1. 2014 dukengineer 27
Healthcare Technology Laboratory this
past summer helped me delve deeper into
the complex interplay of social, political
and economic factors surrounding the life
of medical equipment in LMICs.
Maneuvering a vast dataset comprising
thousands of pieces of medical equipment
from Honduras, Rwanda and Cambodia
from the past five years and being able to
identify the variety of influential factors
leading to medical equipment failure was
truly remarkable. In many cases, some-
thing as helpful and innocuous as a
medical donation can turn out to be one
of the most significant potentiators of this
medical equipment dilemma.
Medical equipment donations from
international organizations are given with
good intentions, but their influence may
seem beyond belief. Typical complex,
delicate, leading-edge medical devices are
not built to handle the widely varying
conditions across LMICs. As a result,
broken probes, monitors and bottles are
just a few of the common component-
based obstacles that put medical equip-
ment out of commission. In addition,
general lack of information about these
intricate machines makes repair nearly
impossible in the field. Even if the know-
how is present, parts and consumables are
often not available in their region. These
issues have been shown to produce and
increase in the proportions of partially
functional medical equipment within the
first year after donation and the emer-
gence of vast storage rooms of out-of-
service equipment that takes away from
potential treatment rooms.
As the international committees and
organizations focus on policies to increase
local accessibility and effective application
of medical equipment in LMICs, engi-
neers must work to develop medical
technologies for the majority in need. As
engineers at Duke, we are enabled with
powerful tools to truly make a long-lasting
difference in our fields. Getting involved
in immersive international programs is the
first step to understanding first-hand the
full burden of medical equipment defi-
ciencies. Lessons gained from experiencing
the highs and lows in LMICs will guide
our future designs to incorporate robust
sustainable materials combined with
locally derived parts and supplies—the
key to helping alleviate the medical ten-
sions in LMICs through the establishment
of a design platform conducive to long-
term medical independence.
Deepak Sathyanarayan is a junior majoring
in biomedical engineering.
26 dukengineer 2014
aking up one February morning to the
smell of ox manure and the cat that
sought refuge in my room that night, I
quickly realized I wasn’t going to class in
Hudson Hall today. Outside, bike bells
rang, dogs fought and thirty men from a
neighboring village arrived in (and on)
a rickety vehicle built only for eight.
Welcome to the village of Madra, a
small, lush farmland beside a river of some
72 kilometers from the urban center of
Udaipur, Rajasthan, in India. Far from
the bustling city, the lives people lead
here are simple and devoid of the stresses
that accompany urban lifestyle—or so it
seems. On the surface, the essential infra-
structure, such as homes, schools and
clinics appears in place. But much of
this façade simply shrouds the severe
instabilities within. School meals being
taken by teachers, bribery of supervising
authorities and misrepresentation of the
people in political settings are just a few
of the recurring issues. While conducting
research in the nearby village of Kukada
Kheda, I realized these problems were
magnified and compounded by the
lack of water, medication and adequate
transportation.
While exploring the villages, I visited
the government clinics that served the
villages surrounding Madra. In addition
to being unreliably open and under-
staffed, these medical facilities were filled
with broken-down or partially functional
equipment and the premises were covered
in medical waste. Single-use devices and
questionably disinfected needles being
reused multiple times were a common
sight in the village clinics. During my
time in India, I noticed a common set of
four factors contributing to the develop-
ment and continuance of the observed
medical breakdown.
First, a general lack of transportation
makes it impossible to bring equipment
hundreds of kilometers from the city to
the remote villages. Second, the existing
infrastructure in villages is not adequate
to operate the necessary medical equip-
ment due to sporadic power outages,
overheating of light fixtures and other
factors. Third, a lack of training and qual-
ification of the medical staff to properly
use and repair equipment leads to the use
of partially functional equipment. And
last but not least, a lack of funds at the
medical facility makes it difficult to
obtain new equipment without the gener-
ous donations of charities and non-
governmental organizations.
After my time in Udaipur, I set forth to
better understand these trends in medical
equipment usage on an international
scale. We always hear of groundbreaking
medical technologies being developed
around the world, yet the improvement
in health status of many low-income
nations seems marginal at best.
According to a 2012 WHO publica-
tion1
on local production and technology
transfer to increase access to medical
devices,
“Despite various international efforts,
agreements and commitments to
promote transfer of technologies to
LMICs [Low-/Middle- Income
Countries], in many sectors such
transfers are not occurring at a pace
rapid enough to support countries to
achieve their development objectives.”
Gaining the opportunity to work in Dr.
Robert Malkin’s Developing World
Developing Technology
for the Developing World
Effectively designing solutions for the unspoken majority
School kids working together to pump water from a well after being denied their school lunches that day.
Kukada Kheda, Rajasthan, India.
Bottle of Ceftriaxone (antibacterial) used by
a village doctor to treat pains associated
with menstrual cramps.
Madra, Rajasthan, India.
References:
1. World Health Organization, “Local Production and Technology Transfer to Increase Access to Medical Devices”. Geneva, Switzerland. 2012. Print.
education
WBy Deepak Sathyanarayan