When we discuss global surgery, we often focus on the physical workforce that it takes to support a patient through their surgical needs. The other side of this process is the digital or mechanical support that makes surgery all possible. It is easy to take for granted the countless computers, x-ray machines, ventilators, and more. We often don’t recognize the biomedical engineering that takes place to make all those tools function - we just know it works (but often not how it works). Acquiring these machines in low-resource settings is important, however, understanding how the machine works and how to maintain it is equally as important for its longevity as a surgical tool. In an effort to help, there has historically been a flow of second-hand or cheaper machines from high-resource environments to low-resource environments however often without the needed tech support, product manuals, or training to upkeep them. End-of-life equipment can be common and its utility is limited. Donations are vital to the progression of surgery in these settings but can sometimes create more of a burden than a support. Join us as we speak with Tom Monahan, the prior director of Biomedical Engineering at Health Equity International and previous Master Biomedical Technician at Massachusetts General Hospital about the engineering challenges of surgical equipment and strategies for tackling this problem at the grassroots through apprenticeship and training models.