June 22^nd, 2012

Whew!  It’s been a busy week at Queens.  Here are some of the highlights:

• Demonstrating our Paediatric Technologies: We demonstrated the NeoSyP, Babalung, and IV DRIP to the Paediatrics Department on Thursday morning.  Overall, the doctors were very enthusiastic about the technologies!  They gave us some great feedback on how we can improve each design, and discussed how each device could be used on the different wards.  We will be following up with the nurses on each ward sometime next week to get their feedback as well.  Here is some specific feedback we received for each device:

• NeoSyP: The doctors could definitely see the NeoSyP being used in the neonatal ward at Queens.  They particularly liked the idea of using a metronome to power the device – but they did comment on the loud noise it made!  However, the noise won’t be as noticeable on the loud wards at Queens.  The doctors also agreed that the NeoSyP would need to have a safety function added on (to stop the administration of fluids if the device malfunctioned or if the needle came out of the patient’s vein) before it could be implemented on the wards.

• Babalung: The Babalung also received very positive feedback – Queens currently has no method for detecting apnea in premature infants, so many babies who suffer from apnea attacks are not detected until it is too late.  The main concern with implementing the Babalung is its power source.  Right now it relies on rechargeable batteries, but the rechargeable batteries currently used at Queens tend to wear down quickly or go missing altogether.  We’ll be collaborating with the doctors and nurses over the next few weeks to determine the ideal source of power for the Babalung.

• IV DRIP: The doctors loved the idea of using a mousetrap to kink IV tubing and stop fluid flow!  The Paediatric Department at Queens treats many children who are severely dehydrated, and the IV DRIP device would allow patients to receive a large volume of fluid at the beginning of their treatment, without the risk of overhydration.  The doctors we spoke with emphasized how it is very important to keep the IV bag as high above the patient as possible while fluid is being delivered (so that the fluid can travel “downhill” with gravity).

• Demonstrating the SAPHE Pad: Bridget and I presented the SAPHE Pad to the Obs and Gynae Department this past Wednesday.  The doctors liked the idea of being able to easily measure post partum hemorrhaging, and seemed interested in trying the pad out on a patient at QECH.  We plan to follow up with the Head of Department next week to see if this will be possible.  We also surveyed some of the doctors on the readability of the SAPHE Pad user manual, and received some helpful feedback about important details that could be added to the manual to make it easier to understand.  (For example: the current manual does not specify how long a health worker should wait for blood to be absorbed before counting the amount of blood-soaked squares on the pad)

• CPAP Repair Session: Bridget, Jocelyn, and I met with the Physical Assets Management Department (which is responsible for managing and repairing the medical equipment at QECH) to demonstrate how to repair the pumps used in the bubble CPAP machine.  The repair session went well!  The pumps used in the CPAP device are actually the same pumps used in fish tank aquariums – and they’re fairly simple to repair.  Although none of the CPAP pumps have broken so far, the repair session is one of the many steps we’re taking to help ensure the sustainability of the Rice bubble CPAP devices even after the CPAP study is completed.

• Exploring PAM:  After our CPAP pump repair session, Bridget and I had time to explore the Physical Assets Management (PAM) building.  The PAM building was overflowing with piles of broken equipment.  It was evident that the PAM department has nowhere near enough engineers on staff to manage all of the equipment at Queens.  There is a LOT of medical equipment at Queens, and when broken equipment is sent to PAM it is typically stored on shelves for months before being attended to.  In most cases, the “broken” equipment simply needs a missing part replaced…but unfortunately there are rarely spare parts available.  As a result, the PAM Department mostly serves as a graveyard for unusable equipment.

• A few thoughts on donated equipment: Based on my experiences at PAM and on the Paediatric wards, I’ve begun to realize that although many organizations donate medical equipment to QECH with good intentions, not much thought is put into the sustainability of their donations.  Most of the donated equipment lasts for 2-3 years, breaks, and then ends up sitting in a storage closet indefinitely.  In order to truly make a lasting impact, it is important that donated medical equipment is easy-to-use, easily repaired, and that any spare parts can be bought in-country.  But most western equipment doesn’t meet this criteria…in the U.S. it seems as if medical equipment is becoming more complicated every day.  It’s a tough dilemma – under-resourced hospitals desperately need new technologies, but technologies designed for western hospitals are rarely much of an improvement.  The bubble CPAP machine is a great example of an appropriate technology, but as the nurses at Queens all say: “we need more CPAPs!”