”
The story begins with the Duke-Engineering World Health Summer Institute program, which sends Duke and other engineering students to assignments overseas with the main mission of helping technicians and heath care workers keep their medical equipment in good working order. Like medical McGyvers, these students use their ingenuity and scavenging skills to help technicians keep these machines running.
Alison Keane, BME ’09, spent the summer of her junior year on an EWH Summer Institute trip to Tanzania, where she worked in a large full-service, government-run hospital with 300 beds. She helped in the maintenance and repair of such items as suction machines, blood pressure monitors, lighting, bedside monitors, nebulizers and incubators.
“When we’d fix something, whether in Tanzania or somewhere else, we’d keep track of the problem and how it was fixed,” Keane explained. Keane, and classmate Jenna Maloka, BME ’09, later sorted through more than 3,000 repair records to determine what knowledge or expertise was needed to fix each piece of equipment.
“One of the more interesting things we found was that people had assumed that equipment was not being fixed because of a lack of spare parts,” Keane explained. “However, we found that about 72 percent of the machines could be brought back to working order without the need for new parts. With the exception of some of the electrical work, most of the fixes were relatively simple.”
These and other findings led the group to believe that training would be an effective approach to the problem.
Sisters Mhoire and Kathleen Murphy, both BME ’09, and now Marian Dickinson, BME’10, took the data and analysis and began to develop a curriculum to guide local technicians in fixing the most common problems they encountered. They concluded that 107 different skills could handle the bulk of the problems. These skills ranged from patching pipes and tubes to strategies for replacing fuses when the exact match is not available.
All of the 107 skills have been grouped into 6 different general areas of focus, or modules, such as power supplies, installation, motors, electrical, mechanical and user training.
“When we write the modules, we have to assume that the person reading may not understand every concept in the process,” Dickinson explained. “So we have to write them simply, with each step broken down completely. It’s a lot more challenging that you think.”
The first batch of modules are written. The team hopes to have all the modules completed by the end of summer. Each local technician to be trained will attend two sessions per year covering many modules per session. After three years the training will be completed and it is expected that a number of these “graduates” will return to teach modules to successive students, making the program self-sufficient in terms of instruction.
The GE Foundation will fund the training of a biomedical engineering technician for each of the more than 200 hospitals and clinics in Rwanda.
“I’m very excited about the rollout in Rwanda – I didn’t think it would happen this quickly,” Keane said. “We thought it would take longer to get funding. I am proud of the fact that this was largely an undergraduate effort, and that something I spent so much time on will be helping people.”
Malkin is in discussions with the Center for Disease Control and Prevention to establish similar training programs in Ethiopia and Mozambique.