Good first step

April 28, 2009
Location: Mulago Hospital, Kampala, Uganda

Today, we finished cleaning out the future clinical engineering workspace for the technicians at Mulago Hospital.

The picture to the left was the room before we started cleaning. We started an equipment triage and assessed what was worth saving. Many of the items had no hope of ever being repaired for use. The problem was that some of these things were so old that the company that originally manufactured them were either no longer in business or no longer supporting the device. All those items - immediately in the "Return to Main Stores" pile, which grew steadily throughout the day. Some items required proprietary disposables that there would be no hope of getting replenishing supplies for, as Mulago Hospital was not ready to import large quantities of disposable medical supplies. So on to the pile they went... Ancient machines - Gone!

Sabo Rashid, the environmental services guy (who really takes pride in his work), really did a good job! Here is the "After" photo of the same room after Rashid (pictured below) sweeped and mopped the room. We then put back the equipment that survived the scruitiny. Approximately 70% (by volume) of the equipment went to the trash bin. Anesthesia carts from the sixties and the seventies - gone!

Next, we needed to clear out the actual lab space next door where the technician benches will be located. We are hoping to put in three benches.





April 29, 2009
Mulago Hospital, Kampala, Uganda

Somewhere near Operating Theater 4, there is a door marked "Maintenance." This is the new home of Mulago Hospital Clinical Engineering deptartment. Here is the room before we got there:

The stack of papers to the right included OR records (they were pretty articulate and thorough) back to 1994. All record keeping is still done on carbon copy paper. Please help! We need to get them a better way to keep track of expenses and OR activities.

As before, most of these equipment went to the stores. Notice the ZEISS microscopes... I think they have three total. Very nice units.




Once again, Rashid did his magic and voila!

Cleanliness! All is well. Now to fill this space with three technician's benches, fully stocked. We shall see how this goes in the coming days. We finished the day by putting together a pediatric ventilator using some spare parts. This was a good day.

Peace Out,
Keita Ikeda, PhD.

Donation Dilemmas

Provision of adequate medical supplies and equipment has been a problem for Mulago since its inception.

Donations have been pouring into Mulago for decades... all well-intentioned... but not all can be utilized as invisioned.

Here are some pics of the warehouse which contains vast stores of partially sorted and misplaced equipment donations to the Hospital.

There are many reasons why equipment lands here unused and doomed including:
-No trained staff to use them
-Multiple packages of supplies separated in shipping never to be reunited (proprietary cables and power adapters are missing for millions of dollars of equipment here)
-No use at Mulago
-No labels (hundreds of unlabelled boxes sit on the shelves)

It is difficult to even start to systematically go through these stores... but today we did manage to find a few power supplies that belong to propaq vitals monitors that have been sitting inoperable in the theatres until today.
We are working through a system - possibly picture-based - to help staff sift thru the stores to find the useful parts.

More to come soon.

BioMed Needs Reassessment

We have arrived in Kampala once again to follow-up on several ongoing projects, primarily focusing on the state of biomed engineering at Mulago. The team this time includes Keita Ikeda (Biomed engineer from Duke) and Helder Chin (UCSF anesthesia research assistant).


First order of business was checking in with operating theatres to update the Mulago equipment inventory list and to make sure each operating theatre has a functioning anesthesia machine vent/vaporizer, pulse oximetery, capnography, and vitals signs monitors.

Though we haven't been able to test the functionality of the equipment (because the step-down transformers are kept under lock and key on the weekends), each theatre did have "full set" of machines. Most had the usual homemade/makeshift cables, as well as "disposable" BP cuffs and pulse ox probes which seem to have been on their last life quite some time ago. Between the vitals monitoring, vent, and capnography there are a hodge podge of at least 3-4 manufacturers per theatre to complete a set.

Some of the machines were obviously missing cables (an thus not likely functioning or being used) and others (like a vent which was slowly but obviously leaking oxygen) were in need of some quick fixes.

We also have met with engineers at the hospital to identify some of the major problems the encounter around the hospital. They have identified several areas that we began brainstorming about how best to support them.

One area identified was providing some support resources such as access to service manuals and basic repair equipment.

Another was helping to define rules for donated equipment. Equipment donationes are a double edged sword at Mulago. Inappropriate equipment donation is as much of a problem as the general lack of equipment.

Engineers here say they spend significant amounts of time trying to make donated equipment functional. Because they have no clinical and/or engineering support or training for these devices their efforts are often unsuccessful and equipment ends up in piles in hospital store rooms - making it impossible to keep track of smaller parts like proprietary cables, etc...

Through the course of this trip we hope to make some progress in the areas idenitifed by the engineers.

We were excited to hear that progress is being made with a technical biomed engineering program to begin at Kyambogo University here in Uganda in the Fall of 2009. Mulago is likely to be the skills training center for the program.