Angela and I were tasked on adapting and implementing a version of the biomedical equipment troubleshooting workshop (taught as a senior elective to Rice BIOEs) at DIT. The workshop takes approximately two weeks to complete and is structured as a flipped classroom: prerecorded lecture videos explain the operating principles and various components of the devices, and students are left to open up the devices and troubleshoot instructor-created “breaks.”

There are six devices covered in the troubleshooting workshop that are present in most clinical settings:
Microscopes, Centrifuges, Sunction Pumps, Rerigerators, Syringe Pumps, and Oxygen Concentrators. At Rice, the workshop is taught in a lab space that contains multiple fully functional versions of each device. We brought a used Suction Pump with us from Rice, but we had no other equipment with us at DIT.

The classroom we were given to use as a workspace contained a lot of sophisticated laboratory equipment and medical devices donated by nonprofits and local hospitals, but the thick layer of dust on the equipment indicated that these devices hadn’t seen a lot of use. Students were quick to tell us that they had never seen most of the devices before, even when taking classes about those devices, and they had not been allowed to touch or operate the few devices they had seen before. This was confirmed by the instructors we spoke to, who expressed concerns about students potentially breaking expensive equipment.

Medical Equipment Sitting in the Telemedicine Room

All this was predicted by Dr. Renata Ramos, head of the BIOE curriculum at Rice and current teacher of the troubleshooting workshop. When we met with her before our trip, she explained that DIT and other unversities in the developing world simply didn’t have the resources to buy functional equipment and provide it to students to use and potentially destroy. The way the course is taught at Rice is incredibly expensive, requiring significant investment every year to repair equipment and buy replacement parts. Such a proposal at most universities in the world would seem laughable.

So our task at DIT was to adapt the structure of the course to make it feasible and sustainable to teach in this environment. But how to teach a troubleshooting workshop without access to equipment? We didn’t want the students to sit through yet another course that focused on theory without any practical application.

We concentrated on using the resources we had to source equipment and materials for our workshop. For our firs session on the microscope, we were able to acquire a microscope from the DIT dispensary and a nonfunctional microscope from our workspace. After watching the videos and learning about the device, the DIT interns were able to operate and take apart the device. For many, it was their first time using a microscope and identifying electronic components in a circuit.

The next day, we were also able to work on some microscopes donated by Aga Khan Hospital, which has a partnership with DIT that donates used equipment for instruction.* The microscopes were broken, and we were able to fix them in collaboration with the DIT interns. Using the maintenance guidelines from the course, we cleaned and repaired the microscopes to improve image quality. It was immensely gratifying to see them turn their newfound knowledge into tangible equipment fixes and mainte.

Repairing Microscopes

The workshop continued on like this, with me and Angela improvising at every turn to source equipment. For refrigerators, we trekked over to our hotel room to dissect our minifridges. For centrifuges, we borrowed a delapidated centrifuge from the DIT dispensary and added a safety switch mechanism. And for oxygen concentrators and syringe pumps, we visited Muhimbili National Hospital to help them troubleshoot some broken equipment.

Repairing a “Broken” Refrigerator

In the interest of sustainability, we were able to take constructive steps to add functionality or fix worn-out equipment instead of taking already-working equipment and breaking it. We also had to modify the structure of the course and supplement its contents to suit the needs of the DIT interns. After each session, we sent out a survey asking anonymous questions about the usefulness of the session and desires for future changes or instruction. Once we realized that the interns had little experience working with circuits or electronics, we added instruction about basic circuit components and implemented a brief soldering workshop to teach proper soldering techniques.

Soldering Workshop

* Note: we also bore witness to one of the more gnarly aspects of equipment donation to resource-poor institutions. On one of our first days at DIT, we were suddenly summoned by an administrator to help with unloading an 18-wheeler truck loaded with 5 huge, 900-pound Vitros chemistry analyzers from Aga Khan Hospial. Much fanfare was made celebrating the donation and official handshakes exchanged, but the sad truth apparent to everyone present was that the analyzers belonged in a junkyard. The huge metal and plastic shells were broken beyond repair, stripped of everything of possible value (processors, monitors, and samplers were all notably absent). They were placed in a classroom at DIT, where they will likely sit for years accumulating dust.

We frequently hear about the harms of donating faulty or improperly maintained equipment to the developing world. Here was an in-your-face example of the possible impacts even further downstream.

Chemistry analyzers taking up space in a DIT classroom