Infusion unit project in Tanzania: Simple means with major results

Wurzburg - Heavy loss of blood, vomiting and diarrhoea with the risk of drying out: all over the world hospitals treat these symptoms with infusions. The patient is on a drip and relatively large amounts of liquid are infused into his or her vascular system. In Germany this procedure does not pose a problem, but in countries such as Tanzania, Kenya or Zaire it is often a question of survival since infusion liquids are expensive and not always easily available. For doctors in these countries this is a big problem; for their patients a matter of life and death. How can sufficient bags of glucose or salt solutions be made available - also for emergency cases? How can they reduce the high costs of purchasing?

The anaesthetist Georg Kamm in Tanzania found an answer to these questions, which is now being tried out in several countries. The Medical Mission Institute in Wurzburg supports the development and spreading of the simple and effective technical process.

Ten years ago, the protestant hospital in Machame, a poor town in Tanzania, was like many hospitals in developing countries, dependent on the import of infusions from a few western producers. Over time the demand was greater than the extremely tight budget of the hospital. Bad roads and rickety lorries were the reason why goods arrived only on a very irregular basis.

The anaesthetist Georg Kamm, who was working in Machame at the time, won dered: Wouldn't it be sensible to produce infusions in the country instead of importing them? With the assistance of a German company he constructed a simple but effective filtration machine which is based on the principle of reverse osmosis. During the process water is pressed through fine membranes. If the technique works the result is germ-free and non-ionised water which resembles in its quality distilled water. The purified water is mixed with glucose in a steel bucket, and the solution is filtered and bottled.

The main advantages of this method are the low level of energy use and the large amount of purified water which can be produced in a short period of time. Also, the rapid working process prevents the growth of germs in the infusion solutions. Georg Kamm set up the first production unit in Tanzania, and it has paid off: "Since we produce the infusions ourselves, there is no shortages anymore" he says.

The test period has long since developed into a major project of appropriate medical technology which supplies many hospitals. Kamm moved with his four container boxes to Moshi which is better located due to its big airport. Today, there are about 50 infusion units in Tanzania, which produce about two-thirds of the annual demand of the east African country - about 800,000 infusions. According to Kamm, Tanzania saves at least US$2 million per year. It is therefore no surprise that neighbouring countries and other states are interested in the project.

Meanwhile in Zaire an equivalent project with eleven infusion units was set up. Smaller production sites have also started operations in Madagascar and Kenya. In

Ethiopia a small unit is under preparation. But these countries are not alone in wanting to produce their own infusions with the help of the project base in Moshi. At regular intervals African and Asian countries approach the project in Moshi or the Medical Mission Institute in Wurzburg. An information brochure in English gives information to all those interested.

Kamm was supported by the Protestant Association for Cooperation in Development (EZE) in Bonn. The initial phase was also co-financed by the Bishops' organisation Misereor. For the new infusion units in Madagaskar and Zaire an application has been made to the European Union.

Obviously there is also criticism of the method. Critics say that there could be germs growing in the filter module or bacteria could spoil the purified water. According to Kamm it was on this basis that a company with worldwide operations tried to discredit the project with the Tanzanian government; the latter quickly realised the selfish motives of the company in these attempts, however. In the opinion of Dr. Bernd Kohler of the tropical medical department of the Medical Mission Institute in Wurzburg, these worries are only justified if the equipment is not used properly. Experience so far has shown that this danger is not realised when staff are trained and regular technical service is provided.

Dr. Kohler emphasises that the staff know about the danger of germs. They are aware that rapid processing of the solution is the "bestprecaution". Therefore, the delivery of technical equipment is dependent on a thorough training course of staff at the training centre in Moshi and the setting up of a network of advice and technical services. A user's manual as well as appropriate quality control methods, which have been developed in cooperation with the Medical Mission Institute, are available.

This scientific cooperation exists with the Medical Mission Institute since 1986, in particular regarding further technical developments. When a model unit is set up in the low-tech laboratory of the tropical medical department, the Institute is able to make proposals for improvement regarding sterile filtration and quality control.

The implementation of the proposals are checked through regular visits to Tanzania. The director of the Institute, Karl-Heinz Hein-Rothenbucher points out that since 1988 the institute has spent DM 20,000 per year for visits and vocational training.

The investment of US$30,000 for the initial setting up of a unitis paid off within two years. The sum is low compared with the costs for imported solutions. Service and other follow-up costs are self-financing, through the production process itself. Doctor Kohler thinks that countries such as Tanzania can save a lot of money if they succeed in integrating the preparation of other drugs such as packages for oral re-hydration, eye drops, skin ointments as well as Cloroquin, Quinine on pain killers into the project. In this way, medical care in important areas could be stabilised.

Gideon Zoryiku