AUTHORS: Brian Matovu*, Shadia Nakato*, Nabbaale Prossy** (*Biomedical Engineering Makerere University, **Business Economics Makerere University)

It’s now more than a decade since biomedical engineering was embraced in Uganda by different institutions of higher learning. A few years back institutions like Earnest Cook Ultrasound Research and Education Institute (ECUREI) Kampala and Kyambogo University Kampala started offering biomedical engineering in the country at Diploma level. These institutes have been able to provide a workforce in terms of producing biomedical engineering technicians (BMETs) who offered different clinical engineering roles in different health centres around the country.

It wasn’t long when in 2012 Makerere University decided to offer biomedical engineering in the country at Bachelor level. With this, the government of Uganda also came out to support students offer biomedical engineering at this institute through the Ugandan Government Scholarships. The University offers biomedical engineering for a period of four years and this program is being taught between two colleges i.e. College of Engineering Art Design and Technology and also the College of Health Sciences which houses the program under its school of biomedical sciences.

Specific to Makerere University, the students of BME were able to form a students’ association which is called MAKERERE UNIVERSITY BIOMEDICAL ENGINEERING STUDENTS ASSOCIATION (MUBESA). This association has supported students to further understand what biomedical engineering is all about. The association has been able to hold different activities both at university and National level. It has recently managed to be among the premier organisers of the First bi-annual National Biomedical engineering Conference which took place on 16th -17th January 2017. This conference brought together different stakeholders of biomedical engineering in and out of the country including Health professionals, WHO, delegates from Kenya- USA, UK, Ministry of Health Uganda, academia, regulatory bodies and the biomedical engineers and technicians out already in the field.

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Group Photo at the First Bi-annual Uganda National Biomedical Engineering Conference at Hotel Africana Kampala on 16th -17th January 2017

Working with other academic institutions, the students organise biomedical engineering hospital outreach programs which aim at giving back to the community through repairing different medical equipment in the few chosen hospitals that badly need these services. Students also involve themselves in design contests and competitions and come up with projects like low cost pulse oximeter, POC diagnostic strip for mothers with preeclampsia, phototherapy blanket, PPH Suit, low cost autoclaves among others. These aim at describing what is expected out of a biomedical engineer and mentoring each other.

Despite all that, BME is still new in the country but we appreciated that the government now has a public structure for biomedical engineers in its health centres. Uganda also has the Uganda Association of Medical and Hospital Engineers (UNAMHE) which is a professional body that registers all practicing biomedical engineers and technicians in the country. This association is also a member of the Federation of the East African Health Engineers Association (FEAHEA) and the International Federation of Hospital Engineering (IFHE).

Different research institutes around the country are also yet to appreciate what biomedical engineers can do for them as regards making their work progress to national expectations. And with more institutions like Mbarara University of Science and Technology taking on BME as a program offered, the future of biomedical engineering in Uganda is more promising and we look forward to having the best out of it for national, regional and global development.

Why Biomedical Engineering

Biomedical engineering remains a novel branch of engineering that involves the application of traditional engineering principles and design concepts to healthcare related developments. It is essentially a discipline that interfaces and attempts to bridge the lacunae between engineering and medicine with a view to advancing healthcare treatment strategies in various spheres of diagnosis, monitoring and therapy provision through the combination of the design and problem solving skills of engineering with medical and biological sciences. It is a diverse seemingly all-encompassing field that includes such novel areas as biomaterials, biosensors, biotechnology, bioinstrumentation, bio signal processing, genetic engineering, computational biology, optics and lasers, tissue engineering, biomechanics, clinical engineering and rehabilitation engineering among others.

It is apparently obvious to me that there is a direct correlation between the level of advancement in Uganda’s healthcare system and the degree of its investment in biomedical engineering is increasingly raising. Modern healthcare systems and centres are technologically driven and the inspiration behind most of the technological innovations that have come to characterise advanced healthcare delivery in different healthcare centres come from the stable of biomedical engineers in this country. Examples that readily come to mind include the incidence of the breakdown of the Cobalt 60 radiotherapy cancer machine in April 2016; this left a number of cancer patients stranded and no receiving any more radiation treatments. The quality of services delivered at this facility was affected and the main reason for this breakdown was not appreciating what a biomedical engineer can do as far the life equipment are concerned.

The opinion we have is that Ugandan doctors are apparently better skilled clinically than UK or USA trained doctors. But the key difference lies in the differing levels of exposure to advanced instrumentation and technological aids foreign doctors readily have access to at the snap of a finger. This still stresses the point that their healthcare systems are more efficient, not due to the superior clinical skills of the doctors in those climes, but due to the massive and telling impact their biomedical engineers have made by way of their mind boggling technological innovations. With that, a better advancement in healthcare service delivery has to be embraced with biomedical engineers, designers and innovators at all levels and sectors of our health systems structure.

Biomedical engineers can also play a vital role public health like in disaster management where Uganda is more prone to occurrence of disasters due to resource constraints. The public health crisis that unfolds after disasters, such as earth quakes, landslides like in mountainous districts or man-made catastrophes which can include flooding; over ensuing weeks and months leaves much deeper, permanent scars in the form of reduced quality of life and disrupted national economies. These catastrophes result in population displacement and undermine health facilities’ capacity to provide care, since fully-established disaster management programs are often lacking. Investment in biomedical engineers can bring about better disaster crisis management to a larger scale where they can immediately provide rescue efforts, during which trauma care, food, clean water, sanitation and shelter are provided; provide infrastructural efforts to rebuild houses, schools and hospitals; and also assist in victim rehabilitation efforts consisting of long-term health and livelihood interventions.

Biomedical engineering has essentially supported effective health care delivery through its employment in the multi-disciplinary clinical and research teams in developing strategies for better diagnosis and management of many medical conditions. For instance, a cell phone-based light microscope has exhibited potential for clinically identifying malaria and tuberculosis through the use of fluorescence with light-emitting diode (LED) excitation. Unfortunately, Uganda has few biomedical engineering departments conducting active research because of lack of technical capacity and resources. As a result, hospital equipment is often broken or misused. Maintenance of equipment often relies on expensive international expertise and local capacity to develop innovative engineering solutions is noticeably absent.

Available Challenges:

The development of biomedical engineering in Uganda is apparently still at the most infantile stage. But what am sure more sprouting out of the ground. The reasons for this apparent poor state of embracing biomedical engineering are multi-faceted, and range from a poor understanding of the actual nature of what biomedical engineering in itself is all about by mostly clinicians, administrators and even engineers in the traditional engineering fields alike to a general unwillingness of people to leave the traditional comfort zones and embrace evolving fields or frontiers that are yet to be fully explored largely or apparently because of the age long fear of the unknown.

The commonest challenges that readily come to mind and are apparently visible to any discerning observer include over-reliance on importation of medical equipment produced in the western world, poor understanding of the concept of systematic management of medical equipment by hospital administrators, epileptic power supply, poor government funding of research related activities, exorbitant costs of maintaining purchased equipment, corruption and nepotism, dearth of skilled personnel to effectively maintain purchased or donated equipment.

Specific to equipment repair, design and maintenance, the reasons for frequent breakdown are multi-factorial and are invariably related to a poor understanding and compliance with laid down guidelines in the life cycle of the medical equipment. International guidelines clearly articulate that any equipment life-cycle has six main phases namely: planning and acquisition, acceptance, training, quality assurance, risk management, replacement and disposal. Defective or poor management of any of the above phases, especially the planning and acquisition and training phases for end users, would inadvertently and constantly result in equipment downtime. This becomes the main reason for clinicians or end users to over complain about medical equipment break down and non-functionality and reliability while in operation.

Conclusion:

In today’s technological era, Uganda and other resource constrained countries need to embrace the field of biomedical engineering locally. Support should go in terms of funding, regulation, and employment at different levels of their health systems. The innovations in health care technologies continue being paramount, not only in the advances of medicine and in the self-health management of patients but also in allowing the sustainability of the public health care becomes more important and lastly for national development. With this, the role of the biomedical engineer will turn to be more crucial for societies.

NOTE: The authors have no competing interest in this write up.

For God and My Country

 

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