Building a global community of healthcare innovators.

Worldwide eight billion people need healthcare, and the solutions must be local.

Those of us who have investigated healthcare systems in LMICs are familiar with equipment "graveyards." These piles of broken, imported equipment, often bearing stickers indicating their origins from donor organizations, are easy to dismiss as the status quo, due to a lack of care and maintenance. But what if this is really a design problem? What would happen if local biomedical engineers were actually involved in the design of the equipment that they have to maintain?

This month Leroy Sibanda and I travelled ?? to Nairobi, Kenya and Mbarara, Uganda to teach Three-Day Biomedical Innovation Mini-Courses at Kenyatta University and Mbarara University of Science & Technology (MUST), with remote support from Anthony Pennes back at MIT.

Our mission was to expose eager, young biomedical engineers to the hands-on Mens et Manus culture, which is the cornerstone of MIT, test our new "Biomed Lab in a Box" kit, and encourage them to develop their talents and aspirations as engineers and innovators. We wanted to help empower them to become part of developing high quality, contextually appropriate, technologies that improve healthcare delivery in their own region.

Opportunity

This project was the culmination of over a decade of reflection and three years of preparation, as always with unforeseen delays, couched in two core (and quite obvious) assertions:

?? Solutions that are not crafted in context and with engagement from local engineers will never prove to be appropriate and durable solutions.

?? Those of us who focus on biomedical engineering are united by a shared passion, regardless of where we are located, and must collaborate.

Looking at the root causes of medical equipment that failing and falling out of service in LMICs, we find that the local biomedical engineers truly can't do the maintenance, due to a cascade of challenges, including:

??Fundamental design weaknesses - systems designed for temperate, air-conditioned hospitals and stabilized power do not fare well when confronted with bad power, high heat and humidity, dust and continuous utilization.

??Lack of supply chain - a part that can be ordered in the US to arrive in 48 hours, can take 6 months in East Africa. And when something complex fails, such as a circuit board, it's often not repairable, due to manufacturer lock out.

??Biomedical engineers spread thin - While the large regional referral hospitals do have dedicated biomedical engineers, unenviably tasked with working under the constraints of points 1 & 2, outside major metropolitan centers, technicians rotate through occasionally, arriving by bus and boda boda (two-wheelers), with limited tools and spare parts, if any, for an array of branded and unbranded equipment originating from the US, Europe, China and India.

This list is just scratching the surface of the challenges and worthy of extensive papers and presentations, however, the crux of the matter is both underdeveloped healthcare systems and inappropriate, though often well meaning, solutions. The only way that this can be addressed is by working with local biomedical engineers to empower them to become and perceive themselves to be the developers of appropriate solutions for their context, not just fixers of broken equipment. This starts in the classroom!

Biomed Lab in a Box

Universities in East Africa, while well supplied with talented students, unfortunately have poorly stocked labs, often with just a few examples of retired medical equipment and limited electronic parts. To this end, as a baby step in helping build their curricula, we have built off the curriculum of our MIT Medical Device Design course and labs designed with love and care by Anthony Pennes , to assemble a "biomedical lab in a box" designed to be a self-contained learning experience, accompanied by a USB flash drive with a 96-page! lab manual, written by Leroy Sibanda , and all the needed software, important when internet is unreliable.

In keeping with the mission of local capacity building, our entire kit was assembled in Nairobi by Gearbox Europlacer , which operates the only SMD line in East Africa. Therefore, we are proud to say, "Designed in Cambridge, Made in Kenya!"

The labs were designed to connect the theoretical to the physical, increase in complexity and confront students with the real challenges of biomedical hardware, including weak signals, to ambient noise, to motion artifacts to precision assembly. They included:

?? Breadboarding an optical LED - photodetector finger pulse detector

?? Soldering onto a PCB and testing a 3-lead EKG

?? Assembling and programming a syringe pump

The syringe pump, specifically, is a new exercise in our class which we developed to bring together electrical, mechanical and software hands-on skills, and published open access in the J. Biomedical Engineering Education. In (re)designing these labs, the manual and accompanying 3-day curriculum, we had four main learning objectives for the East African students:

??Engage with biomedical sensing

??Learn basic electronics & coding

??Collect & analyze biomedical data

??Explore frameworks for their own healthcare design projects.

In parallel, we sought to engage with the communities, test and improve this course and find opportunities to strengthen the local ecosystem.

Outcomes & Path Forward

At both Kenyatta and MUST we could not have hoped for more enthusiastic cohorts of students and staff! (Notably, nearly 50% of the students were female!) And we pitched this experience as an experiment, asking the students' participation in testing and improving our materials, so as to make them available to a wider audience.

We surveyed the cohorts before and after the courses to assess their experience with and confidence in design, sensing, circuits, coding and building. In all cases, students grew significantly more confident in their abilities!

As important was the open feedback, both positive and negative. Students universally asked for more time, suggesting that the course should be extended to 5 days, an increased instructor to student ratio, less time on debugging (problems with the lab exercises), pre-readings, more pre-readings, greater depth of topics and ongoing learning opportunities. Two examples of feedback:

Every single section taught me the importance of precision and careful analyzation, for example, really small errors in the code led to too much debugging. In mechanical assembly I learnt that my angles and screwing need to be precise to accommodate the error. I learnt that in engineering, it's best to take time and get it right rather than shortcuts that may sabotage the progress in future.

Equipped with new skills and a deeper understanding of biomedical devices, I'm excited to apply these lessons to ongoing projects and future innovations. I also look to share the knowledge I have gained with my colleagues. Together, we can drive forward the next wave of medical advancements, making healthcare more accessible and effective for all.

As we further analyze the data, please expect a more rigorous writeup.

We're already revising and updating our material, based on the last fortnight, with the aim of improving if for the next pilot (stay tuned!) and releasing it in an open-source format. In hindsight, we realize that we could easily have expanded this course to a semester of material, but we should not be the ones to lead this charge! We want to stay engaged, but in a mentorship role to support our local colleagues.

Our long-term goal is to help the faculty and staff of Kenyatta University , Mbarara University of Science & Technology and others in the region to take, adapt and integrate our materials into their own curricula and empower their students!

The populations of East Africa are young, with median ages in Kenya and Uganda of 20 and 16 years, respectively. The biomedical engineers that we had the privilege of working and learning with truly have the opportunity and potential to build the future of healthcare in their countries. And from their own LinkedIn postings, it's clear that they are ready for the challenge!

More posts from participants: Khalil Awadh, Muthoni Muriithi, Mercy Amoding, Andrew Abila, Lemi Robin Loprimo, Brian Nguyo, Samuel M. Kiragu.

Acknowledgements

Leroy, Anthony and I are most grateful to the students who welcomed us to their campuses, enthusiastically participated in our experimental curriculum, showed great patience as we debugged in real time and provided us rich feedback, which we are still reflecting upon.

We are especially grateful to our host faculty leads, Prof. June Madete and Dean Johnes Obungoloch (PhD) , at Kenyatta and MUST respectively, for taking a chance on us and Latiff Cherono Managing Director of Gearbox, who personally worked with us late at night to pack kits! Of course, nothing could happen without a team, including duncan kamau , Augustine Waswa , Janiffer Nyambura , Ronald Amodoi , Hellen Kobusingye , ASIIMWE ROBERT and Faith Baingana Tusiime , who got up early and stayed late and went shopping for soldering irons with us!

In working to strengthen the biomedical community in East Africa, we drew upon a community of financial and emotional support at home, including the MIT International Science & Technology Initiatives (MISTI) , MIT Jameel World Education Lab and MIT Priscilla King Gray Public Service Center (PKG Center) , as well as the resources, expertise and encouragement of the MIT Department of Mechanical Engineering (MechE) , MIT EECS and The Travel Collaborative , for wrangling our logistics.