Bio-engineering, Africa and the IFMBE Developing Countries Group

This is a reply from Administrative Council Member Mladen Poluta to a request from the IFMBE News Editor to respond on the subject of bio-engineering, Africa and the IFMBE Developing Countries Group

This letter contains the reflections of a relative novice writing in the shadow of Table Mountain at the southern tip of Africa. It is intended to stimulate some discussion on the issue of so-called developing countries and the role of the IFMBE in this regard. I am writing this very much aware of the enormous efforts that have been made by the IFMBE over the years to promote both biomedical and clinical engineering in a truly global sense.

I have chosen to focus on the Sub-Saharan Region, not through any desire to exclude other regions or even African countries to the north of the Sahara, but simply because I am not familiar with activities in these regions and would prefer to remain on more familiar ground.

Although this may seem trivial, perhaps we need to rethink the definition of developing regions (I prefer to think of regions rather than countries). This in itself may open up new and creative ways of addressing the issue. What constitutes a 'developing region'? Is the accepted standard measure of per capita income adequate? Does it refer to a region in which bio-engineers or clinical engineers do not have sufficient resources to function effectively, whether individually or collectively, due to factors such as the lack of a clearly defined role, lack of resources, limited access to published material and other information, the lack of opportunities to meet with fellow professionals etc. ?

Developing regions may also have very different needs; the danger of grouping them all together is that key differences and needs may be overlooked when a common denominator is sought. I also wish to emphasise the need for a holistic, multi-disciplinary approach, particularly in the Sub-Saharan Region. In fact, the pressing needs in this region seem to fall more within the domains of clinical and hospital engineering, rather than bio-engineering. (This also raises the problematic issue of terminology, due to differing historical and current influences).

Perhaps the primary immediate role of bio-engineers in a developing region such as ours is to contribute creatively to the formulation of a holistic vision for health technology and related activities. This vision needs to be born and nourished from within the region, and carried beyond the region by developing effective and supportive interfaces with stakeholders in global bio-engineering and health technology associations, including (perhaps centrally) the IFMBE.

In this regard, the formation of the African Federation for Technology in Healthcare (AFTH) has provided a forum and environment within which such issues can begin to be addressed on a regional basis, and it provides an effective interface to the international 'external' environment.

I also believe that for a 'Developing Countries' group to have maximum impact it should be process- rather than profession-oriented, and should therefore include representation from bodies such as the IFMBE (bio-engineering and clinical engineering), IFHE (hospital engineering), IMIA (medical informatics), IOMP (medical physics), ISTAHC (technology assessment), key stakeholders such as the WHO, UNIDO and other organisations active in developing regions, and perhaps even transnational bodies such as the IEEE EMBS and ESEM. It should also include representation from the regions themselves.

This arrangement may become unwieldy if a top-down approach is adopted; in the worst case, there may not be consensus as to which organisation should act as co-ordinator and the whole process would grind to a halt. One practical alternative is to have regional interfacing bodies (in our case the AFTH) which would take it upon themselves to set up effective channels of communications and interaction with the bodies listed (the external interface) and also with structures within the region (the internal interface).

Since the focus should be on effective interventions that address the most urgent needs with maximum long-term benefits, it would perhaps be more useful to have the regions define their own needs in a prioritised manner. These needs could be collated and tackled either collectively or individually on a project basis, as appropriate. It is also important that individual needs, in addition to group needs, are met.

I would suggest that the publication of regular regional newsletters, containing current news and developments relevant to each region, should be encouraged. Efforts should also be directed towards helping the developing regions become connected to the electronic information highway, providing appropriate published material (perhaps at reduced rates), and providing training and other capacity-building courses that are both affordable and appropriate.

In conclusion, I feel that interventions should be supportive rather than prescriptive, should be part of a large multi-disciplinary process, should assist the formation of appropriate regional structures and should facilitate a process of capacity-building.

I would be delighted to receive comments from readers on the issues raised.

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