Part II: U.S.—Sub-Saharan Africa Educational Partnerships for Medical Device Design
Part II: U.S.-Sub-Saharan Africa Educational Partnerships for Medical Device Design
0 Elsie Eah Kaufmann Department of Biomedical Engineering, University of Ghana , Legon, Accra , Ghana
1 Matthew Glucksberg Department of Biomedical Engineering, Northwestern University , Evanston, IL , USA
2 Brittany Ploss Department of Biomedical Engineering Duke University , Durham, NC , USA
3 William Reichert Department of Biomedical Engineering Duke University , Durham, NC , USA Electronic mail:
4 Robert T. Ssekitoleko Program in Biomedical Engineering, Makerere University , Kampala , Uganda
5 Janet McGrath Department of Anthropology, Case Western Reserve University , Cleveland, OH , USA
Three factors have driven the establishment of engineering design collaborations between U.S. and Sub-Saharan Africa universities that have also contributed to the development of biomedical engineering design capacity for resource-limited settings. First is the need for low cost and robust health technology solutions in Sub-Saharan Africa, which is unparalleled worldwide. Second, is the emergence of bachelor's level degree granting biomedical engineering (BME) programs in Sub-Saharan Africa, which was the focus of Part I of this two part series. Third, is the recognition that co-creative design processes involving local stakeholders generate the most effective global health technology solutions. These three factors have created a collegial base for BME students and faculty in U.S. and Sub-Saharan institutions to engage cooperatively in the design of appropriate technical solutions for global health. Medical device design is an attractive avenue for establishing meaningful partnerships with Sub-Saharan BME because: the need is significant, the educational value of designing subject to constrained resources, and the provision of a good middle ground that emphasizes resourcefulness and creativity rather than technical sophistication. To highlight this trend the Education Track for the 2016 BMES annual meeting organized a session of invited speakers entitled Global Health Engineering 2.0: Building Educational Capacity in Africa that featured illustrative BME design programs from the U.S., Nigeria and South Africa that have embraced the importance of developing co-creative design partnerships (Figs. 1 and 2). In this installment the most significant facets of each educational partnership are described. The focus of Part II is summarizing the key characteristics of the illustrative global health design programs at Rice University, University of Michigan, Case Western Reserve University, Northwestern University/Cape Town University, and Duke University, and provides recommendations to U.S. institutions for entering sustainable BME design-focused partnerships.
ILLUSTRATIVE BME DESIGN PARTNERSHIPS
WITH SUB-SAHARAN AFRICA
The Rice University 360 Institute for Global Health
started in 2007 by Professors Rebecca Richards-Kortum
and Maria Oden, is arguably the most comprehensive
educational program in the immersive co-designing of
global healthcare technology in high-income countries.22
Richards-Kortum and session keynote speaker Maria
Oden gave a joint TEDx talk on their global health
design efforts in Malawi.24 At Rice, undergraduates of any
major may apply to the Global Health Technologies
program to work on design problems identified by
healthcare partners such as the University of Malawi
Polytechnic and College of Medicine and Barretos
Cancer Hospital in Brazil.8 Students in this program may
also intern in their international health setting to
implement their technologies.23 Students and faculty at both
universities benefit from exchange programs that bring
members of both universities to each other’s campus.
International design teams have been responsible for
several new health technologies, the most notable being
the low-cost bubble continuous positive airway pressure
(CPAP) for neonates, a low-cost syringe pump that uses
mechanical energy to last between intermittent power
outages, a diagnostic device for postpartum hemorrhage,
a hand-powered centrifuge made of a salad spinner, an
electronic medical records system, and an alternative
consumable to test for anemia that costs less than
1¢.4,5,18,19,25,29 The Rice BME faculty has also
collaborated with the Malawi faculty to build the undergraduate
BME program at the University of Malawi, which is a
program in the Department of Engineering.17,28
Kathleen Sienko, Associate Professor of Mechanical
Engineering and BME at the University of Michigan,
is Director of the Global Health Design Initiative
(GHDI) and Co-Director of the Center for Socially
Engaged Design.7,28 The GHDI provides engineering
and non-engineering students with credit-bearing and
internship opportunities centered on global health
needs assessments and co-creative and
context-appropriate design experiences at international and domestic
field sites. Prior to entering the clinical immersion sites,
students learn the tools of design ethnography that
they will employ to identify and define unmet needs
and characterize use contexts.21 Since 2011, cohorts of
engineering students from U of M and Ghana have
performed needs assessments during their clinical
immersion experience primarily at Korle Bu Teaching
Hospital. Upon returning to their universities, students
generate concept solutions, and fabricate and evaluate
2017 Biomedical Engineering Society
prototypes.27 These projects have included a
portable pelvic examination table, and a subdermal
contraceptive insertion device that have generated
conference abstracts, journal articles, and device
commercialization (e.g., Hemafuse). Sienko describes
the early work of GHDI in Ghana, Kenya and Uganda
in her TEDx talk.26
Matthew Glucksberg is the Director of the Center
for Innovation in Global Health Technologies at
Northwestern University.20 Glucksberg has
collaborated with BME Professor Tania Douglas of the
University of Cape Town (UCT) to coordinate a BME
consortium that includes two Nigerian universities: the
University of Ibadan (UI) and the University of Lagos
(UL). The Nigerian programs, led by Professors
Akinwale Coker and Akinniyi Osuntoki, respectively,
are developing curricula that emphasize user-centered
design and development supported by expertise from
the faculties of medicine and business. This consortium
has been convening since 2013 with the aid of an NIH
Fogarty International Center training grant
(D43TW009374; PI: Robert Murphy), and is engaged
in faculty exchanges and the cultivation of academic
biomedical engineering in Nigeria. The group is
developing a BME textbook for the African context
and is launching journal named Global Health
Innovation to disseminate knowledge on social and
technological innovation for improved health, particularly
in developing contexts. Inter-institutional projects in
this group have included work on infant surgical
warmers, burn injuries, and a blood management
system. Visits of the Nigerian faculty to UCT (four to six
faculty per annum, staying for six to ten weeks) include
participation in courses on design and healthcare
technology management. This group has also piloted a
short clinical immersion program between students at
the Nigerian universities and Northwestern for design
prototyping. Northwestern University hosts two or
three visiting faculty each year to help develop a
design-based BME curriculum. Faculty members of each
participating university from the schools of
engineering, business and medicine have been tapped to
cultivate ‘‘locally-grown’’ healthcare solutions in Nigeria.16
Case Western Reserve University (CWRU) has
enjoyed a formal multidisciplinary collaboration with
Makerere University in Kampala, Uganda since 1988
to fight the AIDS and TB epidemics. In 2011,
Makerere University School of Biomedical Sciences
admitted its first class of BME undergraduates.3
CWRU Professors Andrew Rollins (BME) and Janet
McGrath (Anthropology) used this confluence of
programs to develop a cross-disciplinary course called
‘‘Interdisciplinary Solutions to Global Health Issues’’
that immerses both BME and Anthropology students
interested in global health in the process of design,
implementation and anthropology of global health
technologies, which includes a spring break trip to
Uganda.2 The class, which was offered for the first
time in the spring of 2015, brings CWRU and
Makerere students together to work on ongoing design
projects focused in three areas of unmet need: the
vaccine cold chain, medical waste management, and
pediatric pulse oximetry.1 Students at both universities
work collaboratively on these design projects,
including fieldwork in Luweero, Uganda about 35 miles
north of Kampala. This combination of engineering
design, anthropology, sustained collaboration with
local design teams, and continuance of projects from
year to year is a novel and compelling vehicle for
teaching the process and nuances of designing
technology for low-resource contexts. The integration of
teams between CWRU and Makerere University also
models sustainable partnerships that contribute to
The newest program at the session is directed by
Duke University Professor of BME William Reichert,
who spent the 2014–2015 academic year as a Fulbright
Scholar at Makerere University in Kampala (MUK),
Uganda. Reichert taught several BME classes to MUK
students over two semesters, and conducted a
thorough curricular review that resulted in a significant
increase in engineering content during the first and
second years of the program. Reichert also observed
that the number of MUK BME instructors were
insufficient to sustain adequate curricular coverage.
Upon returning to Duke, Reichert and Duke BME
chair Ashutosh Chilkoti launched the Duke-MUK
BME Partnership with generous support from the
university.10 Duke-MUK is taking a four pronged
approach: teaching BME classes taken simultaneously
by Duke and Makerere students, offering a class where
Duke and Makerere BME students work
collaboratively on global health design projects originating from
Makerere (which includes a Duke spring break trip to
Uganda), an Engineering World Health Summer
Institute in Uganda, and offering full scholarships to
Makerere BME graduates to study for a Master’s
degree in BME at Duke. Due to Internet resource
challenges at MUK, Duke-MUK also set up a BME video
conferencing facility at Makerere to facilitate
communication. The Duke-MUK scholarship comes with
a payback agreement where the scholars must return to
Makerere to teach BME classes for at least three
semesters. The first two scholars started their studies in
August 2016 and plan to finish in December 2017.9
Finally, much of the need in LMICs lies in relatively
straightforward maintenance and repair of routine
equipment that does not require Bachelor-level of
training in BME. Dr. Malkin (Duke University),
cofounder of Engineering World Health (EWH),12
developed a curriculum to train and deploy undergraduates
from mostly Europe and North America to LMIC
hospitals and clinics during their summer break to
maintain and repair medical equipment. Brittany Ploss
presented her work with Malkin on the benefits of
extending EWH training to local staff that become
certified as Biomedical Engineering Technicians (BMETs).
EWH provides open-source curricular materials for
other institutions that may want to begin a BMET
curriculum.13 The training programs usually award
students a diploma (analogous to an associate’s degree)
after one to two years of coursework. Locally owned
BMET programs with an EWH-based curriculum now
exist in Rwanda and Honduras, while schools in Ghana,
Cambodia, Nigeria, and Ethiopia are in various stages
of ownership transition.15 A one-year post-transition
monitoring visit by Duke to Honduras demonstrated
significant educational impact for the technicians, all of
whom were still in the public sector. Hospitals with an
EWH trained BMET (compared to a non-EWH trained
BMET) had 35% less out-of-service equipment. This
visit also revealed sustained educational efforts by the
program, with ongoing program activities more than a
year after the EWH funding had ended.11
The most effective BME education for medical
device design for global health possesses mutually
beneficial partnerships between institutions in high- and
low-income countries. Any U.S. university with a
global health program has multiple such relationships.
Also consider contacting the university’s international
affairs office. These inquiries can result in a network of
established interactions that can be used to start
building a relationship.
The next step is to consider how deeply immersed
into this relationship one should become. Clearly, the
more immersed one gets the greater is the potential for
mutually beneficial impact. Listed below in
approximate order of increasing effort and cost, are
suggestions of actions to consider when building a
cooperative relationship with a BME program that
would benefit from capacity building efforts.
1. Make available existing course material such as
lecture notes, homework solutions, videos,
software, and lab exercises. The priority should be
courses in device design, such as electrical circuits,
computer software, modeling and simulation,
medical instrumentation, clinical engineering,
biomechanics and rehabilitation.
2. Use distance-learning technology to offer classes at
both institutions by delivering streamed or recorded
lectures. Some resource investment here may be
necessary (e.g. modems, data plans, and
3. Offer existing or new online courses that cover
priority BME topics. This requires the same
technology considerations as recommendation 2 above.
4. Assist in starting an EWH chapter at the partner
institution that specifically links with the EWH
chapter in one’s own university. EWH chapters are
pervasive within BMES as evidenced by the student
design awards given each year at the BMES annual
5. Bring BME students from the partner institution to
one’s own university using existing research
experience for undergraduates (REU) programs.
6. Build in visits of one’s students to the partner
institution around a course or internship where
students at both institutions participate.
7. Work with the partner institution teaching staff to
develop or revise their BME curriculum if needed. It
is important to be aware of differences in curricular
expectations so that the instituted revisions are an
8. Bring students from the partner institution to study
at one’s own university longer term. This poses
significant challenges from the cost of attending to
the preparation mismatch.
9. Partner with a university to establish a design
program that takes co-originated ideas from concept to
prototypes, and even to manufacturing and
distribution when possible, including shared intellectual
10. Use these educational partnerships to build
research collaborations that address problems
significant to the partner institution. From a
university perspective, this may be the highest order
form of interaction, as it requires taking on
commitments for experimental tasks, funds for
personnel costs, research supplies and equipment.6
Tania S. Douglas
Division of Biomedical Engineering,
University of Cape Town,
Cape Town, Republic of South Africa
Robert A. Malkin
Department of Biomedical Engineering
Durham, NC, USA
Department of Civil Engineering,
The Polytechnic, University of Malawi,
Department of Biomedical Engineering,
Houston, TX, USA
Department of Biochemistry,
University of Lagos,
Department of Biomedical Engineering,
Case Western Reserve University,
Cleveland, OH, USA
Departments of Mechanical Engineering and
University of Michigan,
Ann Arbor, MI, USA
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