The Nuts and Bolts of Better Health

By Kaylyn Koberna

This morning I sat down with the Maintenance Supervisor and Medical Engineer at Bwaila Hospital to go line-by-line through an exhaustive inventory of spare parts.

Half inch galvanized sockets? Cut the quantity by half. Thousand-watt theatre halogen bulbs? Essential. Nine-volt rechargeable batteries? We will make do without.

It was tedious, frustrating, and probably the most important meeting I’ve had so far this year.

As part of our work under the Ministry of Health’s Reproductive Health Directorate, my co-fellow Esnatt Gondwe and I have been drafting a grant proposal that would provide up to 30 million Malawian kwacha worth of medical equipment, administrative goods, and maintenance necessities to Bwaila’s staff.

While 30 million initially sounded like a huge sum, a quick needs assessment determined that Bwaila Hospital, the tier-two referral facility for over 1 million people in Lilongwe district, was facing a budget shortfall of more than eight times that amount. To fit the parameters of the grant, therefore, we had to drastically slash each department’s proposed budget – which meant going back to the drawing board with the maintenance team.

Given the scale of Bwaila’s needs, convening a meeting to discuss whether 40 or 50 mm PVC pipes are more essential can feel almost futile. In the absence of show-stopping breakthroughs, however, paying attention to these details is the single most important thing Bwaila can do for its patients.

There is no quantitative data on how many lives are lost each week to poor sanitation or non-functioning equipment, but the maintenance team has plenty of anecdotal evidence. What’s more, they know the solutions: In the course of a two-hour meeting, they identified 6 million kwacha worth of electrical, plumbing, and carpentry inputs that could be leveraged into systems-wide improvements.

New gaskets would ensure the sterilization machine reaches maximum temperature. Veto-type wall fixtures would make it possible to mount hospital-grade lights in the theatre. These interventions are notable in part because they are so simple, so low-tech. But what’s also notable is who’s proposing them.

Global Health Corps believes you don’t need to be a doctor to contribute to public health, which is why this year’s fellow class includes not only pharmacists and epidemiologists but also architects, civil engineers, communications experts, and artists.  Sitting in the maintenance office, surrounded by life-saving equipment rendered useless by a lack of spare parts, it was clear that the burden of ending preventable deaths does not rest with clinicians alone.

The scope of global health challenges demands that we engage in strategic thinking and everyday collaboration across a number of disciplines. It means that, as a health policy professional, my most productive day can take place in a supply room. And it means there are more routes to improved health outcomes than I thought.