When you walk into a hospital in the United States, you expect many things. You meet a receptionist who knows nearly everything about you; when you broke your foot in second grade, what blood type your father has, your grandmother’s arthritis medication, and more. You expect to be seen in a timely fashion, and when you do, in a clean room with brand new equipment. Well, for nearly half of the world, the expectation is entirely different. As a result, the methods and responsibilities of engineers in low-resource hospitals drastically changes.
The Reality of Low-Resource Hospitals:
This summer I worked as a biomedical engineering technician (BMET) at Hospital Nacional de Retalhuleu in Guatemala. Retalhuleu is a small, rural town in the southern part of Guatemala. It is extremely humid and the heat is unmatched. The hospital I worked in was the main public
hospital in the area and served the majority of the population. Now, there is a huge difference between public and private hospitals. The public hospitals are government funded and typically serve the lower and middle class population. At the hospital, I made a few observations that distinguished healthcare in low-resource environments and environments I am used to. First, the lack of medical history. Nearly all medical records in the hospital were physical. There were huge hallways filled with files upon files of records of patient care.
Second, the lack of privacy. Individual patient rooms did not exist in this hospital. There were no privacy curtains, or barriers to allow patients to have their own space or be seen by doctors in a private area. Even the maternity ward had rooms of 20 beds with mothers straight out of labor and in the process of nursing their babies. Third, the lack of space. Patient beds typically had two feet or less of space between each other. Oftentimes, patients were left to share beds, especially in the maternity ward. Even isolation patients were in no way isolated from others. This encourages another problem, which is a lack of patient information privacy. All diagnoses were given in the vicinity of others, and we often saw families hearing and processing difficult news in very public hallways. Fourth, cleanliness. Since these hospitals are low-resource, many of the equipment is very old. Most of the patient beds were rusted and in poor condition. This creates a lot of dirt and makes sterile conditions nearly impossible. Another problem this creates is contamination of high-risk patients. All in all, the root of all
these issues is lack of funding and wealth distribution. Many of the medical professionals
in the hospital had not been paid for months. A lack of salary creates a lack of motivation, and a lack of motivation creates poor patient care. There was little to no money for new equipment or repairs which left most medical devices in very poor condition or completely unusable.
Challenges Engineers Face
Many of the issues that engineers face in low-resource hospitals stem from lack of funding. Although blaming all issues on money is overheard, it is the reality. Again, since these workers are not being paid regularly, passion and motivation are very hard to come by. In one instance, when speaking with an electrical engineer at the hospital, he needed to repair a circuit board on a suction pump that was only missing a capacitor that cost around 30 quetzales (around $4 US). He told us the hospital had no budget for repairs and thus the device would remain unusable until he could make the purchase. Now, there were plenty of medical device graveyards in the hospital that had a lot of good salvageable parts. However, theft was a big issue. It was very common for batteries or other parts to be stolen and sold for profit from the junkyards. In my opinion, these engineers should not have to rummage through garbage in order to repair vital hospital equipment. Sometimes we would look through the junkyards for hours just to discover there was nothing that would fit our needs. These engineers were heavily relied on because new equipment wasn’t an option. Either these engineers had to discover a solution to a device's issues or it simply would get thrown in the trash with no replacement. Thus, it is vital as engineers that we recognize these issues and have the tools to work in any environment we are placed in.
Adapting as Engineers
The first, and arguably most vital thing we can do as engineers is listen. Coming into my time in Guatemala I didn’t realize how crucial it was to sit back and absorb the advice and knowledge of the engineers and medical staff working there. It was very easy to look at a device and believe that we had a solution, when in reality we hadn’t taken the time to hear the actual issue. In one case, we spent hours working on an infant incubator that the nurses believed was broken. When we took the device back and claimed it worked, they admitted that they were unable to understand the instructions and manuals of the device due to it being in English, not Spanish. Additionally, we need to approach problems simply. When my group presumed we knew the issue of a device we ended up wasting a lot of time. It helps to start looking at a device as a big picture and narrowing in as things do not function. Many of the devices we fixed had issues much more simple than we thought. If we look at devices as if we know nothing about it, it is much easier to discover issues without bias. This saves endless amounts of time and energy. Last, we need to be creative. Devices in low-resource environments can be very straightforward or completely wild. The point I’m trying to make is that any solution that allows a device to be used is a good solution (within reason of course). We used rubber bands to create a good connection for suction pumps, old desks to create mobile bilirubin lights, and even a dog collar to conjoin an immersion blender. The stakes are high in these hospitals. There is no replacement device, no backup waiting in a storeroom, and no budget for new parts. Our jobs are crucial to the lives of patients and by using a creative perspective, our
likelihood of fixing devices increases incredibly.
How We Can Create Sustainable Change
There are many things we can do to offer some sort of change to these circumstances. At a large scale, we can only do so much about the state of finances in other countries, and by that I mean we can’t do anything. So, here are some ways that I believe can change something, somewhere, even on the smallest level. A huge issue in many countries, especially the United States, is medical waste. Hospitals must always have the newest equipment, regardless of the state of the previous equipment. This is a good thing, we want patients to receive the best care they possibly can. However, this creates a huge amount of waste from the leftover, functioning equipment that the hospital no longer uses. There are many organizations that work with hospitals to receive their older equipment and send it to hospitals in need. One I frequently work with is Project C.U.R.E. that is incredible about delivering necessary equipment and making sure it continues to function for years to come. Another way is to get involved with programs that send engineers to low-resource environments. This is not limited to hospitals. I worked with Engineering World Health to travel to Guatemala which I could not recommend enough. Volunteering in a respectful manner can make huge amounts of change, even if you only end up fixing one device. Who knows? Maybe that one device allowed some patient somewhere to receive better care. Moreover, to create sustainable change, we need to emphasize education. On a fundamental level, there won’t be lasting change unless the people in these incredible things. Whether it’s volunteering, or even just getting educated on low-resource environments, it is helping. Recognizing these issues and taking the initiative to do the littlest thing like donating old masks is vital. As engineers we are called to use our creativity and intelligence to better the world. The next time you walk into a hospital, notice that these luxuries are not available to billions of people in the world and notice we have the ability to do something about it communities are educated on how to continue the work we do. The ultimate goal is to make these hospitals self-sustaining so that volunteers no longer need to work in these areas. We need to target the youth and make sure we are including all of the population in these efforts. Finally, our time is the most important. Although we can’t facilitate massive political reform, our time is capable of doing
-Emily Herbert
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