Pay it Forward: Engineering World Health
Most medical missions are focused on providing ad hoc care or limited-term relief for the residents of a developing nation and then returning home. The equipment that is requisitioned for these tasks is typically donated from surplus or aftermarket inventories, and may not be appropriate for use in other settings.
Many nonprofit organizations send health care professionals overseas to participate in such missions or help provide support to supplement the fragile infrastructure of a people in need. The focus of the founders of Engineering World Health (EWH), however, lies in building a self-sustaining network of technicians in the countries they visit while also developing equipment designed to meet the challenges of the environments they encounter there.
Most medical equipment donated for medical mission work is designed to work in American hospitals, which are climate-controlled, dust-free, and have electricity that “is very predictable,” said Jessica Baker, marketing and communications manager for EWH.
“If you go to [places like] Nicaragua and Tanzania, this is not the case,” Baker said. “They often have open-air hospitals. Dust, bugs, anything can get into the equipment. There are surges and outages which are really hard on the equipment.”
As a result, Baker said, “the donated equipment doesn’t last very long.” She cited a statistic from the World Health Organization that as much as 70 percent of it is “out of commission” after two-and-a-half years.
“Maybe the electricity requirements are different,” Baker said. “Maybe nobody in the hospital knows how to fix it because they don’t have technicians.”
To combat both issues, EWH sends biomedical engineering students from universities throughout the world to Nicaragua, Rwanda and Tanzania. The students learn first-hand the challenges of operating in medical environments that are substantially different from those in first-world nations. Since 2004, the EWH Summer Institute has accepted almost 500 students who have repaired about 4,900 pieces of equipment valued at about $10 million, Baker said.
The focus of the program is two-fold: first, to train and equip biomedical technicians in those countries who can create and support a sustainable medical technology infrastructure; second, to absorb cultural and environmental information to inspire the next wave of equipment designed specifically for use under the conditions present in those countries. Students live with host families, study local languages and work with nearby hospitals to repair medical equipment.
“In Nicaragua, most of the hospitals have a technical staff, but most of the training might be mechanical instead of technical,” Baker said. “In Tanzania and Rwanda, there are a number of hospitals that have no technical staff. They might have an electrician, but not [one] specifically trained for [repairing] medical equipment.”
Enter the EWH biomedical technician training program, which the organization said helps establish “a lasting program that will train students after we’re gone,” Baker said.
In Rwanda, for example, the program has operated for five years and trained more than 100 BMETs.
“Rwanda basically didn’t have any technicians when we began in 2009,” she said. “Now, we have technicians in every district.”
Similar programs in Cambodia (begun in 2013) and Nigeria (begun in the fall of 2014) require a considerable commitment not only to establish, but to sustain, Baker said. The agency has received generous long-term funding from the GE Foundation, and has created partnerships with GE as well as in-country officials, including local ministries of health, to recruit the initial classes for its training schools, as well as the instructors and coordinators to sustain it.
Once the programs are underway, they are intended to operate in a standalone fashion. A program begun in Honduras in 2010, for example, concluded in 2013, leaving behind a team of trained technicians and a staff of three local professors “to keep this program in Honduras, hopefully forever,” Baker said.
EWH also built Centers of Excellence in Ghana and in Cambodia, which Baker said are “the most direct way we address the infrastructure problems” in those countries. The centers provide “closed environments” that are “well-stocked, clean, and give the technicians the tools they need to do their jobs.”
While the BMET training program is operating, EWH remains “very much in the country the whole time,” Baker said. The organization works to create networks that connect local students in training with their classmates as well as other professionals in a network that allows for technical questions to be asked and answered after their schooling has concluded.
“I think that’s worked particularly well in our Rwanda training program,” Baker said. “They know where each other works; they also know how to get in touch. We [also] teach them how to use the Internet to find the resources they need beyond what exists within Rwanda.”
Since 2009, EWH has trained more than 80 students in Rwanda, and the school it established there has registered 120 students of its own in full-time training.
“They’re almost independent of us now,” Baker said. “The Rwandan government issues certificates in these programs and recognizes these students as trained technicians.”
The EWH design competition for its student chapters also grows ideas that will benefit the health of the people in the countries in which they operate, Baker said. One group from Washington University in St. Louis won the design competition a few years ago with an asthma management technology, and has spun off into its own technology startup, Sparo Labs.
Even for those students who don’t have such lofty aspirations, Baker said, the experience is worthwhile on a number of levels.
A student at the Technical University of Denmark, identified as Semira, had the opportunity to restore five incubators while on a mission.
“At our hospital no one had been able to use an incubator in four years, and we finally got it working on the last day,” Semira said.
Mathias, a student from Aalborg University in Denmark, recalled fixing a pair of non-functioning suction pumps that were used immediately thereafter in emergency surgery.
But perhaps the best testimonial came from Elliott, a student from Syracuse University, who said, “I’m really grateful that this is outside of the textbook.”
“I see it more of a way of thinking than any type of job.”
Last year, EWH pushed 70 students through its summer institute, and is planning to host another 75 in 2015. Its next area of focus is its Nigerian training program and a three-week winter institute in Guatemala. The $7,200 student tuition is typically offset by corporate sponsorships from donors like Covidien, Tensentric and BD. Further support is always welcome, Baker said.