A look at some of the main medical equipment issues in Haiti Ismael Cordero, Clinical Engineer Consultant for ORBIS International Haiti Eye Care Symposium May 18-20, 2012 Port au Prince, Haiti

3 Categories of Equipment Problems 1.Donations 2.Maintenance and repair services 3.Procurement

Donations- Proportion of medical equipment in Haiti that is donated… A Lot!

Donations- Problems – Not designed for the environment – Obsolete – Not compatible with local clinical practices – Broken, not fully functional, or missing accessories – Requires expensive or impossible to find consumables & accessories – No operation manuals (or in the wrong language) – No service manuals – No repair parts – Not repairable in country – Too many different types of models (no standardization)

The Iceberg Principle

Donations- Why are they usually less- than-ideal? Poor -or no- communication between donor and recipient!

Donations- Poor Communication donors lack awareness of the local realities of the intended recipients donors and recipients often do not communicate as equal partners in the pursuit of a common goal recipients have difficulty articulating to the donor how best they can be helped the recipients circumstances may lead them to believe that anything is better than nothing

Donations- Changing the Dynamics donor recipient

Donations- Changing the Dynamics donor recipient

Donations- Changing the Terminology donor recipient solicitor

Donations- Some things that can be done Standard equipment lists of models prepared by solicitors Priority equipment needs lists prepared by solicitors Checklists for donors Checklists for solicitors Solicitors should reject inappropriate donations- donation policy Signed MoUs between donors and solicitors

WHO guidelines for medical device donations -Adapt to Haitis reality and needs -Develop and distribute by SHO/CNCP

Maintenance- problems Very few technicians available to repair medical equipment Very few hospitals with biomedical equipment technicians on staff The technicians that are available have not received specialized medical device training Technical schools not offering diplomas for medical equipment maintenance Spare parts not available locally

Maintenance- possible solution Create a small independent equipment maintenance service available to all eye care providers – Train two or three technicians on common eye care equipment – Provide specialized factory training for sophisticated devices – Equip with tools, manuals, physical space – Charge nominal fee for services – Endorsed and monitored by SHO/CNCP

Procurement- problems Procurement not possible within Haiti Shipment and Customs barriers Procurement performed overseas by each doctor individually No standardization on models No discounts for bulk purchasing No strong relationships with vendors

Procurement- possible solution Procurement performed by equipment maintenance service for a small fee Eye care providers to agree on standard preferred models Buy several of the same devices instead of one at a time Share expensive sophisticated devices

WHO guidelines for medical device procurement -Adapt to Haitis reality and needs -Develop and distribute by SHO/CNCP

Maintenance- problems Many different brands and models of equipment- no standardization Many devices are obsolete No budgets for repairs and spare parts

Thank You!