By Matt Skoufalos
Internist Sue Abkowitz Crawford has practiced medicine in many remote parts of the world for much of her professional career. She and her husband Glen Crawford, an orthopedist, started volunteering overseas in Tanzania after finishing medical school.
Sue Crawford said the pair fell in love with the idea of volunteering and were quickly swept up in the work. Conditions they’d never seen in the United States – cerebral malaria, arrow wounds to the chest – were presented in hospital conditions under which they’d never practice back home. She described it as “a lot of innovation, jury-rigging, and flying by the seat of your pants.” Nonetheless, stepping into the Kilimanjaro Christian Medical Center (KCMC) in 1985 was an eye-opener.
“They had nothing there,” Sue said. “They were reusing gloves and hanging them up dry, autoclaving them in newspaper. They were even reusing IVs there. It was an eye-opening experience.”
After completing their internships and residency work at Beth Israel Hospital in Boston, Massachusetts, the couple was back on the road with the nonprofit Health Volunteers Overseas. For the past 30 years, the couple has done so much work overseas that Sue Crawford considers her part-time hospital position in Portsmouth, New Hampshire a side job that supports her volunteer habit.
Becoming parents didn’t slow them down, either. They visited Indonesia with a 3-year-old and a toddler. In 1994, they entered Bhutan when the insular nation was only admitting as many as 2,000 global visitors a year; while there, Glen was the only orthopedic surgeon and Sue one of only three internists in a nation of 800,000 people.
Every other year, the Crawfords took two months off from practicing and traveled somewhere else: South Africa, Ethiopia, Tanzania, Vietnam. They’ve been back to KCMC often; Glen began a teaching program, Orthopedics Overseas, there. Today, the facility houses a medical school, a residency program, and regularly receives the infrastructure support necessary to elevate the standard of care there, not least of all due to their efforts.
“You’re constantly improvising and jury-rigging and reusing,” she said. “That’s what attracted me to IMEC.”
Fifteen years ago, Sue Crawford joined the International Medical Equipment Collaborative (IMEC) of North Andover, Massachusetts as its medical director and the coordinator of its African projects (in addition to being a veteran world traveler, she’s also conversant in Swahili and French). She didn’t pick up the position to have something to occupy her time, but rather because she appreciated the agency’s “intense commitment to quality and completeness.”
“We send refurbished medical equipment to facilities in developing countries all over the world, from small rural clinics to large referral teaching hospitals, and everything in between,” she said.
IMEC boasts “a very specific project process,” Crawford said, which begins with rigorous identification of a project location and “project shepherd,” its institutional term for an in-country non-governmental organization (NGO) with which to partner. Through the shepherd and the organization, IMEC performs a specific assessment of the local needs of the facility it’s looking to help, and focuses on helping build a technology infrastructure appropriate to the levels of care provided there. The organization works to deliver on its focus of “complete suites” equipment provision, which ships all the equipment and supplies necessary to provide hospital-specific services.
“We don’t just send the exam table,” Sue said. “We send the exam table, doctor’s desk, chair, sharps basket, exam light, blood-pressure cuff, oto-opthalmoscope – all the supplies you need for an outpatient setup, all shrink-wrapped on a pallet.”
“The surgical suite includes not only the OR table but all the different accessories,” she said: “the arm boards, the foot boards, the overhead light, the suction, the cautery, the surgical instrument kits, the monitors – there’s everything you need in the entire suite packed on a double pallet.”
IMEC prepares packages for a variety of hospital service lines, including laboratory, inpatient, maternity, delivery and neonatal, and specialty environments. The organization assesses floor plans at each site to determine the appropriate resources to ship, and then procures everything involved, from bedside tables to linens to neurosurgical equipment. The bulging manifest of IMEC’s recent, eight-container shipment to Ethiopia included inpatient and outpatient suites, an imaging suite with X-ray and ultrasound equipment, a laboratory suite, and laundry and kitchen suites.
“For a rural clinic, you might send a clinic lab, a clinic delivery suite, exam suite, and a minor procedure suite,” Sue said, “and for a big hospital, we might send several 40-foot containers that contain bed suites and neonatal, lab, radiology, and other services.”
Pre-owned gear comprises much of the shipment, as IMEC gets lots of donated technology, and subsequently relies on its “very robust” biomed department, Sue said. Led by chief technician Mark Heydenburg, the team performs power conversion, parts replacement and testing, and curates a library of manuals for service and training. After the suites arrive, IMEC biomeds also support in-country technicians via Skype consultations and in-person classroom education. Sue said it’s part of the agency’s goal of “completeness and sustainability” in the geographic areas in which it operates, which are often places where medical care is sparsely available.
“I’ve been impressed with the ingenuity of people who work in these low-resource environments because they can do so much with so little,” she said. “That’s why it’s so wonderful for IMEC to be able to bring the equipment to them. We want the equipment to last 10 years, not two years.”
Sometimes IMEC receives fully functional equipment that is donated after facilities undergo generational upgrades, Sue said; when it does not, Heydenburg’s team restores the devices to service. Its institutional commitment to shipping only complete suites means that the remainder of the technology must be purchased. The organization enjoys favorable manufacturer relationships, but the demand for its services is ongoing.
“The main frustration I have is that the need is just tremendous,” Sue said. “We have access to the equipment, a well-proven quality process, and experience getting it shipped and through customs, but we are always in need of the financial support to help us do this important work and fulfill our mission to provide quality medical equipment and supplies to underserved facilities.”
For more information, visit www.imecamerica.org
By Matt Skoufalos