“Welcome to the graveyard,” says Dr. Dominic Akaateba, an internal medicine specialist in Wa, northern Ghana.
His ironic sentiment becomes clear as he peels back a bedsheet to reveal stacks of unused and broken-down medical equipment, including oximeters, incubators, and anesthesia machines, that line a corridor in the Sandema Regional Hospital. Donated by aid agencies, NGOs, and biomedical companies—likely with the best of intentions but little practical thought—the devices sit lifelessly, seemingly strangled by the electrical cords coiled around them.
It’s estimated that, in resource-poor settings, like rural Ghana, about 40 percent of medical equipment is out of service, despite being integral to preventing, diagnosing, and treating illness. Patient outcomes suffer as a result. And banished, unrecyclable devices heap into “medical equipment graveyards”, cluttering arteries in health facilities and turning hospital grounds into junkyards.
In some cases, the donated equipment remains idle upon arrival, still boxed because it’s technically incompatible for use in low-resource settings, or staff haven’t been trained to use it. But a lot of vital equipment is often shelved because it’s broken-down—and there’s a scarcity of local clinical engineering expertise, tools, and spare parts to fix it.
All this is starting to change in Ghana, thanks in part to an innovative “Clinical Engineering Project” led by Dr. Kelly Hadfield, a rural physician in Qualicum Beach, British Columbia (BC), and her non-profit organization, Ghana Medical Help. With a $10,000 grant from RCCbc’s Rural Global Health Partnership Initiative, Dr. Hadfield, Dr. Akaateba (who’s also Operations Director with Ghana Medical Help), the Canadian Medical and Biological Engineering Society, and the Ghana Health Service are breathing new life into the country’s biomedical equipment infrastructure.
“Clinical engineers in northern Ghana don’t have opportunities for training and aren’t given any tools because of the poverty and lack of infrastructure,” explains Dr. Hadfield. “So, if a hospital engineer needs a basic screwdriver, they have to buy it with their own pocket money. As a result, they can’t do very much in terms of equipment maintenance and monitoring.”
Through the Clinical Engineering Project, hospitals located primarily in two of Ghana’s most remote and resource-poor regions in the north receive toolkits containing screwdrivers, hammers, and other essential tools. The toolkits enable clinical engineers to diagnose equipment failures, and clean, maintain, and repair the medical equipment.
“It’s not a flashy thing,” laughs Dr. Hadfield. “People like to buy the stethoscope, but not the screwdriver, so it was very hard to fundraise for toolkits because they’re not medical tools. And yet, their presence is so important for supporting patient care.”
People like to buy the stethoscope, but not the screwdriver, so it was very hard to fundraise for toolkits because they’re not medical tools. And yet, their presence is so important for supporting patient care.Dr. Kelly Hadfield
In addition to toolkits, the Clinical Engineering Project offers Ghanaian clinical engineers free online access to advanced professional training. Taught by members of the Ghana Health Service and the Canadian Medical and Biological Engineering Society, the training sessions also build strong ties between Ghanaian and Canadian engineers who continue sharing knowledge and supporting one another.
“Local rural hospital engineers, regional senior engineers, and senior management from the national engineering office comprise the Ghanaian side of our team,” explains Dr. Hadfield. “Then, here in Canada, we have three biomedical engineers—Martin Poulin, biomedical engineering manager with Island Health, Dr. Bill Gentles, chair of the International Outreach Committee for the Canadian Society of Medical and Biological Engineers, and Akshay Puli, chief executive officer of Reveal QI, a software design and development company.”
While tools and training are crucial for improving Ghana’s biomedical infrastructure, Dr. Hadfield says the most critical component of the Clinical Engineering Project is the development of a standardized hospital inventory and computerized maintenance management system (CMMS).
“The CMMS has the potential to change the country,” says Dr. Hadfield. “It allows for ongoing documentation and report generation, so trends in medical equipment malfunction can be identified, predicted, and troubleshot. This saves hospitals time, money, and resources by enabling better capital planning, resource management, and quality improvement assessments. Building this capacity sustainably improves the standard of patient care for the surrounding community.”
The CMMS is currently being piloted in the largest hospital in the most northern region of Ghana. Once refined, Ghana Health Service will roll it out across the two northernmost rural regions, affecting the care of over 2 million vulnerable people—then, possibly, the entire nation.
The grant from RCCbc was extremely powerful. It was the only one that we had behind this project, so that $10,000 went very far—we were able to stretch it. And now, we hope to build on that momentum—to leverage into other funding opportunities so we can continue building health equity in Ghana.Dr. Kelly Hadfield
In keeping with the intent of RCCbc’s Rural Global Health Partnership Initiative Grant, Dr. Hadfield says she has gleaned several takeaways from the Clinical Engineering Project that will improve her ability to practice rural medicine in, and beyond, British Columbia.
She says: “The Rural Global Health Partnership Initiative grant is amazing because, not only is it impactful on an individual level for honing additional skills that you then bring back to your own community, but because it also helps you find new ways of approaching problems and advocating for patients in your local healthcare context.
“The grant from RCCbc was extremely powerful. It was the only one that we had behind this project, so that $10,000 went very far—we were able to stretch it. And now, we hope to build on that momentum—to leverage into other funding opportunities so we can continue building health equity in Ghana.”
The Rural Global Research Partnership Initiative supports projects spearheaded by rural British Columbian physicians or medical trainees and their partners based in underserved communities in British Columbia, other parts of Canada, or internationally. Projects considered for funding must be founded on strong ethical partnerships that contribute to supporting the local capacity of health services in underserved rural communities, promote and enhance rural generalism, and result in sustainable benefits to partner communities. Those interested in applying for a Rural Global Health Partnership Initiative grant, which is available for projects within British Columbia, Canada or internationally, can apply here. There are two intake deadlines each year: April 30 and October 31.