THE waves came and wiped out everything. Seventy seven health centres in Banda Aceh, Indonesia, were damaged or destroyed. In both Banda Aceh and Meulaboh, only one hospital remains functional on the outskirts of each city. Many hospitals and health units located along the coast of Sri Lanka have been severely damaged.
The burden continues to grow heavier. These tsunami-hit countries now face the urgent need to redevelop their health sector, as the currently crippled health systems strain to deal with the increased needs of the communities.
During a recent seminar on Effective Management of Healthcare Technology organised by Healthtronics Sdn Bhd in Kuala Lumpur, several experts held a workshop on post-tsunami rehabilitation.
In one of the presentations, Peter Heimann from the Department of Health System Policies and Operations, World Health Organization, said that in revamping a crippled health sector, authorities had to increase its equity, effectiveness, appropriateness and efficiency.
The workshop also focussed on areas to consider in managing healthcare technology for the rehabilitation of health systems in tsunami-hit countries.
“What is technology?” Prof James Wear, chairman of Biomedical Instrumentation at University of Arkansas, posed this interesting question.
“People frequently think of technology as high-tech equipment, yet it (means) more than that. It includes medical devices, disposables, pharmaceuticals, information technology as well as medical or surgical procedures and services,” he pointed out.
The United States Congress defines health technology as “? the set of techniques, drugs, equipment and procedures used by healthcare professionals in delivering medical care to individuals, and the systems by which such care is delivered.”
All health systems today depend on health technology to serve their primary purpose of improving people’s health and saving lives.
In rebuilding the hospitals and clinics that were destroyed by the tsunami, health authorities will be starting from scratch, not only in terms of infrastructure, but also the technology.
“It is an opportunity to upgrade the technology, if you do it right,” said Prof Wear.
He listed several considerations that need to be looked at in managing healthcare technology:
·What level of technology do you need – This depends on the needs of the hospital or clinic and the community that it will be serving.
·What is the cost of the technology – The cost goes beyond merely purchasing the technology but also includes the cost to use and maintain it. “You need to transport and install it, have space for it, train people to use it, repair it and keep it operating,” said Prof Wear.
·What is the lifetime of the technology – Technology changes very rapidly. You may find yourself buying technology that is so new it hasn’t been proven to be safe, or so old that it has become obsolete.
·How do you get rid of it – It costs money to get rid of something, especially if it is a major piece of equipment. You need to consider how you can remove it in a cost-effective and responsible manner.
“What is important is the sustainability of the technology,” said Dr Sablee Aspar, director of the Department of Healthcare Technology in Brunei’s Health Ministry.
“Some countries acquire technology only to have it become useless after six months, simply because they did not have the means to acquire spare parts or the people to maintain the technology.”
He added that technology had to be appropriate for a specific country, as some advanced technology was not suited for Third World countries because the people were not prepared to assimilate it.
The consensus among the experts seemed to be that a high-tech piece of medical equipment does not necessarily translate into good patient care.
“If you have technology, but you don’t properly assess it or effectively utilise it, then what you have is very costly technology that does not satisfy your needs,” said Azman Hamid, director of the seminar and senior manager of Healthtronics, a company that provides consultancy on biomedical equipment maintenance and management services.
Right intentions, wrong technology
The issue of appropriate technology arose at a crucial point during the tsunami disaster. In the immediate aftermath of the waves, local authorities and relief teams, already hobbled by the scale of the destruction, faced another problem: all the wrong medical equipment was arriving.
“Many parties were keen to help, but some sent technology that was inappropriate and caused an even bigger burden,” said Dr Sablee.
Clearly, Indonesian doctors would not have been able to utilise high-tech equipment that came with foreign manuals which they could not read.
To make matters worse, the equipment that was desperately needed was nowhere to be seen.
Dr Sablee provided the example of semi-drowned survivors who were rescued but could not be saved because medical teams lacked the right equipment to prevent lung infection from setting in.
“As a result, hundreds and hundreds of children who were recovered died,” he noted.
He emphasised the need to assess the immediate, mid-term and long-term needs of the situation, to avoid recurrence of mistakes like sending electrical-operated ventilators to areas that had no electricity.
Investing in the future
In countries like Sri Lanka, India and Indonesia, existing hospitals are now struggling to cope with the increased turnover of patients, with mobile clinics fulfilling most of the healthcare needs in the rural areas.
“Redevelopment of technology should rank high (for healthcare authorities), because the health of the people is a major priority,” said Ashok Shah, CEO of Healthtronics, who added that prevention of diseases was of utmost concern.
Dr Sablee pointed out that “governments shouldn’t even be thinking of priority, (they) should give equal distribution of resources to all areas of rehabilitation, be it healthcare, social or spiritual development. One shouldn’t stop one and concentrate on the other.”
But at what cost to the authorities of these countries, who are already struggling to deal with the massive loss of lives and infrastructure following the disaster? And if better technology comes at a higher premium, do poorer countries get the shorter end of the stick?
“Medical equipment does not carry a price tag,” Dr Sablee immediately replied. “Healthcare technology is about patient care. If the technology helps saves lives, then you’ll have to get it somehow, whether you’re rich or poor.”
Huge amounts of foreign aid have been pledged to help tsunami-affected countries in redevelopment.
What the governments need to do now is to assess their resources and plan their investment wisely.
The final element that is needed to put things in motion is the political will of each country. It is to be hoped that governments recognise what they can achieve in the long term, by rightfully managing the redevelopment of healthcare technology now.
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