AAMI News October 2018

Tech World: For a Biomed in Haiti, ‘Every Situation Is New’

Tom Monaghan
Tom Monaghan

As a biomedical engineer at Massachusetts General Hospital in Boston, with decades of experience handling crises in surgical suites, Tom Monaghan knows how to multitask, prioritize, and solve problems.

But these challenges pale in comparison to Monaghan’s experiences in Haiti, where he is on a mission of mercy to support the safe and effective use of healthcare technology. His tenure there resulted from a devastating earthquake in 2010. At the time, doctors sent to aid the relief effort by Harvard-affiliated hospitals found no working anesthesia machines when they arrived. The hospitals shipped half a dozen or so spare machines there—and they wanted to make sure they worked.

“I work for the anesthesia department at Massachusetts General,” Monaghan said. “So I asked, ‘Do you think you could use me?’ That’s how I got involved in Haiti.” At first, he got those first few machines up and running. Then he visited for two-week stints once or twice a year. “But it wasn’t really fixing anything sustainably.”

He offered to commit to a long-term assignment, with the aim of developing Haiti’s healthcare technology management (HTM) capacity by training a cadre of biomedical equipment technicians. Now, Monaghan is in the midst of a three-and-a-half-year stint as the director of biomedical engineering at St. Boniface Haiti Foundation (www.haitihealth.org) in Newton, MA, which operates St. Boniface Hospital in Fond-des-Blancs, Haiti, his home base.

In all, Monaghan supports five hospitals, spending a week every month at Hôpital Universitaire de Mirebalais, a 300-bed Partners in Health hospital, and checking in regularly to support biomeds at three other hospitals. The foundation sponsors his work through a public–private partnership with the U.S. Agency for International Development and the GE and Kellogg foundations.

Opportunities and Challenges in a Developing Nation

Monaghan works with six to eight apprentices in hospitals throughout Haiti. “There are a lot of guys down there with good electronics ability; they just don’t really understand their role as biomeds,” including their responsibility to train clinicians to use the equipment.

“Clinical training is almost nonexistent down there,” which often leads to reports that equipment is broken when it’s not. “A lot of hospitals don’t even have biomed. Once they have biomed, they see that they don’t want to be without it, which is a good sign.”

Being a biomed in Haiti means being a jack-of-all trades. On his home turf, Monaghan specializes in anesthesia equipment. In Haiti, he services infusion pumps, hospital beds, incubators, X-ray machines, computerized tomography scanners—often older equipment he’s never encountered in the states. Parts, manuals, and technical support are hard to come by, or too expensive for hospitals to afford.

He also improvises to repair equipment without affecting safety, and he has learned to “dig deeper” to solve problems. For example, he’s now trying to turn a fleet of old, motorized incubator–infant warmers that still work into manually operated devices that lock in place safely. The problem? The motor belt fails, and the part is too expensive to replace. When he travels to Haiti, he fills a suitcase with parts—and he asks visitors to do the same.

Haiti also has endemic challenges, including sparse electricity, potable water, and oxygen supplies, and sporadic civic unrest. Most hospitals are not climate-controlled, so keeping equipment such as sterilizers free of dust and dirt is difficult. Monaghan is encouraged that some companies are designing equipment that will stand up to harsh environmental conditions—and he is offering advice to some.

Asked how the HTM community could help in remote locations, Monaghan offered a few suggestions:

  • For companies and healthcare delivery organizations that donate equipment, provide service manuals, spare parts, and a plan for technical support, such as funding or help lines.
  • For AAMI and other organizations with online forums for HTM professionals, provide discussion boards dedicated to biomeds in remote locations—and make sure questions are answered promptly.
  • For fellow HTM professionals, share your expertise by training biomeds, either on-site or online.