Kangaroo vs. Machine

Photograph by Nicole Duplaix, via National Geographic

Photograph by Nicole Duplaix, via National Geographic

It’s a thought we’ve all had at one point or another: you’ve just purchased a shiny new electronic device—a computer, say, or a CD player—but your old one still seems to have some useful life in it, even though it’s not working as well as it used to. Surely, you think, a charity will be able to put your hand-me-down device to good use for a few more years. Right?

Probably not. Your aging MacBook, for example, may not be compatible with the PC-based system your favorite charity uses and would require costly investments in software and maintenance in order to make it useful. And, honestly, who listens to CDs any more?

The same goes for medical equipment. A recent article in The Atlantic, “The Inadequacy of Donating Medical Devices to Africa” by Mike Miesen, looks at the practice by some NGOs and aid agencies of donating secondhand devices to healthcare facilities in poor countries….which have a tendency to break down soon after delivery. Even when the donor agency has carefully and thoroughly refurbished the equipment, it still requires expensive parts to operate and specialized expertise to maintain. As a result, many hospitals in developing countries are host to “graveyards” where inoperable donated equipment is stored.

In an ideal world, all hospitals everywhere would be stocked with the best medical devices and the technical capacity to keep them up and running. Until that day comes, however, there may be less high-tech but more effective uses of limited resources that can produce better-quality healthcare. Writing in The New Yorker, physician Atul Gawande recently described his work on the BetterBirth Project, an initiative to test the efficacy of the World Health Organization’s Safe Childbirth Checklist. The checklist identifies 29 steps for birth attendants to follow during a normal delivery, among the simplest of which is binding a newborn baby skin-to-skin with its mother in order to help the infant regulate its body temperature, a practice known as “kangaroo care” (other steps include ensuring that sterile supplies are on hand and administering medications at certain key junctures). Kangaroo care, which is free, rivals the efficacy of all those broken-down incubators littering medical device graveyards; the challenge is in convincing birth attendants to take up the practice. The BetterBirth Project is seeking to increase adoption of the Safe Childbirth Checklist by training “childbirth-improvement workers” to help birth attendants understand why the checklist is essential and practice implementing the steps until they become part of the attendants’ regular routine. It’s a low-tech but highly personalized approach to improving medical care in resource-poor settings.

Gawande argues, “We yearn for frictionless, technological solutions. But people talking to people is still the way that norms and standards change.” Donors of medical equipment expend enormous amounts of time and resources to source, refurbish, and deliver the devices. Would poor countries be better served if those same donor organizations instead focused on raising money to hire and train childbirth-improvement workers, or fighting to ensure the availability of affordable generic drugs? My money’s on low-tech, high touch solutions all the way.


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