Prior to departure there was a meeting of interested parties at Malmesbury to go over the safety briefing and sign a few documents, and it was also a chance to meet my co volunteer Ray. We divided the short list of equipment’s between us on what topics each of us would cover. We each then went our separate ways, organised inoculations and awaited flights and hotel booking. Amalthea need your services, but it’s all voluntary, they do however cover costs, such as flights, transport and you get daily allowance to cover food whilst in the respective country you will be working in. A few odd things about Ethiopia: you cannot get a visa until you arrive, nor can you get their currency (Birr) beforehand. I would only be living and working in the capital Addis Abba, known simply as Addis. Its altitude of nearly 2400m means that the problems of mosquito and potentially malaria are minimalised. However, the altitude can affect you individually, causing tiredness and sleepless nights until you acclimatise. It also had an effect on the weather. Apart from it being the winter season I saw big electrical thunderstorms almost every night, as the heat of the day caused the clouds to form and the geology of the capital meant these clouds rose over the mountains on the outskirts of the capital, dropping rain in huge deluges, which 30 minutes after they finish, have dried up. The time frame for the 4 week program coincided with the winter season, so no hot steamy African days and nights for me.
The flight from Heathrow only takes approximately 7 hours, just enough time to get a snack on the plane and watch a movie or two. I arrived at the airport but could not find my contact, Mr Getachew, the head of the EBME department in Tegbareid Technical College, which was first established in 1942. I contacted my hotel, who then sent a cab to collect me. The trip only lasted 15 minutes or so but it was a crash course in Ethiopian life. Cars drive on the right and they all drive with horns blaring, little or no lane discipline and stopping at zebra crossing seems optional!. The route went round through the capital, Addis Abba, to a region of the city called Mexico where my hotel (Wabi Shebelle) was located. I ate in the hotel roof restaurant every night, with spectacular views over the city and tasty food. The first image shows the view from my hotel with the building in the distance with the red roof being the college I was to be teaching in. In the image, the line of white tents on the left hand edge, was my daily route to work. The tents had vendors selling food and trinkets and there were a number of beggars along the route. This I had expected, but both the vendors and beggars are not aggressive nor pushy, even to an obvious “tourist” such as myself.
Day 1: Monday morning set off for the college. Rucksack with laptop and assorted teaching aides, put my head down and walked briskly to the school. Fortunately, the day before, Mr Getachew had taken me to the site so I knew where to go. I was also fortunate to get indoors before the hail storm. Hail as big as golf balls, so much for African sunshine. I did not however have a clear idea of how many students would be coming, “between 20 and 28” I was assured. 9am came and went and by 11am students were trickling into the classroom. This was my first introduction to the phrase “TIA”. This means “This is Africa”. Time here is not seen the same way as in Europe, if you have a meeting and it’s urgent, that means within the next 15 to 30 mins. If it’s soon, that could be perceived as a few days or more!
I had on average a minimum of 22 students. I introduced myself, and from then on they called me “Mr Ian”, rather than just Ian as I asked for. This was also my introduction to my assigned class assistant, Malik (pictured centre, with me, in the second image). He worked in the engineering department and soon proved to be worth his weight in gold. For the first 2 days, we covered medical device safety, classifications and testing. Traditionally in Ethiopia, and indeed in Africa as a whole, there is little if any electrical safety testing of medical devices. Similarly what we in Europe take for granted, such as IEC standards, reference books and reliable power supplies are not always available. The safety tester was a strange device that was capable of working with both American and European testing standards, and after some time the students got to grips with this and were identifying the different classes of medical devices and indeed relishing the opportunity for practical work. Unfortunately due to the continuing power failures and the dark storm clouds, we called it a day. It later transpired that the building has its own generator, which apart from not being turned on in several months had no fuel to run it. We resumed the topic the next day where we discovered the route of the earth issues. The building had no earth. Myself and class followed the cable outside and found it was tapped off the major junction box of a building next door. This junction box had no ground spike, hence no earth neither, unlike the very shiny new box at its side, installed for the computer room and servers. There are plans for the servers, but nothing fitted as yet. Similarily, the power and water to the building are yet to be connected. In the end, this was used as a learning oppurtunity for the students as what to check in their prosective workshops.
The first week progressed without any major incident. The group was made up from approximately a third students, the rest were themselves trainers. The issue here was that no one had any exposure to clinical environments, nor clinical devices. This did though explain their enthusiasm for all things practical. Also it became aparrant that the level of understanding of technology, in regards to transistor theory, circuitry and general understanding would put many a European engineer to shame. It was through neccesity that these people had to know what every component was for and its interaction with its surroundings, as when it came to repairing machines, there is no local RS Componants shop, nor the availabilty of oem parts. Hence the resourcefulness of these individuals to work with what they had. There was a flip side to this curiosity, their thirst for knowledge was relentless, particulary in the practical, and quite exhausting at times. But speaking as a teacher, it is a tremendously rewarding feeling to get such particiption from your students, and for that I was thankful.
Often the noise from outside the college was loud, hence the windows would mostly remain closed however I remember hearing bells early one morning above the sound of traffic, and looked outside the window to see a goat herder and his flock under the window, heading to market I suspect. For days 3 and 4, we would work on water baths and sterilsers. So with a quick overview on both topics we set about stripping, cleaning and testing these device. The students loved it. It also gave me an oppurtunity to pick out my first “volunteer” teachers. The two individuals were clever, but would stand back in the class. However when I spoke to them in small groups or as individuals it was clear they understood, but it was more peer pressure from those older members of the group. I can recall the name of the first volunteer “Obisara”. I explained to him the concept of the steam generator in the particular device and wanted him to then present to his table. I repeated the process with the second volunteer, whose name I cannot recall. I observed both with Mailk explaining to me what they and “their” respective students were saying. Both gentlemen did extremely well, and it seemed that all they needed was a confidence boost. After that both moved to the front of the class and had their hands up every time there was something to answer.
For the last day of the week we had planned to work on the infant incubator, instead we started on the oxygen concentrator, then utilised it with the incubator and furthermore incorporated an infant phototherapy unit. It was also the initial introduction of manometers, multimeters, basic hand tools and some specialised gas flow and sensor devices. In less than a week these students had progressed to complete systems, including human physiology. Very kindly, as the students said their goodbyes a few offered to take me to see the sights, one even offering to take me to a friend’s wedding as his guest! I had already arranged to tutor Malik on the Saturday and he in return would take me sightseeing.
Week 2 came and the students, ever hungry for knowledge, wished to tackle anaesthesia. I explained that I could teach them this, but it is usually done over a whole week, there was lots of theory, and they possessed no manuals nor tools. At the same moment I was asked could I cover x-ray, to which I agreed, until that is when I saw the device I was to train them on. It was an AMX+ Mk 2. These have been in use since the 1970’s. Still, that was not the issue. The biggest problem was there was no x-ray head, the machine had been broken for years and to top that, they insisted the training must take place in the imaging classroom. The first and most formidable problem was how to move a machine that weighs 500kg up 2 flights of marble steps with no lift (the lift shafts are in, no lifts). The pictures show the “temporary ramp” made from doors and the sheer determination to try and push the half ton machine up a flight of stairs. We did not cover x-ray on this trip! Instead, we moved onto anaesthesia and gases. That’s when we hit a little problem. There was no piped gas nor bottle gas on the site. We did however acquire an oxygen bottle with about 10 mins of use left, for a very brief demonstration of powering up a device. We had two devices, the first machine was a basic model, approximately 50 years old. The second machine was a Draeger Narcomed. We started on the basic model, showing how gas and agent get into patient, then replicated these processes on the newer model. But with limited gas, practical was difficult.
Conclusion: I thoroughly enjoyed the experience, the people and its challenges, and am very grateful to Martin and Rene Lenssen of CINOP Global (the organisers) for this opportunity. When I left the students on the Wednesday and said my goodbyes, I received a standing ovation from them! I’ve never had anything like that before. Very emotional. Power and Wi-Fi, which we take for granted here in UK, are not as reliable in Africa. I would urge any potential volunteer to sign up to Messenger/ Skype to keep in touch with family whilst away. I would also strongly urge other clinical engineers who feel like a challenge, and are willing to share their skills and knowledge with other individuals, to volunteer: its rewarding. Search for the Amalthea Trust online, see what they do and see what you can offer.