Focus on Non-Traditional Health Workers: Interview with Melissa Driver Beard of Engineering World Health
An interview focusing on the role of biomedical technicians in health produced by the HRH Global Resource Center.
Melissa Driver Beard is the Executive Director and CEO of Engineering World Health. She oversees a number of programs, including the Summer Institute, a student summer study and service abroad program run in collaboration with Duke University; and Biomedical Equipment Technician training (BMET) programs in Rwanda, Cambodia, Ghana, and Honduras.
What is Engineering World Health (EWH)?
Engineering World Health is a non-profit based in Durham, North Carolina and our primary focus is on building capacity for equipment maintenance and repair and the design and development of appropriate technology in developing countries.
What is a biomedical technician?
Biomedical technicians are responsible for repairing the broken medical equipment within their hospitals and clinics, which can be a huge task. Up to 95% of the equipment in developing world hospitals has been donated or purchased from abroad and of that equipment, over 90% may not be functional within 5 years. Nearly 40% of it never worked. The techs are charged with repairing that equipment, and in the countries where we’re running the Bio Medical Equipment Technician (BMET) program, they simply don’t have the training to do their jobs. Most developing countries do not have formally trained biomedical technicians. Some of the techs have taken limited training courses held by manufacturers’ reps or by other groups. Others have found themselves in their position because they had some experience in electrical or plumbing work and were then asked to repair medical equipment as well.
Can you talk about the Summer Institute program with Duke University?
The Summer Institute is the cornerstone of Engineering World Health and has been running through Duke since 2004. It includes university students who are math, science, physics, chemistry, pre-med, and biomedical engineering majors and places them in Tanzania and Central America. For the first month the students live with families and learn about the language and the culture. They have practical lab applications every afternoon and go on field trips to see different parts of the country. The second month is more intensive and includes going to our partner hospitals where the students work with the techs to repair medical equipment. Since 2004, students have touched over 2600 pieces of equipment valued at over $5,000,000.They’ve been able to put back into service about 70% of the equipment they have tried to repair.
What is the Bio Medical Equipment Technician (BMET) program?
Through EWH’s BMET program, we train local techs on critical maintenance and repair skills. In Rwanda, for example, we are training 16 Rwandans from hospitals all over the country. Some of them have never had any formal training and don’t have the tools they need to do their jobs, so we provide them with the educational tools as well as the physical tools. During the classes, they learn what we call Basic Technical Assistance (BTA) skills. There are over 100 very basic skills that make up that part of the course. Some of it is quite simple – learning how to use superglue and duct tape to make repairs, for example, but it also includes more complex, equipment-specific training.
The program also provides professional development opportunities for the participants. They learn how to give presentations, develop preventive repair schedules, and how to create inventory systems and determine equipment needs in order to accept appropriate donations through Healthcare Technology Management (HTM) skills. This has enabled the techs to become part of the leadership team of the hospitals and help make equipment decisions. It’s been fulfilling to see the increase in their professional stature, their inclusion in the decision making process, and the administrators’ reliance on technicians as they develop their new skills. I don’t know if it is unique to Rwanda, but the Ministry of Health and hospital directors have been very supportive of the HTM piece, so that the country as a whole can make intelligent decisions about medical equipment needs.
Can you give some examples of how biomedical technicians contribute to health service delivery?
One of the techs we trained said that before this class he had no idea how to fix blood pressure cuffs. He didn’t know what was wrong with the cuffs, but he knew they weren’t giving reliable readings and threw them away. One of lessons that they learned in class was submerging the tubing from the blood pressure cuff in water will produce bubbles that indicate there is a leak in the tubing; and all you have to do is fix that to solve the problem. He was able to go back to his hospital and fix over 30 blood pressure cuffs. Something that simple – just putting a piece of tube in water and watching it bubble, allowed his hospital to put 30 cuffs back in service for doctors and patients and save them money that they needed for other important services and equipment.
One of the other techs was able to fix an x-ray machine that had been out of service for quite some time. It was the only x-ray machine within a 200 mile radius, and it was supposed to serve 25 patients a day. After the BMET training, the tech was able to identify the problem as three blown fuses, which he could easily replace, and put machine back into service. The hospital was able to see the 25 patients per day rather than spending the money to transport them to another hospital. There are patients who must drive, walk, or bike, for hours or days to get to a health clinic or a regional hospital, but they can’t get the care they need because the equipment doesn’t work. Enabling techs to make quick and inexpensive repairs of this critical equipment has a huge impact on the availability and timeliness of patient care.
Can you share some other examples of EWH program success stories?
One of my favorite examples is from one of our Tanzanian Student Institutes. The students realized that they could use the plastic lid liner from soda or beer bottle lids and a sewing snap to create a reusable and recyclable electrocardiogram (ECG) pad. Often, when health workers ran out of new ECG pads, they just reused the old ones, which is very unsanitary. The plastic lid liners and snaps can be boiled so they can be reused; they are readily available and very inexpensive.
In Tanzania, one of the Summer Institute groups was devastated when twin infants died from the cold. Around the Kilimanjaro area, it gets very cold in winter and the hospital didn’t have functioning phototherapy lights, infant warmers or incubators for the babies. The students couldn’t repair one out-of-service incubator, so they welded a space heater to the wall and developed a thermostat so the nurses could keep the room at an acceptable temperature. These are some of the creative, ingenious solutions that so very necessary; and this is what the Summer Institute program is about.
What do you see for the future of the EWH training programs?
For the BMET program, I would love for us to provide the training in additional countries. We’re already in Rwanda, Cambodia, Ghana, and Honduras. In addition to being able to take that training to other countries, I want to go deeper into those countries and find other ways to continue to be a resource to the people that we are training and continue to add to their sustainability. Also, I would like to bring the Summer Institute program into the BMET countries. The BMET students can exchange practical ideas with the students who have the theoretical background, and provide a balance for each other. I'm hoping to bring the first Summer Institute into Rwanda by 2012 or 2013.