Making It Work in Uganda

The whole system should cost about $3,000. The cost is so low because, Fitzgerald says, the project uses “the human-centric design process,” a cycle that starts with long discussions with the people who will use the tool and never loses track of what they need. “We’ve basically designed laparoscopic surgery equipment for the needs and also the resources of Africa.”

Resources of all kinds. “The other thing we’ve tried to do in this project is intentionally design it so it can be built here in Uganda, with a company here,” Fitzgerald says. “That  way it creates jobs. It creates a local biomedical infrastructure, and it makes a space where we’re trying to stretch the capacity here for regulatory approval and things like that.”

Enabling a local company to work its way through the maze of approvals in a new Ugandan industry is critical to the project’s success. Fitzgerald, Mueller and their compatriots want to help Ugandan biomedical engineers, students and workers change their world.

ShiShi co-founder and managing director Sheillah Bagayana says that is essential. “Even though we innovate, if there is no industry to take it from development to the market, you might as well never have developed it.” After she studied biomedical engineering at Makerere, she visited Western universities. “At MIT,” she says, “literally the venture capital is at the university.” Uganda lacked not only investors but companies for them to invest in. “Right then I said, ‘This is where the gap is.’”

 It was a global surgery rotation in her final year of medical school that defined Fitzgerald’s future: “I came away from that trip thinking ‘I don’t know how I’m going to make this work in my career, but I know this is what I want to do.’” A mentor brought her to Uganda, where she began working on the pediatric surgical fellowship. She earned a Ph.D. in biomedical engineering along with her M.D. An introduction to Robert Ssekitoleko, the head of the biomedical engineering program at Makerere University, assured her continued work in the area. Ssekitoleko has become a linchpin of the work Fitzgerald does in Uganda. The two met when Ssekitoleko visited Duke in 2017. With that meeting, a million collaborations were born.

Ssekitoleko says Fitzgerald’s seeing things from both the medical and engineering perspectives “makes a very big difference.” Physicians “want this technology and [I] want it now,” he says, “without paying attention to the hurdles of getting that technology from idea to use.”  Not Fitzgerald: “While she’s working in the hospital here she’s also able to see the gaps and then start having a go at solving those gaps using technology.” 

Back at ShiShi, as Fitzgerald edits research papers emerging from this work, Mueller works with graduates of Ssekitoleko’s program to bridge those gaps, building the most recent generation of the KeyScope. They look forward to upcoming meetings, one where Ugandan surgeons will get a chance to test KeySuite tools and another with regulatory agencies, to try to move KeySuite into clinical trials. It has sailed through animal trials with surgeons at Duke. Clinical trials, on actual patients in Uganda, will be its last hurdle. 

Many steps along the development of KeySuite have been Bass Connections projects, giving Duke students the opportunity to travel with and learn from Fitzgerald and her collaborators. Students address the current Bass Connections piece of KeySuite at the Makerere Design Cube, made of two shipping containers, which houses design tools. (A single-container version has been set up on the Duke campus.) Under the direction of surgical resident Dr. Shannon Barter, a group of Duke and Makerere students works on that box trainer. If African surgeons get laparoscopic equipment, they’ll need training. “The major challenge is you’re doing a three-dimensional task,” Barter says, “but you’re viewing it on a two-dimensional computer screen.” The low-cost, locally producible box trainer holds a series of tasks – move objects, tie knots – that surgeons must master for certification.