Medical Equipment Project

As it is now March and I have been in Haiti since January, I suppose it is time for a blog post dedicated to my main project, work with the medical equipment in Hôpital Bon Sauveur de Cange. The hospital is run by Zanmi Lasante, the Haitian sister organization of Partners in Health. The Cange hospital was the first hospital started by Dr. Paul Farmer, and from there Zanmi Lasante expanded across the Central Plateau of Haiti, and Partners in Health began evolving into the international medical NGO that it is today.

My interest in the medical equipment project began in 2014, when I joined what was then a brand new project at CEDC. My team was told that the hospital in Cange had a problem with old and barely functioning equipment being donated at the end of its lifespan. In order to get rid of unwanted equipment and demonstrate humanitarian-mindedness, hospitals in the US donate old equipment to Cange. I regularly come across equipment from the 1980s and 1990s! Unfortunately, by the time the equipment gets to Cange, it is already broken or will be soon, due to its age and the fact that it has spent its lifespan in a hospital in the US. Planned obsolescence does not just exist with iPhones, but medical equipment too, if you can believe it.

If a piece of donated equipment does work when it arrives in Cange, the technicians do not have the parts they need for repairs when the equipment inevitably malfunctions due to its high volume of use. For example, I can think of 11 devices that are currently sitting in the biomedical equipment depot unused due to the shortage of replacement batteries. The list of equipment that only needs batteries ranges from surgical microscopes to vital signs monitors to the only X-ray machine at the hospital. It is maddening to imagine the shelves full of batteries waiting in reserve back in hospitals in the US. Sometimes, the equipment is functioning perfectly but it is still unusable due to budget restraints. A fully-functioning centrifuge machine is currently sitting in storage because there is no money to buy the cleaning solution it needs.

However, those are just the examples of easy fixes. Some equipment is deemed beyond repair and sent to what I call the “The Crypt.” It is an underground, unlit basement-like place that holds equipment that should be thrown away, but isn’t due to the lack of any type of waste collection service. I feel as if it is a metaphor for Western donations: throwing money and “stuff” at the issue just leads to a pile of broken “good intentions.” The good news is that some of the equipment in there is salvageable. The bad news is that the parts needed to replace it are usually too expensive to be feasible.

Out of commission equipment in "The Crypt."

In addition to the problems with donated equipment, there is a systemic issue with the way equipment is managed and maintained. There currently exists no inventory of all of the hospital’s equipment, and there is no record of maintenance trends or malfunction reporting. If a system of preventative maintenance is put into place, where technicians are regularly checking devices to ensure they are operating at maximum efficiency, the lifespan of equipment will improve. Additionally, an inventory of all equipment and records of repairs will enable administration to monitor trends and order replacement parts or arrange donations accordingly.

Additionally, the technicians themselves need to see their status in the hospital increase. If they have an input in decision-making, doctors and administration will be better informed about the status of equipment. More visibility and communication with the technicians will enable doctors to report equipment malfunctions more efficiently. Unfortunately, technicians are usually not treated as vital or important, sometimes considered to be of the same skill level as a mechanic. A few times when I have been describing my project to other Americans, they are quick to ask if equipment is broken due to the technicians’ lack of training or knowledge of how to use the equipment. That is not the case, and it is disheartening that this is the initial assumption. The technicians possess the skills to repair the equipment, but they are limited by the resource constraints in the environment they work in. The technicians in Cange do not currently even have an adequate toolkit to do repairs.

All of what I have described above has presented an interesting conundrum for my project. I served as the project manager of this project since I first became involved in 2014, and I am finally in Haiti to work on it full-time. From the beginning, my team quickly realized that the solution was not in ensuring better donations, because that would be too costly. The system of equipment management needs to be reformed. Over the past few years, we have compiled a 4,000 file medical equipment database, because donated equipment usually comes with no service manual for the technicians to use. We have done extensive literature reviews on management of equipment in similar hospitals, and we have targeted the issue of malfunction reporting by developing the prototype of a QR-code based maintenance and reporting app. The idea is that each piece of equipment will have a QR-code linked to a database of the equipment. When a doctor reports a malfunction, they will send in a report, which will notify the technician and track a history of repairs. The idea for this app came from the director of the hospital here in Cange, who recognized the need for such a system. While I am here in Haiti, the team back in Clemson is still working on the app, and future interns will oversee its implementation.

Armed with all of this work, I came to Haiti to lay the foundations as the first medical equipment intern. I am doing a lot of the groundwork regarding inventory and process-flow mapping of the hospital’s system of operation. Future interns will continue the work, because we recognize that this will be a long process. So far, I have created a drawing of the hospital, because I was told no map of the hospital layout has ever existed. Apparently, whenever they had money they just continued to add on to it. My first few weeks here I took dimensions, which a lot of times involved measuring over patients. I have since completed the drawing in the software Visio and have color-coded it on a gradient depicting the percentage of functioning equipment in each ward of the hospital.

For the past few weeks, I have been doing an extensive inventory of all of the hospital’s equipment. This includes make, model, serial number, if the device is functioning or not, and the cause of existing malfunctions. This information will serve as the foundation for the equipment database, and we can then use this information to begin to monitor trends and put in a system of malfunction reporting and maintenance tracking. In the coming week, I will finish organizing all the inventory. I have images to go along with all of the inventory entries, so I am currently incorporating them within my file.

My next step will be to map out the entire process of equipment use. I will detail everything including overall use of equipment, doctors’ and nurses’ use, technicians’ maintenance, and the process for procurement of new inventory. I will make process-flow diagrams of this information, along with accompanying written documents. With this information, we can identify areas for improvement and begin to target the system and increase the hospital’s efficiency of use of the medical equipment.

As the Haitian proverb goes, “Piti, piti, wazo fe nich li.” Little by little the bird builds its nest.