Along the coast of the East African islands of Zanzibar sits a cluster of crumbling, concrete, whitewashed buildings that constitute Mnazi Mmoja, the islands’ biggest hospital. Lining its dim, rancid hallways are ancient machines with frayed cables, gathering dust.

It was here that I met an ENT surgeon from Somerset, England, who had traveled to Zanzibar to volunteer. I was working for MED International, a medical equipment nonprofit that I founded in 2011 and run with Han Sheng Chia ’14.

“How is it that every piece of equipment in my [own] hospital is always in perfect condition?” the surgeon asked. “I don’t think I’ve ever stepped into an OR where broken equipment was a problem.”

The seamless efficiency to which the surgeon was accustomed was in sharp contrast to what we found in Zanzibar. As of June 2012, about 80 percent of Mnazi Mmoja’s equipment in the maternity theater—and about 75 percent in the neonatal unit—was broken. Though the hospital had four ultrasound machines, three had long been broken, and dozens of women waited for hours outside the radiology room each day.

Simpler equipment didn’t work either. I saw doctors use kidney dishes to scoop blood out of patients because suction machines rarely functioned. I saw nurses surround preemies with hot water balloons because the incubators wouldn’t heat up.

Well Oiled

Hospital machinery requires an astonishing amount of maintenance. Some top-of-the-line ultrasound machines won’t last 90 days without regular checks and adjustments. And a quarter-million-dollar CT scanner? Probably even less than that.

In America and other developed nations, equipment stays running because it is supported by professionals wholly dedicated to its upkeep. In addition to all the nurses and doctors darting around a hospital, there is also an army of carefully coordinated clinical engineers and on-call technicians focused on keeping everything functioning—all day, all night, all year, and in compliance with industry and state regulations. They are aided by multimillion-dollar software that issues alerts for machines that need maintenance or parts replacements.

It’s a remarkable system, one that runs on tight management, relevant expertise, and strict regulation.

It is a system that operates so smoothly that even some doctors barely notice it until its absence is unmistakable—in a setting like Mnazi Mmoja.