Maintaining ophthalmic equipment is vital for any hospital, especially where services are few and far between. Keith Shirley, Medical Eye Center’s biomedical engineer, recently traveled to Ethiopia to provide two weeks of training to local biomedical maintenance technicians. On behalf of the Himalayan Cataract Project, Keith worked with nine local technicians at five institutions to examine equipment, make repairs, and provide hands-on guidance and training.
The first medical device Keith tackled was a Pachymeter which had a missing power connector. It would have been impractical to replace the connector due to the age of the device, so Keith cut the connector off and attached the cable directly to the circuit board. The Pachymeter was immediately placed back in service. “I like these types of repairs,” says Keith, “because it shows you can often work around a problem.”
Unfortunately, access to parts for aging equipment frequently plagued Keith’s ability to help the Ethiopian hospitals. In the US, a biomedical engineer can easily get technical support via the internet, and then have replacement parts shipped directly to the facility. Keith quickly learned that’s not so easy in Ethiopia.
He wondered if there were any electronic component suppliers in Addis Ababba or general repair facilities where things could be rebuilt. Keith asked the local technicians, “but they always seem to be confused. It’s as though a supplier that specializes in such a narrow market is nonexistent.” Keith believes that finding a way to order parts off the internet will be a key to supporting the technicians in Ethiopia.
Next up, two Reichert Tonopens that didn’t seem to calibrate. Keith performed a few tricks of the trade, and he was able to get one of the devices to self-calibrate. Unfortunately, he had no way to test the other, which was suspected of reading too low. They could be easily calibrated in the US, but the round-trip journey to America and back could take a year. “It’s small problems like these that beg for a logistical solution,” Keith frets.
Reported problems of low illumination were common. “Next time I’ll have a photographic light meter in my tool kit.” Thinking long term, Keith recommended that the hospitals use LED or MR16 halogen lights, which are better suited to countries with limited resources.
Keith found the people working at the hospitals had to wear many different hats. “Asasahegn works in finance, but he’s surprisingly adept at working on equipment,” says Keith. “He was very helpful throughout my time in Addis. He came in on Saturday to help work on microscopes. He traveled to the Military Hospital with me and put in a long day there as well. He even gave me a ride to the airport on my way home.”
WGGA, a private eye clinic outside the capital, had two dead Phacos—one of which was a machine that was used for parts, the other frequently blew fuses which indicated a power supply problem. Keith tried swapping in parts, but he quickly found that the power supply had already been cannibalized from a previous repair. Again, replacing the part would be easy, getting the part is another story.
There were still items that needed repair at Melenik hospital, but after an 11-hour day, Keith began to feel ill and headed back to his hotel. He was too sick on Friday to go to the Armed Forces hospital as planned. Fortunately, he was well cared for. “Trudie was amazing. When she heard I was sick, she hurried to get medical advice and supplies. She also asked the hotel to move me into a non-smoking room, which greatly enhanced my comfort. And instead of going in to her office, she worked out of the hotel restaurant all day so she could be nearby. This was one of the nicest things anyone has ever done for me.”
On Saturday, Keith was feeling much better and was able to spend another half day at Melenik hospital. A local technician named Haftamu was proud to show Keith his system of problem reporting, tracking, and maintenance records. Keith congratulated Haftamu on his fine work. “This said to me that he has a strong commitment to his job. Given the proper resources, I know he will progress.”
In the West, we take internet access for granted. But in Ethiopia, Keith found “there was no data plan on my phone, so it was critical to have WiFi so I could do email and access the web.” Unfortunately, Quiha hospital doesn’t have WiFi and Keith thinks it would be invaluable to the doctors, staff, and technicians. “There’s talk they will have it in three years. I’m not an IT expert but I imagine all they need is a $50 wireless router plugged into their cable in the main office. Perhaps they would welcome a donated wireless router?”
At the Armed Forces hospital, a Keratometer wasn’t operational. First, Keith disassembled the unit and cleaned the optics. It was filthy and he could see dust caked on several of the mirrors. At one point, Keith thought he might get the keratometer working, but in the end he was defeated due to a defective microswitch. “The switch is a very common and inexpensive part. I’m sure I have a couple laying around my tool box at home. Just about anyone could replace it. If we only had that switch, they would be up and running!”
It’s frustrating to have limited time and resources in a foreign place. “I wish I could bring all these projects home with me to work on them,” says Keith. “Dr. Oliva mentioned Medical Eye Center might have doctors going back soon, so I’ll work with him to get some of the urgent items ready, and help arrange for other items to come back.” Keith is sincerely looking forward to working with Asasahegn, Trudie and the others to improve effectiveness and facilitate equipment maintenance in Africa.
“This was an interesting trip with all the different venues,” reflects Keith. “Thank you all for giving me the opportunity to do my small part.” Keith Shirley’s work is greatly appreciated. The Himalayan Cataract Project hopes to expand opportunities for biomedical maintenance training throughout Ethiopia and Nepal.