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Source: MIL-OSI Submissions
Source: University of Auckland

It is one thing for more affluent countries to donate medical equipment to developing countries, but how can we ensure the healthcare workers receiving the equipment know how to use it?

This was the issue that Kiara Miller, a PhD candidate at the Auckland Bioengineering Institute (ABI) encountered when she went to Uganda on an Engineering World Health (EWH) internship for three months in 2019/2020.
She and her fellow interns, Jay Anand, an engineering student at UNSW, Sydney, and Moreen Kyomukama, a biomedical engineering student at Makerere University, were struck by the scale of the problem.
They also came up with solution; they developed a training app for healthcare workers for particular medical equipment, which has been awarded first place in the EWH (Engineering World Health) Design Competition for students.
Their e-platform is called “Fishing: An E-Learning Platform and ERP system for Limited Resource Environments”. It was named in reference to the aphorism, “Give a man a fish and you feed him for a day, teach a man to fish and you feed him for a lifetime.”
The EWH internship, which Kiara was able to participate in with the support of the ABI, involved visiting and working with a number of different clinics and hospitals in Uganda. While she was had read up, and knew that the misuse and poor maintenance of medical equipment in developing countries was a problem, seeing it first-hand took her aback.
“I had read about these medical equipment graveyards, but when you get there you realise how huge the problem is, how much equipment was just sitting there, not being used.  User training was rarely given to on-the-ground healthcare workers or training about how to maintain and manage the equipment.”
“In one hospital a bacterial incubator was incorrectly labelled as an autoclave and being used to sterilise dental equipment, and in another health centre, medical equipment in the maternal department was being sterilised in a water bath.”
While her primary role as an intern was to repair medical equipment, it became clear that the problem required more than a drop-in-and-fix solution.  “Often we would repair equipment, and money was spent on spare parts, only to return the following week to find the same piece of equipment broken or lost.”
She and her fellow interns concluded there had to be a better way. As she notes, while they worked in places where the power supply was unpredictable, and internet connection poor, most people had a mobile phone, and used them in myriad and innovative ways. “So we thought this problem could addressed in a different and quite simple way.”
In their last month on the internship, the team of three repaired the medical equipment by day and (enlisting the help of colleagues and friends) developed and designed the “Fishing” App by night.
“It was initially quite challenging to build the app when we were over there, because of limited internet availability and power surges,” says Kiara. “We would have to ensure we charged our devices when power was available so we could still develop the app during the outages.” They also relied on Bluetooth capabilities, including an app called Xender, which the locals used to distribute content without depending on the internet.
“That experience was really critical in understanding how Ugandans interact with technology differently and do so ingeniously without relying on the internet and 24/7 power,” says Kiara.
The prototype they developed is currently being used by healthcare workers in Entebbe Hospital, where it has been well-received.
The EWH internship is largely aimed at engineers, and Kiara isn’t an engineer. She completed her bachelors and post graduate diploma in Applied Science, and completed  a Master of Engineering last year, in which she focussed on the investigating gastrointestinal physiology. As a PhD candidate at the ABI, she is working in the GI  group developing tools and techniques to improve our understanding of the GI system. (Her research is focussed on non-invasive electromyography recordings for assessing swallowing and creating biofeedback therapy for patients with dysphagia – that is, people who have difficulty swallowing.)
“However, I did design for technology as one of my majors in my undergrad years, so I have always been passionate about human-centred design, particularly frugal innovation. So the ‘Fishing’ app has come out of that.”
The first stage of the “Fishing” project involved the development of the app, and an offline E-Learning library called Health Care Technology Trainer. They are now hoping to gather more evidence of how it is being used by healthcare workers, and identify what improvements need to be made.
Their ongoing research has been frustrated by restrictions resulting from the pandemic, which is what makes receiving first place in the EDW awards so timely. “The impact of Covid-19 has meant that we haven’t been able to follow up on this as much or as soon as we’d like to, but this award has really motivated us to develop the software. There’s a lot of good medical resources that are sitting in storage in hospitals in Uganda and other countries, which properly used and maintained could really benefit a hospital and their patients.”