One of the unrecognized backbones of medicine is machine technology. Oxygen concentrators, anesthesia machines, incubators, ventilators, and so many more machines are integral to modern medical care. According to the World Health Organization, “Without medical devices, common medical procedures – from bandaging a sprained ankle, to diagnosing HIV/AIDS, implanting an artificial hip or any surgical intervention – would not be possible.”

What happens when these lifesaving machines break and there is no one around who knows how to fix them?

Tom Monaghan, a biomedical engineering technician in the Massachusetts General Hospital (MGH) Perioperative Services Team, is part of a team at MGH that ensures these machines, specifically those related to anesthesia, function.  Wanting to share his expertise beyond MGH, he became a member of MGH Center for Global Health Disaster Response and Humanitarian Action team.

In 2010, a magnitude 7.0 earthquake struck near Haiti’s capital, Port-au-Prince.  The earthquake killed over 200,000 people and destroyed countless buildings, damaging crucial infrastructure and medical technology when it was needed most. In response, MGH dispatched a medical team that identified a critical need for anesthesia machines and the biomedical engineer support for them. Monaghan traveled to Haiti in response to this need.

“All the Harvard hospitals got together about 10 to 15 anesthesia machines they were going to send,” Monaghan recalls. “MGH Senior Vice President Ann Prestipino, MPH, at the time was in charge of the disaster response and wanted someone to go who could help put them in and install them. That was my initial introduction to Haiti.”

For three weeks, Monaghan supported earthquake response efforts. Though the initial request was to support the installation of anesthesia machines, the need for other biomedical support quickly became apparent.

“[I helped fix] sterilizers and anesthesia machines, I moved x-ray machines around and helped with moving supplies,” Monaghan said. “It was just an insane time. I mean we would just go go go.”

This initial experience led to relationships between Monaghan, Partners In Health, and Health Equity International—formerly St. Boniface Hospital.  Once his earthquake efforts were completed, Monaghan grew those relationships into a series of trips to Haiti where he continued to fix machines, find parts, diagnose problems, and more importantly, train local technicians in the biomedical sciences, trying to find ways to create a technical support system for biomedical workers in Haiti.

“A big thing I realized when I first got down there is that there’s limited clinical training,” Monaghan explains. “Someone will send down a bunch of monitors with no guidance for [Haitian staff] how to work them or even to changes the language so it’s in French instead of in English so they can understand what the alarm says.”

Monaghan found that a lot of the machines he worked on required relatively simple fixes. However, without training or technical support, the local staff were unable to address them.

“I was going back once or twice a year to help out,” Monaghan said. “But as I was doing that, I [realized] this really isn’t changing anything. I go for two weeks and then I leave. A month later it’s back to normal.”

He soon shifted his efforts to training new biomedical technicians in Haiti, conducting periodic visits to Fond-des-Blanc and Mirebalais over the course of many years.  When the COVID-19 pandemic limited his ability to travel, he changed his strategy by shifting to virtual webinars.

This 11-year partnership has allowed Monaghan and his colleagues to quickly identify solutions when faced with disaster.  For example, when another earthquake struck Haiti earlier this year, Monaghan knew exactly how he could best be of assistance.

“[St Boniface Hospital] had a new oxygen system that had been installed, but it wasn’t working,” Monaghan said. “The goal was for me to go fix that one and then they had another oxygen system to fill cylinders that had been broken for a while. Those were my two big concentrations down there. I also was able to sit down with someone I worked with and trained for many years. I got to ask what parts do we need? How can we support you better?”

Monaghan plans to continue to train and support biomedical engineering staff in Haiti. However, he recognizes that due to resource constraints, many hospitals in Haiti can’t afford biomedical engineering technicians, and don’t see the value in adding them at the expense of other healthcare workers. Over his 11 years working with partners in Haiti, Monaghan has seen this slowly change.

“Once I trained two biomeds and they were doing well, hospitals wanted to send these guys off to other places to repair things,” Monaghan recalled. “Suddenly, they realize they need a biomed. And that’s a win right there.”

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