The Logistics of medical devices for indigenous health care attending in remote sites at Brazilian Amazon Rain Forest
Authors: FERREIRA RYAN PINTO , Andrade Fernando Oliveira , Ramos Anderson Alberto , Bernardes Rodrigo , Calil Saide Jorge 
Published: March 2020

BACKGROUND AND OBJECTIVE: There are in Brazil 896.917 indigenous and 47% of them dwell in the Amazon rainforest region. In order to avoid expensive displacement for this population, especially for surgeries such as hernias and cataracts, the Expedicionários da Saúde NGO attends this specific population three times a year since 2003 organized as a work party regime. This attending is done through a Field Hospital (FH) and is supported by Clinical Engineering (CE). This article presents the characteristics of logistics as well as operation of medical and hospital devices in remote sites of Amazon region. The object of this paper is to describe the transportation processes, installation, operation and maintenance used to ensure safe use of medical devices in one FH in the Amazon forest and to present solutions to proposed adverse conditions throughout the course of several expeditions.
MATERIAL AND METHODS: It was Initially done a survey of the processes of transportation, installation, operation and maintenance of medical devices collected from 24 expeditions to the Amazon forest in a period of 8 years, since the implementation of CE team. A Task Analysis processes was performed to systematically identifying the process used for plan, prepare, transport and operate the medical devices in those past expeditions. Understanding the complexity and the specificities of each expedition a evolutive planning process based on Software Development Spiral Model was used to describes a continuous activity flow, prone to implement and test improvements in each new expedition. Besides the continuous improvement the model also takes in consideration budget solutions once all the work done by the ONG is voluntary. The efficacy of the method was evaluated from indicators of use of medical equipment, the assessment of reported adverse events and the interviews with the professionals of the EC team, users of the medical devices and opinion of the responsible for the managing of the expedition.
RESULTS: Several improvements were observed speciality in the transporting and installation processes, mainly through the adoption of customized packages and manuals for assembly and disassembly of the parts of the medial equipment. Further enhancements were obtained through customizations and adaptations of the devices to the hostile characteristics of the environment. Both physicians and nurses were satisfied with the performance of the devices, and few procedures for repair and calibrate were required after the equipments were installed.
 CONCLUSION:  The CE team is crucial to the implementation of FHs, being essential in the  management of medical technology and in the planning and operation of this type of health structure. The spiral planning method were shown to be very satisfactory mainly because it takes into account the experiences and needs of the past expeditions and for allowing the continuous improvement of the already used processes. Given the great complexity of the RainForest environment in which the technologies will be used and the unpredictability of the risks and challenges to be faced by the EC team the evolutionary work approach presents itself as an applicable solution to planning of future expeditions.