Jayson Marwaha '14 and Han Sheng Chia '14, co-directors of Medical Equipment Donations International, spent about 10 weeks in Zanzibar this summer assessing medical equipment needs in the region. MED International is a recently-formed nonprofit organization that focuses on the delivery and use of medical equipment in underdeveloped countries.
While in Zanzibar, Marwaha and Chia conducted an extensive field study to document what equipment was already available at the Mnazi-Mmoja Hospital in Stone Town, Zanzibar City. In addition to the study, which involved cataloguing over 1,000 pieces of medical equipment at the hospital, the pair was able to oversee the repair of equipment worth nearly $50,000 using a volunteer team of biomedical engineers. The team was recruited by MED International through another organization, Engineering World Health.
Among the machines available at the hospital when they arrived was a set of infant incubators of which only two were operational, meaning that babies often had to share incubators.
"On really bad days, (doctors) would fill up gloves with hot water and wrap the babies in blankets," Chia said.
Without adequate equipment, the hospital recorded a 50 percent premature death rate in February, Chia said. When the team of engineers arrived over the summer, they restored the set of eight incubators to full functionality.
"It was a four-fold jump on incubators, and we believe this will go a long way in helping clinicians improve these figures," Chia said, referring to the infant death rate. The maternity unit of the operating theater at the hospital, where surgical operations are performed, also increased functionality from 30 to 80 percent, Marwaha said.
The business model of MED International is based on a three-part intervention.
"It's one-third equipment management - repair and making sure that all machines are properly logged - one-third training of local technicians and one-third donation of equipment." Marwaha said. This model has changed from its original conception, when the action plan was broken down into three different steps - "supply, delivery and utilization" of equipment, The Herald reported in February. But ground realities forced the organization to seriously cut down on the first and second steps. The group found the nonprofit sector "saturated with donors" and donations, which resulted in them shifting their focus from equipment donations to maintenance and repair, Marwaha said.
"I think they were able to pay close attention to what was and what wasn't working and incorporated what they learned into their business model," said Alan Harlam, director of social entrepreneurship at the Swearer Center for Public Service. Harlam serves as a board member for MED International and originally introduced Chia to Marwaha as a potential partner. The pair's reflections during their summer experience are key, Harlam said.
"They did a fabulous job. Starting a new company is a long process, and what they are doing right is taking stock of what they have learnt during the summer," he said. "Their knowledge of the problem is strong."
Elaborating on the new business model, Chia said cataloguing the existing equipment in Zanzibar "was accomplished through working with a local programmer to input data into manageable software that the Ministry of Health (of Zanzibar) now runs." Chia added that "the software helps us see gaps so we can make smarter donations."
This program is currently being refined by computer science concentrators on campus, Chia said.
Training technicians, the second part of the model, is equally important, as it drastically reduces the cost of repair, Chia said. The organization is currently exploring ways to support Zanzibar's public college training program to increase the number of qualified technicians.
Not including the funds needed to bring in technicians from abroad, the cost of repairing machines was less than $200 in total. Machines varied from simple suction machines to complex ultrasounds.
The two also stressed the importance of working through the government rather than setting up a non-governmental organization.
"Donations take pressure off of governments. They lose motivation, start relying on others and become dependent," Marwaha said. "We are concretely in the business of equipment maintenance, but we're also there to instill change. The goal is to systematically get the Zanzibar government off foreign aid for equipment and equipment repair."
Marwaha said he believes that if their marketable service proves effective, as it has so far, they can take on more projects in Zanzibar and in other parts of Africa.
"It has always been part of the philosophy to go deep within a country's health system because it is only through an investment of time that we understand the dynamics of a place," Chia said.
