Hi all,
I usually enjoy reading posts here but never have the time to post myself but I am now hoping some of you can assist me with the identification of and prioritisation of modules for a new Biomedical School I am helping to coordinate.
I am a biomedical engineer advisor - my job is to advise Pacific Island nations on health issues and most specifically on medical equipment management. In the Pacific we have a common issue in that aid agencys and the MOH's will purchase equipment but never allow for cost of life nor have a maintenance and repair procedure which currently means that if the device fails for any reason it is discarded and worked around with the subsequent negative impact on health care. I have been advocating we set up a training school here and that has been enthusiastically accepted by all countries involved (14).
It will be based through the Fiji National University and will be a modified 3 year Diploma in Electronics course with medical modules from the Fiji Medical School and biomed modules that I and several others will compile - what I would welcome are your thoughts on is what electronics modules do you consider are the most suited to a biomedical technician - I am biasing more in favour of digital and IT but really would like to have others thoughts on this as we design the curriculum in three weeks and I really want this to be a long term solution here
Many thanks in Advance and all comments welcomed

Welcome to the forum, Andy.

I must admit that the sad news that the state of affairs you outline remains the case after all this time astounds and disappoints me.

I am old enough to remember reading a WHO paper in the late '80's written by a small team who travelled the globe reporting on such sorry circumstances ... together with sound suggestions to remedy them, and assurances given by Ministries here, there, and everywhere.

One can but wonder where all the money went.

After all this time ... and you only have three weeks?

Meanwhile, have you seen this thread?

OK ... let's be positive.

You asked for advice, so here goes:-

Firstly, you need to get some sort of deal in place so that, once trained, the techs are retained to work locally, in government hospitals (I presume) for the Good of the People ... not "attracted" to servicing companies, or to the idea of [censored] off to seek their fortune (with their newly marketable skills) elsewhere.

In my opinion, unless you can get that sorted out, all your efforts may well be in vain.

Many thanks Geoff,

its a common issue still - I am also working with Project Care from the US - they send medical equipment to Africa and have a keen interest in this as they encounter exactly the same issue there.
I do have a relationship with WHO and actually use their guide to donated equipment as a basis for a lot of advice to donors - I should perhaps clarify that I have been here for two and a half years and proposed this at a meeting of Heath Secretarys in Fiji in June 2010 - - it has taken a year and a bit for the aid agencys to analyse their existing programmes and consider it as a,hopefully,better alternative - I have been working on it for all of that time but now it has been accepted it has been given high priority and is moving very quickly so we can have it running early 2012.
As for money - sadly there are a lot of fly by nighters who pray on small island nations lack of expertise and sell them poor quality equipment at huge markups - often 400-500% - I have spent a great deal of time getting procurement procedures into place and obviously a spin off of having knowlegable locals trained in medical equipment will be to assess and avoid equipment offers for themselves.

As regards retention its a tricky one - there exists a bonding scheme for clinicians and we intend to use that - a large proportion of income - in fact the majority, in these countries comes from overseas relatives in Australia, New Zealand the US or the UK sending money home so even if we do lose some at least it indirectly contributes to the economy and prosperity of the home country. Also studies have shown that in middle age most of these overseas based nationals will return home so long term we hope to have a mature knowlege base.
Thankyou for the reference to the other thread - it will be useful to compare and add to my ideas.

I know a bit about medical aid groups. Good folk, no doubt ... but also lots of "agendas" there as well, in my opinion.

Having "hands-on" techs out there is the way I would tackle the problem(s) too.

In all honesty, I don't see the need for University Training. Good leadership, and training at vocational level is what's required, in my opinion.

That plus back-up as required (funding, and availability, of parts for example).

Regarding the "other thread", it might be useful for you to get in touch with Mr.nerobot. I have his email address, so send me a message (or an email) if and when you want it.

The course offered through the FNU is a diploma level course not a degree - they are the only institution in the region able to offer the course. I still see a need for engineers for several years - of course the day one of my graduates comes up to me and says I want to go to Australia and do a degree and have your job I will hug them, shed a few tears and have a few beers in celebration - we have been down the path of imported hands on techs since 1999 - it has proved non sustainable as as soon as these techs leave the countries revert to what was before - this is a vocational course but you have to remember that this is the second or third world - by using outside techs we have created a dependency that hinders development.
As for funding - don't go there - in at least one of my countries the finance secretary has caught my wrath on that issue to the point he thought I was goint to hit him - the fact i had him by the shirt collar probably gave him that conclusion.

Ah ah ... the "hands-on" style of management. That's what I like!

Dependency? No. Those days are over (or should be, at least).

"Imported techs" is a phrase that I had not heard before. But I hear what you're saying. Hands in the bucket of water, splashing about ... and afterwards:- then what?

But again, no. That can only be a short-term expedient, at best.

"Helping Them to Help Themselves" is the mantra ... that, and "No Junk for Jesus" (or whomever), of course.

But (obviously) without funding (and as you know it can come in many forms:- aid, taxation, sponsorship or what-have-you) the whole idea is, I'm afraid to say, a non-starter.

PS: the preferred term these days is, I believe, the "Majority World"!

Not known for my political correctness Geoff - just ask the one of my health ministers who I suspect dislikes me because I called him a fool when he advocated we purchase the equipment to perform routine open heart surgery as they are the only place in the Pacific with first world operating theatres - I sorta lost it a bit and told him that rather than think of personal prestige think about the several hundred people that die each year because they will not fund a renal suite!
We call them developing or emerging countries here to be technically correct.
As for the Junk reference - my version is if its junk there its junk here - I coined it and titled a confrence paper with it - someone in Australia quoted it at me the other day so it seems to be gaining some acceptance and hopefully will be bourne in mind when institutions donate.

Yes, I'm sure we can all agree that limited resources (and they always are limited ... even in places like the UK where successive governments keep bunging mega amounts of money at health services [just to appease the Masses - or the Media ... or even more likely, both]) have to be rationed with due care. That is, with an eye to the likelihood of "Quality Outcomes" for the Many, rather than the Few ("high profile" cases).

But, as many of us know (and as you have alluded to), some ministers seemingly cannot resist a good "photo opportunity" should one arise.

Yes, junk is junk. But even (sending out) junk can produce that warm, happy, feel-good feeling at this end. I've seen it (but I hasten to add, not felt it) a few times myself.

But (just out of interest) where does the open-heart stuff get done, then? Do patients get flown out to Oz, or some such place?

No Geoff - the Pacific has major problems with RHD and so we have literally hundreds of young people who will have a very short life expectancy if we dont do something about it - unless the family can afford to pay for the medical treatment in Australia or New Zealand and can convince the authorities to issue them with a visa (also difficult as a very large deposit is usually required). Thats also assuming that someone can come up with the $40 thousand a medivac costs, then its a death sentence - in Tonga a paediatrician who is a close friend actually started a screening program to target children in the suceptible age group (RHD as you may know is caused by a bacterial infection that is easily treatable with antibiotics if detected early enough) as a result of her efforts rates went from 17 % to less than 1 % and she was awarded the International Heart Associations international cardiologist of the year award last year - its having the privelege of working with people like that that makes my job so rewarding. By the way the last open heart visit which finished two weeks ago performed 32 proceedures including 29 single or multiple valve replacements in ten operating days - they are all Australian volunteers that give up there vacation time to come and do this so its humbling.

Yes. Good stuff.

So I guess I may as well mention another of my favourites, then:- having hospitals in the "Developed World" (or whatever we like to call it) sponsor hospitals and clinics "out there".

That is, not only with "working visits" of the kind you mention, but also exchange visits (or placements), equipment donations, advice, training etc., etc. ... in fact, "mentoring" in general.

To my mind, that way forward "ticks all the boxes"!

Meanwhile, as we know RHD is basically a preventable condition ... so it sounds a bit like the emphasis out there needs to be (more) on Primary Health Care!

it sounds great in theory but what i have found in practice (and we do have these partnership arrangements with hospitals in the region and the 'States) is that often they have a first world frame of reference - for example a visiting surgeon was insisting that the theatres buy an istat for immediate blood testing at a cost of several thousand $. I asked him to look out the theatre window to the opposite window several feet away and wave to the guy there - he seemed puzzled until I pointed out that was our haemotologist and the path lab was twenty feet from theatre where we have very capable staff and equipment to get his results quickly. I also run into the issue that staff at a partner hospital suddenly become zealots and send every item they can regardless of age, suitability or even checking if our clinicians have the skillsets needed to use the equipment, completely ignoring the procedures I have instituted for assesment - the WHO own figures indicate that less than 20% of donated medical assets are worthwhile and the rest, at least in my backyard, pollute some of the most exotic and breathtaking tropical islands in the world as I am paid well to live in these dream locations and feel a certain degree of ownership of the region I am not happy about that.

As for RHD and other chronic NCD's here - to give you an example - the Cook islands are made up of 15 small islands over a greater sea area than mainland Europe occupies - the Northern group are only accessible by a several day voyage in a chartered boat - primary health care here is only applicable if you can get the staff to the location - there is also a reliance on traditional healers - witchdoctors if you like - by the time we see them it is often too late and it negatively reinforces our image (they went to hospital and died anyway - the fact that if they had presented four weeks ago instead of getting a shaman to wave a smoky stick and chant over them we may have saved them).

Well, I guess we all know that surgeons often have to be handled with care!

Charity folk that I have come across here in the UK usually work against a "wish list" of equipment for donation. That is, it's a "pull" situation (as far as the recipient is concerned), rather than a "push" (from this end). This is as it should be, I feel.

Meanwhile ... Doom on all Zealots (not to mention purveyors of mumbo jumbo by the sound of it)!

Yes, the Grass is Always Greener (as "they" say) ... (even when it was in fact the dirt, as it was usually in my own case of adventures outside the Western Comfort Zone).

How's the internet access situation in the Northern Cook Islands, I wonder?

Internet is non existent - a lot of these islands dont even have a phone service - that's the same throughout the Pacific sadly except for Niue which is a single island and instituted free wireless internet over the entire island.
I have no mobile in the main island at the moment because i left my sim in Fiji and the telco has run out of sims and cannot give me a date for replacements - again our issues are much different to first world.

The WHO donated equipment guidelines are very clear on the point of not sending unsolicited donations but even in the biomed community I find there is very little awareness these guidelines exist

Satellite is the answer there, then.

Better get those on the "wish list" as well!

Not so much Third World -versus- First, but more like a small population sprinkled over many small islands, scattered over a vast expanse of ocean, I would have thought.

That ... plus long pipeline times to and from the "Mother Ship" (New Zealand, presumably).

Or, in a word:- logistics!

yes - certainly not a versus situation - but satellite phones are expensive and give someone a satellite phone here and it becomes their personal property much in the same way vehicles do with the result it does not get used for its intended purpose - actually I "lost" four laptops the same way a few months back.
first world help is nessesary and much appreciated but it needs to be done with an awareness of the unique cultures we have here - I have just helped plan and design two new referral hospitals - one was Japanese aid and the design team and I sat down for several weeks and came up with a really good well designed facility - the second was funded through China - they gave me the plans and said thats what we are building - when I asked about specifications and standards it was always "as we specify' or "Chinese standards" - they wouldnt even detail what light fittings they are providing - as a result the hospital is going to be struggling before it begins and the country will be faced with a very expensive bill if they choose to bring the hospital up to AS/NZ standards.

No, not satellite phones. I meant internet access via satellite (dishes).

And yes, I'm aware that the Chinese are "moving in" out there (as they continue to do in other parts of the world). Not much the Kiwi's can do about that, for sure.

It's the New World Order, after all.

most of these islands dont even have reliable power - a couple of hours every few days and the spikes kill electronics dead.
we operate on gas or solar powered equipment wherever we can but again if its gas we need or diesel powered we need a way of getting a regular supply - one of my hospitals served raw fish for a week as there was no cooking gas.

and thank whoever for non refrigerated pharmacuticals!

so I am afraid internet is, of nessesity,way down our list of priorities at the present.

BTW I am Australian myself - AusAid seem more focussed on discouraging Cuban Doctors moving into the region than China which is sad as the Cubans I have met are very professional and really nice folk.

Sounds like there's some real engineering to be done out there!

Ah ... politics! And politicians. What do they have to do with caring for folk (very little, in my experience). As I say, all of these aid agencies have some sort of agenda ... even if it's only evangelising!

Those of us who like to offer help with no strings attached seem a bit few and far between, unfortunately.

There's nothing much wrong with the provision of healthcare to the people of Cuba (apart from lack of funding due to "sanctions", of course).

Compare the state of the Cubans in Miami to those in Havana, for instance (I'll say no more).

Meanwhile, what do the governments out there spend their income on, I wonder? I believe I'm right in saying that defence is taken care of by New Zealand, for example.

On seconds thoughts, perhaps you'd rather not reply to questions like those.

yes Geoff - I will keep those opinions private and anyhow I am not allowed to - actually as I have a huge love for where I work, what I do and the Pacific people so it would also be very two faced of me to critise them - the vast majority dont deserve the raw deal they get from their politicians.

one of my former colleagues in Australia was an English ex RAF biomed who spent two terms in Rhiyad - I think thats how you spell it - maybe you met him he now works for Queensland Health Jim Fraser?

He had some stories about how hard it can be there dealing with hospital manangement and the religeous police so I know you do understand the frustrations of the job in remote climes.

Hey Andy,

Long time no chat!, I got a call from one of our Clinical Nurse Consultants, about a group of surgeons who are travelling from Brisbane to Fiji with the intent of doing some Navigated Hip / Knee operations.

I believe they are heading over next week to check out the theatres etc first so they can plan to send everything they need over.

We are planning on sending over one of our Navigation units so they can do this, are the electrical outlets in theatres over there the same as in Oz?

There have been a number of threads here on the forum that have touched on the topic of "donated" (and donating) equipment. Here are a couple:-

One
Two

Just like everywhere else in the world, then.

PS: I was generally able to avoid the big hospitals in Riyadh. I was more of a "desert clinics" kind of guy myself!

Hi Nick hope Stryker are treating you well.

I will send you the email of an engineer in Fiji who may be able to advise you - last I know is that suva are having real difficulties getting their theatres ready - they use 240 v same as Australia but from what I can remember they use sleeve index gas terminals in theatre but have taper index in ICU and, I think, recovery which makes it difficult if the team bring their own gas equipment

Thanks for the links on donated equipment - I have experienced it firsthand when I was in Australia for a conference - some bean counter worried that they might get sued if a patient was "injured" (this was a finance guy not a medical guy) ordered the destruction of 42 retired but functional WA spot 4200 monitors - I had to stand by and watch two guys with hammers render them inoperable whilst I fumed - the assets manager to his credit told me to take what I could carry - he wouldn't tell! However I was flying out next day and couldnt fit any in my luggage. However, being on the receiving end I do encourage anyone donating to read the WHO policy document on donated equipment and contact someone like myself first - we welcome equipment but as I remarked before I live in a magical picture postcard type of place and we dont have space for the landfill unwanted equipment ends up in. I have a presentation for aid donors that contrasts the amazing postcard type locations here and with the reality of the unwanted medical equipment dumps cluttering up our medical facilities - its over dramatic but thats because I want the point stressed. If I knew how I would upload the WHO document - it really addresses the issue well and stresses not to send unrequested equipment.

Well, that's the Modern "Western" World for you ... too many people more worried about covering their ... er, assets than salving their conscience.

You'd think that folk who work in healthcare would ... er, care a bit more, wouldn't you? In my opinion, "suits" and bean-counters are just a bunch of jokers, Andy. I have little time for such people myself. To my mind they just get in the way.

Meanwhile, it seems that many (most) folk just see the "picture postcard", without giving a second thought to the reality behind it.

Heck, we even see that here, when the grockles descend upon the South West of England during the summer months!

For all everyones help - many thanks guys.
I go into meetings tomorrow to start to thrash this out and all the ideas help and suggestions have been invaluable.
I really appreciate it and have taken on board suggestions made and advice given
Thanks again

Ok - for thoughts and comments what we are looking at is a trade level certificate - it involves a two and a half year course - an introduction to healthcare - how a hospital works, simple A & P, what we do and where we fit in the picture then two eight week block courses per year on electronics and basics followed by mentored on the job work including nine modules on equipment servicing to be delivered over the training period - these start with simple tasks such as sphgymos, and other simple stuff followed by progressively more advanced modules (the first time they encounter powered devices is after term 2) or practical module 3.

The lessons lead progressively through more involved electronic theory plus diagnostic methods and standards until by the end of the last one the student has completed theory and practical hands on of every device he or she is likely to encounter in a general hospital setting.

Later after he or she has got some experience we plan to offer some specialist add on certificate courses in imaging, dental, lab equipment, renal etc as we think by then they will have an idea of where they fit in what their abilities are and what they want to specialise in.

The course is a technician level course not a diploma or degree as that would only encourage them to seek better money overseas and at the moment, in my countries I fill the clinical engineering role so its not necessary nor practical to train to that level.

any thoughts or perspectives I haven't thought of would be welcomed

Yes ... get them all drafted into the Armed Forces, so that discipline may be enforced!

(In fact, why not suggest to your friendly Ministers that the whole of Health Services be organized in such a fashion [that is, by the Military]? It sounds to me that the logistics of the situation out there really needs such an approach).

Otherwise, how are you hoping to "retain their attention" (and/or interest and enthusiasm) over a period of thirty months ... and beyond?

In my opinion that's way too long. I would get them out and working far sooner than that!

The famous "Arborfield" course, which has been mentioned ad nauseum on this forum, was something like six months (if I remember rightly) ... and "Falfield" was (is) only two weeks!

In the circumstances you have been laying out, I would have thought that an "apprenticeship" approach may be a better way. That is, having the young techs trained "on the job", under the wing (and watchful eye, gentle tongue etc.) of an experienced hand. OK ... don't tell me ... there aren't any "Old Techs" around!

Exactly right Geoff - there aren't any "old techs" around and the few "techs" we have in some countries are not suitable mentors by a long chalk.
this is viewed as an apprenticeship scheme - they only do 16 weeks a year in school (2 x 8 week blocks), the other 32 are on the job mentored by myself and any one else we can find who is suitable (i.e. won't teach them that as no one really watches them they can sign in in the morning, go down town and hang about all day then come back and sign out and no one is the wiser - or wasn't until I caught the buggers!). So they wont loose interest - you have to realise we are talking about people with no electronic background - we are recruiting school leavers so the vast majority of the course is centred around practical skills in electronics - with the medical stuff graduated to match what they have learned and mostly delivered on the job. That also gives the MoH in their country an immediate return on their investment.

Also, in at least one of my countries, we now have a professional standards panel and a six month course would never qualify for registration.

I will post a clipping in other business about how little our pollies in Tonga care for the health system - that may give you an idea where the problem lies - they would rather spend health dollars flying business class with their wives to the US for paid treatment than think about the poor buggers they are supposed to be serving.

Re: your last paragraph ... nothing new there, Andy. From what I've seen, most of the world is like that.

But that shouldn't mean that we should turn aside. As those who know me would no doubt attest, I've said it many times before:- somebody has to give a [censored]!