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Biomedical technology is broadly defined as the application of technology to the solution of medical problems. This technology includes more basic equipment such as a wheelchair or microscope ranging on up to high-tech diagnostic equipment such as an MRI machine or a flow cytometer, which represents the gold standard for testing CD4 and T-cell counts.
In many low-income countries around the world, more than 95 percent of the medical equipment found in hospitals is imported. Unfortunately, much of this equipment is out of service, but could be easily repaired at minimal cost by trained professionals. According to a survey of 52 African hospitals conducted by experts at Carleton University in Canada, 85 percent of these facilities indicated that their medical device maintenance services had trouble finding qualified engineers and technicians locally.
To a great extent, biomedical engineers and equipment technicians in low-income countries are affected by the same challenges that doctors and nurses face, including inadequate numbers of qualified personnel to meet existing needs, limited educational opportunities, lack of on the job training, absence of regulatory bodies, brain drain to higher-income countries, and competition with the private sector for the limited pool of skilled professionals.
AIHA’s Biomedical Technology Program
In January 2013, AIHA initiated a partnership that applies our twinning model to engage multiple education institutions from the United States and Ethiopia in a concerted effort to rapidly train new biomedical engineers and equipment technicians, as well as to support the ongoing continuing education needs of existing biomedical technology professionals. This partnership represents the first PEPFAR-supported project to address biomedical technology in sub-Saharan Africa.
Jimma University Institute of Technology established Ethiopia’s first biomedical engineering degree program in 2008, while and Tegbare-id Polytechnic College has been home to one of the country’s only diploma-level biomedical technician vocational training programs since 2006. Tasked with producing enough biomedical technology specialists to meet the country’s very high demands, both these institutions face significant challenges, including acute shortages of of qualified biomedical engineering instructors and a dearth of crucial professional development opportunities. They also lack training capacity and access to well-equipped skills labs and design workshops, as well as strong curricula and teaching methodologies. Yet another challenge is that most Ethiopian healthcare facilities do not adhere to evidence-based international standards for the management of biomedical equipment, which often hinders professional development
and growth opportunities for new biomedical engineers and technicians.
By linking Jimma University and Tegbare-id with Rice University and Texas Children’s Hospital, AIHA helped the Ethiopian partners build the capacity to produce biomedical engineers and technicians capable of meeting the country’s burgeoning demands. Together, partners worked to strengthen pre-service biomedical engineering and equipment technician training programs at both the bachelor and diploma levels by updating curricula, trained faculty, and provided evidence-based learning resources. Partners also collaborated to expand the capacity of these cadres to
manage and maintain critical medical equipment through the expansion of practical in-service training opportunities. Finally, they are worked to establish standardized protocols and processes to ensure ongoing equipment maintenance at the healthcare facility level.
In 2016, this partnership progressed to a second phase with the addition of a third Ethiopian institution: the Addis Ababa Institute of Technology. At this time, AIHA replaced the US partners with a consortium led by the University of Wisconsin at Madison to better address the evolving technical assistance needs of the Ethiopian schools.
Through this groundbreaking twinning partnership, AIHA is helping to develop a core group of biomedical engineering and biomedical equipment technology leaders in Ethiopia, who can identify local needs and gaps in healthcare delivery — with a special focus on technologies related to HIV/AIDS treatment and care — design and implement appropriate solutions, and repair and maintain existing biomedical equipment.
Based on its success, in 2016 AIHA launched three other PEPFAR-supported biomedical technology partnerships in Kenya, Uganda, and Zambia that are focusing on in-service training and capacity building. A fourth new partnership in Tanzania, which will focus on developing training programs at both the pre-service and in-service levels, is currently in start up.
Selected Program Results
- Curricula and training capacity assessments conducted at the onset of the partnership by Rice University experts revealed that both Ethiopian partner institutions had limited technical expertise in biomedical engineering. Curricula at both institutions had been designed by professionals outside of the field, predominately focused on electrical and mechanical engineering, and lacked hands-on practical learning opportunities. During the first year of the alliance, partners worked closely with the ministries of health and education and other local stakeholders to adapt Rice University’s strong undergraduate bioengineering curriculum to the local context.
- Rice University partners developed an online bioengineering course through Coursera, an educational technology company that offers massive open online courses (MOOCs). The course, which is offered free of charge, focuses on troubleshooting, repair, and maintenance of standard biomedical equipment used in hospitals, particularly in low-income countries. While this course has initially only been offered to students at Rice, Jimma, and Tegbare-id, partners plan to eventually open it up to biomedical engineering students in low-resource settings who may not have access to training programs such as the ones that have been established in Ethiopia. They also plan to offer it as a continuing education opportunity for practicing biomedical engineers and technicians.
- Through Rice University’s Beyond Traditional Borders (BTB) curricula, Rice 360° is helping their Jimma partners develop an Appropriate Design for Global Health course. BTB also promotes global health technology by hosting a design competition. In March 2014, five participants from Jimma University participated with a pre-recorded presentation. One Jimma entry — a low-cost, low-tech device that alert practitioners to overflowing suction pumps, which present a serious problem in many developing-world hospitals that often lack backup pumps — was awarded third place in the competition. This marked the first time that a team placed in the competition via long-distance submission and conference organizers said they hope the win will spur international interest.
- In collaboration with the Ministry of Health, AIHA and our partners developed a mentorship plan that includes experiential attachments at 10 government hospitals and five medical equipment dealers to promote the acquisition of hands-on practical skills for biomedical technology students.
- AIHA and our partners developed a troubleshooting workshop course that was delivered to a mixed group of 48 fifth-year biomedical engineering students and biomedical engineering and biomedical equipment technicians from Debre Berhan Hospital during the partnership’s first year. US partners led this workshop, which teaches fundamental troubleshooting skills for medical devices commonly found in hospitals and health centers, such as microscopes, suction pumps, centrifuges, oxygen concentrators, and refrigerators. Each module included proper device usage, component and function overview, safety, preventative maintenance and common failures and repairs. Pre- and post-tests revealed an average improvement of greater than 20 percent. The US experts trained and mentored their Ethiopian partners, who are slated to deliver a similar workshop for the second cohort of bachelor level biomedical engineering students set to graduate this year thus better ensuring long-term local sustainability.
- Responding to the shortage of qualified faculty at the Ethiopian institutions, the Rice partners helped recruit two fellows, who are serving as biomedical engineering instructors at Jimma University, which funds these expat placements in support of the partnership’s objectives. These instructors are mentoring current faculty members and teaching basic and core biomedical courses, including bioinstrumentation, basic science, and research methodology, which are all part of the newly revised curriculum that was implemented through the partnership.
- AIHA and our US partners have focused a great deal of effort on strengthening local training capacity by developing a number of training and continuing education opportunities, particularly courses that stress practical, hands-on experience and problem-solving skills. With the objective of creating and maintaining robust technologies designed to deliver highly effective care in low-resource settings, the US partners developed in-service training opportunities through exchange programs that have brought faculty from Ethiopia to the United States for intensive training. Led by the Biomedical Engineering Department at Texas Children’s Hospital, which has extensive experience hosting training programs for international biomedical equipment technicians. The Ethiopian faculty return home and, in turn, train their counterparts to more effectively impart knowledge to their students.
- Partners jointly identified biomedical equipment that the Ethiopian educational institutions need to effectively provide students with practical learning opportunities that will help them develop the skills they need. AIHA has purchased and/or upgraded equipment for this purpose, with additional purchases planned for the coming year. US partners have also donated portable medical test equipment that is being used for teaching purposes.
- Through Rice University’s BTB Summer Program, four Rice student interns implemented a digital equipment inventory management system in collaboration with Jimma University, Tegbare-id College, and Debre Berhan Hospital biomedical technicians and students at five hospitals. This project involved tagging medical equipment with numbered, bar-coded labels to record the make, model, serial number, manufacturer information, power requirements, and functionality status for each device. It is an open source database system that can track biomedical equipment and recommend scheduled maintenance and was fully installed at Jimma University Teaching Hospital, Jimma Teaching Health Center, Ras Desta and Zewditu Memorial Hospitals in Addis Ababa, and Debre Berhan. In addition to developing and installing the system, the interns trained local staff in an effort to help partners scale up inventory management systems and standards at all hospitals and health centers throughout the country.
- In March 2016, AIHA launched a second partnership to build the institutional and human resource capacity of the national and regional equipment workshops operated by the Uganda Ministry of Health’s Health Infrastructure Division the Central Public Health Laboratories with technical support from the Lorma Consortium, a coalition of biomedical engineering and health sciences schools and international subject matter experts.
- To date, AIHA and our Uganda partners have developed a training curriculum covering non-automated lab equipment relevant to HIV diagnosis and treatment, as well as refrigeration and air-conditioning training to better support routine viral load testing. As of December 2016, two 15-biomed cohorts have been trained on non-automated equipment and seven of the 30 have been identified as leaders who will participate in training-of-trainers courses and receive additional mentorship and supportive supervision to enable them to step down trainings in their respective regions.
- In Uganda, AIHA has so far trained eight biomeds through a comprehensive two-week training on refrigeration and air conditioning equipment, which becomes ever more important as laboratories shift to routine viral load testing. Additionally, in August 2016, we launched the first phase of a year-long, three-phase biosafety cabinet calibration and certification course for four biomeds conducted in partnership with the Eagleson Institute in Maine. With limited capacity to conduct this crucial training throughout Africa, AIHA is working to empower Uganda’s biomeds to address the need in their own country and to serve as a model for the continent. The four biomeds participating in the course are currently conducting monthly assessments as required of the program.
- In June 2016, AIHA launched a third twinning partnership focused on building the capacity of Kenyan biomeds under the Ministry of Health’s National Public Health Laboratories (NPHLS). The Kenya partners are working with experts at the University of Texas Medical Branch (UTMB) and San Jacinto College (SJC) with an initial focus on building national-level capacity in Nairobi, with planned step-down to the PEPFAR priority counties of Kisumu, Siaya, Homa Bay, and Migori. Partners are working to establish a sustainable NPHLS Center of Excellence for equipment calibration and model county referral facilities; develop standard operating procedures for laboratory equipment preventative maintenance, safety testing, and repair; and develop and implement sustainable in-service training short courses and distance-learning opportunities for biomeds.