Could Donkey Ambulances Save Lives in Poor Countries?
Thursday, September 8, 2011
Professor Chris Lavy, an orthopaedic surgeon who spent years working in Africa, gives a vivid example of inappropriate medical technology for the developing world.
One of the newest hospitals in sub-Saharan Africa, he points out, was built with infrared sensors to turn the taps on in the operating theatres. “Wonderful idea, but is it really appropriate in a country where there are no other infrared controlled taps and no engineer to fix them,” he asks rhetorically. “Within a year most of them had failed, some in the off position and some in the on position.”
It is a familiar problem. A well-meaning donor gives a shiny new piece of equipment to a poor country only for it to gather dust. Parts that are expensive and difficult to replace, the need for a constant electricity supply, a lack of trained operators, unsuitability to rough terrain are all factors preventing the use of these devices in the developing world.
The scale of the problem is considerable. The World Health Organisation (WHO) estimates that as much as three-quarters of all medical devices in the developing world do not function.
“Factors contributing to this are: lack of needs assessment, appropriate design, robust infrastructure, spare parts when devices break down, consumables and a lack of information for procurement and maintenance, as well as trained healthcare staff,” says the WHO. “These issues are part of a broader problem in many countries: the lack of a medical device management system.”
To avoid such pitfalls, the Institution of Mechanical Engineers (IMechE) organised a one-day conference in London this week, bringing together engineers, health workers, donors and charities to look at devices specifically designed for the developing world.
They include a nipple shield for breastfeeding HIV-positive mothers, which can block transmission of the virus to their babies; an eRanger ambulance – a motorbike sidecar stretcher that can handle rough terrain far better than a four-wheeled ambulance and is much cheaper; and a stethoscope that can attach to a mobile phone, allowing doctors to monitor hard-to-reach patients remotely.
The heart-rate monitoring device is particularly ingenious as the microphone on a mobile phone is used as a stethoscope to analyse and record heart sounds. This means a patient’s condition can be analysed by a doctor hundreds of miles away. The device specifically targets tuberculosis pericarditis, which affects around 10% of all TB patients and has an unusually high mortality rate (40%). It would be particularly useful for remote rural communities where access to qualified doctors for routine check-ups can be difficult.