ANALYSIS

            Let’s dock on our journey for a moment and think about what we are seeing…

The PROBLEM about medical technology (medical devices) is…

Almost 95% of medics (World Health Organization) practicing in less developed countries are reliant on medical technology that has been imported. More than half of this technology is not used by healthcare staff because they either don’t know how to use it or have insufficient means to maintain the equipment - leading to inadequate healthcare provision in the developing world ...

The SOLUTION is sustainable/appropriate medical technologies/devices...

But when we say technology what do we mean?

            CPAP machines and CT are accepted high tech medical devices but what about spectacles, mosquito nets, syringes, measuring taps and weight scales… that are used at different times in medical intervention (diagnosis, treatment, prevention).

Sustainable/appropriate medical technologies/devices – what does that mean?

·         Using existing medical technologies in new ways e.g. mobile phones in health promotion anywhere in the world?

·         Making sure that imported medical technologies actually get used in developing countries? So ensuring training, manuals in local languages, and wider locally available engineers and parts possibly leading to wholesale redesign…

·         Imported technologies are designed to cope with developing country conditions? So making sure that a device is robust enough to cope with developing country conditions – notice this in itself doesn’t meant that devices get used….

WHO would agree with the last and argue that appropriate devices are those technologies that can work in the CONTEXT  in which they will ultimately be used . For WHO, this also includes being affordable…

And sustainable - when thinking about sustainable medical technologies, at what point in the technology development and uptake cycle is sustainability an issue?  

Uptake of technology can have serious social consequences. Import, use and patient demand for ultrasound in pregnancy has powered increasing sex ration imbalance in Asia, with early termination of female fetus reported in Vietnam, India and China (HESVIC In addition, it is known that the growing private sector in Asia has over prescribed pharmaceuticals and medical procedures (academic press). Should sustainability be extended to human behavior – not only ensuring medical experts prescribe necessary treatment but also to modifying the demands of patients and their families?

Since WHO also believe there is a critical shortage of medical engineers, I imagine that WHO sees wholesale training of engineers as part of the solution also that is, not just a short demonstration of training or donated engineering time (usually from western countries) undertaking very short charitable missions to repair equipment in the developing world, rather a longer term ambition to influence education systems. So for WHO sustainable is before, during and after a short term need for a particular medical device has been identified....