“Pull away the infrastructure and sophisticated just becomes complicated”

A great piece on why Medical Equipment ends up sitting unused in so much of Africa, over at WhyDev:

When an anaesthesia machine designed for use in an American hospital is used in a poorly-supported hospital in Uganda, things often go wrong – even when it’s a brand-new machine (and, as we all know, often it isn’t). The machine isn’t designed to work in low-resource hospitals, which violates the cardinal rule of medical device design: Know Thy Hospital.

2 thoughts on ““Pull away the infrastructure and sophisticated just becomes complicated””

  1. It is a familiar problem. Once I spent some time in Jinotepe, Nicaragua, watching hospital operation there. One day, we saw a campesina straining forward in 44C heat, pushing a wheelbarrow towards us. Her husband had seriously damaged his foot in a threshing accident. He was sprawled across the front of the wheelbarrow. They had called the hospital for help, because, three weeks earlier, an ambulance had been donated by the good folks of Bremen, Germany. They hoped for transportation to the hospital.

    But the wheelbarrow was necessary because the brand new ambulance was already broken. The companera had been driving it, she wasn’t really licenced, the roads out in the boondocks are filled with huge potholes, and when the ambulance hit one, the fuel pump broke.

    There were no replacement fuel pumps for a Toyota in all of Nicaragua, and the foreign exchange necessary had to be approved by the government, and finally El Imperio was causing problems, so it would have to be obtained from Japan. The doctor sighed and told me it would take six months to get the ambulance back in service.

  2. In Umea, Sweden, the chemistry department ran a program to train foreigners – originally from Vietnam, then Cambodia – in repair and maintenance of technical equipment , mainly pumps, detectors and the like. This was funded by the swedish government as part of its foreign development assistance programme. The guy in charge was Lars Lundmark. During a conversation with him a few years ago he mentioned that the government of Reinfeldt was setting restrictions on who could receive support – Vietnam being communist it wasn’t on a list of “friendly” countries. Politics aside, maintenance is a good place to invest in in “developing” countries. There are other pitfalls as this post notes. All repairs in the world cannot circumvent or even be performed if the rest of the infrastructure is a shambles. But it’s a start.

    A related story that came up in a popular economics book relates the plight of nepalese farmers after an irrigation dam was build in their area. Those upstream in an irrigation channel stopped assisting in maintenance duties because it was no longer in their interest to encourage support from downstream farmers in maintaining the dam, which more or less took care of itself. Whenever you share resources – anywhere in the world – you will run into this kind of problem.

    With regard to Venezuela 😉 there was a NYT article not so long ago that discussed problems encountered by crocodile reintroduction efforts because of the lack of resources for basic maintenance: the lack of repair parts for an IR lamp used in an incubator was apparently obstructing one effort.

    The list of such examples is certainly endless.

    Let’s not even go (but lets) to another subject: cannibalization, or the use or misappropriation of equipment. That ambulance that Jeffry refers to? Maybe it was being used as a bus…

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