Visit a hospital or clinic in any developing country and there will almost certainly be a room devoted to the dusty remains of equipment donated from a developed country that may or may not have at some point functioned. The WHO has estimated that as much as 70% of equipment donated by developing countries to sub-Saharan Africa lies inoperable.[i]
There are many reasons behind these so-called “equipment graveyards” that are well understood and, from a distance maybe even obvious. Just a few of them include:
- The receiving hospital doesn’t have the proper infrastructure required for the device, such as consistent electricity;
- When a part of the device breaks there is nowhere in country to find a replacement part (or if the machine is old enough, replacement parts may no longer be manufactured anywhere);
- Even if a replacement part is available, there is no one at the hospital who knows how to fix the device.
Enter Gradian Health Systems, a non-profit social enterprise. Gradian is working to improve safety and access to surgery by designing and manufacturing the Universal Anaesthesia Machine (UAM), an anesthesia machine that will function in any setting, even with a loss of electrical power or compressed oxygen. While the UAM can use compressed oxygen, when this runs out the UAM will seamlessly convert to a system which concentrates nearly pure oxygen from the surrounding air to carry the anesthetic vapor - a system called the “draw over” mode. Both the compressed oxygen and draw over modes of delivery can be powered by a hand pump when the electricity is out.
Perhaps the greatest ingenuity behind the design of the UAM is its simplicity, with as few moving parts as possible. Many parts are not specific to the machine, and can be readily found in LMICs - the air filter used in the machine is a basic car filter, for example.
More important than the machine itself is the sustainability of care and maintenance that the machine will receive. Upon delivery of a UAM, a Gradian trainer spends several days with staff, teaching anesthesia providers how to operate the machine, and teaching technicians how to repair it should the UAM break down. When a repair is not able to be completed by hospital staff, Gradian has individuals who will fly in to complete the repair.
As a non-profit social enterprise, Gradian sells the UAM at its cost of manufacture and shipping – which is about half or less of the cost of a conventional electricity-dependent anesthesia machine. The training and service provided with each machine is underwritten by Gradian. While much of the cost of the UAM is usually covered by NGOs of government agencies, Gradian believes it is important that hospitals pay some of the cost, in order to encourage ownership and a commitment to maintaining the product.
What makes the UAM different is that Gradian has built the machine with a low-resource setting in mind and a sustainable maintenance plan in place to fit the hospital’s needs. A broader approach to providing medical equipment to developing countries, such as the one taken by Gradian, could significantly improve the rates of unused medical equipment filling up the medical device graveyards.