Supporting medical technology in developing countries-what is appropriate?

One takes it for granted that equipment used in hospitals will work when required and one gives little thought for the maintenance and servicing that occurs unseen. Living, as one does, in a "developed" and "industrialised" country, if medical equipment is faulty, the medical procedures will be interrupted just long enough for a replacement machine to be wheeled in. However, if equipment is to have a long life and be used effectively and efficiently the technical staff who provide the technical management and maintenance of the medical equipment are just as important as the medical staff. Advances in medicine are occurring all the time. Quite rightly these advances are recognized for the improvements that they offer one but all these benefits are assisted or made possible by equally significant advances in the technology of the instrumentation. Consider the situation in those countries of the world where industrial development is less established. In these countries, maintenance of the medical equipment is very difficult and in many countries nearly impossible. Repair and maintenance require several pre-requisites before they can be undertaken. The skilled staff must have had the appropriate training so that they can carry out the work effectively without making the situation inadvertently worse. They need the correct tools and test equipment and it is essential that they have the correct spare parts to fit when they need them. Unfortunately, in developing countries most of these necessary requirements are missing. There is a shortage of technical staff, and even those employed may lack the experience to deal with the more complex technical problems that are growing as one's advanced medical technology is introduced haphazardly. Workshops are inadequately equipped and lack the technical manuals that are so necessary for correct maintenance. Spare parts are also a major problem since they are almost always imported. This poses another problem since such imports usually have to be paid for with foreign exchange, which in many developing countries is in very short supply.