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Self Education.

I have written else where about the importance of helping yourself to improve your level of training and skill and the efficiency of your department, but now I am going to devote a whole section to just this matter.
One of your problems may be that you work in a hospital that does not know the importance of good maintenance, and unless you are prepared to push yourself you will get nowhere.
This leads to frustration for you and a much lower standard of care for the patient, but what might be your strongest point in trying to improve your position and your ability to do effective maintenance is that at the same time you make the doctors work much easier, by improving their working day you gain their support and are thus reasonably assured of success.

The first point is one of self-appreciation, you have to consider the importance of your job, do not let people talk down to you or treat you with disrespect, your skills, once you acquire them, are as valuable as any one in the hospital in the whole scheme of things and a great deal more at times.
A surgeon may consider himself very clever at being able to do cataract operations, but he is not so clever when his scalpel is blunt.
This is where your skill comes in and it will be his turn to look on in admiration.
That’s not to say that you must have an arrogant attitude to others, simply a quiet self-confidence, but it is something that you have to learn and earn.
You must treat others with the respect that they earn and others with the respect that they think that they deserve.
Sometimes you will find that you can gain powerful support by non medical excellence, repair the senior surgeons car once or twice and you will gain more respect than sharpening a hundred pairs of scissors, repair his wife’s car and your standing rises even more.

There are a number of things that you will need to run a successful workshop.
Firstly you need a good room in which to work, it should have plenty of good light, bench space, and storage space for your spares and somewhere to lock your tools away.
Once you have organised your workshop begin to collect a good tool kit, you will probably start with very little in the way of tools, but you can do a lot with a small kit, so get a good reputation first then press for improved tooling.
As I mentioned before use all ways of getting tools and spares, one is to make use of missionary health workers, they are often willing to provide items if you approach them in the right manner.
Make use of foreign aid groups that may come to your hospital.
They are often looking to provide medical equipment to the hospital, anaesthetic machines and so forth, they tend to forget that there is an important need for good back up maintenance.
Even the very best quality tools are cheap compared with medical equipment, for the price of a modern ventilator you could provide all the tools and test equipment you will ever need and fit out a really good workshop. Spares are much the same, you can do much with a small selection and a lot of personal ingenuity.

Sometimes you might find that you are quite unable to repair something, should it be because you do not have the spare part, make this quite clear to the user and the senior administrator.
If you can, remove the item from service and put a label on it saying ‘waiting for spares’.
As these build up it might make your problem more obvious and lead to some spares being ordered.
I have written before of the quality of your work, this is something that should never be forgotten, never let a job leave your workshop till you are quite happy with it.

The next matter concerns learning how things that you repair are used by the doctors and nurses.
For this you need to leave the workshop and go in to the operating theatres and the wards.
You will do best to ask the anaesthetic department for assistance.
Try to get to work with one of the anaesthetists in the theatre.
Look to see how the equipment is used, ask questions, at the right moment, see what their problems are.
Do not confine yourself to the anaesthetic equipment, look at the way the surgeon uses his instruments, and get to know the names of them.
This is something that you should do for some time, perhaps for one day a week for a year. Learn to help the anaesthetist, pass things, hold things, and perhaps even do simple tasks under his supervision. This all helps to raise your level of understanding of the equipment, it widens your knowledge of the whole process and gets your face and name known.

Your knowledge of medical matters will increase as you spend more time in the theatres and on the wards, this will help you no end.
If you live in a large city there may be a public library if not you may find that various foreign organisations will have them, the British Council frequently have very good libraries in capital cities, do make use of them.
The matter of language is an important one, should English not be your natural language or one you know already it really will be of untold benefit to you to learn to speak and write it, if you live in a country that has French as its second language then learn that first, but go on to learn English.
Many of the service books are in English, most firms you may deal with will at least understand English.
Should you ever get a chance to train abroad then knowledge of English will almost certainly be one of the major qualifications to going.
Probably the first step will be to ask one of the surgeons or anaesthetists, they may well have trained abroad and learned the language, ask them to help you get started, go to a library, if you are near one, there should be books that will help.
Ask at any English-speaking Embassy or cultural agency they may run courses; ask any missionary groups if they will teach you. Listen to English language programmes on the radio such as the BBC world service.
It really is worth making an effort.

When new equipment is given to the hospital, make sure that you are there when the box is opened, because there will very often be some sort of service book with it, even if it a very simple one it will be better than nothing and will often give you a list of spares available and their part numbers.
It is also wise to check that all the parts are there.
Test it at the earliest opportunity, if you find that it does not work and you are quite sure of this, or should it fail because of a manufacturing failure within the guarantee period do complain to the makers or the person who sold it to you.
If an aid agency or charity gave it to you, tell them.
If you are new to the hospital, spend some time looking at the equipment you have, make lists of everything.
Decide on the condition of each item.
To do this use the attached table below, next to each item on your list put the number from the chart that most closely represents the state of the item, and the availability of spares.
Keep this record and alter it as things get better or worse, over a period you should hope to see an improvement.
If you really want to be clever, add all the figures up and divide by the total number of figures, this will give you an average condition figure. As the years go by this average figure should rise.
When you get time, get all the scrap equipment in the hospital together in one room and sort it out.
Take out any useful parts and store them away with a note as to what they are and what they came out of. Collect all the nuts, bolts and washers, even lengths of wire, anything you think might come in handy.
When all you have left is a pile of real scrap, sell it to a local scrap merchant and buy your self a few tools.
Ask permission first.

Draw up a list of items that need regular maintenance, (see maintenance section), regular maintenance is very important.
Keep your workshop clean, dust is often a problem. Do not let it gather, cover items that remain in the workshop for any length of time.
Dust inside can cause a lot of damage to some things.

The whole point of this chapter is contained in the heading, Self Education, if you are not prepared to help yourself then you will get nowhere, this leads to a boring job with no self-satisfaction.
Push yourself and your job in a gentle manner.
Get to know what you need to improve matters and then make every effort to get it.

Equipment condition classification.

All items should be given a number from the list below.

1. Not working, no good for spare parts, scrap only.

2. Not working, not repairable, good for spare parts.

3. Not working, repairable with spares from scrap machines, spares not available from abroad
or local suppliers.

4. Not working, repairable with spares from scrap machines, spares available from
local supplies.

5. Not working, repairable with spares from scrap machines, spares available from
abroad and local supplies.

6. Not working, new spares available on site, and locally.

7. Not working, new spares available on site, locally and abroad.

8. Working, spares available from scrap machines, new spares not available.

9. Working, spares available from scrap machines, spares available from abroad.

10 .Working, spares available from scrap machines, spares available from abroad
and locally.

11. Working, spares not available from scrap machines, spares available from
abroad.

12. Working, spares not available from scrap machines, spares available from
abroad and locally.

13. Working, new spares on site and available from abroad.

14. Working, new spares on site and available from abroad and locally.

15. Working, new and under guarantee, no spares ordered or on site, spares
available abroad.

16. Working, new and under guarantee, no spares ordered or on site, spares
available abroad and locally.

17. Working, new and under guarantee, spares ordered or on site, spares
available from abroad.

18. Working, new and under guarantee, spares available on site, spares available
from abroad or locally.

Total up the numbers recorded and divide by the number of items to arrive at an average condition figure.
This can be done for all items and / or for items of one classification.
This can be repeated a number of years later for a comparative study.

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