When representatives from Engineering World Health (EWH) first arrived at one hospital in northern Rwanda, the x-ray machine had been down for a year and a half. The problem was a loose connector and a blown fuse.
The fix was simple, says Ed Hutton, COO and head engineer for EWH. The organization sends American students to the developing world for 2-month stints repairing medical equipment, but it also trains local BMETs through regional educational programs. But in this case, no staff at the hospital had the expertise to make the repair. As a result, the chief medical director had been bussing patients who needed imaging into the capital an hour and a half away.
Once the scanner was repaired, the director asked Hutton how much it would have cost. “Less than your first tank of petrol,” he replied.
International donation efforts have increased the flood of medical equipment to the developing world, but once it arrives, there is a disconnect: few, if any, locals have the skills to maintain or repair the devices. As a result, equipment often sits in disrepair, quickly falling out of circulation pending minor or major service. In some cases, it was broken to begin with.
In 2001, two young assistant professors of engineering at the University of Memphis encountered this problem firsthand. Bob Malkin and Mohammad Kiani wanted to start a nonprofit to arrange for donations of equipment, but they soon learned that the absence of professionals trained in installation and maintenance was a much larger problem.
To address this situation, they founded EWH. In 2004, EWH launched a summer institute to begin sending students abroad to receive training and help repair equipment.
During the first 4 weeks of their sessions, the students attend lectures, participate in hands-on labs, and collaborate with their instructors in a hospital setting. They also take intensive language classes for 4 hours per day.
In the second half of the program, small groups of two or three students are sent into local hospitals within an hour’s radius of the training location. Once on-site, they learn to interface with doctors and nurses, using their newly acquired language skills to track down and repair faulty equipment. In some cases, hospitals store up equipment all year in anticipation of EWH’s arrival in July. Last summer, 58 participants repaired $1.2 million worth of equipment.
“The engineering students are all trained in theory, but they may not ever have held a soldering iron or a screwdriver, or actually tried to fix a medical device,” says Leslie Calman, CEO of EWH.
The students are mostly junior and senior biomedical engineering undergraduates from 4-year programs in the United States, Canada, Mexico, Europe, and India, although about a fifth are masters or PhD students. Following the program, roughly a third apply to medical school, a third enter the medical device industry, while another third enter academia. Nearly half the participants are women. And the numbers are growing—this summer, the program will export 71 students, its largest class yet.
Past destinations have included Honduras, Mexico, and El Salvador. This year’s targets are Nicaragua, Tanzania, and Rwanda. The program offers students an immersive cultural experience as well as training. Throughout the program, students stay with local families, and many report feelings of personal growth, pride, and accomplishment by the program’s conclusion.
“Sending American students to the developing world to fix equipment is great both for them and for the hospitals whose equipment they fix. Last summer, our students put over 600 pieces of equipment back in service. It’s great for the students’ own learning, their own sense of themselves as global citizens, and their understanding of the world,” Calman says. “But in the long run, it’s not a sustainable way to create change in those countries.” Long-term growth requires a different framework.
Building Human Capacity
EWH began expanding its efforts beyond the summer institute in 2009, with an eye toward making an enduring difference in its partner locations. Efforts are currently established in Rwanda, Honduras, Ghana, and Cambodia. A program for Nigeria is on the way.
“It’s wonderful what people do going abroad,” Hutton says. “It’s far better to take your skills and knowledge and help set up a school that’s going to be permanent, with local teachers that churn out local students. They’re living there, and their skills and knowledge permanently affect the healthcare system.”
Under the domestic training model, EWH works with the country’s Ministry of Health to identify a suitable educational partner. Using a curriculum developed in collaboration with Duke University and designed for the developing world, the organization brings in a team of biomedical professionals from the United States, Australia, and Europe to begin training local teachers. Centers of Excellence are established at nearby teaching hospitals for hands-on learning. Students there have a chance to tinker with used equipment preloaded with fixable bugs in a safe clinical environment.
Over a 3- to 4-year period, participants attend spring and fall classes, partake in clinical internships, and receive mentorship. The program is roughly equivalent to a similar 2-year degree in the United States.
Volunteer biomeds from the United States—sometimes retired, sometimes sponsored by their employers to attend—can help serve as mentors and guest instructors. The program thrives on their expertise, often the result of 25 to 40 years spent working in the field. “They’re the knowledge that keeps the program moving forward and keeps it real and practical,” Hutton says.
As local instructors become independent, EWH turns over the curriculum to the school and withdraws. One such location, a polytechnical institute in Honduras, will go fully independent in August 2014. Another, in Rwanda, is slated for independent operation by the end of 2015.
The lack of training in most low-income countries is “a human capacity problem,” Hutton says. “Once you create the school and it keeps going, you’ve strengthened the healthcare system by adding this vital component: the BMET.” Studies have shown that in hospital settings with trained personnel, 40% more equipment functions properly.
A Generation of MacGyvers
Part of the ongoing challenge—why the profession has struggled to establish itself internationally, even in countries where biomedical engineering degrees are offered—is the absence of domestic resources. Many academic programs, lacking the capital to purchase equipment on which students can practice, remain strictly theoretical. That proves to be a serious handicap when those students move into hospitals and are suddenly confronted with real patients and equipment. As a result, the program has seen demand even among advanced students with bachelor’s and master’s degrees as a way to earn real-world training.
For most equipment, “there’s no one there who knows how to install it, maintain it, calibrate it, operate it. There’s no one there to help the staff understand how to use it. Once we get people trained, this starts to change,” Hutton says.
In many hospitals, it’s not uncommon for incubators to house two or three infants at a time because so many machines are broken. The program addresses these realities by teaching students how to cannibalize that unused equipment for spare parts and “MacGyver” a solution until there are enough incubators to go around.
The organization has seen rapid growth since 2008, from an all-volunteer organization to the current, more formalized structure. It now consists of seven full-time paid staff and a host of Western and indigenous contract employees internationally. The domestic programs are sponsored by GE Healthcare, which provides funding and donations of equipment while leaving EWH to execute the details. “They’re very good partners. They know what we can do, and they let us do it,” Hutton says.
In addition to its international work, the organization produces training kits for its 33 regional chapters based at college campuses. This summer, EWH will run a STEM summer camp organized by North Carolina State University and funded by Biogen Inc to educate K-12 students in global health and engineering. “We span generationally and globally,” Calman says. Future plans include establishing a January institute in Central America as a less costly alternative for students who need to work over the summers. Eventually, EWH plans to expand to additional countries.
“We’re starting to see the standard of care increase. The equipment is operational. The doctors and nurses have the tools to do their job,” Hutton says.
Jenny Lower is the associate editor for 24×7. Contact her at [email protected].