“This is a person who can decide to wipe out an entire community by just altering a few things in the x-ray machine”, said a concerned Matungulu legislator, Stephen Mule as he discussed a bill he brought before the parliamentary committee in health.
The biomedical engineers Bill, 2015 — one of the 13 bills that have been proposed in the health sector since 2013 — seeks to carry out oversight on the training, registration and licensing of biomedical engineers in the country.
A biomedical engineer (BME) is involved in the design, manufacture, installation and maintenance of medical equipment in hospitals. A critical role as the country awaits the installation of the Sh38 billion equipment acquired for county hospitals by the national government in February this year.
Imagine waking up unable to move yet conscious of the every movement of the surgeon’s knife. The psychological trauma from that experience would be, partly but not entirely, a biomedical engineer’s fault. Peter Matoke who is the chair of the Association of Medical Engineers in Kenya or (AMEK) defines the profession:
“We regulate the temperatures and the humidity in the premature babies’ incubators, ensure that the energy from any ionizing radiation imaging equipment such as X-rays, CT scans for pelvic examinations are not harmful to the body”.
The biomedical engineer ‘calibrates’ equipment used for administering inhalational anaesthesia, a simpler term to mean he ensures the amount of gas the anaesthetist adjusts is no more than what is standard such that it may cause death, or no less that the patient wakes up in the middle of the surgery.
Crucial as this profession is, the country is experiencing an acute shortage of the professionals but the industry operates without regulation or proper training.
An official statement from Mulei Muia, Ministry of Health’s public communication, to the Jobs reported that there are only 420 BMEs employed in public hospitals. Of these, the report breaks down, a paltry 10 have an undergraduate degree and higher diploma.
About 140 of these bear the name medical engineering technologists and have only diploma qualifications.
The remaining 270 have certificates. These figures do not include the few that may have been hired by county governments.
KNH, Kenya’s largest referral facility with 1,200 types of sophisticated medical equipment — both for urgent and selective surgeries — boasts of a paltry 24 BMEs.
While the Jobs could not establish the exact numbers of the professionals in each of the public hospitals visited, complaints of shortages were rife in Jaramogi Oginga Odinga Training and Referral Hospital in Kisumu, Mbagathi District hospital, Homabay District Hospital, Nakuru Provincial General Hospital as well Naivasha District Hospital.
With this job description put in consideration, the role of these engineers are crucial for not only diagnosis but also treatment in cases such as machine-dependent treatments such as radiotherapy, surgery and dialysis.
During the discussion of the bill before the health committee, certain legislators criticised the bill saying that though it was needed it may serve to further bloat the wage bill in the health sector. However, it was unanimously agreed that the bill highlighted the crucial profession whose existence is neglected.
According to Engineer Martin Owino, the Head Biomedical Engineering and Maintenance Services Division, there should be at least six biomedical engineers in each of the district hospitals, which the World Health Organisation quote to be 627 in Kenya by early this year.
Each of the 16 provincial hospitals should have at least 11 BMEs.
“They should be more and the expertise more complex than an undergraduate degree due to the nature of machines they handled,” said Mr Owino.
When this is summed up, there should be at least 5,000 of these professions with diplomas and degrees in healthcare.
The WHO survey in 2009 reported that nine in ten of all the countries surveyed about medical device maintenance services had trouble finding engineers locally with proper qualifications.
The aforementioned survey cited, among many other things, the absence of a national and professional regulatory body as well as a lack of training as the main causes.
Included in the proposed bill from the parliamentary research services are reports that Kenya Medical Training College (KMTCs) offers medical engineering courses on a higher and diploma level in five campuses — Nairobi, Eldoret, Meru, Loitokitok and Kilifi—as well as Technical University of Mombasa, formerly Mombasa Polytechnic introduced a diploma in 1986.
In the document, also, is a cursory mention of a degree course in Kenyatta University from starting from 2013 as well as an option of specialising in biomedical engineering while pursuing industrial technology in Egerton University.
However, the Engineers Board of Kenya (EBK) — the national body mandated by an act of parliament to regulate all engineering professionals — revealed there are no institutions of higher learning accredited to offer the course.
In fact, not only are the aforementioned institutions not listed in EBK’s website as the institutions that offer engineering courses, there is not a single biomedical engineer licensed to practice by the board.
This training gap has forced the professionals like AMEK’s Matoke to undertake their degree through correspondence and distant learning. Matoke says that a BME earns between Sh100,000 to Sh450,000.
The Medical Practitioners and Dentist Board executive (KMPDB) officer Daniel Yumbya also said that the biomedical engineers are not part of KMPDB.
Citing cases of deaths in hospitals that he is aware of and probably caused by the faults of the biomedical engineer, or lack thereof, Mr Yumbya said that there is a serious need to regulate the professionals by the mere fact that their work touch patients’ lives.
“People who handle patients need to account for their time, their training, skills and actions”, Dr Yumbya said.
Before devolution, the national government’s guidelines and strict supervision for the work of biomedical engineering professionals employed in the public hospitals ensured their work does not impede the work of doctors or endanger the lives of patients.
The devolved structure which is now responsible for the professionals, the ministry of health fears, cannot be effective in ensuring proper adherence to work ethics.
The fear may explain why the ministry is backing the bill which, if passed, will penalise defaulters in a manner similar to the Medical Practitioners and Dentist Board. Notably, the Ministry of Health lobbied to change the name of the bill to Biomedical Engineering Practitioners Bill so as to differentiate it from the Engineers Act under which the engineers’ board operates.
Consciously aware of the need WHO started compiling all information from surveys earlier this year in order to apply for recognition of Biomedical Engineering as a discipline in the International Standard Classification of Occupations by the International Labour Organisation.
The global regulating body for health had issued a deadline of submissions from representatives of biomedical engineering institutions or programs, professional societies and those responsible for labour statistics to complete the following survey on Biomedical Engineering professionals as February 6, 2015.