by: Neil Rens
“You’re going where?” groaned my parents, and just about everyone else that heard I was going to Rwanda for the summer. But nine weeks of taking classes and fixing medical equipment as part of the Engineering World Health Summer Institute turned out to be a tremendous experience. Here are some of my takeaways as an undergraduate biomedical engineer and novice traveler:
- Devices are just one piece of the puzzle
- Prior to my trip, I thought a well-designed and capable medical device could solve the biggest global health problems. I was wrong. For starters, no amount of technology is going to solve all of the healthcare challenges in a country where fewer than 1,000 doctors serve 11.5 million people. Moreover, the actual design and development of a device, though crucial, is hardly the final hurdle it must navigate in order to be successful. Who’s going to pay for it? How will it be implemented? Who will actually use it? How will it be maintained?
2. But medical devices are an important piece of the puzzle
- New point of care (POC) and mHealth strategies could be a boon for rural, developing countries like Rwanda. However, they need to be complemented by increased human capital and infrastructure.
3. Design constraints for devices:
- Consumables = not sustainable. In my experience, devices that require new components to be purchased on a regular basis seem doomed to fail. While this is a winning business model in the U.S., this is a losing strategy for helping people in the poorest countries of the world. There is very little money to purchase new consumables, so either the device will not be used at all or the consumable will be re-used. I witnessed this on multiple occasions. In the hospital setting, clinicians used mercury thermometers instead of digital ones because the latter require disposable plastic tips. Things that require importation (of consumables) or exportation (for repair) are generally not ideal.
- Design for the end user. If your user is going to be a community health worker (CHW), then your solution needs to require minimal training, almost no understanding of biology or medicine, and it absolutely needs to be in the local language.
- Appropriate technology. Building power-sucking devices for a country without decent electricity is probably not a good idea. Of course, that could also be a case for building a power plant for the country. Dr. Paul Farmer highlights one of the chief misunderstandings about appropriate technology with this remark in Tracey Kidder’s Mountains Beyond Mountains. “Do you know what ‘appropriate technology’ means?” he asks at another point. “It means good things for rich people and [$@%!] for the poor.” [Kidder 90]
- Design for them, not for you. In the workshop where I worked in Rwanda, I watched patients get wheeled from operating rooms up to the post-op ward. In between lay a 20m ramp that was at an incline of at least 40 degrees. Sometimes attendants had to take a running start to successfully wheel the patient, who is not strapped in and probably has fresh stiches, up this steep, diagonal ramp. I was floored, so I started drawing designs for a low-cost gurney that could be locally made with bike parts. But then I realized that the current method, although crazy to me, worked for them. Is it ideal? Absolutely not. But there are plenty of other health challenges for which a new device could make a much more measurable impact.
- 4. The cultural experience should not be overlooked
- Although my stated purpose was to fix medical equipment, Rwanda ultimately had much more of an impact on me that I on it. With such a (relatively) short-term stint, my impact will be somewhat short-lived. From what I have seen, making lasting impacts requires a lasting presence. But my short trip allowed me to develop an appreciation for Rwanda’s history, culture, and people, and that will not be short-lived. Rather, it has built a new perspective through which I can view my career, family, and goals.