Engineering: issues, challenges and opportunities for development ...

ENGINEERING: ISSUES CHALLENGES AND OPPORTUNITIES FOR DEVELOPMENTcontaminated unless correctly stored. These items are usuallyimported at a high cost to the importer. More sophisticatedmodern equipment is often not needed and a basic item isof greater use, but the sophisticated system may have to bebought at a high price because of the lack of choice. Repairfacilities and spare parts are often unavailable, and the equipmenthas to be returned to the manufacturer, or specializedtechnicians have to be brought in at great cost.A problem particularly relevant to developing countries is thedonation of equipment, which is surplus to requirements oroutdated. Many countries depend on the donation of medicalequipment but often there is no funding for the transportationof equipment, installation, maintenance and training. 7Personnel and trainingIn developing countries there is a shortage of properly trainedmedical engineering professionals, with very few engineers –most being technicians – and very few training institutes. 8 Ifequipment is to perform optimally, and have a long servicelife, then the engineering staff are as important as the medicalstaff in the delivery of healthcare. These skilled staff musthave appropriate training so that they can carry out the workeffectively. They must also be conversant with the appropriatestandards and regulatory bodies.It is important to build up the knowledge and expertise availablein developing nations. This will require training programmesand courses at undergraduate and postgraduatelevels, but to achieve this, support is needed from internationalbodies such as the International Federation for Medicaland Biological Engineering (IFMBE), the International Unionfor Physical and Engineering Sciences in Medicine (IUPESM),the World Health Organization and UNESCO.It is also important to arrange ‘training’ facilities between universitiesfrom both the developing world and richer countries,as well as benefitting from distance learning Master degrees(such as the MSc in Clinical Engineering offered at Cardiff University,UK). This high-level cooperation will involve organizationswithin the developing countries: for example, the NigerianInstitute for Biomedical Engineering (NIBE) was set up in 1999and has held six national biomedical engineering conferencesand four national professional development courses in Nigeria.NIBE’s professional journal, the Nigerian Journal of BiomedicalEngineering, was first published in 2001.The African Union of Biomedical Engineering and Sciences(AUBES) was set up in 2003. The aim of AUBES is to fostercooperation between biomedical engineering professionalsacross Africa. 9 A similar success story is reported from Bangladesh.The futureInformation and communication technologies ( ICTs) havethe potential to transform the delivery of healthcare and toaddress future health challenges. 10 The Royal Society reportDigital Healthcare identifies three broad areas where ICTs willmake a significant contribution to medical practice: HomeCare Technologies, Primary Care Technologies and Secondaryand Tertiary Care Technologies.Home Care Technologies could be used by healthcare professionalsor the patients themselves for ‘treating known medicalconditions, self care, detecting and identifying new conditionsand/or monitoring/maintaining health.’ 11 Primary CareTechnologies would be used by general practitioners, publichealth specialists, community nurses, health centre staff andcommunity hospitals. Areas such as prevention and controlof common health problems, hygiene, and education, andthe diagnoses of common diseases/injuries and provision ofessential medicine would benefit. Secondary and TertiaryCare technologies would be used in hospitals for diagnosisand treatment of medical conditions that need specializedfacilities.Sensor technologies could be used to monitor individualsmore effectively within the home and workplace environments.Sensors are being developed based on low-cost computertechnology bought over the counter or the Internet. 12Instrumentation such as thermometers, measuring scales,heart rate and blood pressure monitors, blood sugar and bodyfat monitors could send information to personal computers oreven mobile phones. This information could then be assessedby the individual concerned as well as their healthcare supportteam resulting in immediate support for the patient concerned.At present most developing countries do not have the necessaryinfrastructure to contribute as equal partners in the areaof knowledge production and dissemination. The numbersof computer terminals, networks, communications channelswith bandwidth and so on are limited. However, an investmentin this infrastructure would markedly improve all aspects ofinstrumentation and training problems 13 and open up theemerging opportunities in the above three areas.9 Ibid. 105.10 Ibid. 107.11 Ibid. 107.7 Digital Healthcare: the impact of information and communication technologies on healthand healthcare. The Royal Society, Document 37/06, 2006.8 Ibid. 105.12 Ibid. 107.13 Srinivasan, S., Mital, D.P., and Haque, S. 2008. Biomedical informatics education forcapacity building in developing countries. Int. J. Medical Engineering and Informatics,Vol.1, No.1, pp.39 –49.134