Biomedical engineers or technicians (BMEs/Ts) play a critical role in healthcare provision, particularly in ensuring hospitals can provide lifesaving medical oxygen supplies to the patients who need it most. They are responsible for repairing and maintaining a range of medical apparatus, including oxygen equipment, ensuring that nurses and doctors have the tools they need, when they need them, to effectively provide care for patients young and old.
However, in countries like Nigeria, there are not enough BMEs being trained and of those graduating annually, only a small percentage go on to be employed. This is because recruitments do not happen often, and when they do, other health work professions are prioritized. A Unitaid funded CHAI assessment in 2021, across five states in Nigeria, revealed that an average of 300 BMEs graduated, but only one in four went on to practice. The assessment also found that in the health facilities it investigated, there were insufficient oxygen equipment, and the equipment and systems that were present were often poorly maintained—exacerbating critical medical oxygen shortages.
To address these challenges in Nigeria and improve medical oxygen supplies, CHAI has for the last two years, collaborated with the Biomedical Engineering Training Institute of the Lagos University Teaching Hospital (LUTH), to conduct a national training of trainers (TOT) for 64 Biomedical Engineers from 34 states. The first workshop was carried out in December 2021 and included site visits to oxygen production facilities, practical sessions on equipment management and repair, and inventory management. In February 2022, the two trained trainers in each state were further engaged to cascade the training on planned preventive maintenance and equipment repairs to 34 BMEs/Ts in their respective states.
It was these sessions that were the catalyst for BMEs in one state to take matters into their own hands and set up their own peer-led mentoring program. In Akwa Ibom State, the BMEs have become a close knit group, passionate about their role in helping health facilities provide the best care and organizing sessions to aid continuous professional development.
The peer-led mentoring program meets bi-annually and is independently planned, organized, and funded by the BMEs/Ts in the state through a contributory scheme. The first mentoring program took place from February 21 to March 31, 2022, and provided practical training for 34 BME/Ts on the management of pressure swing adsorption (PSA) plants and various oxygen equipment. They also visited three facilities who rely on the PSA plants; Ibom Multi-specialty Hospital in Itu Local Government Agency (LGA), Infectious Diseases Control Centre in Uruan LGA and the General Hospital in Ikot Ekpene LGA.
“The peer-led mentoring was the first of its kind in the history of Akwa Ibom state biomedical engineering unit”
-Ndiana Essien, Biomedical Engineer, General Hospital Etinan
The second peer-led mentoring session took place from October 19 to November 11, 2022. Four facilities were visited and participants were trained on preventive maintenance of on-site PSA plants, and how to handle and repair faulty oxygen equipment.
Specifically, the group were able to:
- Provide planned Preventive Maintenance (PPM) of the PSA plant at the General Hospital Ikot Ekpene
- Diagnose a faulty PSA plant in Isolation Center Ituk Mbang leading to its repair
- Repair ten neonatal incubators, one radiant warmer, one phototherapy unit, two concentrators and five suction machines at General Hospital Ikot Ekpene, General Hospital Etinan and General Hospital Iquita Oron
- Train 32 HCWs on basic management of oxygen equipment
“I benefitted in so many ways…I was able to interact with healthcare workers and train student nurses on the use of a patient monitor and pulse oximeter.”
-Anthony Ini Okon, Head of BME Unit, General Hospital Iquita
The BMEs are excited and motivated by the opportunity to continually strengthen their knowledge and skills in equipment handling. One of the BMEs, Eno-Obong John Ekpo said, “The peer-led mentoring activity taught me how to repair oxygen concentrators, assemble different oxygen cylinders, and check the purity of oxygen. Now I am able to fix this equipment in my facility when the need arises.” Another BME, Ndiana Essien said, “I strongly recommend that the peer-led mentoring should not be limited to only oxygen-based equipment, but should embrace other hospital equipment like the lab and theatre equipment.” As a result of these repair and maintenance activities, an estimated 1,000 patients have benefitted to date and the previously out-of-service PSA plant in Isolation Center Ituk Mbang now produces 2,000 liters of oxygen per cycle.
With additional funding from Unitaid, in July 2022, CHAI organized a training on oxygen equipment inventory systems management for BMEs/Ts in the five project states, including Akwa Ibom. Plans are already underway to add this module into subsequent mentoring sessions, with the goal of covering all health facilities in the State. Furthermore, the BMEs/Ts are sharing wins from this learning approach at the State Oxygen committee forums, with the goal of State adoption and financing of the mentoring model for long-term sustainability and strengthened health systems.