Tuesday, November 24, 2015

Medical Technology in Global Health

by Denali Dahl and Rosa Castro

In his engaging presentation last Tuesday, Dr. Robert Malkin introduced us to a shocking reality: most of the medical equipment donated to the developing world ends up being a burden. Donors might have good or bad intentions but the reality is that most donations are ineffective, troublesome, and often cause more harm than good.

The accumulation of ineffective technology in low and middle income countries is due to the lack of spare parts and the technical knowledge, which lead to an inability to repair or maintain the donated medical equipment. Without the capacity to fix technical equipment, the devices intended to improve access to quality medical care end up “parked” in a hospital, taking away space rather than helping anybody.

Donors are more excited to donate different pieces of equipment rather than fundraising to provide spare parts or money to maintain the medical equipment they have dumped in another country. This fundamental flaw in the system must be addressed for donations to become sustainable solutions that have provide long-term improvement.

3D printing technology has the potential to create new materials and parts on large and small scales with a wide variety of applications, a concept that has revolutionized the engineering world. The question becomes, can 3D printing extend beyond the laboratories and be applied to improve the donated medical equipment problem?

3D printing can generate spare parts and consumables without having access to large-scale manufacturing facilities. With thousands of pre-programmed designs at hand, using a 3D printer is becoming more user friendly everyday. All the user has to do is load their material--usually a plastic polymer--select design specifications, and watch while their creation comes to life.


Technology like 3D printers has the potential to provide low and middle income communities with ways to build products for themselves, especially small parts to repair the larger medical equipment constantly being donated. In Haiti, 3D printerswere recently used to help Haitians build their own umbilical cord clamps. The ability to 3D print the necessary items empowers hospitals and clinics by giving them a tool to become more independent, instead of having to rely on donors or the government to provide everything.  

Image credit: Makezine.com

The main drawback is, what happens when the 3D printers break and need their own spare parts? Would donating 3D printers along with medical equipment be helpful or harmful? Would the 3D printers be another sophisticated device “littering” the developing world? 

Source: http://www.scientificamerican.com/article/medical-equipment-donated-developing-nations-junk-heap/

3D printers have the potential to alleviate the disparity between having and using medical equipment, but to be effective technology in any form must be donated in a sustainable manner to ensure long-term benefits to the selected communities. 

12 comments:

  1. You bring up an interesting idea with the 3D printers. I'd like to add another thing to consider when proposing 3D printers to help hospitals and clinics in developing countries be more independent: blue prints. Every single machine has a specific design, so if a part breaks, the person in charge of the 3D printer will need to have a very good understanding of how that machine works and all the parts that are involved. Accessing the necessary designs for 3D printing would start to get into some grey areas, with respect to proprietary issues. Many companies don't file international patents, so perhaps these clinics could get around the patent-law issue be default. Another challenge is these clinics/hospitals receive a hodgepodge of machines made from a variety of companies. For instance, what if they have 3 bed-side monitors all donated from different hospitals that used different companies? That means, if the technician figures out how to replace part X in one monitor, it will not necessarily be compatible with the other monitors. I think 3D printing would be best suited for manufacturing new tools (such as the umbilical cord clamps you mentioned) as opposed to manufacturing parts to fix a complex medical machine.

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  2. Thanks for your comment Hannah. You bring excellent points to the discussion and I totally agree that 3d printing might be helpful only for a narrow set of cases. I haven't though about the fact that maybe manufacturing new tools (and probably simple ones) might be a more suitable use of 3d printing. I was actually thinking about the potential they might have in solving the spare parts/consumables problem Dr. Malkin mentioned in his lecture. But of course, both spare parts and consumables might be quite complex pieces, covered not only by patents but also by design rights. I also tend to agree that this might not be such a big problem in many developing (and least developed) countries as patents/design rights and trademarks are national. But the problem remains as to how do you make those machines able to produce exactly the spare parts/consumables you need, and which type of technical assistance they might require.

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  4. The use of 3D printers will revolutionize the future and especially in healthcare. This can change the world due to the cost of the materials being minimal and the ability to manufacture specialized parts after a short bout of using a CAD software is extremely desirable. One problem that developing countries may have are access to reliable energy connection to power computer that run CAD software as well as the 3D printers that require hours of uninterrupted power and also trained individuals to use the complicated engineering software. From a chemical perspective the use of 3D printers will only be effective if the materials that are being used can hold up to the stress of what they are being used for and also the toxicity of the materials when used in medical equipment should be considered. Finding solutions to these problems to create a sustainable model in countries will definitely change the world.

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  5. I think 3D printing could have a small niche in creating biomedical equipment in LMICs, but it will not be the "holy grail" some might hope for. Much of the equipment that is donated is complex electronics - bedside monitors, ventilators, vital sign machines, blood sugar machines, etc. The consumables themselves have multiple pieces, and come in direct contact with patients and bodily fluids. I could see for very simple things, like umbilical clamps, a 3d printer might have a role, but for any of the other complex medical equipment, I don't see how a 3D printer is going to address the issues of lack of consumables and repair parts. And at that point, is it worth bringing a 3D printer to a developing country just to make umbilical clamps? I don't know the answer.

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  6. I think 3D printing could have a small niche in creating biomedical equipment in LMICs, but it will not be the "holy grail" some might hope for. Much of the equipment that is donated is complex electronics - bedside monitors, ventilators, vital sign machines, blood sugar machines, etc. The consumables themselves have multiple pieces, and come in direct contact with patients and bodily fluids. I could see for very simple things, like umbilical clamps, a 3d printer might have a role, but for any of the other complex medical equipment, I don't see how a 3D printer is going to address the issues of lack of consumables and repair parts. And at that point, is it worth bringing a 3D printer to a developing country just to make umbilical clamps? I don't know the answer.

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  7. I do agree with Devon that there is a small niche for 3D printing, however perhaps it is a a little bigger niche than people give it credit for. 3D printing is not limited to simple mechanical parts, but can also produce replaceable that come in contact with bodily fluids. Obviously, once these replaceable are produced they would need to go through the proper sterilization, but they can be produced. 3D printers can also be expanded to implant technology as well which can do wonders in an LMIC. The difficulty would be the constant software updates for the 3D printing technology as well as the training needed for the personnel using the 3D printing technology. If the training and maintenance isn't there, then a 3D printer will for sure be a trophy piece.

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  8. I liked the Professors idea on donation sometimes kills local business. I think in the end, the local business is the way out, and donation is not the final solution. I also liked his idea why low-cost equipment cannot become universal? He gave two main reasons
    1. Capital cost of equipments is not the problem.
    2. Infrastructure (Electricity), operation skills (new training program), maintenance capacity (accessories and spear part resupply).

    By Hanati, Hailati

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  9. Thanks for the wonderful blog. In the Lancet article about global health technology, it argues that technologies used in developing countries should focus on the poorest population and follow with innovations. I think this indicates why so many donations in developing countries end up in vain: they are not what these countries really need or able to consistently utilize. I think the donors should focus more on supporting the development of local agriculture and industries. 3D printer seems to be an opportunity to garner sustainable and broader usage in low-income countries, at least providing an easier way to get the medical equipment with urgent needs.

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  10. I think Yudong brings up an excellent point regarding the approach to bridging the healthcare engineering gap that seems to exponentially widen with every passing day. Pulling LMIC up by donating the latest or what the donors think are necessary may be only short-term and often headline stories that lack sustainability and local buy-in. Driving innovation by equipping the locals with the skills, providing the opportunity for advanced education, and creating an incentive plan to retain talent and avoid the brain drain may be potential long-term sustainable solutions. I guess as we delve deeper into global health issues, the more we realize the importance of holistic integrated solutions over flashy interventions in silos. And what about bidirectional learning. How could industrialized nations better optimize their systems based on lessons in LMICs?

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  11. I wasn't surprised, but was very disturbed by the fact that many high income countries donate medical equipment to simply avoid disposal fees. The Medical Equipment Services of an NGO called, International Aid, attempts to solve the issue of surplus of broken medical equipment donations; it serves as a link between equipment donors and recipients, ensuring that the equipment donations will be functional. Perhaps this is the kind of NGOs that we should encourage instead of the NGOs that open up new clinics in another LMIC (although they are just as important). Initiating a new project has always sounded more appealing than maintaining or trouble shooting an existing program, and I think the same concept can be applied here; not many people are interested in fixing things that take time and effort. In order for NGOs that help fix broken medical equipment prior to its final destination, people who are knowledgeable in equipment, machinery, etc. and skilled in repair and maintenance of medical equipment should be recruited. Also, there should be a way to educate equipment donors about the consequences of their actions in LMICs and perhaps hold the donors accountable for their actions. In general, philanthropists/donors should become more aware of the importance of maintaining an existing a project rather than initiating a new project.

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