Our Ugandan team’s focus is multidisciplinary approach to health systems strengthening particularly medical devices. The overall head is Dr Erisa Mwaka, a senior lecturer at Makerere University and an orthopaedic surgeon. The team has plenty of Biomedical Engineers lead by Dr Robert Ssekitoleko. We have a Biomedical Engineering research assistant, Brenda Nakandi and two PhD students, Kenneth Rubango who started in May 2019 and Martha Mulerwa who started in February, 2019. Recently, we recruited six undergraduate Biomedical Engineering students to expose them to research experience help in building capacity of young engineers interested in developing appropriate rehabilitation technologies for low-and middle-income countries. This F4P project has had a lot of impact on many stakeholders in the country. For instance, it is the first prosthesis design project in the country where local people are fully involved in the entire process.
We have had a busy year where we have been involved in a number of activities are briefly discussed below.
Interviews with amputees – March 2019
This year has been particularly interesting under the F4P project in Uganda. It started with conducting interviews with 17 amputees in March 2019. We got to learn about the amputee’s experiences and limitations to the devices they are using or the reasons why they do not have any artificial limbs. There are a number of different experiences but generally all the amputees interviewed pointed to lack of funding for buying high end devices but also how the number of devices are not functional.
Whereas government hospitals offer services, there are usually no limbs and accessories for people who need them. The amputees heavily depend on donations which are not necessarily suitable for their daily activities. Activities such subsistence farming, hand washing of clothes are unique cases that are not commonly found in high income countries where they have been replaced through use of technology.
We found that the Rotary Club plays a key role in sourcing donations for people with disabilities. For example, they have an extensive program for donating LN4 hands to upper limb amputees in the country.
TIPS ISPO Conference, March 2019.
Dr Ssekitoleko and Martha Mulerwa, a PhD student on the project, attended a TIPS ISPO Conference in Salford from Wednesday 20th to Saturday 23rd March 2019. During the same visit, the two worked with the collaborating team at the University of Salford from Monday 18th to Tuesday 19th. The conference, which involved over 30 presentations including three keynotes and many exhibitors demonstrated low and upper limbs on the market as well as at research stages. It was very interesting to see that upper limb devices still presented many challenges and the rejection rates even in high income countries are still very high. Whereas the general trend is on improving myoelectric devices, it was demonstrated that body powered devices have a number of advantages and in many cases are preferred over the myoelectric ones. The prices of all the devices were high and could be an impediment to individuals who have to pay by themselves especially in Low- and Middle-Income countries (LMICs).
At the conference, three papers about the specific work in Uganda were presented, namely:
- M. Deere, S. W. McCormack, R. T. Ssekitoleko, H.L. Ackers, L. P. J. Kenney. An initial exploration of the impact of Ugandan prosthetic provision and repair services on users. International Society for Prosthetics and Orthotics UK Annual Scientific Meeting (ISPO UK ASM), Salford, March 2019.
- Donovan-Hall, A. Chadwell, D. Zuleima Morgado Ramirez, R. Ssekitoleko, M. Sobuh, C. Holloway and L. Kenney. Harnessing Public and Patient Involvement for upper limb prosthetics design. Trent International Prosthetics Symposium, Salford, March 2019
- Cockroft, P. Graham, L. Ackers, J. Head, R. Ssekitoleko and L. Kenney. Prosthetics and Orthotics facilities in Uganda. Trent International Prosthetics Symposium, Salford, March 2019.
Commonwealth UK Visit by Orthopaedic Technologists -29th April, 13th July 2019
In April 2019, we sent four Orthopaedic Technologists and one Community Based Rehabilitation Expert to University of Salford for 3 months under the commonwealth professional exchange program. Under this, the team worked with researchers, prosthetists and orthotists under a number of activities aimed at improving practices around people with disabilities in Uganda. The team came from different health facilities including public and charities: Akram Semwanga- Orthopaedic Technologist at Katalemwa Cheshire Home for Rehabilitation Services; Henry Mafabi Gizamba – Orthopaedic Technologist Mulago National Referral Hospital; Mark Giggs Kalibbala- Rehabilitation Officer at spinal injuries association Uganda; Muhindo Yosiah – Lecturer at school of orthopaedic technology; and Tom Baguma – Orthopaedic Technologist Fort portal regional referral Hospital.
In their presentation the team highlighted key skills improved such as: digital skills such as better communication, documentation and research; more professional and practical skills i.e. fabrication of upper limb prosthesis manually with the available resources paying attention to patient involvement in planning and decision making; teaching and practical educator skills to support the health training system. i.e. teaching methods in the UK are prompting, practical, MSLAP Course; and better time management.
The team also established networks and collaborations e.g. Legs for Africa, Opcare ability centre, Red cross Hub and the Ugandan community in the UK. professional networks (within us the fellows and professionals in the UK). Some people were inspired to go for further studies. The team also had extensive discussion with the director of Biomedical Engineer at Joint Medical Store (JMS) in a bid to start suppling orthopaedic materials and consumables.
Global Report on Assistive Technology (GReAT) Consultation, Geneva, 22-23 August 2019
Dr Ssekitoleko was funded by WHO to present along with Prof Kenney the collaborative paper on ‘’Prosthetics services in Uganda: a series of studies to inform the design of a low cost, but fit-for-purpose, body-powered prosthesis’’. This was a great meeting where many advances and challenges for all different assistive devices where presented by experts from all over the world. During this meeting, Dr Ssekitoleko discussed with Prof Chris Nester on how he and Makerere University would be involved in the Centre for Doctoral Training in Prosthetics and Orthotics.
UNBEC Conference and F4P stakeholders meeting- 6th-8th November 2019
This meeting, held as a breakaway session from the Uganda National Biomedical Engineering Conference (UNBEC2019)[1], brought together stakeholders to discuss the issues around supply chain of prosthetic devices especially for upper limbs. Among the representatives were: the Rotary club, responsible for local distribution of LN4 limbs and general donors to people with disability; Orthotech and Physical Rehabilitation International, a private clinic but also a key supplier of devices and consumables; Mulago orthopaedic workshop, a public hospital department in the Mulago National Referral Hospital; Joint Medical Store, one of the largest medical equipment supplier in the country; Katalemwa Cheshire Home, a charity rehabilitation services provider, Uganda Industrial Research Institute, a government arm for translating innovations; Kyambogo University as well as researchers and students from Makerere University.
The meeting highlighted many key areas for different stakeholders to work together so as to improve services for people with upper limbs. We found that there are many issues around the supply-chain of upper limb prostheses and rehabilitation technologies in general.
UK Student placement in Uganda
Bernadette Deere and Steven McCormack, who are trainees under the NHS Clinical Scientists training scheme took a placement with us earlier on this year. They enjoyed their experience and their findings written as ‘’UK universities lead the call to develop body-powered prostheses Preliminary investigations with the “fit-for-purpose” project in Uganda for the development of affordable options in low- and middle-income countries for patients with upper limb loss’’are published in the December 2019 IPEM SCOPE Magazine. This placement is in line with our Knowledge for change (K4C) placements aimed at health systems strengthening in Uganda.
Activity monitoring for prostheses users July 2019 to date
This activity is still on-going, but it is a great way to monitor how prosthetic devices are used. The amputees wear activity tracking devices on their prosthesis and normal hand while routinely recording diaries. This is helping us understand when the prosthetic hands are won and how frequently they are used.
[1] https://unamhe.or.ug/2019/07/30/2nd-uganda-national-biomedical-engineering-conference-unbec-2019/
