









































39 J Global Clinical Engineering, Special Issue 3, 2020

Received February 2, 2020, accepted March 27, 2020, date of publication April 17, 2020

Emergency Relocation of a Cardio-Surgical Health 
Facility due to war  

By T. L. Djankou and V. Albonico
St. Elizabeth Catholic General Hospital Cardiac Centre, Shisong, Cameroon.

ABSTRACT
This article seeks to share our experience on the consequences of a poorly managed conflict and its impact on a healthcare 
institution. We further try to talk about what it takes to relocate, especially such a vital sector like cardiac surgery amid the 
socio-economic and socio-political context in which the hospital happens to be situated. Bearing in mind that the prompt-
ness of a patient’s recovery in a healthcare facility depends immensely on how accurate the engineers were during the 
design and construction phase how precise international standards are implemented in the various engineering sectors of 
the hospital is of capital importance. Following the Cameroonian mindset, wherein division of labor and meritocracy are 
usually far fetch realities, it is therefore of prime importance to choose experienced and qualified contractors, architects, 
project managers to take part in the implementation of healthcare projects. The process of relocating either temporarily 
or permanently some health services from a crisis-stricken zone to a safer environment also demands a lot of tactfulness 
in decision making as well as personnel involvement. All personnel from the various sectors being relocated must work 
closely with the team leader such that all necessary equipment, consumables, surgical materials are put together to sim-
plify logistics and even safeguard the logistical process.    

Keywords – Healthcare, Outreach, Crisis, International standards, Facilities, Emergency
Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribution 4.0 International 
- CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original 
publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

INTRODUCTION
The St. Elizabeth Catholic General Hospital Cardiac 

Center Shisong is a hospital founded in 1936 as a dispen-
sary by the Tertiary Sisters of St. Francis. The Tertiary 
Sisters of Saint Francis are a Roman Catholic Religious 
Congregation of Pontifical Right with motherhouse in 
Brixen, South Tyrol – Italy and General Administration in 
Rome – Italy. The hospital was recognized by the Cameroon 
Government in 1952. The hospital has several depart-
ments amongst which the Cardiac Center is our point of 

interest in this article. The Cardiac Center Shisong is a 
state-of-the-art hospital constructed on a surface area 
of 12,500 m2 in a remote area of Kumbo, Bui Division, 
North West Region – Cameroon between 2005 and 2009. 
It was officially inaugurated on November 19th, 2009 by 
the Cameroon minister of public health. This was done 
in the presence of the Italian ambassador to Cameroon 
amongst other top-ranking personalities. Following this 
inaugural ceremony, the Cardiac Center was recognized 

http://www.globalce.org
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Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

J Global Clinical Engineering, Special Issue 3, 2020  40

as a National Referral Center for cardiovascular diseases 
in Cameroon. On November 4th, 2015, following Presi-
dential Decree № 2015/493, the Cardiac Center Shisong 
was recognized as a “Public Utility.” This hospital is the 
end product of a fruitful collaboration between 3 main 
partners (Non-Governmental Organization) which are: 
“Tertiary Sister of St Francis” (Cameroon), “Bambini Car-
diopatici nel Mondo” Onlus (Italy), “Cuore Fratello” Onlus 
(Italy). These 3 partners signed an MoU in June 2010 to 
define management, responsibilities, and ownership of 
the Cardiac Center. 

RESPONSIBILITIES BEFORE INAUGURATION
Table 1 summarizes some responsibilities of the 3 

partners before inauguration.

Table 2 summarizes some responsibilities of the 3 
partners after inauguration. 

The following day after the inauguration ceremony, 
the first cardiac surgery was performed in the new in-
frastructure which was very successful. 

PRESENTATION OF CARDIAC CENTER SHISONG 
HEALTH FACILITY

1. Total bed capacity is 86 with 13 Intensive Care Unit 
(ICU) beds included

2. An outpatient department
3. Well-equipped ICU
4. Electrophysiology and hemodynamic (angiograph)
5. Two well-equipped operating theaters in which heart 

surgeries can go on simultaneously
6. Blood bank service
7. Pharmacy and procurement
8. Technical department

TABLE 1. Responsibilities of the Various Partners before 
Inauguration

Tertiary Sisters of St. 
Francis

Cuore Fratello Onlus
Bambini Cardiopartici 

Nel Mondo Onlus

Selection of patients 
to be operated upon 

in Milan

Accommodation of 
patients and staff who 

travel to Milan
Training of chosen staff 

Staff recruitment 
before sending to 
Milan for training

Technical assistance 
to site engineers

Carry out surgical 
interventions

Construction of new 
infrastructure to 

accommodate the new 
Hospital

Provision of 
medical, electrical 

and mechanical 
equipment 

Provision of some 
medical equipment and 

surgical materials

Management

Sponsorship of 
surgical procedures 
for underprivileged 

patients

TABLE 2. Responsibilities of the Various Partners after 
Inauguration

Tertiary Sisters of St. 
Francis

Cuore Fratello Onlus
Bambini Cardiopartici 

Nel Mondo Onlus

Selection of patients 
who cannot be 

operated upon in 
Shisong due to the 
complexity of the 

surgical intervention

Accommodation of 
patients and staff who 

travel to Milan
Training of chosen staff 

Staff recruitment 
and management, 

selection of 
those needing 
supplementary 
training in their 
respective fields. 

Organization with 
foreign partners for 

possible training

Technical assistance 
to site engineers and 
help desk function. 
Connection with 

potential suppliers of 
spare parts. Follow up 
purchase and dispatch 

to Shisong.

Carry out surgical 
interventions in 

Shisong. Collaboration 
with other foreign 

healthcare practitioners 
for possible organization 

of pediatric surgical 
missions in Shisong

Facility management 
of the infrastructure

Donation of 
medical, electrical 

and mechanical 
equipment 

Donation of some 
medical equipment and 

surgical materials

Management of 
hospital activities

Sponsorship of 
surgical procedures 
for underprivileged 

patients



41 J Global Clinical Engineering, Special Issue 3, 2020 

Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

METHODS
In November 2016, social unrest broke up in the 2 

English speaking regions of Cameroon (North West and 
South West regions). The Cardiac Center Shisong hap-
pens to be situated in one of these regions that is the 
North West region. The crisis which initially started as a 
non-violent protest in which teachers and lawyers were 
demanding reforms of the educational and judicial sector, 
and were molested and chased from the streets. Some 
youths took upon themselves to retaliate and fight for 
their rights, a situation which transformed into violent and 
deadly confrontations. From thence, an extremist part of 
the population became radicalized and transformed the 
protest into a fight for independence (cessation). 

The number of extremists grew and we started to ob-
serve a wide proliferation of arms of all sorts. There was 
chaos all over the Anglophone regions as the confronta-
tion between separatist fighters and the military became 
deadlier, leading to the massive internal displacement of 
citizens. It was after the October 7th, 2018 presidential 
election that the confrontations gained grounds generally 
speaking (although some localities had already experienced 
severe and deadly confrontations). People fled from their 
homes into bushes with the hope of returning after a few 
days. They then fled from their hideouts into neighboring 
villages until some found themselves in neighboring coun-
tries while others settled in the French-speaking regions 
of the country. This situation forced many companies and 
hospitals to shut down. Some were even reduced to ashes. 

The Cardiac Center Shisong, fortunately, was not re-
duced to ashes but suffered from a long period of inactiv-
ity. Some patients who were hospitalized just before the 
situation aggravated were stranded and couldn’t return to 
their homes and some patients who had been booked for 
cardiac surgeries ended up dying. Due to the low patient 
turnouts, the hospital administration was forced to send 
about 75% of staff on technical leave. 

ACTIVITIES PERFORMED BY THE CENTER 
BEFORE OCTOBER 7TH, 2018

Table 3 shows medical activities performed between 
November 2009 and October 2018.

SOME TECHNICAL FACILITIES FOUND AT THE 
CARDIAC CENTER SHISONG

Table 4 groups some of the biomedical, electrical and 
mechanical equipment found in the hospital. 

TABLE 3. Various Activities Performed Over 10 Years

ACTIVITY NUMBER

Consultations 74,655

Echocardiograms 24,000

Diagnostic and interventional 
catheterization 515

Cardiac pacemaker 185

Open-heart surgeries 769

TABLE 4. Various Activities Performed Over 10 Years

DESIGNATION QUANTITY

Electricity generators (700 kVA, 900 A, 3 phases) 2

Voltage stabilizer (650kVA, 3phases, regulates 
between −35% and +15% of nominal voltage) 1

Voltage transformers 10KV–400V (630 kVA 3 
phases) 2

Vacuum pumps for centralized suctioning (7 kW) 3

Medical oxygen production plant (6m3/h) 1

Syringe pumps 30

Infusion pumps 25

Patient ventilators 8

Multi-parameter patient monitors 18

Anesthetic machines 4

Coagulation analyzers 3

Blood gas analyzers 4

Chemistry analyzer 1

Portable ultrasound machines 3

Mobile ultrasound machines 2

Defibrillators 5

Surgeon’s headlamp 1

Auto-transfusion pumps 2

Intra-aortic balloon pump 1

Heating/cooling machines 5

Air compressors (11 kW, 3 phase, 108 m3/h) 3



Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

J Global Clinical Engineering, Special Issue 3, 2020  42

SOME IMPACTS OF THE CRISIS ON THE 
CARDIAC CENTER

1. The growing cost of preventive maintenance due to 
prolonged shutdown of equipment. 

2. Worries about the state of equipment containing in-
ternal batteries which had not been charged.

3. A long blackout period or lack of electricity leading 
to the possible deterioration of rechargeable batter-
ies in equipment. In the event of a fault on the grid, 
workers from the electricity supply company would 
not be able to intervene unless a period of ceasefire 
was announced. 

4. Increased expenditure on fuel for the electricity 
generators.

5. Travelling for distances of about 100 km during violent 
confrontations in search of fuel for electricity genera-
tors. This led to the rationing of the electricity supply. 
In a bid to economize fuel, the electricity generator 
would work for only 4 hours a day. 

6. A growing number of patients on the waiting list need-
ing prompt surgical interventions. 

7. Expiration of drugs, surgical materials, valves, patches, 
and other consumables.

8. Loss of manual dexterity of the personnel due to the 
long period of technical leave.

It was following some of these points that studies were 
made to create an outreach program for the cardio-surgical 
unit of the hospital in a safer city. The challenges were 
numerous for this project to go operational and we had 
to keep in mind that not all pieces of machinery were to 
be transferred out from the Cardiac Center as surgical 
activities could resume in the Cardiac Center whenever 
the crisis was resolved.

There was a lot of discussion mostly between the 
surgeon and the technical coordinator seeking the most 
appropriate model of implantation to be adopted. Our first 
worry was the city in which we were to settle in. We had 
to choose between Yaounde, Douala, and Bafoussam. The 
criteria which guided our choice of city were:

1. The climatic condition of the city (temperature and 
humidity).

2. Level of pollution.
3. Population density.
4. Security and safety in association with urban disorder.

After carefully deliberating on these points, we re-
alized that Yaounde, the capital of Cameroon, was the 
most suitable. We were convinced that our proximity to 
decision-makers (ministries, insurance companies, and 
Non-governmental Organizations) could increase our 
chances of integration and reaffirming our place in the 
healthcare sector. The next challenging task was to find 
either an appropriate piece of land to construct new facili-
ties to accommodate the services or to collaborate with 
an existing hospital or clinic. Due to the unavailability 
of enough funds, the second option was chosen to raise 
another problem of which hospital to work with. This 
was very challenging knowing that we were to choose 
among close to 20 renowned government, private, and 
confessional hospitals.

1. Criteria for Choosing a Partnering Hospital
2. The close proximity to the center of the city.
3. An institution with lesser administrative latency.
4. An institution with similar religious perspectives.
5. An institution who puts patients’ recovery as the 

main priority.
6. An institution with similar hygienic standards.

DESIGNATION QUANTITY

Sternum saws 2

Electrosurgical units 4

Weighing scales 3

Measuring tapes 3

Blood warmers 3

Drug refrigerators 6

Extracorporeal circulation machines SIII 2

Mobile suction machine 1

Infusion stands 20

Drug trolleys 15

Electrocardiograph machines 2

Transesophageal probe 1

Oxygen flow meters 45

Negatoscopes 15

Patient’s bedside tables 48



43 J Global Clinical Engineering, Special Issue 3, 2020 

Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

7. An institution in which workers and administrators 
are completely apolitical. 

After visiting several health institutions both state 
and privately owned, our choice was made on a private 
clinic considering the above-mentioned criteria. It should 
be noted that Cardiac Center Shisong is the only center 
in Central African Sub-region where routine open-heart 
surgeries are performed. We have in Cameroon, the Douala 
General Hospital who also does open-heart surgeries, but 
patients are grouped and wait for foreign specialists to 
come once or twice a year for surgeries.

We had several challenges to kick-start activities in the 
chosen healthcare institution and we expected to meet 
these challenges knowing that hospitals not performing 
such levels of surgical interventions would not invest in 
upgrading facilities.

CHALLENGES ENCOUNTERED HINDERING THE 
SMOOTH TAKE OFF OF SURGERIES IN THE 

CHOSEN CLINIC
1. There were 2 split-type air conditioners in the operating 

theater. Contrary to the conventional air-handling units 
with high-level filter management of air pressure in the 
rooms, we had a completely closed operating theater 
with no possibility of renewing the air. Among the 2 
air conditioners, none was cooling to our satisfaction. 

2. There was only 2 outlets for oxygen in the theater. 
The operating theater had no anesthetic pendant nor 
enough outlets for medical oxygen. We needed at least 
3 outlets for our machines. 

3. Piping for medical air in the operating theater was ab-
sent. Medical air (air containing 21% oxygen) is needed 
by the anesthetic machine and heart-lung machine. 

4. There was an absence of piping for the anesthetic gas 
scavenging system in the operating theater. 

5. Only 3 electrical sockets were present in the oper-
ating theater. Mindful of the number of appliances 
connected during heart surgeries and even general 
surgeries to a lesser extent, it was unworkable to have 
only 3 electrical sockets. We also noticed electricity 
distributors were being used with little knowledge 
about their electrical rating.

6. There was the presence of a very tight and poorly 
ventilated 2-bed ICU. We also had a slit-type air con-
ditioner with no possibility of air renewal. 

7. There was a poor disposition of oxygen cylinders and 
supply networks. The health facility was supplied with 
medical oxygen from a two-cylinder ramp. Knowing 
very well the role and importance of oxygen in heart 
surgery and hospitals with emergency units, we won-
dered how the patients survive during the process of 
replacing empty cylinders. Furthermore, the distri-
bution network was composed of only one pressure 
reducer situated beside the ramp. It was reducing the 
pressure from 145 bar to 4.5 bar. Meaning that there 
wasn’t any second stage reduction.

8. A centralized vacuum system was absent. We found only 
3 mobile suction machines available in the hospital. 

9. A medical gas alarm system was absent. We witnessed 
instances where oxygen ran out and no one knew 
about it. 

With all these challenges in mind, discussions were 
scheduled with the CEO of the clinic. The aim is to present 
all the listed challenges hindering a smooth take-off and 
to propose recommendations according to international 
standards which would be taken into consideration while 
upgrading the facility. Bearing in mind the complexity of 
the task and huge financial constraints involved and the 
fact that all investments were to be borne by the CEO of 
the clinic alone, we were obliged to reshape or soften 
our recommendations while still trying to align with 
international standards.

RECOMMENDATIONS TO BE IMPLEMENTED WHILE 
UPGRADING THE HEALTHCARE FACILITY TO 

ACCOMMODATE THE CARDIO-SURGICAL SERVICE
1. Due to financial constraints, we asked that the air 

conditioners in the operating theater be repaired and 
cleaned rather than purchasing an air-handling unit. 
This issue was to be reviewed after the first year of 
collaboration. 

2. More oxygen sockets were to be added to the operat-
ing theater.

3. Installation of new pipeline for medical air in the 
operating theater.

4. Installation of piping and scavenging system for anes-
thetic gas from the machine in the operating theater. 

5. To foster a continuous supply of oxygen to the hospital, 
we recommended the installation of at least 2 ramps 
with 2 cylinders each, having an automatic switchover 



Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

J Global Clinical Engineering, Special Issue 3, 2020  44

between both ramps. This new system should be 
linked to a medical gas alarm system to indicate ramp 
discharge, low, and high pressures. We also asked that 
a second stage pressure reducer be installed.

6. The purchase of more mobile suction machines to 
serve in the operating theater as well as in the ICU.

7. Owing to the very limited space in the existing ICU, 
we asked for a new location to be provided. The CEO 
instead promised to construct a new building to ac-
commodate the ICU as he was about to embark on an 
extension project of his clinic. 

8. Increase the number of electrical sockets in the operat-
ing theater and reevaluate the power rating of the UPS 
to make sure that it matches our demand of 15 kVA.

9. Review of the earthing system.

RECOMMENDATIONS FOR THE 
IMPLEMENTATION DURING THE CONSTRUCTION 

OF THE NEW ICU
The ICU was to be constructed on a 35-square meter 

piece of land (7 m length and 5 m width). After careful 
analyses, we decided to design the room such that it could 
contain 3 adult patients’ beds and 2 infants’ or neonates’ 
beds with warmers for a total of 5 head beds altogether. 
1. Each bed should have 12 electrical sockets. All sockets 

including those in the operating theater were to be 
protected following the NFC 15 – 100. More specifically, 
the earthing system was to be the IT system. 

2. The installation of 2 oxygen sockets per bed and one 
socket of medical air per bed. 

3. The installation of rails on the wall for hanging medical 
fixtures and equipment. 

4. The installation of an air-handling unit comprising 
recommended levels of air filtration (F5, F6, F9, and 
absolute filter) including the management of room 
pressure, temperature, and humidity.

5. The provision of a sluice room.
6. The installation of 2 small drawers on the wall for 

each bed.
7. The installation of a washbasin with a tap that has a 

lever mechanism or PIR sensor.

LIMITATION OBSERVED IN THE CONSTRUCTION 
OF THE ICU

After handing over the recommendations for the 
construction of the ICU to the hospital’s CEO and project 
coordinator, we were told that the entrepreneur was up 
to the task and would deliver the goods based on the 
recommendations. 

One month after the kick-off of the project, a site visit 
was scheduled to understand the level of progress and to 
validate the implementation of our recommendations. To 
our greatest dismay, we had the following lapses which 
were immediately corrected while some other lapses were 
discovered in the course of using the facility.
1. There was a small number of electrical sockets (4) in-

stalled per patient bed contrary to the recommendations.
2. There was no provision for a sluice room. Nurses were 

asked to move completely out of the zone housing the 
ICU to empty waste.

3. There was a poor installation of water collectors on 
the roof. During rainfall, some walls were completely 
soaked leading to the proliferation of fungal growth.

4. There was poor anchorage of bedside cupboard/
drawer on the wall which broke when syringe pumps 
or patient monitors were placed on them. 

5. There was the poor demarcation of sterile zones, hence 
communication of construction site with the ICU. 

6. There was the poor implementation of the oxygen 
distribution system which lead to frequent ruptures 
in the oxygen supply to the various services. 

7. Contrary to requests, a split-type air conditioner was 
installed in the ICU. 

CHALLENGES OR LIMITATIONS TO A SMOOTH 
TAKE OFF FOR THE CARDIAC CENTER 

While working closely with the partnering clinic, we 
faced many challenges that could equally delay if not ad-
dressed, the smooth take-off of surgical activities. They 
were: 
1. The means of transporting required equipment, me-

dications and consumables from Shisong to Yaounde 
amid the prevailing crisis. Many truck drivers were 
reluctant to travel to the area for fear of being killed 
or seeing their vehicle burned.

2. Regrouping all displaced workers who were to take 
part in the outreach activity. 



45 J Global Clinical Engineering, Special Issue 3, 2020 

Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

3. Compilation of a list of needs (consumables, materials, 
and equipment) from the various sectors involved in 
heart surgery. 

4. Negotiating and obtaining a balanced MoU between 
both institutions.

5. Discussion by the Cardiac Center administrator with 
staff to arrive at an optimum working condition in 
Yaounde.

6. The main technical coordinator, not being in Shisong, 
found a lot of difficulties in selecting medical equipment, 
spare parts, packaging, labelling, and transporting out 
of the hospital for onward transmission to Yaounde. 

7. Establishing a list of medications and surgical con-
sumables based on a predefined list of pathologies 
to be handled. 

INFRASTRUCTURE AVAILABLE FOR THE 
OUTREACH ACTIVITY

1. Bed capacity: 
• ICU = 3 adult and 2 infant beds.
• Pre-surgical ward = 2 beds.
• Post-surgical ward = 2 beds.

2. An operating theater. 
3. An office for pre-surgical consultation and post-surgical 

follow up.
4. Due to limited space in the hospital, the room for 

magnetic resonance imaging was used as an extended 
storage facility.

5. The point of care was performed in the ICU.
6. The blood bank hosted by the clinic.

THE CLINIC’S LABORATORY WAS RESPONSIBLE 
FOR ALL TESTS.LIST OF DIFFERENT PERSONNEL 

CHOSEN TO TAKE PART IN THE OUTREACH 
PROGRAM

Some of the personnel chosen to take part in the out-
reach program are detailed in Table 5.

TABLE 5. Personnel Chosen To Take Part in the Outreach 
Program

DESIGNATION NUMBER

Administrator 1

Cardiac surgeon 1

LIST OF MEDICAL EQUIPMENT, FIXTURES, 
AND OTHER APPLIANCES SUCCESSFULLY 

TRANSFERRED FROM SHISONG TO YAOUNDE
Table 6 lists some of the equipment taken for the 

outreach program.

Anesthesiologist 2

Cardiologist 1

Pharmacist 1

Biomedical engineer 1

ICU nurse 6

Perfusionist 2

TABLE 6. Equipment Taken for the Outreach Program

DESIGNATION QUANTITY

Syringe pumps 16

Infusion pumps 15

Patient ventilator 3

Multi-parameter patient monitor 9

Anesthetic machine 1

Coagulation analyzer 1

Blood gas analyzer 1

Chemistry analyzer 1

Portable ultrasound machine 2

Defibrillator 2

Surgeon’s headlamp 1

Auto-transfusion machine 1

Heating/cooling machine 1

Air compressor 1

Sternum saw 2

Electrosurgical unit 2

Weighing scale 1

Measuring tape 1

Blood warmer 1

Drug fridge 2

Extracorporeal circulation 
machine SIII 1

Extracorporeal circulation 
machine S5 1



Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

J Global Clinical Engineering, Special Issue 3, 2020  46

TIMELINE OF ACTIVITIES
Table 7 presents a visual timeline of activities leading 

to relocation or creation of outreach.

DESIGNATION QUANTITY

Mobile suction machine 4

Infusion stand 6

Drug trolley 4

Electrocardiograph 2

Transesophageal probe 1

Oxygen flow meter 5

Negatoscope 1

Patient’s bedside table 3

TABLE 7. Timeline

DATE ACTIVITIES

October - 
November 
21st, 2016

Anglophone lawyers and teachers began protesting. Gradual 
transformation of peaceful protest into violent confrontations 

after this date.

September 
20th, – 

October 14th, 
2018

Separatists groups ordered the complete lockdown of both North 
West and South West region in view of upcoming campaigns for 
the presidential election, including the day of elections and post-

electoral activities.

October – 
November 
7th, 2018

Discussions and underground works between the cardiac 
surgeon and technical coordinator concerning the possibilities of 

reviving surgical activities in a safer location.

November 
17th, 2018

After sharing our thoughts with the hospital administrator, we 
performed the first site visit to the health facility which was our 

first choice. 

November 
20th, 2018

Sharing of an elaborated report of the visit with the Cardiac 
Center administration and cardiac surgeon. This report 

brought forward the state of the partnering healthcare facility, 
improvements to be made in the facility, how long it would take 
to upgrade before the kick-off of cardiac surgeries and the list of 
equipment not available within the healthcare facility but needed 

to be transported from Shisong. The target is begin surgeries 
within the second week of January 2019.

November 
20th, – 

December 
12th, 2018

Review of upgrading tasks to be accomplished at the Jordan 
Medical Services, review of the hospital’s layout to understand 

and reorganize work flow. Proposal of a second healthcare facility 
as second choice. Sharing of idea to relocate with the several 

partners of the Cardiac Center Shisong including the Cameroon 
Ministry of Public Health.

December 
12th, 2018

Second visit to our first choice partnering institution to see the 
level of work progress, organized meetings with the contractors 

responsible for executing the recommendations given the 
constructing a new ICU block. Equally paid a first and second 

site visits to a healthcare institution which was our second choice 
and was equally under renovation and restructuring. 

November 
2018 – 

January 2019 

Sharing of an idea to relocate with the several partners of the 
Cardiac Center Shisong including the Cameroon Ministry of 

Public Health.

December 
29th, 2018

Discussions after sharing reports of the last interventions. A 
decision was taken to collaborate with the Jordan Medical 

Services. Upgrading work was to last for 5 months.

January – 
February 

2019

Prepared the list of various equipment, accessories, spare parts, 
and consumables to be transported from Cardiac Center Shisong 

to Yaounde. 

March 2019

Third site visit to the clinic to follow up on the work progress 
and implementation of recommendations. In the course of the 
evaluation meeting, there was a change of location for the ICU. 
A new building was being erected to serve this purpose, more 

recommendations were given for this ICU block. Commissioning 
scheduled for mid-May. Preparation of storage space to safely 

pack all materials and equipment from Shisong. Investigations to 
understand the best moment to transport materials safely out of 

the hospital in Shisong.

March 2019
Holding of Technical Committee meeting (hospital’s board of 
directors) to designate management and to elaborate a model/

draft of the MoU between both healthcare facilities.

March – 
April 2019

Dismounting, packaging, and transportation of listed equipment, 
accessories, spare parts, medical as well as technical consumables, 

drugs, and surgical materials to Bamenda using an ambulance 
before onward transmission to Yaounde given that there were 

more security threats on the stretch of road Kumbo – Bamenda 
than Bamenda – Yaounde. 

Mid - April 
2019

After grouping close to 95% of the materials in Bamenda, we 
organized and transported them to the clinic in Yaounde. 

Received them in Yaounde and packed in the already previewed 
storage space. 

April 27th, 
– May 8th, 

2019

Commissioning of the new ICU and upgraded operating theater 
amid some adjustments and finishing touches to be made. 

Reception of remaining materials required to complete the list of 
items used to perform cardio-surgical activities.

Unpacking, assembling, cleaning and testing of all equipment 
before sending them to their various locations. 

May 18th, 
– June 6th, 

2019

Signing of an MoU and the kick-off of first surgical mission with 
a total of 9 patients with cardiomyopathies operated upon.



47 J Global Clinical Engineering, Special Issue 3, 2020 

Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

RECOMMENDATIONS
1. Diversification of production units is of key importance. 

This means that for a given healthcare institution 
performing open-heart surgeries, it won’t be good to 
concentrate all investments in one city or town. They 
should divide the investment and implant of another 
healthcare unit in another town. Also recommended 
in bilingual countries like Cameroon or countries with 
2 distinct groups of people or races, not locating both 
structures in the towns belonging to the same group 
of people or race. 

2. When the relocating health facility is discussing with 
the partnering hospital, it will be good to take part in 
sharing the cost of renovation or upgrading work if 
any. This is because the partnering hospital may not 
have enough funds to put in place all the facilities 
necessary to carry out safe surgical interventions 
according to international standards or may simply 
be ignorant about international standards and by so 
doing not see the need to invest and implement all 
recommendations. To this effect, the relocating hos-
pital once made aware of the importance of having all 
recommendations implemented, may decide to assist 
financially and later include in the MoU the terms to 
recover the investment. 

3. The neutrality of the hospital trying to relocate must 
be made known to all conflicting parties or the differ-
ent groups of activists engaged in the war. This neutral 
position is very important to the safety of materials 
when transporting them out of the war zone. 

4. Before organizing any transport activity in the war 
zone, a good investigation must be carried out to 
understand the safest periods. This is to avoid being 
caught up in a cross fire during transportation leading 
to death or destruction of goods. 

5. The implementation of the heads all of units involved 
in heart surgery for instance will go a long way to 
avoid forgetting important materials needed during 
the process knowing that transportation within the 
crisis hit zone becomes risky.

6. While planning and organizing the workflow in a chosen 
healthcare facility, emphasis must equally be paid on the 
reduction to near zero the transmission of nosocomial 
infections. This is because, a surgical procedure can 
be performed perfectly with the required instruments, 
equipment, and consumables, but because attention 

was not paid to the sterility of instruments and air, 
the patient, later on, develops severe complications 
or bacterial infections. This situation may couple with 
the patient’s long stay in the ICU to produce bed sores 
aggravating the condition and even leading to death.

7. For those who want to relocate to a city where stable 
electrical supply is still a farfetched reality, care must 
be taken so that uninterruptible power supplies are 
installed, stand-by electricity generators installed, and 
a proper grounding system implemented. 

8. The availability of enough medical oxygen for continu-
ous activities is also very important knowing that the 
life of a cardiac patient in the operating theater and 
ICU depends primarily on it. 

9. When both institutions meet to discuss the model of 
partnership, it is advisable to strive at maintaining 
autonomy in management. That is, personnel manage-
ment, medical supplies, and billing must remain under 
the control and supervision of the visiting hospital or 
relocated healthcare institution. 

10. For none profit-making healthcare institutions, a frank 
and sincere discussion should be held with all potential 
benefactors including the government for possible 
sponsorship. This assistance can go a long way to even 
acquire new or refurbished machines which cannot be 
easily displaced from the crisis-hit zone like an angio-
graph or computed tomography scanner. These are 
vital and supportive equipment used for pre-surgical 
diagnosis of the coronaries for instance, (in most aging 
patients above 45 years or younger patients presenting 
a higher risk factor of having coronary stenosis). Also, 
the angiograph can also be used in correcting some 
cardiopathies within the scope of minimally invasive 
procedures. If these discussions held before starting 
upgrading or renovating works, the problem of limited 
space can be handled by transforming the operating 
theater into a hybrid operating room. 

RESULTS
A glance through the results obtained after the creation 

of the outreach program may not be very encouraging 
vis-à-vis our capacity, but for those patients who survived 
through the period during which we were inactive, it is a 
success (Table 8). Irrespective of the several limitations 
encountered along the line with the construction of an ICU 



Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

J Global Clinical Engineering, Special Issue 3, 2020  48

within a short time, the threats to burn down equipment 
and consumables during their transportation out of the 
crisis-hit zone, we were able to perform successful open 
surgeries. The creating of this outreach program has given 
hope to some Cameroonians and beyond for a better life 
and health condition. 

TABLE 8. Achievement Over 10 Months 

SURGICAL MISSIONS PERIODS
NUMBER OF 
SURGERIES

First surgical mission May 18th – June 2nd 2019 9

Second surgical mission July 16th – 28th 2019 8

Third surgical mission
September 23rd – October 

8th 2019
8

Fourth surgical mission November 12th – 18th 2019 5

Fifth surgical mission December 6th – 15th 2019 7

Sixth surgical mission
January 17th – February 4th 

2020
7

TOTAL 44

FIGURE 1 & 2. The staff at work in the operating theater dur-
ing open-heart surgery.

FIGURE 3 & 4. Staff at work in the ICU.

DISCUSSION
After the kick-off of surgical activities, notwithstanding 

the successes recorded, the Technical Department con-
tinued working hand-in-glove with the different sectors 
involved trying to know their level of satisfaction. We 
also sought to know those areas which needed improve-
ment either by adding equipment to ameliorate working 
conditions or speeding up patients’ recovery. In this line 
we were able to change the noisier and space-consuming 
mobile vacuum/suction pumps to a miniature less noisy, 
wall-mounted vacuum regulator using compressed air to 
generate a negative pressure (Venturi effect). Although while 
implementing this solution we created another problem 
(that of increase in the demand of compressed air), we 
have been working on possible fundraising to purchase 
a bigger air compressor to cover the entire needs during 
surgical missions. 



49 J Global Clinical Engineering, Special Issue 3, 2020 

Djankou, Albonico: Emergency Relocation of a Cardio-Surgical Health Facility due to war

The absence of an air-handling unit in both the operat-
ing theater and ICU has been one of our major setbacks 
in patient recovery and infection control. To that effect, 
while seeking funds to handle this issue, we intensified 
the use of an antiseptic spray for in-depth sterilization 
and antiseptic solution for cleaning of surfaces.

CONCLUSION
The prompt and speedy recovery of patients after heart 

surgery are the driving forces that keep energizing medical 
and paramedical personnel to continue working harder to 
attain better results. These driving forces are also respon-
sible for the quest to brainstorm and come up with lasting 
solutions which when implemented per international 
standards would step up the level of healthcare offered 
in the outreach setting. Mindful of the fact that the term 
outreach here does not mean working at the minimum 
level prescribed by standards, we are determined to put 
more efforts such that surgeries shall be performed under 
safer conditions and that the right health technologies are 
utilized. The hospital administration is working closely 

with some benefactors who have opted to offer some 
equipment in a bit to meet up with the standard working 
conditions and patients’ safety.

We are also determined to work closely with all parties 
concerned if asked to do so, towards the resolution of the 
pending conflict which has dispersed a majority of patients 
who were already living in a precarious situation before 
the escalation of peaceful protest into armed conflict. 

BIBLIOGRAPHY
1. Cardiac Center Management Team. Cardiac Center Shi-

song Development Plan 2018 – 2022, November 2017. 
2. Shikder S and  Price A. Design and Decision Making to 

Improve Healthcare Infrastructure. Longborough, UK: 
School of Civil and Building Engineering Loughborough 
University; 2011.

3. O’Neill T (editor). Technical Design Requirements for 
Health Care Facilities, “The Blue Book” Second Edition. 
Edmonton, Canada: Infrastructure Alberta; September 
2005. Available at: http://www.infrastructure.alberta.ca/
Content/docType486/Production/BlueBook-2005.pdf


