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Equipment for eye care - Community Eye Health Journal

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1. theatre It was never used because of a lack of parts and problems with the power supply SIERRA LEONE perform preventive maintenance and calibration services If yours is to be the only piece of equipment of this make and model in the country or if breakdown support is non existent or very expensive you should discuss these issues with the donor Would it be best to refuse the donation and ask for an item of a different make or model Especially with sophisticated and expensive equipment preference should be given to companies with established track records for after sales service in the country or sub region 4 Accessories and spare parts What essential accessories and consum ables will be required such as cables reagents filters electrodes and recording paper Are they being donated If not can they be obtained locally and does your eye unit have the budget to buy them Does the donation include the necessary spare parts If not are spare parts easily available locally and can you afford the monthly or yearly costs You can request that donors include commonly required spares Such as replacement bulbs fuses etc in the donation as well as any other items that would take longer than six months to be delivered 5 Supporting materials Above all you need to check that the donated item comes complete with all appropriate installation instructions and operating manuals in a language you can understand Ide
2. e What still needs to be repaired which allows you to prioritise the next week s tasks e The duration equipment is not in use down time e What the most common causes of delays are skill labour spare parts transport bureaucratic delays money and what additional resources may be needed to complete work on time will help you to get the most use out of the equipment you have With equipment prevention is usually better than cure It is also good practice to keep learning and to stay open to new ideas Communicate with colleagues in other eye units whether locally or through the internet about the challenges you face and share with them the solutions you have found Copyright 2010 DS Walia Jane Huria and Ismael Cordero This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited EXCHANGE Jonathan Pons Ophthalmologist and Programme Director Good Shepherd Hospital Eye Care Project PO Box 218 Siteki Swaziland Email jono goodshepherdhosp org High volume eye surgery requires that patients be moved quickly in and out of the operating room OR Static operating tables in the OR make this difficult Better patient flow can be achieved when using mobile tables which can be expensive We have developed an economical
3. Other tips for care and maintenance e If the clinic is subject to voltage fluctuations the slit lamp should be plugged into a voltage stabiliser e When examining several patients in a row the illumination should be maintained at a low level rather than switching it off between patients and then on again for each patient This prolongs the bulb s life e Moving the slit lamp should be avoided when the bulb is hot because the hot filament is more likely to break e When not in use the slit lamp should be covered with its plastic dust cover If not provided a simple cover can be made out of cloth the thicker denser the better e If the slit lamp is stored in an environment prone to humidity keep a sachet of silica gel drying agent or fungicidal anti mould pellets within the dust cover or use a dehumidifier in the room e The forward and backward and left and right movements of the slit lamp rely on the joystick 4 a rod 15 connecting the two geared wheels 16 and the two rails 17 which support the wheels These mechanical devices may seize up and affect the smooth operation of the slit lamp If this is the case apply a light oil spray such as WDAO to a piece of paper tissue and use the tissue to wipe the rod the pad under the joystick 18 the wheels and the rails This should solve the problem Oil should never be sprayed directly onto these parts This is the first installment in a series on pract
4. expected demand If your donor is overseas or is likely to import the equipment or consumables first ensure these cannot be purchased locally at competitive prices Encouraging donors to buy locally will help develop local markets and will make it easier to get direct support from the vendors without needing to involve the donor Show that you are a credible organisation You could do this by providing Explain your needs and how the requested equipment or consumables will meet these needs Donations how to ensure you really benefit Questions to ask the donor As mentioned in our article on purchasing page 34 getting a new item of equipment is not a simple matter Equipment may require some or all of the following e Installation and user training e Regular preventative maintenance e Breakdown support e Accessories and spare parts e Supporting materials e Electricity and water supply The questions below should help you cover all the most important aspects of the donation with your prospective donor 1 Installation Who will be able to install the equipment If your eye unit does not have the skills and resources required is the donor willing to arrange and pay for installation Who will train the people who will use the equipment 2 Regular preventative maintenance How will the equipment be maintained on a regular basis Will this mean training the people who will be respon sible If so
5. how can this be achieved Ideally training in maintenance should be given at the time of installation although it is also possible to arrange training with a similar piece of equipment ina neighbouring eye unit before the donated equipment arrives Especially with very expensive unfamiliar or a list of references your ministry of health non governmental organisations charities or religious insti tutions which the donor can contact TIP Ask for photographs of the equipment you are requesting where possible This will reduce confusion and possible waste as equipment and instru ments may have different names depending on where a person was trained particularly in non English speaking countries Many projects have requested instruments and equipment that were never used because they asked for the wrong item 32 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 sophisticated equipment some users may feel reassured if an experienced user were available to demonstrate proper assembly use and routine maintenance Short of this complete documentation in the local language including circuit diagrams for local maintenance technicians and engineers should be made available 3 Breakdown support Despite your best efforts to keep equipment in good working order break downs may occur from time to time Is there an agent in the country and within easy reach to undertake the repair or
6. wheeled operating table that can be constructed in a local engineering workshop Because this mobile operating table can transport the patient between the different areas before during and after an operation the patient can stay on the table throughout and does not have to transfer beds Four tables are in use at any one time one for a patient being prepared for surgery one for a patient being given local anaesthetic one fora patient being operated on and one fora patient being wheeled out of the OR and returned to the ward One patient recovers after the operation while another is given local anaesthetic SWAZILAND Our finding is that multiple mobile operating tables minimise interruptions in the flow of work surgeons can concen trate on surgery and may stay scrubbed for the entire day The tables improve a O Gi c o lt e o fal Multiple mobile operating tables for eye surgery patient comfort through better head support and are also more comfortable for surgeons as they leave more room for surgeons legs Another advantage is that fewer staff are needed to manage the flow of patients The results are dramati cally improved time and cost savings one surgeon can comfortably perform up to forty eye operations in a day The tables are designed to be manufactured in a local engineering workshop and the simplified design incor porates the following e A tubular steel welded frame A
7. 155 million Zithromax treatments have been distributed But trachoma remains a blinding scourge It is still believed to be endemic in 57 countries Figure 1 Globally 1 2 billion people live in trachoma endemic areas primarily in the poorest communities in low and middle income countries Nearly 41 million people mostly women and children have active trachoma and could benefit from treatment An estimated 8 2 million already have trichiasis the end stage of the disease and are at risk of becoming blind or visually impaired Figure 1 Trachoma endemic countries We only have ten years left to reach the goal of eliminating blinding trachoma In order to achieve this all endemic countries must have the full scale SAFE strategy in place by 2015 to allow enough time for implementation to have an impact Enormous challenges lie ahead of us Some of the remaining endemic countries are in conflict or have just come out of conflict and lack infrastructure and resources to fully address the disease Even countries free of conflict lack financial resources for the epidemio logical surveys to determine which districts need intervention or to support intervention in endemic districts Implementing the SAFE strategy can be a strain on resources as well since providing access to clean water and latrines is not inexpensive However we believe that together we can overcome these challenges and reach our goal In this iss
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9. Naughton A eds Technology for VISION 2020 Contains selected and updated articles on technology for ophthalmic practice from the Community Eye Health Journal Available for free download from www cehjournal org files b0501 html 1 9 MB or can be downloaded in smaller sections Order paper copies from TALC free to low and middle income countries otherwise 5 Srinivasan V and Thulsiraj RD Ophthalmic instru _ ments and equipment a a handbook on care and d 2 maintenance 2003 Available from Aravind UK 1 40 Indian Rs100 Or download from http laico org v2020resource files instruments_book pdf 780 kB Video DVD Ophthalmic instruments and equipment care and maintenance By V Srinivasan and RD Thulasiraj A step by step guide to the care and maintenance of ophthalmic instruments and equipment e Video PAL format only order from TALC UK 7 e DVD order from Aravind UK 7 Indian Rs500 Has English Spanish and French language options Past Community Eye Health Journal articles All articles available online at www cehjournal org Vidhya SS Srinivasan V Technology for eye care training in the care of equipment and instruments Comm Eye Health J 2002 Issue 43 pages 43 44 Srinivasan V Equipment repaired is equipment gained Comm Eye Health J 2009 Issue 70 s02 online supplement page 2 www cehjournal org 0953 6833 22 jceh_22_70_sO2 html RD Thulasiraj and V Srinivasan Care
10. be accompanied by a weekly or monthly tick sheet near the item of equipment with a space for each day so that users can date and sign it thereby showing that they have carried out the required tasks This may include a space for users to indicate what spare parts such as bulbs were used On a regular basis the list of spare parts used should be noted in the central mainte nance and repair record so that more spare parts can be ordered The central maintenance and repair record can be used to keep track of all other maintenance including mainte nance done by the in house team by vendors or by service agents The infor mation captured should include the date the equipment reference number what was done who did the work and when next maintenance is due Figure 2 One way of keeping track of regular maintenance tasks is to affix a tag to serviced or maintained equipment This information should be reflected in the central maintenance record a iva iia Q g o 2 8 io x3 E 2 Record keeping for repair Table 1 shows what information about repairs should be recorded in the central maintenance and repair record and what useful information this can provide In addition to the practical benefits of a central maintenance and repair system it also provides eye care unit administrators and the equipment maintenance team with valuable information and proof that they can use to ask for more resources Bud
11. eye unit s needs and that maintenance and repair support as well as spare parts will be available for each donated item for the next 5 10 years Copyright 2010 Ismael Cordero Neil Murray and Henry E Nkumbe This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited PURCHASING Catherine Cross _ Formerly Manager International Programmes Sightsavers Grosvenor Hall Bolnore Road Haywards Heath West Sussex RH16 4BX United Kingdom Programme Procurement Manager Sightsavers Grosvenor Hall Bolnore Road Haywards Heath West Sussex RH16 4BX United Kingdom eo Philip Hoare If VISION 2020 is to meet its objective of eliminating avoidable blindness in ten years time eye units have to ensure that they have the equipment they need so they can work quickly and effectively In this article we aim to show you how to get the best results when purchasing procuring equipment Who is responsible The manager of the eye care unit is ultimately responsible for ensuring that equipment and supplies are adequate However the manager may delegate a member of the team to act as the equipment person This person will have some responsibilities for ordering and will also be responsible for keeping the equipment inventory up to date Th
12. is the extent to which it can foster high level political commitment from the national government Simply having a government represent ative on the NTTF is not enough These individuals must be doers people who take Robert Essel International Trachoma Initiative e e Initiative www trachoma org iTi International Trachoma Initiative an active interest and are willing to act and lobby their peers in government on behalf of the NTTF The reality is that there is always going to be competition within government departments and between departments for limited budgets The NTTF needs to have strong political and financial support from within government The following may help e Invite the national director of public health or a similarly high level government Official to join the leadership of the NTTF e Use visits by experts or other key international leaders as an opportunity to organise meetings with potentially helpful government officials Once political commitment to the national plan and the NTTF is achieved the next goal is for this to be sustained in the long term This is best achieved by putting systems and processes in place that will ensure that trachoma prevention becomes part of the regular business of government Consider doing some or all of the following on a regular basis e Develop a trachoma organogram showing the various partners including government and their activit
13. optical fibres from equipment such as laser machines vitrectors indirect ophthalmoscopes etc have very delicate interiors and or optical compo nents within them and some of them may carry power or electricity and heat up with use Staff should know how to handle and fold them properly in order to prevent damage In situations where wires and fibres have to lie on the floor they should not be walked on or run over with heavy items such as trolleys or other wheeled furniture and equipment Lenses Protect lenses from dust by always covering optical equipment when not in use Humidity or liquid spilled on instruments can cause fungal growth mould on lenses Many producers of optical equipment supply sachets of silica gel drying agents or fungicidal anti mould pellets that you can place inside the dust cover You can also use a dehumidifier to keep the air in the room dry Electrical connections Pulling on the cord instead of on the plug can damage the wires Check that equipment is plugged in properly and that the cord is not in danger of shorting for example if it is exposed to water or steam or in danger of being cut Handle plugs or connectors with care A break in a wire inside the plug casing is hard to find and causes equipment to work intermittently This can result from bending the wire at the same place or unplugging from the socket by pulling on the cord Power sources Expensive and delicate equi
14. page 32 contains some additional questions you can discuss with the supplier before acquiring new equipment Most of these are also valid for purchased equipment Budgeting for an equipment purchase Prices quoted in a catalogue or on the internet may not include value added or sales tax As this varies from country to country you may have to ask the supplier what the full cost is If the equipment is to be imported the cost of packing insurance and clearing must be included in your budget As mentioned above you also need to budget for accessories spare parts consumables maintenance user training and electrical stabilisers if needed As a guide budget 3 6 of the purchase price for every year of use It is recommended that you order enough consumables and spare parts for at least one year when purchasing the equipment Philip Hoare When buying expensive equipment such as an operating microscope ensure that you have also budgeted for accessories spare parts consumables user training and electrical stabilisers such as voltage regulators if needed BANGLADESH 34 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 Members of the eye care team check the paperwork of newly arrived eye care equipment and consumables They will also check the integrity of the boxes to ensure they haven t been tampered with en route MADAGASCAR Finding a supplier Once you know what you need look for th
15. stocks and stores e Procurement procedures e Financial planning and accounting e How to work in a health facility environment The equipment team also needs other skills common to equipment users such as e Basic do s and don ts when handling equipment e How to operate equipment e Basic anatomy physiology and medical terminology e Cleaning of equipment e Safety procedures Training is not an activity that only happens once Training is required at various times throughout an employee s career e Induction training when staff are newly placed in post move to a new department or facility or to a new location with different responsibilities e Training when new equipment first arrives e Refresher training regular training to update and renew skills throughout the working life of staff After training the team can be expected to do the following e Communicate effectively with clinical personnel on medical equipment and safety issues e Train users to operate and care for equipment properly e Perform repairs in a cost effective and timely fashion e Help to establish a safe environment for patients and staff e Take part in decision making about medical equipment management planning and procurement TIP If an item of equipment is used far away from the location of the manufac turer or supplier and service personnel are not available an effort must be made to obtain the service manual Thi
16. the user manual and then familiarise yourself with the equipment before attempting to assemble or operate it Ensure that each item of equipment has a maintenance plan that is respected and followed and that there is a budget allocated for maintenance each year Keep the donors informed about both the successes and challenges with the donated equipment this will help you to build a positive and hopefully long term relationship In conclusion maintaining open commu nication with your donor and following these guidelines should ensure that your donation goes smoothly With time your eye unit will be able to demonstrate that the donations have resulted in improved services that bring satisfaction to patients staff and the donor Develop a relationship with the eye unit What do they need Find out what equipment is best suited to their work and environment This depends not just on the durability and function ality of the equipment but also on the eye unit itself does the unit have staff with the knowledge and skills needed to use the equipment Can the unit afford the operation and maintenance of the equipment Balance need and quality Although it is not appropriate to donate out of date equipment an eye unit ina low or middle income country may be able to use equipment that is no longer considered suitable in a high income setting However it is your responsibility to ensure that the equipment meets the
17. this equipment ends up being dumped Figure 1 Good maintenance habits and an effective repair system will minimise the amount of time equipment is unusable Who does what In our experience approximately one third of problems reported with ophthalmic equipment arise from problems caused by the user one third from easy to solve technical problems such as a blown bulb or fuse or a loose power cord and only one third require more serious fault finding procedures and special knowledge of the equipment Equipment Ismael Cordero ORBIS The maintenance and repair of equipment should be centrally managed p r z imi Ee a i E N n r Figure 1 An operating table lies abandoned outside a hospital in a low income country equipment maintenance and repair team you may consider sharing such a service among several units Depending on the equipment you may have a service contract with the vendor or manufacturer who will be responsible for more complex maintenance and repairs These will be carried out by specialised maintenance and repair personnel either employed by the vendor or manufacturer or working as independent maintenance contractors Whatever system your eye unit has in place the maintenance and repair of equipment should be centrally managed The person responsible the equipment person will assign tasks keep maintenance and repair records design mainte nance schedules and u
18. License which permits unrestricted use distribution and repro duction in any medium for non profit purposes provided the original work is properly cited ANSWERS 4 Test yourself Continuing Professional Development CPD also known as Continuing Medical Education CME describes courses and activities which help professionals such as health care workers to broaden their knowledge and improve their skills Through this CPD Test yourself section we aim to support your continued professional development We hope that you will use these questions to test your own knowledge and understanding and that you will discuss them with your colleagues and other members of the eye care team These questions have been developed in association with the International Council of Ophthalmology and are based on the style of the ICO Advanced Examination www icoexams org exams advanced 1 Think about the responsibilities of eye care workers for the care and maintenance of equipment Which of the following statements are true True and which are false It is better to wait no more than one week before reporting a fault with your equipment Equipment users are responsible for checking the safety of their equipment Equipment that is being taken out of use decommissioned can be disposed of along with other waste Only junior equipment users are responsible for looking after the equipment they use 2 Think abou
19. More information www cehjournal org competition Keppel Street London WC1E 7HT UK or email her on Anita Shah Lshtm ac uk This journal is for all health workers with eye care responsibilities whether you are a nurse community health worker medical doctor or specialist ophthalmol ogist If you know of anyone else who will benefit from reading this journal please tell them how easy it is to subscribe or send their details directly to us Erratum The answer to our CPD question 1D page 19 of Issue 72 should be FALSE There is in fact a great deal that can and must be done for a blind infant by specialist instructors specialised occupational therapists and early intervention specialists for the visually impaired to support both the infant and the infant s family We hope that you spotted the error and apologise for any confusion Meetings Access Africa The 5th Institutional Development Programme IDP Africa Forum Ghana Institute of Management and Public Administration July 3 8 2011 Themes include technology access and social and economic empowerment for people who are blind or partially sighted For more infor mation email africaforum2011 gmail com or write to Aubrey Webson c o Perkins International 175 North Beacon Street Watertown MA 02472 USA Courses Lions Aravind Institute of Community Ophthalmology LAICO LAICO offers instrument maintenance courses with a trainee trainer ratio of 1 1 Sup
20. Srinivasan and RD Tulasiraj 2003 pg 4 5 2 See page 36 for details on how to get a copy of the Standard List Copyright 2010 Daksha Patel Elizabeth Mercer and Ingrid Mason This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited PRACTICAL CARE Equipment maintenance and repair DS Walia Director of Clinical Services Eye Unit PCEA Kikuyu Hospital PO Box 45 00902 Kikuyu Kenya Email deseye pceakikuyuhospital org Jane Huria Instrument Repair Technician Eye Unit PCEA Kikuyu Hospital Ismael Cordero Senior Clinical Engineer ORBIS International 520 8th Ave 11th Floor New York NY 10018 USA The repair and maintenance of ophthalmic equipment including surgical instruments and diagnostic devices can be compared to the maintenance of a motor vehicle something many of us understand well If you had a car would you drive it until the fuel runs out or until a tyre punctures and then abandon it to buy a new car Of course not However many eye care units purchase or receive as a donation expensive and delicate equipment which because of poor maintenance ends up breaking down If there is not a system in place to report breakdowns and to plan or carry out repairs equipment can remain unusable for long periods of time Sometimes
21. T Ingrid Mason CBM Capacity Development Officer and Medical Advisor PO Box 58004 00200 City Square Ring Road Parklands Nairobi Kenya Wanjiku Mathenge Regional Medical Advisor Fred Hollows Foundation Email ciku email com In many low and middle income countries it is often the people who are poor or with a disability or both who find it most challenging to access and pay for health care When people do come to us for eye care it is therefore vital that we provide quality services efficiently and effectively To achieve this goal we must ensure that our equipment is well maintained and that we have enough spare parts and consumables for it to function with minimum interruptions To cope with the sometimes inevitable breakdowns we also need systems that will respond quickly to carry out repairs and replace broken or worn out parts Unfortunately the survey commissioned by this journal page 23 has shown that many eye units in low and middle income countries have vital equipment that is not working often for long periods of time and that this has affected the services offered to patients Equipment needs to form part of our planning for eye care This must start when eye care programmes are being designed and should include those who will be using the equipment Without careful planning it is likely that our equipment will not perform optimally and might even fail completely And without working and effe
22. a laser will not make much difference Or in a clinic where ophthalmoscopes are shared between clinicians a few extra ophthal moscopes will have a similarly positive effect on patient flow Continues overleaf gt IN THIS ISSUE 21 Equipment for eye care Ingrid Mason and Wanjiku Mathenge 22 Ophthalmic equipment survey 2010 preliminary results Daksha Patel Elizabeth Mercer and Ingrid Mason 26 Equipment maintenance and repair DS Walia Jane Huria and Ismael Cordero 30 Training for equipment maintenance and repair Sam Powdrill Ismael Cordero and V Srinivasan 32 Donations how to ensure you really benefit Ismael Cordero Neil Murray Henry E Nkumbe 34 Purchasing equipment for an eye unit Catherine Cross and Philip Hoare COMMUNITY EYE HEALTH JOURNAL 29 EXCHANGE Multiple mobile operating tables for eye surgery Jonathan Pons 36 USEFUL RESOURCES 37 EQUIPMENT SERIES How to look after and care for a slit lamp 38 TRACHOMA UPDATE SERIES 39 CPD TEST YOURSELF 40 NEWS AND NOTICES VOL 23 ISSUE 73 SEPTEMBER 2010 w Ismael Cordero ORBIS Community Eye Health for Eye Health Volume 23 Issue 73 September 2010 Editor Elmien Wolvaardt Ellison editor cehjournal org Editorial committee Nick Astbury Allen Foster Clare Gilbert lan Murdoch GVS Murthy Daksha Patel Richard Wormald David Yorston Special advisor for Issue 73 Ingrid Mason Regional consultants Sergey Branche
23. ake time to read it If possible keep the manuals close to the equipment e Make sure you get every issue of the Community Eye Health Journal over the next three to four years we are publishing a new series on equipment care maintenance and repair which will have practical tips and guidance on the most used items see the first instalment on page 37 e Look at Useful resources page 36 for additional sources of information 2 Check equipment before use or at least once a week e Inspect equipment for any sign of damage or parts that may need repair or replacement and lubricate as necessary according to instructions e Check that equipment is plugged into the voltage stabiliser or uninterrupted power supply where these are required 3 Tell someone if there is a problem e As a user it is your responsibility to report any problems You will most likely be the first person to know that something is not working as it should e Don t assume that someone else will report a fault what if everyone thinks that someone else will report it e It may sound obvious but a repair can t be attended to if nobody knows there is a problem The longer you take to report it the longer before the repair will take place e Don t wait for equipment to break down before reporting a fault Even a small change in how the equipment moves or how it responds could indicate that something has gone wrong or that a part nee
24. al disabilities e An electrical outlet should be available nearby and the power cord should not be in the path of staff or patients e The slit lamp should not be exposed to excessive temperature extremes such as those produced by direct sunlight or air conditioning e The slit lamp should be kept in a dry environment since there could be fungal growth mould or mildew on the optical components if they are exposed to humidity combined heat and moisture Spare parts e Spare bulbs and fuses should be kept within easy reach in order to avoid delays in patient care e The minimum recommended stock of bulbs and fuses is two of each per slit lamp e When a part is used it should be restocked immediately Replacing the bulb e When handling or replacing a bulb take care not to leave fingerprints on the bulb Oil from your fingers can create hot spots on the bulb which will reduce its life As a rule handle bulbs with paper tissue or with cotton gloves e Check that you replace the bulb housing in the right position otherwise the quality of the slit beam is compromised Adjusting the position of the housing may correct a distorted beam Cleaning e The slit lamp should be cleaned weekly at a minimum or more often if ina dusty environment e The slit lamp housing should be cleaned with a cloth that has been slightly Figure 1 Diagram of a Haag Streit style slit lamp dampened with water No other liquids or corr
25. ally there should be expertise locally to support the instal lation and maintenance but it is worth asking the donor whether there is also a remote troubleshooting facility such as an internet or telephonic technical help desk 6 Electricity and water supply Has the equipment been fitted with all the devices it needs to work in your location For example electrical equipment needs the correct electrical plugs voltage surge protectors and other devices necessary to ensure regular uninterrupted power supply see top tips on page 27 If the item of equipment requires running water will this be available If not is the equipment really suited to your circumstances Shipping and clearing donated equipment You need to be sure that the donated equipment or consumables are shipped with a recent biomedical certification and a minimum one year guarantee The donation should be packed and Neil Murray shipped in accordance with international shipping regulations with appropriate packing for the donation and mode of transport Documents must list everything in the shipment and clearly indicate that it is a donation You will need to check the customs regulations in your country and inform the donor in advance before shipping to reduce the risk of high clearance charges and delays which may result in extra charges by the shipping company demurrage After receiving the donation Make sure you read and understand
26. articularly in the case of electrical items The connections and voltage must be checked and voltage stabilisers and regulators installed in areas where electrical supply is unreliable In conclusion if procurement is approached in a planned systematic way as described in this article you will have the best possible chance to acquire good quality equipment that will meet your needs well into the future References 1 SGS write to SGS SA 1 Place des Alpes PO Box 2152 1211 Geneva 1 Switzerland Phone 41 22 739 91 11 www sgs com 2 Cotectna write to Cotecna inspection SA 58 Rue de la Terrassi re PO Box 6155 1211 Geneva 6 Switzerland Tel 41 22 849 6900 www cotecna com Copyright 2010 Catherine Cross and Philip Hoare This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited Useful resources equipment for eye care Publications IAPB Standard List for a VISION 2020 Eye Care Service Unit 2010 Lists the equipment instru ments and supplies required by primary and secondary level district eye care units along with suppliers and their addresses Download from the VISION 2020 website www vision2020 org main cfm type CLINGUIDE 2 3 MB or order a copy from TALC send your name occupation and address Stevens S and
27. articularly those parts that come into contact with the patient such as the chin rests on the slit lamp and keratometer e Check for sharp metal or broken lenses in the instrument that could injure the patient or user e Keep equipment tubing tools and electrical cords out of the path of patients who may be blind and could trip over them Top tips for training equipment users e Demonstrate what to do e Allow the student to actually do the work and practice under supervision e Maintain a friendly environment rather than a highly competitive environment in which to learn e Be patient with your students but expect effort and excellence e Always have a back up plan in case equipment breaks or a part is not available 30 6 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 Training for equipment maintenance and repair The person responsible for equipment in the eye unit the equipment person should periodically remind staff about the proper care and use of equipment using the user manual as a guide to discussion Training the equipment maintenance and repair team Since new makes and models of equipment are constantly becoming available the equipment maintenance and repair team needs to update its skills continually Training should cover e Preventative maintenance and repair for maintainers e Teaching preventative maintenance to users e Maintenance management e Management of
28. ba awos asje4 9 amu q a pawwu payOoda aq pinoys s jne4 asje4 e T 7 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 39 NEWS AND NOTICES Two losses for eye care We are sad to report the deaths of Drs Moses Chirambo and Tom Little in recent months Moses Chirambo was Malawi s first ophthalmologist and was later appointed minister of health for his country He passed away on August 14 during medical treatment in South Africa Dr Chirambo worked for Sightsavers as Eye Care Programme Consultant for the East Central and Southern African Region he also established and ran the Southern African Development Community SADC ophthal mologist course at the Malawi College of Health Sciences He pioneered Malawi s first eye training school in the capital Lilongwe and helped establish similar programmes in Botswana Namibia Zimbabwe and Zambia k Tom Little an optometrist from New York was killed during outreach work in Nuristan province Afghanistan on 6 August Dr Little had worked in eye care in Afghanistan for thirty years and supervised a network of eye hospitals around the country At the time of his death he was leading a team of nurses doctors and logistics personnel providing specialist eye treatment and health care to people in remote communities Have you got news for us We would like to hear from you about new developments in eye care in your country or region You can als
29. be packed and carried with special precau tions so they are not damaged in transit Heavier equipment such as operating microscopes should be carefully dismantled and packed in damage proof containers Specially designed microscopes for mobile use are available with proper packing containers for safe transport Sufficient stock of light bulbs and fuses should be carried together with a set of screw drivers and other basic tools Staff travelling with outreach programmes should know how to pack set up and dismantle the equipment With thanks to Ingrid Mason Neil Murray Kola Ogundimu Sam Powarill Tony Walia and Ismael Cordero N COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 27 PRACTICAL CARE Continued Repair Repair means responding to the breakdown of equipment and undertaking work to correct the problem in order to return the equipment to a working condition Before equipment can be repaired you need to be aware that there is a problem Therefore there should be a clearly understood system for reporting faults and breakdowns and equipment users should be encouraged to report faults and breakdowns as soon as possible If there is no back up equipment a breakdown will mean that the service the equipment was providing will come to a halt Simple repairs can be done by the in house or external maintenance and repair team If the equipment is repaired where it is used it is important that the tea
30. bed made of a shaped stainless steel sheet e Adjustable bed height using a simple hand operated thread e Ahead end with non castoring wheels for stability during surgery e A foot end with lockable castoring wheels e Bumpers on all wheel mountings which prevent contact damage with door frames Each table costs approximately UK 300 to produce and drawings are available from the author Copyright 2010 Jonathan Pons This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited TRAINING Sam Powdrill Assistant Professor University of Kentucky College of Health Sciences Division of Physician Assistant Studies 900 S Limestone Street Lexington KY 40536 USA Ismael Cordero Senior Clinical Engineer ORBIS International 520 8th Ave 11th Floor New York NY 10018 USA V Srinivasan Aravind Eye Care System Madurai India Email v srinivasan aravind org In order to ensure the that equipment functions well both equipment users and the equipment maintenance and repair team must be trained Users must be trained in basic care and maintenance of equipment and the equipment team must be trained to undertake repairs and more complex maintenance tasks Training equipment users The primary responsibility for the care and maintenance of equi
31. cision ask the supplier the following e Do they supply the consumables and spare parts as well or will you need to go elsewhere e Will they help to set up the equipment once it arrives e What services do they offer if the equipment breaks down and will they send a replacement while yours is being repaired e Will they train local staff in maintenance and replacement of spare parts Preparing an order The more details that are included on the order the greater the likelihood of a speedy response from the supplier and of receiving exactly what was requested Include e Catalogue number e Make and model e Detailed description of item e Quantity Henry Nkumbe When planning to buy expensive items you may want to evaluate the supplier before making a decision The Operating Room section of the Standard List helps by placing these with references under the main item Ask the supplier what spare parts may be needed in the first year such as light bulbs fuses spare paper for an A scan and fungicidal anti mould tablets these should be ordered at the same time Placing the order and paying for it Most overseas suppliers will require payment in advance or with order The majority of the suppliers in the Standard List are tried and tested but be cautious when dealing with unknown suppliers You can use an inspection company such as SGS or Cotecna to verify such trans actions and ensure yo
32. ctive equipment our eye care programmes will not achieve their potential Trainees learn how to repair and maintain a slit lamp ETHIOPIA Making the best out of an investment in equipment We should critically assess whether investment in a new piece of equipment will add value to the services we offer Does it allow the eye care team to provide a better quality service Does it allow the team to help more patients per day Does it help the clinician to work more comfortably and therefore more quickly The desire for sophisticated equipment should be balanced against the need for basic public health equipment such as ophthalmoscopes as mentioned on page 32 Ultimately the deciding factor must be our patients What equipment will allow the eye unit to help the largest number of patients and provide them with the best possible care When facing difficult decisions on a limited budget it may be helpful to look at patient flow within the eye unit or eye care programme Where are the longest queues the longest delays or the longest waiting times These are the areas where additional investment in equipment may be of most benefit provided everything else including staff is in place to support the equipment For example in some eye clinics there may be a queue of patients waiting to be examined at the slit lamp One extra slit lamp may then allow the Clinical staff to see many more patients per day whereas one extr
33. ds to be replaced soon If left unchecked a more serious fault may occur which will be more expensive and time consuming to repair 4 Clean equipment after use or at least once a day and lubricate when necessary e Dust and then clean equipment including optical components with the appropriate cleaning agents and solutions Lubricate moving equipment as often as indicated Always follow the instructions 5 Protect equipment when not in use e Store equipment in a dry clean environment where it is not in danger of falling and breaking e Place plastic dust covers on larger equipment like slit lamps in order to prevent damage to the optics and other delicate components If cloth is used ensure it is heavy and non porous or else dust will get through e When transporting equipment pack items securely and handle with care 28 6 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 manage its equipment effec tively it needs good maintenance and repair records It is very difficult to manage the unknown A central maintenance and repair record will help you to keep track of the maintenance and repair work done Ideally this system should correspond to the eye unit s equipment inventory mentioned on page 34 this means that you will have maintenance and repair records for each of the items listed in the inventory Record keeping for maintenance The preventative maintenance schedule for users can
34. e inventory should contain information about all items of equipment in the eye unit when these were bought from whom at what cost and where the items are now situated in the hospital or clinic When new equipment arrives this should also be recorded in the inventory The equipment inventory can be stored on computer or in a paper filing system The equipment person will also be responsible for ensuring that all equipment has sufficient consumables Such as reagents filters recording paper spare parts including light bulbs and accessories cables electrodes and so on and will order replacements when stocks run low The equipment inventory is a good place to note how satisfied the eye unit is with the services offered by different suppliers When it is time to order again this information will help the equipment person to determine whether to continue with the same supplier or consider other suppliers Finding out what you need The IAPB Standard List for a VISION 2020 Eye Care Service Unit Standard List is a useful guide to the equipment you are likely to need in your eye unit The Standard List is updated every two years by the IAPB Technology Programme Committee and also contains the names and contact details of suppliers see page 36 for details on how to get your Own copy With equipment you have to be sure that what you buy will last and will suit your needs and circumstances In addition to consulting the S
35. e best supplier if you are satisfied with your existing suppliers you can skip this step The Standard Listis a good place to start it contains the names and contact details of suppliers for all of the equipment and consum ables it lists Once you have identified suppliers who can provide what you need request up to date catalogues or price lists as well as more information about their products You can ask for quotations or invite the supplier to tender or submit a proposal When planning to buy expensive items in particular you may want to evaluate the supplier before making a decision Ask the supplier whether they can put you in touch with some of their other customers Suppliers who are confident in their products and services will normally be happy to do so You may ask to examine samples of the product being considered or ask for a trial period with an item of equipment At least request to see a photograph of the equipment this will help ensure that there hasn t been a misunderstanding about what exactly you want to buy Depending on the product ask whether installation warranty and maintenance or a short maintenance workshop for local staff are included in the price This is also a good time to negotiate access to the service manual see tip on page 31 particularly if your eye unit is in a remote location and specialised maintenance and repair personnel are not available Before making a final de
36. e parts maintenance water and electrical supply will be required Before accepting the donation the recipient must ensure that they can fully support the equipment and that they have the budget to do so see article on page 32 New items of equipment should be purchased with all spare parts and consumables for at least the first year of use see article on page 34 Arrangements need to be made ahead of time for the maintenance and repair of both donated and purchased equipment Newly purchased equipment should be installed by the manufacturer or supplier where possible and training given to staff on the basic care and maintenance that the equipment requires Equipment is central to service delivery and quality and is closely linked with the motivation of eye care personnel to do their job More efficient effective and long term use of equipment will be possible if eye units are able to acquire appropriate equipment which meets their needs which they are trained to use and care for and which they can afford to maintain Our thanks to everyone who responded to the survey including the MSc Community Eye Health alumni Special thanks to William Felch from the International Council of Ophthalmology and Marcia Zondervan of the ICEH Links Programme for allowing us to expand circulation of the survey through their contact databases References 1 Ophthalmic instruments and equipment A handbook in care and maintenance V
37. each Photocoagulation laser St ii it Visual field analyser i itt A scan i Autorefractor Si i Operating microscope ST is Goldmann tonometer TS iii Slit lamp i Retinoscope ME a Ophthalmoscopes indirect B Ophthalmoscopes direct M Ei 0 10 The impact of equipment that did not work Some eye units have had to cancel or reschedule clinics and operations when their equipment broke down Outreach programmes in almost 20 of the eye units were cancelled at some point due to lack of operating microscopes which meant that screened patients have had to be turned away For both outreach services and those at the clinic the inconvenience to patients is great particularly in rural areas where patients often have to travel long distances Long term or repeated cancellations result in disappointment and loss of trust This can damage the reputation of the eye care service and will have an impact on its ability to attract patients in future The impact of breakdowns was described as increased waiting times for patients delays due to sharing of equipment and referral without a proper examination In addition inability to conduct a proper preoperative assessment due to non functioning slit lamps increases the risk of complications and poor visual outcomes Delays and cancellations are frustrating for eye care staff and have an impact on their motivation this will in turn diminish their ability to deliver high
38. ed and is it the best use of scarce resources For example has the donation of sophisticated devices phaco machines lasers or ultrasound machines been balanced against the need for basic public health equipment such as ophthalmoscopes e Is it the right tool for the job Is it an appropriate make and model Refer to the JAPB Standard List for a VISION 2020 Eye Care Service Unit 2010 Standard List See page 36 e Does your organisation have the necessary resources and skills to make good use of it e Do you have the budget to use and maintain the equipment in the long term You will have to budget 3 6 of the purchase price of the donated equipment per year for consumables parts maintenance and user training This may or may not form part of the donation e Is the potential donor a credible individual or institution Talk to others who have received donations from them Give preference to items from companies with an established track record for after sales service in the country or sub region most of these companies are in the Standard List Talking to a potential donor Explain your needs and how the requested equipment or consumables will meet these needs Describe e Why the resources presently available are not satisfactory e What specific interventions the requested equipment or consumables will be used for e Which and how many procedures will be performed using them e How they will help you meet the
39. environments Another venture is the training of biomedical technicians in low and middle income countries in the installation care and maintenance of their equipment This positive partnership between VISION 2020 IAPB consortium partners eye care programmes and end users demonstrates how careful and creative thinking can benefit both end users and equipment manufacturers In conclusion if we are to meet the goals of VISION 2020 we as eye care providers must acknowledge the potential of equipment to contribute to these goals and plan accordingly Copyright 2010 Ingrid Mason and Wanjiku Mathenge This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited EQUIPMENT SURVEY Ophthal Daksha Patel MSc Course Director and Clinical Lecturer International Centre for Eye Health ICEH London School of Hygiene and Tropical Medicine Keppel Street London WC1E 7HT UK Elizabeth Mercer Courses Promotion and Scholarship Administrator ICEH Ingrid Mason CBM Capacity Development Officer and Medical Advisor PO Box 58004 00200 City Square Ring Road Parklands Nairobi Kenya The delivery of ophthalmic services at all levels is completely dependent on equipment from the simple torch light to the highly sophisticated equipment used fo
40. geting for maintenance and repair When we purchase a motor vehicle we understand that we will have recurring costs for maintenance theft and accident insurance cleaning parking etc The same is true for ophthalmic equipment since it costs money to operate and to maintain during its life cycle On average the original purchase cost only makes up about twenty per cent of the entire life cycle cost of the equipment As a general rule you should budget anywhere from 3 to 6 of the equipment purchase cost per year for each device to cover consumables parts maintenance and user training Plan for maintenance when you purchase Table 1 Record keeping for repair What should be recorded The details of repair work done on each machine including cause suspected cause and who carried out the repair The spare parts and materials used The date equipment has broken down and the date it is repaired The causes of any delays the equipment and ensure that you buy the necessary accessories including voltage stabilisers surge protectors and uninterrupted power supply units as well as enough spare parts bulbs fuses and so on to last for at least a year In conclusion adopting practical and workable systems to manage eye care equipment as suggested in this article This provides information about e The history of each machine e Common problems e The parts most frequently used e What needs to be re ordered
41. goals can be set e Help staff to develop their skills e Putin place suitable employment conditions such as a salary holiday and sickness leave and overtime entitlements e Ensure suitable working conditions such as supportive supervision and suitable tools Establishing and running an equipment workshop In general hospitals with fewer thana hundred beds are more likely to save money and maintain quality by outsourcing equipment mainte nance as opposed to having an in house mainte nance department Most small health organisations simply cannot provide the needed resources such as salaries for qualified techni cians to operate a good quality in house workshop However larger hospitals may find it helpful to have their own workshop The main benefits are Q ira S g eS D 2 8 S po E EH e Better control over the maintenance budget e Faster response speed e Better understanding of user needs and organisational priorities You can find out whether an in house equipment workshop will save costs compare the money spent on mainte nance performed by outside vendors to the anticipated initial investment and recurring expenses needed to establish and operate an in house workshop It is important to note that even with an in house workshop there will always be a need for outsourced maintenance services for example when the equipment is too complex for the in house technicians or when repai
42. hereas the maintenance team can set aside a specific day of the week or month to carry out regular maintenance tasks More sophisticated maintenance tasks such as those which need to be carried out by service agents should be scheduled for a specific day or week in the year It is helpful to display maintenance schedules for users on or near the equipment they refer to this can serve as a useful daily reminder of the tasks that should be performed Continues overleaf gt Tools Where possible avoid using hammers pliers and files these usually cause irreparable damage Use the right tool to tighten screws and other parts Lubrication e Petroleum jelly Vaseline or white grease is good for lubricating parts that have gears or sliding surfaces It is clear and less likely than regular grease to leave stains on hands and clothing e Silicone spray is useful for sliding plastic or nylon parts Take care not to spill any on the floor as it is very slippery and hard to remove e Graphite can be used as a dry lubricant or as a paste for moving or sliding parts e Avoid excessive use of oil as it is messy and collects dust Foot pedals These frequently become wet when floors are being cleaned especially in the operating theatre Moisture seeps into the electrical components of the foot pedal which with time will stop working Always place any foot pedal off the floor when mopping Wires and optical fibres Wires and
43. ical equipment care maintenance and repair Copyright 2010 Ismael Cordero This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited TRACHOMA UPDATE SERIES Danny Haddad Director International Trachoma Initiative 325 Swanton Way Decatur GA 30030 USA In 1997 the World Health Organization formed the Global Alliance to Eliminate Blinding Trachoma by 2020 GET 2020 a coalition of governmental non govern mental research and pharmaceutical partners In 1998 the World Health Assembly urged member states to map blinding trachoma in endemic areas implement the SAFE strategy which stands for surgery for trichiasis antibiotics facial cleanliness and environmental change such as clean water and latrines and collaborate with the global alliance in its work to eliminate blinding trachoma Over these past 13 years much progress has been made Pfizer Inc has committed to donating the Zithromax necessary for eliminating blinding trachoma by 2020 non governmental organisations have scaled up their support to national programmes to implement the SAFE strategy and some trachoma endemic countries are now close to reaching their intervention goals Since the Pfizer donation began in 1999 through the International Trachoma Initiative ITI more than
44. ies in the country e Provide frequent and professional reports of meetings e Disseminate reports updates and fact sheets to key government officials ona regular basis e Regularly review the current trachoma knowledge base e Reach consensus with partners and all districts on how to report on trachoma data or develop a harmonised management information system MIS for trachoma in the country e Jointly celebrate achievements or special dates share the credit for tasks accomplished e Organise routine meetings with specific government officials the meetings should include a cross section of members of the NTTF e Share with government feedback from international meetings that one or more NTTF members have attended Having a strong well functioning and collab orative NTTF will assist trachoma endemic countries in sub Saharan Africa to realise their goal of eliminating blinding trachoma An NTTF will not achieve this without specific investments in capacity building in the areas of leadership partnership management and political ownership Make use of every oppor tunity to build skills in these areas whether through formal courses or informal sessions during NTTF meetings Investments made now will reap benefits beyond the time when trachoma ceases to be a public health problem Copyright 2010 Paul Courtright and Emmanuel Miri This is an open access article distributed under the Creative Commons Attribution
45. ire was circulated by email to members of the ICEH alumni network and the International Council of Ophthalmologists as well as to participants in the various VISION 2020 Links programmes The survey was also made available on the ICEH website for visitors in charge of eye units to provide information Data collection was active between 24 January and 24 April 2010 Only one questionnaire was completed per eye unit This simple survey was not designed to obtain a representative sample across regions or countries but rather to capture the key trends and themes with regards to equipment About the participants We received 173 responses 55 7 of which were from training facilities tertiary hospitals Over two thirds of the respondents were from Africa Figure 1 Figure 1 Regions represented in the survey E Africa E The Americas E South East Asia E Europe E Eastern Mediterranean E Western Pacific Background information on the main source of funding for each eye unit was also collected as this affects procurement of new equipment as well as maintenance and repair Overall half 50 9 the responses were from government hospitals 21 8 were from non governmental organisations NGOs or mission hospital settings whereas the remaining were either from private or insurance company supported institutions In Africa 80 of all training institutions were government funded compared to only 18 in South East Asia Encou
46. irst year such as spare microscope or operating light bulbs before shipping the equipment This will allow you to make the necessary plans to clear the goods well in advance of the date of shipment The equipment person should check the goods received against the order immediately on arrival Are the correct items received in the right quantity Is Continues overleaf gt N COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 35 PURCHASING Continued the quality good and is the equipment functioning as required Delays in checking incoming goods may result in the guarantee running out before faults are discovered The equipment person should enter items received into the equipment inventory with details of date of purchase model serial number and cost All associated documents including manuals service contracts and warranties should be filed in a safe place Setting up and testing equipment Ideally this should be done by the supplier s agent or a medical equipment engineer but members of the eye care Take care when transporting new equipment NIGERIA team should participate in order to learn how the equipment works and how to care for it Where there is no medical equipment engineer or supplier s agent available it is important that the item is carefully unpacked and the manual Philip Hoare thoroughly studied before assembly Testing the equipment needs to be done thoroughly p
47. m is trained to work safely and that they don t create hazards for patients or staff More complex repairs will be carried out by specialised mainte reached the end of their lives and must be taken out of service decommissioned or retired and be replaced if the service they provide is to continue Equipment that is being decommis nance personnel they Plan for sioned should be disposed of might come to the eye care safely and according to unit or you may have to send maintenance proper disposal procedures the equipment to them for Remember to update your repairs when you records accordingly In all these situations it is purchase the important to keep equipment users informed of how long equipment Record keeping In order for an eye care unit to their equipment will be unavailable Some items of equipment will be found to be damaged beyond repair For others spare parts may no longer be available as the equipment has become outdated These will have What YOU can do to look after your equipment Care and maintenance of equipment is everyone s responsibility unusable equipment affects the quality of care we can offer our patients and makes our work more stressful Whatever your role in the eye care team there is a lot you can do to look after and prolong the life of the equipment you use 1 Learn as much as you can about the equipment you use e Find out where the manual is kept and m
48. n a regular basis such as dusting cleaning lubricating protecting and checking equipment including safety checks e Other maintenance tasks can be performed by an in house or shared maintenance and repair team that has been given additional training These include tasks such as cleaning a microscope lens replacing an electronic component performing a mechanical adjustment or any other action that requires mechanical skills and or a knowledge of electronics e More complex work has to be done by specialised maintenance and repair personnel contracted or employed by the vendor or manufacturer Preventative maintenance schedules It is important to have a schedule for preventative maintenance of each item of equipment This consists of a timetable stating when and how frequently maintenance should be done and a list TOP TIPS Equipment care of maintenance activities for each item These schedules should provide simple guidelines for all types of equipment covering the tasks to be undertaken in the following areas e Care and cleaning e Safety checks e Functional and performance checks e Maintenance tasks changing bulbs lubricating moving parts etc The best source of this information is usually the manufacturer s user and or service manual Schedules need to be developed separately for both users and maintainers For example users can perform checks and basic maintenance tasks on a daily basis w
49. ngineers worldwide Requires a Flash plug in The Inter Agency Procurement Group IAPG is a forum for international non government organisations to share logistical information and procedures it meets every quarter Visit www iapg org uk for more information Suppliers TALC Teaching Aids at Low Cost PO Box 49 St Albans Hertfordshire AL 1 5TX UK Email info talcuk org or visit www talcuk org Aravind Mail your order or enquiry to The Manager Stores Aravind Eye Hospital 1 Anna Nagar Madurai 625 020 Email stores aravind org or visit www aravind org publications catalogue asp EQUIPMENT SERIES How to look after and care for a slit lamp Ismael Cordero Senior Clinical Engineer ORBIS International 520 8th Avenue 11th Floor New York NY 10018 USA The slit lamp is an essential and often used diagnostic instrument in ophthalmology It provides illumination and magnification for the examination of many structures of the anterior segment With complementary lenses it is also used to examine the chamber angle and a significant part of the retina Its name derives from the fact that a narrow slit of light is used to illuminate the various structures being examined By following these simple suggestions you can ensure that a slit lamp performs optimally and remains functional for longer Location e Place the slit lamp where it is easily accessible to both staff and patients some of whom may have physic
50. not working for longer than a year was predominately a problem within government hospitals For example 59 of government units reported that slit lamps remained unrepaired for more than 12 months compared to E NGO Aebhubaut Figure 4 Causes of equipment not working E Manageable Mil Preventable E Don t causes Photocoagulation lasers Visual field analysers Operating microscopes Goldmann tonometers Ophthalmoscopes indirect Ophthalmoscopes direct causes know A scans Autorefractors Slit lamps Retinoscopes zL Figure 5 Percentage of eye units in which basic equipment did not work for different time periods E Opthmalmoscopes direct E Operating E Slit microscopes More than 12 months a Figure 6 Percentage of eye units with equipment that was non functioning for over a year by provider E Government 40 20 10 O 10 20 30 40 50 E Private E NGO Le Lb ie N D m Q O 00 O H oO lamps Why did equipment not work for long periods of time One of the common reasons that equipment did not work for long periods of time was that the model was too old and that spare parts were not available this was true for slit lamps retinoscopes indirect and direct ophthalmoscopes and visual field analysers in particular No one to fix it was a common reason given in the African region Lack of funding especially in government settings was rai
51. o accommodate the equipment techni cians and their physical resources Maintenance work on eye equipment in particular requires a separate workspace that can be kept clean to avoid damage to lenses etc You will also need e Workbenches stools shelves and other furniture An office area with desks filing cabinets a notice board telephone etc e Work lights e Repair tools e Test and calibration equipment e Safe storage for user and service manuals e Sufficient number of electrical outlets e Ventilation e Running water and a sink e Secure storerooms for spare parts and materials e Secure outside storage areas for gas bottles old or unrepairable equipment awaiting safe disposal etc e Where possible a computer for keeping your equipment inventory and repair records and accessing the internet to obtain technical information source vendors and parts and participate in equipment maintenance discussion groups to solve problems You should have enough spare parts in stock which may need to be pre ordered from the manufacturer or distributor Useful spare parts to have include specialised light bulbs gaskets air filters and other equipment specific parts that wear out frequently Most of the other maintenance materials you need can be found in local markets such as oil grease electric cables washers screws fuses generic light bulbs cleaning agents disinfectant solutions brushes and cloths Cop
52. o let us know if you have meetings courses or events you would like to announce in the journal Write to The Editor International Centre for Eye Health London School of Hygiene amp Tropical Medicine Keppel Street London WC1E 7HT UK or email editor cehjournal org Get your own copy Do you live in a low or middle income country Did you know you can get your own free copy of this journal delivered free to your home address All you have to do is send your name occupation and postal address to Anita Shah International Centre for Eye Health London School of Hygiene amp Tropical Medicine Community Eye Health i cbm ORBI g s a saving sight worldwide Sightsavers Video and photo competition What does the Community Eye Health Journal mean to you Send us a photograph or short video showing how you use the journal in your daily work whether to teach others to refresh your knowledge or to improve the lives of patients The overall winner will receive Kanski s Clinical Ophthalmology kindly donated by Elsevier worth UK 164 Extended deadline 1 March 2011 Patient permission if your photograph or video shows any patients you must get their written permission and include this in your entry Send to The Editor Community Eye Health Journal International Centre for Eye Health London School of Hygiene and Tropical Medicine Keppel Street London WC1E 7HT UK or email editor cehjournal org
53. of instruments and equipment a success story Comm Eye Health J 2007 Issue 61 page 16 Equipment courses ORBIS International conducts two week workshops on ophthalmic equipment maintenance and health care technology management worldwide For more information contact ismael cordero orbis org or write to him at ORBIS International 520 8th Ave 11th Floor New York NY 10018 USA Lions Aravind Institute of Community Ophthalmology LAICO in Madurai runs six week training courses for techni cians that are repeated four times a year US 325 LAICO offers shorter courses two three or four weeks on invitation at a range of different countries Visit 36 6 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 www aravind org education course details asp or write to Prof V Srinivasan LAICO 72 Kuruvikaran Salai Gandhi Nagar Madurai 625 020 Tamil Nadu India Other resources The Eye Care Equipment Maintainers Discussion Group is intended as a meeting point for people who use or maintain ophthalmic equipment or are interested in learning more You can ask questions share successes or discuss any problems you are having with your ophthalmic equipment Visit http groups google com group eye care equipment maintainers to join in Visit the World Health Organization site http who ceb unicamp br for an up to date list of the available training units for biomedical equipment technicians and clinical e
54. omplex challenge In order to implement all four components of the SAFE strategy on a national level Surgery for trichiasis antibiotics facial cleanliness and environmental change such as clean water and latrines there needs to be national coordi nation supported by political commitment at the highest level In each trachoma endemic country the body responsible for making this work is the national trachoma task force NTTF The NTTF consists of government repre sentatives NGOs donors academic institutions and other stakeholders In practical terms the work of the NTTF involves e Devising a national plan for tackling trachoma that addresses each of the four components of the SAFE strategy and which is based on evidence and technical know how Setting national targets and timeline activities for the plan e Planning and managing different activities within the national plan Bringing together the different groups needed to make the national plan work government NGOs donors etc ensuring good communication and trust between the groups and ensuring that everyone has realistic expectations e Coordinating operational research on trachoma e Monitoring and evaluating the successes of and challenges faced by the national plan and revising the plan as needed e Sharing information about the ongoing progress of the national plan with everyone involved including the public Of vital importance to the success of an NTTF
55. order made payable to London School of Hygiene and Tropical Medicine to the address above International Centre for Eye Health London Articles may be photocopied reproduced or translated provided these are not used for commercial or personal profit Acknowledgements should be made to the author s and to Community Eye Health Journal Woodcut style graphics by Victoria Francis ISSN 0953 6833 The journal is produced in collaboration with the World Health Organization Signed articles are the responsibility of the named authors alone and do not necessarily reflect the policies of the World Health Organization The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned EQUIPMENT FOR EYE CARE Continued Budgeting and planning The costs and expected benefits of investing in an item of equipment need to be carefully considered and put into a business plan by the eye unit manager before purchasing goes ahead It is not always true that investing in a piece of equipment will improve productivity and outcomes Developing a business plan will help the manager and team evaluate the cost
56. osive agents should be used The exposed surfaces of the eyepiece optics 1 and the objective lens 2 should be cleaned using a soft optical Oh J dust brush If after being dusted they still need additional cleaning the lenses should then be wiped carefully with a lens cleaning cloth or with cotton swabs and lens cleaning solution E Operational checks The following functions should be checked weekly The hospital s maintenance team or the service agent should be called if any problems are noticed during these checks Brightness control should noticeably vary the bulb s brightness e Table top movement should move up and down freely e Chin rest adjustment 3 should move up and down freely e Joystick 4 should provide smooth motion up and down forward and backward and left and right e Slit controls should smoothly vary the slit width 5 length 6 and inclination 6 e Illumination rotation arm 7 should move smoothly and lock into position with the locking screw 8 e Microscope rotation arm 9 should move smoothly and lock into position with the locking screw 10 e Illumination tilting latch 11 should vary the illumination angle in stages Filter changing knob 12 should change the filters e Magnification lever 13 should switch the magnification e The mechanism just behind the objectives that adjusts the pupillary distance 14 should move smoothly
57. pment rests with the user Users should understand how their equipment works what its limitations are and what it can and cannot do All of these are usually well described in the user manual that is supplied by the equipment manufacturer or supplier It is important that users read and understand the user manual and keep it in a safe place In situations where surgeons or clinicians work under extreme time pressure they may not be able to pay sufficient attention to the care and maintenance of the equipment they use In this case nursing staff and patient attendants can be trained in basic preventative maintenance and care However surgeons and clini cians must still be trained to use equipment properly and safely they are also responsible for reporting faults and should be included in discussions about maintenance and repair Users should be trained to do the following preventative maintenance tasks on a regular basis check the manufacturer s guide or user manual for details S e Clean outer as well as inner surfaces and lubricated parts e Check for damage loose or missing screws and corrosion Ismael Cordero ORBIS e Change filters and renewable parts e Lubricate movable parts All users including clinicians are respon sible for the safety of their equipment Users should be trained and encouraged to do the following e Carefully wipe the surfaces of the instrument regularly with a disinfectant p
58. pment such as bench top autoclaves lasers micro scopes slit lamps and vitrectors can be severely damaged by sudden surges in electricity Using a voltage stabiliser or regulator will protect equipment against damage and will generally also prolong the life of equipment We recommend good quality units which monitor the mains voltage continuously Look for units i a 2 2 a 4 which will stabilise the output to ensure the voltage reaching your equipment remains constant at 230V 6 If the input voltage falls below 142V or rises above 295V the stabiliser will automati cally disconnect the output Stabilisers of poorer quality may be overwhelmed by large fluctuations which will then damage any connected equipment The use of an uninterrupted power supply UPS unit is strongly recom mended for equipment such A scans visual field analysers fundus cameras lasers and operating microscopes This ensures continuous operation of the equipment and less inconvenience for both surgeons and patients when there are power failures We recommend using a UPS that is also able to act as a voltage stabiliser and protect the equipment against power surges The type of UPS and its power output requirements can easily be determined by a qualified electrician Equipment suppliers may also be able to give these details Using equipment for outreach Equipment and instruments that are transported for outreach work need to
59. ported by The Fred Hollows Foundation 40 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 72 MARCH 2010 Four courses take place in 2011 starting on 1 February 1 May 1 August and 1 November respectively Duration six weeks per course Cost US 400 including tools Location LAICO Aravind Eye Care Systems Madurai India Visit www aravind org education coursedetails asp for more information or write to Prof V Srinivasan LAICO 72 Kuruvikaran Salai Gandhi Nagar Madurai 625 020 Tamil Nadu India Email v srinivasan aravind org Kilimanjaro Centre for Community Ophthalmology KCCO All courses held in Moshi Tanzania For information contact Genes Mng anya KCCO Good Samaritan Foundation PO Box 2254 Moshi Tanzania Tel 255 27 275 3547 Email genes kcco net or visit www kcco net Bridging communities and eye care providers to achieve VISION 2020 in Africa 8 12 November 2010 Management for VISION 2020 programme managers 15 26 November 2010 Writing a research manuscript 29 November to 3 December 2010 Community Eye Health Institute South Africa Certificate course in community eye health Aim to provide training in the management of district VISION 2020 programmes Start date February 2011 Duration 10 weeks Cost ZA R16 500 approximately US 2 400 plus living expenses in Cape Town Email cehi uct ac za or write to Community Eye Health Institute University of Cape Town Private Bag 3 Rondebo
60. purchased but was awaiting assembly for a long period of time over six months There are several possible reasons because the equipment was not really needed because there was no one assigned to take responsibility for it or because there was no one who was able to assemble it Recommendations e All clinical staff should be trained in basic maintenance of commonly used equipment for a district level eye unit e When new equipment is purchased staff should be instructed in the basic care and maintenance that the equipment requires e Every unit must nominate an equipment person who has a keen interest in maintaining equipment This person should be supplied with a clear job description which includes 60 maintaining an inventory list for equipment and spare parts reporting on the functionality of equipment and tracking repair work This person should have undergone at least some basic training in equipment maintenance More ophthalmic and biomedical technicians need to be trained in ophthalmic equipment maintenance A module on the maintenance and repair of commonly used equipment found at the district eye unit should be developed and embedded into the training curriculum of all mid level eye care workers Local or regional equipment maintenance and repair training centres should be established Donors of equipment should inform the potential recipient what is being donated and what support consumables spar
61. r diagnosis and treatment In order to achieve the aims of VISON 2020 The Right to Sight and eliminate avoidable blindness by the year 2020 it is not enough to have the right equipment available at all levels of service delivery there has to be a good maintenance and repair support service The purpose of this equipment survey commissioned by this journal was to obtain an overview of the key issues and challenges faced by eye health providers with regard to their equipment The main objectives of the survey were e To identify what essential equipment was available and functional based on the IAPB Standard List of Equipment Drugs and Consumables for a VISION 2020 Eye Care Service Unit Standard List 7 and where this equipment was e To establish how much of the essential equipment was not working the reasons equipment was not working and for how long equipment remained that way e To identify the impact on the provision of eye care services when equipment did not work Survey methods The Bristol Online Surveys tool was used to implement the questionnaire and to collect the data online The questionnaire was based on the equipment in the Standard List and refined after pilot testing with the students enrolled in the International Centre for Eye Health ICEH Community Eye Health MSc course The questionnaire required participants to give numerical responses and to share their comments and views The finalised questionna
62. ragingly 71 1 of the eye units knew about the Standard List this proportion was similar across the different regions Figure 2 Availability of equipment E units with one or more functional Photocoagulation lasers Visual field analysers A scans Autorefractors Operating microscopes Goldmann tonometers Slit lamps Retinoscopes Ophthalmoscopes indirect Ophthalmoscopes direct N O What equipment was available and working Overall the private and NGO sectors were better equipped than government ophthalmic units This was true in all regions surveyed and across the full range of equipment covered in the survey Cataract surgery In total 80 of the units reported that of the equipment required to provide basic cataract surgery and follow up operating microscope slit lamp ophthalmoscope and retinoscope they had at least one that was functional Figure 2 However only 57 of all units had an A scan for carrying out biometry Without biometry surgeons cannot select the most appropriate intraocular lens IOL power and patients may need optical correction after surgery Within Africa only 38 of the eye units reported having a functional A scan When considering training institutions separately we found that 79 4 of the training institutions in Africa reported having no working A scans This was still a problem in the Eastern Mediterranean and Western Pacific regions 50 had no A scan but le
63. re 3 Percentage of eye units with one or more items of equipment that did not work by provider E Government 100 90 80 70 60 50 40 30 E Private 20 10 s Where was the equipment Figure 3 highlights the challenges faced in the government sector the main health service provider in many countries compared to the NGO and private sectors In all instances more government eye units had equipment that did not work Notably 60 of the government units reported that one or more slit lamps did not work Why did the equipment stop working The causes were divided into e Easily manageable causes blown bulbs faulty electrical connections blown fuses etc e Preventable causes poor maintenance inadequate cleaning breakages during transport etc e Unknown or complex technical causes On average easily manageable or preventable causes were responsible for more than a third of the equipment that had stopped working Figure 4 Breakage due to poor handling for example being dropped or damage during travel to outreach raised questions about the care taken with equipment For how long did the equipment not work and why On average over 20 of all the eye units who responded to the survey reported that they had equipment which was not working for more than 12 months Figure 5 In one extreme case slit lamps were not working for over 15 years The key trend noted was that equipment
64. rs require special tools test equipment and service manuals Most medium sized health organisations will therefore have a mix of in house and outsourced maintenance services In smaller hospitals the role of medical equipment maintenance may be incorporated into the facilities maintenance department Smaller hospitals that are part of a larger hospital system may also receive their medical equipment maintenance services from the medical equipment maintenance department of the central tertiary hospital of the system What do you need The workshop should be staffed by maintenance personnel of varying skill levels artisans technicians and engineers according to the amount and complexity of equipment in the health unit As a rule of thumb for every 100 beds at a district hospital there should be two medical equipment maintenance technicians An equipment maintenance workshop in a district level hospital ETHIOPIA You will also need a budget to pay the setup and ongoing costs The setup costs include the cost of tools equipment parts materials and the physical space for the workshop as well as the costs of recruiting and training staff The ongoing costs are salaries consum ables spare parts replacement tools and ongoing training It is important to have an equipment workshop management plan that includes department policies proce dures standards and guidelines The workspace must be big enough t
65. s and benefits in a rational and logical manner before taking any decisions Plan for installation training of users and the maintenance team maintenance and repair contracts where needed procurement of essential spare parts and consumables and the physical require ments of the equipment Space temperature and water and electricity supply The plan should contain the purchase cost and the cost of delivery customs clearance setup and training as well as yearly budgets for spare parts consum ables maintenance and repair The importance of training The sharing of technical knowledge should become part of the eye care team s normal way of working It is important to assign some of the responsibility for this to an equipment person or manager who will ensure that the necessary technical knowledge is shared with both users and the equipment maintenance and repair team Training of users and the equipment team is funda mentally important to the successful use and potential impact of equipment page 30 In turn those who have been trained have a responsibility to pass on their knowledge to others who need it until everyone in the eye unit has at least a basic understanding of the equipment in use Relationship development with industry Recently some equipment manufacturers have enrolled the assistance of end users in low and middle income countries to clearly outline the specifications for equipment in such
66. s manual contains more detailed information than the user manual and is usually reserved for the use of contracted service personnel Reading and understanding the service manual will give in house maintainers the information they need Keeping it safe is essential Top training tips e Send staff to factories that manufacture equipment e Invite engineers from manufacturers to visit your facility to conduct training on their equipment e Send staff to other locations which have already developed the skills required e Link the provision of training by the vendor to the procurement process e Run in house on the job training sessions e Make use of regular clinical professional meetings e Make use of academic courses at various levels e Approach local colleges to develop run and accredit new modules specifically designed for your equipment needs e Provide opportunities for practical on the job experience e Provide opportunities for studying and teaching e Let maintenance staff attend peer group meetings or conferences e Provide various training materials for staff to refer to e Provide work placements internships for students in your workshop Managing motivating and retaining skilled staff e Create multidisciplinary teams so that staff are not overstretched e Use suitable reporting and feedback methods so that staff know what is going on e Evaluate staff performance so that career development
67. sch 7700 South Africa Next issue street The next issue of the Community Eye Health Journal will be on VISION 2020 why information matters Lutful Husain
68. sed as a major barrier in all regions Figure 7 Reasons equipment did not work for a period of time E Lack of funding E No spare parts E No one to fix it E Repair at another site E Old equipment E Don t know other In total 60 of the units indicated that they had no reporting system or log for faulty equipment Furthermore there was no desig nated person to take responsibility for the equipment that did not work This could help to explain the delays in arranging for repairs Nursing staff in only 31 of the units had received any form of training to maintain or clean the equipment Specialist training for technicians was available for only 33 of the eye units overall In total 51 of the eye units reported having access to the services of a trained general technician One of the respondents pointed out that access to a general technician was not sufficient We have two medical technicians who are looking after all the medical equipment in the hospital We need somebody who can teach them 3 in private settings and 0 in NGO settings Figure 6 Slit Retinoscopes Operating Visual field lamps microscope analyser ophthalmic instrument mainte nance 24 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 Figure 8 Percentage of eye units that cancelled services due to lack of functioning equipment E Cancelled clinic E Cancelled theatre MM Cancelled teaching Ml Cancelled outr
69. sers therefore have a significant role to play in the everyday care and maintenance of equipment Usually a well balanced mix of user in house and out sourced maintenance and repair leads to the best results both technical and financial in settings with limited resources If it is not feasible for an eye care unit to have an in house arrange the necessary training of staff Sometimes maintenance or repair support may be required from vendors and other external maintenance contractors In all of these instances it is important that a designated person at the eye Care unit is monitoring the respon siveness quality and cost of the service provided 26 6 COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 at Ey F Preventative maintenance Preventative maintenance prevents breakdowns and ensures that equipment is operational and safe to use It also guarantees the accuracy and reliability of equipment that the autoclave sterilises properly and the keratometer readings are correct for example and saves money it can reduce the running costs of equipment and is cheaper than repairs following a breakdown Preventative maintenance consists of a number of tasks of varying technical complexity carried out by different groups of people Equipment users including clinic and operating theatre staff can be trained to perform many of the simple care and maintenance duties that need to be done o
70. ss so in South East Asia just 11 If the results can be assumed to be representative of the different regions it is cause for concern that so few cataract mic equipment survey 2010 preliminary results MS units without any equipment 40 60 80 1 Q 0 surgeons in Africa the Eastern Mediterranean region and the Western Pacific region have the opportunity to be trained in routine biometry Refractive error Refractive error diagnosis was possible at 87 of the units who responded as they had at least one functional retinoscope Over 63 even had an autorefractor Glaucoma Encouragingly 78 of the units in Africa and 97 in South East Asia reported having at least one tonometer A total of 14 of units in Africa reported that non functioning tonometers remained unrepaired for over a year mainly as no one was trained to identify and manage the technical problems that occurred Over half of the eye care institutions responding from Africa and South East Asia had no visual field analysers this highlights the need to strengthen quality glaucoma management in these regions Equipment that had stopped working We were interested to find out e In which eye units equipment had stopped working e Why equipment had stopped working e How long equipment didn t work for and why Continues overleaf gt N COMMUNITY EYE HEALTH JOURNAL VOL 23 ISSUE 73 SEPTEMBER 2010 23 EQUIPMENT SURVEY Continued Figu
71. t the practical aspects of equipment maintenance and repair Which of the following statements are true and which are false Because of their design it does not matter if foot pedals get wet A voltage stabiliser or regulator cannot always prevent damage to equipment You should take bulbs screwdrivers and fuses along when going on outreach There is nothing you can do to prevent fungal growth mould forming on optical components True False 3 Think about equipment donations and purchasing equipment When purchasing equipment order enough spare parts and consumables for at least two months You should always accept donated equipment when it is offered Delays in clearing equipment through customs can end up increasing your costs Budget and plan for maintenance and repair as soon as the equipment arrives 4 Think about training for equipment maintenance and repair A highly competitive environment helps equipment users learn better Formal courses are the only appropriate way of training the equipment maintenance and repair team The service manual can be very useful in isolated eye units Even with an in house workshop there will always be a need for outsourced maintenance services wea BSNOY UI BU 10 X9 ALUOD 00 31E Syse WO andl P sal ddns au Woy jenuew 30S 2Y uleyqo 0 Ay aseyoind zo aw au yy
72. tandard List we would recommend that you also obtain catalogues or visit suppliers websites to see what is available and whether it meets your needs It is helpful to ask yourself the following questions about the equipment you want to buy e Is the item durable and can it handle heavy use e Is the model already in use locally and is there local expertise to repair and maintain it e If other local eye units are using the same or similar equipment have they had good results or encountered problems with the functioning or maintenance of the equipment e What is the cost of the item e What is the cost of accessories consumables and spare parts and are they available in our country e What are the associated requirements electrical consumption wiring water supply environment room temperature and can we provide these What electric voltage does the item require and is it compatible with what we have e If the local electricity supply is erratic Purchasing equipment for an eye unit will back up items such as electrical stabilisers and voltage regulators also be necessary What are the costs e Is training needed in the use and care of the equipment Who can reliably conduct the training What is the likely cost e Will it be necessary for the supplier to come and install the equipment and or maintain it Will special training in use and maintenance be needed NOTE The article about donated equipment on
73. ue of the Community Eye Health Journal a series of articles begins on blinding trachoma which has incapacitated families and communities for centuries in nearly every corner of the world The goal of this series is to explore what is new in the campaign to eliminate the disease including recent developments in trichiasis surgery mass drug administration and cost effective ways to improve sanitation and hygiene Previous editions of the Community Eye Health Journal that focused on trachoma editions 32 and 52 remain important resources for trachoma The first article in the series is about national trachoma task forces We hope that this new series will provide tools to assist those who are implementing programmes to eliminate blinding trachoma Source Mariotti SP Pascolini D Rose Nussbaumer J Trachoma global magnitude of a preventable cause of blindness British Journal of Ophthalmology 2009 93 563 568 Copyright 2010 Danny Haddad This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited Mass distribution of antibiotics is one of the four components of the SAFE strategy ETHIOPIA National trachoma task forces how can we work better Paul Courtright pcourtright kcco net Emmanuel Miri emmamiri yahoo com Tackling trachoma is a c
74. ur equipment is shipped as contracted It is vital to give the correct shipping details in particular your correct address to the suppliers This infor mation will be used to ship your equipment and will be applied to all shipping documentation If the details are incorrect it could delay the shipment and or clearance through customs which may result in an expensive demurrage charge a charge applied when shipped goods are not collected on time The local authorities may allow you to import duty free In such cases a gift certificate or certificate of donation might have to accompany the shipment At this stage it is worth checking with the local authorities whether any other documen tation is required to import your equipment such as an inspection certificate or certificate of origin Receiving the order Prompt clearance at the port or airport is important This will reduce extra charges demurrage and minimise the chances of loss or damage The member of your team responsible for clearance will need to be familiar with the clearance procedures including any customs and duty waiver When placing the order with an overseas supplier insist as part of the contract that they give you the full shipping details e Unit cost e Total cost The catalogue or supplier s website should be used to ensure that the description and specifications are correct NOTE Remember to order sufficient spare parts for the f
75. volume high quality services As a result retention of trained professionals in poorly equipped centres may become a challenge Problems with donated and surplus equipment Donations reported by respondents included sophisticated diagnostic equipment which was not a priority requirement These included equipment for fluorescein and indocyanine green ICG angiography optical coherence tomography OCT and a Heidelberg Retina Tomograph HRT Some donated equipment was not 20 30 40 50 working because it required specific accessories that were either difficult to obtain or unaffordable One of the respondents noted as follows three donated virectors but only one is working From the beginning they needed different accessories that must be bought in order to use the machine Some donated equipment no one knew how to use Respondents also did not know why some items were given to them in some cases the items were purchased by central government suppliers These items included lasers for retinal photocoagulation phacoemulsifi cation machines and retinoscopes In one instance a respondent reported being unable to use donated retinoscopes because their training is in a French system Some equipment was donated without warranty or instructions for use and handling as reported by an African respondent Other equipment such as A scans ultrasound appliances OCT and Yag lasers had been
76. vski Russia Miriam Cano Paraguay Professor Gordon Johnson UK Susan Lewallen Tanzania Wanjiku Mathenge Kenya Joseph Enyegue Oye Francophone Africa Babar Qureshi Pakistan BR Shamanna India Professor Hugh Taylor Australia Min Wu China Andrea Zin Brazil Advisors Liz Barnett Teaching and Learning Catherine Cross Infrastructure and Technology Pak Sang Lee Ophthalmic Equipment Dianne Pickering Ophthalmic Nursing Editorial assistant Anita Shah Design Lance Bellers Printing Newman Thomson Online edition Sally Parsley Email web cehjournal org Exchange articles Anita Shah exchange cehjournal org Website Back issues are available at www cehjournal org Subscriptions and back issues Community Eye Health Journal International Centre for Eye Health London School of Hygiene and Tropical Medicine Keppel Street London WC1E 7HT UK Tel 44 207 612 7964 72 Fax 44 207 958 8317 Email admin cehjournal org The Community Eye Health Journal is sent free to applicants from low and middle income countries French Spanish Portuguese and Chinese translations are available and a special supplement is produced for India in English Please send details of your name occupation and postal address to the Community Eye Health Journal at the address above Subscription rates for applicants elsewhere one year UK 50 three years UK 100 Send credit card details or an international cheque banker s
77. yright 2010 Sam Powadrill Ismael Cordero and V Srinivasan This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium for non profit purposes provided the original work is properly cited DONATIONS Ismael Cordero Senior Clinical Engineer ORBIS International 520 8th Ave 11th Floor New York NY 10018 USA Neil Murray Medical Advisor CBM West Africa Email n murray cbm gmail com Henry E Nkumbe Medical Advisor CBM Madagascar SALFA Eye Project Antananarivo PO Box 3825 Antananarivo 105 Madagascar Appropriate donated equipment or consumables can help to achieve the goals of VISION 2020 However according to the World Health Organization WHO Guidelines on Healthcare Equipment Donation 2000 an estimated 70 or more of donated medical equipment is not being used Why do things sometimes go wrong Some of the causes are e Inadequate communication between the donor of the equipment and the receiving eye unit so that the eye unit ends up with an item which is not appropriate is not robust cannot be maintained does not include spare parts or a manual and which no one knows how to use e Failure to identify all the costs involved such as training shipping and clearing and operation and maintenance Before you accepta donation Think about the following Is this something you really ne

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