What’s it Like to Work in a Developing Country Hospital?

It is now a little more than a week ago that I returned from and unforgettable journey to Africa. It’s been such a journey that expands horizons, gives new perspectives, creates new visions and changes beliefs and values. During my stay I worked for a month at local hospitals, an experience that was different in so many ways from what I had expected.

Prior to our placements at local hospitals the students of the 2014 EWH summer institute (myself included) took part in a month-long educational course on “Engineering in the Developing World” and an introductory Swahili course – a program which proved to be of considerable advantage as we were soon to develop a trusting relationship with the departments we would come to work for.
After this first month of education I was moved to my placement along with my group, which besides myself consisted of a student from Duke and one from Harvard. We were to work in two hospitals: Kilimanjaro Christianity Medical Centre (KCMC) and Mawenzi Hospital, both situated in the town of Moshi, Kilimanjaro region.
The KCMC is one of the largest and most prestigious institutions in Tanzania and has a biomedical engineering department consisting of 30 engineers and technicians. Despite good will and hard work from the department, it was obvious that we could do much in both hospitals, just as we could learn a lot from them. Our group alone repaired more than 60 pieces of equipment during our stay. Overall, this year’s EWH summer program returned 4,200 pieces of equipment amounting to 8.6 milion according to the latest figures from EWH.
If I was to draw one conclusion about medical equipment in developing countries today, I would say that it simply should not be allowed to donate without informing properly about that specific piece of equipment in the local language (or in English, at the least):
In so many places we found rooms and whole warehouses filled with piles of medical devices. To our surprise, very often these devices could be put back into service by simple mechanical repairs. We even found completely new operating theatres that could not be used because they were packed full of unused equipment. I was left behind wondering if donations do any good at all – or if they do more harm than good. During our month at the hospital we slowly started to learn the reasons why these equipments weren’t in use: How were people supposed know how to use a piece equipment, if they had no manual for it? Or how could they use a machine, if the user interface was in Dutch or in German? When a repair was to be done after all, many reported difficulties and bureaucratic systems when having to acquire replacement parts, such as a lightbulb for a microscope.
The type of problem that could arise when departments were not provided information about new technologies became clear to me one day at the KCMC, when our group was asked to repair an Infant Warmer from GE. We were told the following: The department had received a completely new machine and put it into a small room where they normally observed newborns in the early hours after a birth. But when the staff began to use it, the machine heated the room up to a temperature so high, that it was unbearable to stay in there.
The solution turned out to be immensely simple: the skin-temperature sensor had mistakenly been placed under the bedside, and had to be moved to the skin of the newborn – otherwise the device would constantly work to achieve a temperature of 35.5 degrees under the bed instead of on the baby’s skin. Thus the machine was heating on and on (and on…).
After having cleared out this first misunderstanding, we explained that the machine could not, as some thought, be used to take X-rays images, but that it merely contained a tray for a detector plate so that you weren’t forced to move the baby around unnecessarily,  and that the machine could not calculate an APGAR-score, but that it contains a stopwatch simply to help you with the task. The problem wasn’t lack of education or ability to understand how a machine works. It was simply the fact that people were not provided the necessary information. Even if some information was provided, it was not done properly: How is a nurse going to read a 500 page manual, while working in a ward full of women in labour? Seeing this and other similar cases, one of our main focuses became developing quick start guides in order to provide departments with a fast and simple way of knowing how to use a device.
Another typical issue that we encountered was how departments virtually never took advantage of vital signs monitors and ECG’s because they had run out of the necessary electrically conductive gel. There are a number of alternatives to conductive gel – in principle anything that contains electrolytes, for example aloe vera or ketchup, can be used. It should have been obvious however (as I did not first think of), that most doctors and patients do not want to use these methods, as they are uncomfortable and inconvenient. I remember explaining to a doctor how he could make his own electrically conductive gel using water, flour and salt. His response: “Is that really recommended?”. Imagine his reaction, had I recommended him to use ketchup. In addition, many Africans are proud people to whom one can and should not just offer anything (just as one would probably not do anyone at home). Therefore, developing a gel that is more likely to be used clinically, and in addition could be produced cheaply using local materials, would be an example of a simple and small, but valuable project for developing world hospitals (while you can find alternatives to conductive gels, I still haven’t seen one that actually looks like the gel that is used in clinics). Notably the KCMC already had the means to produce their own ultrasound gel (which is acoustically and not electrically conductive) so they shouldn’t be too far away from being able to produce their own conductive gel too.
This and many other projects are still to be carried out to make the daily life at a these hospitals run smoothly. Here I have given just two examples of what it can be like to work in the developing world. So many ways remain in which one can help this  parallel world of ours, in which resources are so scarce that we are constantly forced to think in new and innovative ways to provide the best possible health care for the all people.

The Greatest Sunset Ever…

As the sun set it lit up the skies from below and turned everything red. We put on music and we were having a great time with the whole staff,  listening to Dimmi, Promesses (the Obama song) – the speach that says:

“it doesn’t matter who you are, where you come from, what you look like or where you love…”

One of the guys told me he gets the chills everytime we listen to it. We agreed that we would listen to it every evening on the rest of the trek. 

The guys on the pictures include Agapit, Rashiti, Kalisti, Thomas, Calvin, Gofrey, Hilary.  

The Hottest, Most Hostile and Surreal Place on Earth

People around here believe it is the gateway to hell…

Sure enough it’s an intimidating experience: Its in the middle of the night and just few meters away waves of lava are splashing into the mountain side spraying lava up into the horizon in front of us.

Located at 160m below see level the Danakil Depression is the lowest, hottest and most hostile place on earth. The vulcanically active areas found in this desert are surreal: they look like something from a different planet. Some friends I have shown these pictures thought they were manipulated. They are not.

The Danakil region is inhabited the Afar people and their salt miners go here to chop salt blocks from the flat grounds. Caravans go from Afar Salt Mines to Mekele, the nearest large town, where 5 kg blocks of salt are sold for 22 Ehtiopian Birr, the equivalent of just one American dollar.

In September (2014) I went to the Lava Lake at Ert Ale (smokey mountain). The following days we saw a salt lake, a sulphur lake, salt mountains, an oil lake and the salt miners of the Danakil.

See more photos on the page for the Danakil Depression.

Matatus – The Kenyan Partybusses

This video shows my humble experience with the Matatus of Kenya: My friend Tekwane told me, that some of the of even more lighting and that these are sometimes joined by disco balls, posters, pictures, special seats – apparently, some have even installed used flightseats in their Matatus.

The greatest thing however, is that every day there is a new musical theme: there is reggae day, pop day, oldies day, party/dance day (friday), and so on…  and the funny thing is, that traffic is so slow in Kenya that the driver has time to do proper DJ’ing while driving.

The Serengeti and Ngorongoro Crater

From ‘Maya ya Simba’ the rock where simba was born to baboons finishing off a Leopard, the wildlife in the Serengeti was so much more eventful than what I have seen in any other national park (Ngorongoro, Tarangire, Manyara). We had three days in Serengeti, which allowed for a full day game drive followed by an early-morning game drive the next day. We were able to go to distant areas to see wildlife play out with no one but us being present.