“Joining efforts to work towards shifting the paradigm of surgical care globally”

The CAMTech Uganda Global Surgery Hack-a-thon which was held between August 26th and 28th at Mbarara University of Science and Technology (MUST) brought together medtech innovators from around the world to co-create surgical innovations for resource-limited settings. With support from the Babson Schlesinger Fund for Global Healthcare Entrepreneurship, the event served as an open innovation platform for a global community of clinicians, academics, engineers, entrepreneurs, industry experts and end-users to co-create innovations over a 48-hour period. Teams—through cross-disciplinary collaboration, mentorship, time/resource constraints and award incentives— accelerated ideas into breakthrough innovations that have the potential to shift the paradigm of surgical care globally.

That vibrancy that was exhibited by the teams during the 48 hours of coding and prototyping was preceded by a pregnant and thought provoking Clinical Summit on Friday August 26th. During the summit, speakers spoke about the surgical care pathways where highlighting challenges and the current coping strategies related to delays in scheduled surgeries, difficulties in managing trauma and emergency response cases in real time. Participants closed off this day’s sessions with visits to clinic and hospital sites to appreciate the real-life experiences of the challenges at hand.

This challenge attracted over 100 participants from various universities, countries and professions including Makerere University, School of Public Health, Massachusetts General Hospital, Kyambogo University; Uganda, India, and the USA as well as over 30 mentors.  

The hackathon had over 20 health challenges that had previously been identified (as highlighted in the table below) and participants were free to pitch solutions from more that one challenge. Participants spent most of the Saturday afternoon doing their problem research, gathering pictorial & video evidence, online resources and conducting user interviews. All participants had a deadline of midnight to make the submissions in preparation  for the presentations on Sunday. Altogether, over 32 innovations were registered and some prominent ones included;

BloodFinder – A low cost easy way for hospitals to track and locate blood [in all its types] in emergency situations between themselves and the blood banks.

AutoClave – A proposed solar powered autoclave sterilizer to manage the absence of power in operating rooms

Stoma Bag– A proposed easy and locally manufactured alternative for the plastic bags attached over the stoma to collect waste

CIF – using infrared light to find deeply immersed birth control implants from patients’ arms.     

The pitches were very intense and motivational as the teams displayed the various prototypes and how they envision change in the health ecosystem.

The hackathon had a number of prizes for the winners that included;

  • $1,000 CAMTech Overall prize
  • $1,000 Prize from the Babson Schlesinger Fund for Global Healthcare Entrepreneurship
  • $850 Prizefrom Safe Surgery 2020/GE Foundation 
  • $750 Prize from the United Nations Population Fund and an extra $2500 in post-hack prizes.

The CIF (Implant Finder) and Solar AutoClave teams scoped the first and second prizes respectively, as listed above. The hackathon was also graced by Hon Frank Tumwebaze (an alumni of MUST), the Minster of Information Technology & Communications and Hon Elioda Tumwesigye, Minister of Science, Technology and Innovation. In their respective presentations, the ministers seemed to read from the same script as they both acknowledged the enormous opportunities that technology brings into the health sector. They pledged to support the innovators through an innovation fund and readily availing infrastructure necessary for such activities.  

The 2016 CAMTech hack-a-thon also received special funders and prizes on top of the four prizes awarded and listed above. These were; the UNFPA prize on reproductive health, worth $ 750, the GE (leading medical equipment producer in Germany) prize on medical equipment of $ 850 and the Babson prize for safe surgery-$1000. The most fulfilling experience was finding students from Makerere University College of Health Sciences in the unit of Biomedical Engineering under the Dep of Physiology that the ResilientAfrica Network (RAN) had also engaged with during the Human Centered Design (HCD) training conducted in April 2016. These students won the 750 USD UNFPA prize on reproductive health. Winners of these other three prizes were selected by representatives of the different organizations.

Challenge Description
Reduce the Delays: Innovate the Systemsubmitted by Babson College Adapted from the Lancet Commissions Global Surgery 2030 Report, experts have observed three delays that significantly impact accessibility and availability of surgical care:

• The First Delay — the delay in seeking care—occurs when patients often wait to seek health care because of financial and geographic restrictions, cultural beliefs, poor education, a history of being disconnected from formal health systems, and low awareness of available services or lack of awareness of available services or low confidence in those services.

• The Second Delay — the delay in reaching care—occurs when hospitals with surgical capacity are scarce, meaning the nearest facility can be hours to days away, and depend on varying modes of transportation.

• The Third Delay — the delay in receiving care—occurs when attendance at a hospital does not guarantee treatment, since few first-level hospitals can provide comprehensive emergent operative care. In addition, resources that do exist may not be mobilized in a timely manner.

How will the innovative product and/or service that your team creates address one or more of these three delays? How does addressing this delay improve the overall service and business of the healthcare organization that may employ your innovation?
Improving Medical Equipment in LMICssubmitted by Safe Surgery 2020 How might we increase surgical volume at district-level hospitals by reducing the number of cases that must be referred or cancelled due to out-of-service medical equipment?

At any given time, an estimated 40% of medical equipment in hospitals in low- and middle-income countries is out of service – compared to less than 1% in high-income countries. When a critical piece of equipment, like an X-ray or ultrasound machine, is down, surgical teams are often forced to refer emergency and essential surgical procedures until the equipment is back up and running – sometimes weeks, or even months. Teams tackling this challenge at the Global Surgery Hack can design their solutions around a number of root causes including accessibility of appropriate spare parts and accessories, availability of context-appropriate medical equipment on the market, access to training resources including appropriate manuals, lack of test equipment, and supply chain management, with an emphasis on creating sustainable models. We prefer teams not design their solutions around Bio-Medical Equipment Technician training.
Assessing Intra-abdominal Pressure We need an objective way to assess intra-abdominal pressure. For example, this can help decide whether the abdomen can be closed or not, such as when deciding on primary closure versus silo for gastroschisis.
Cost-of-Service Calculator How can we help patients and their providers compare costs of alternative treatments? Is there a workable way to develop an algorithm which would enable patients in poor-resource settings to receive reasonable and affordable treatment? We need some type of “Cost-of-Service-Calculator”, which would include a choice of technology, capacity to pay, effectiveness of treatment regimes, and relative convenience for the users.
Accessing Test Results It is difficult to access to diagnostic test results in remote surgical centers. Can we develop a way to reliably obtain these?
Laparoscopic Surgery Training Training new surgeons in laparoscopic surgery techniques is often difficult. We need an affordable, high quality simulator that would give young surgeons experience and confidence and enable experienced surgeons to train with new techniques without exposing patients to risks.
Auto-Transfusions in Organ Abdominal Traumas There is a need for a better alternative to straining blood through gauze, for patients experiencing abdominal traumas, such as splenic/liver injuries and ruptured ectopic pregnancies.

The usual method adopted in low-resource settings involves using a few layers of autoclaved gauze to filter blood and clots from the peritoneal cavity into sterile containers, and then inject these into blood bags for transfusion in patients with ruptured ectopic or other conditions where there is ‘clean’ blood inside the body.

While this method is inexpensive and effective, it can be cumbersome, as the blood has to be scooped out of the peritoneal cavity, handed over to another person to filter and then filled into a blood bag before it can be transfused. All of this has to be done quickly to avoid further bleeding. It is also possible for loose strands of gauze material to pass into the filtered blood container.

An ideal alternative would be a sterile device that combined a funnel with a filtering layer and a detachable collection container that had an anti-coagulant that could be removed and connected to a blood-transfusion device.

The team innovating this type of instrument will need to figure out how to fit the parts together, get the right mix of components, make it leak-proof, sterile and cost-effective.

Safe, Effective Instrument Removal Mops and instruments that are left behind in body cavities before closure cause serious complications and often require multiple surgeries. We need to develop a warning system to alert surgeons of equipment left behind.
Alternatives for Blood-Oxygen Transport There is a need for providing tactile sensation to a consultant who is giving tele-consultations.
Alternative Power Sources in Operating Rooms Operating rooms need reliable power to function properly. We need to develop a mechanism to employ solar and alternative power sources to ensure safe and effective nighttime operations, instrument sterilization, lighting, suction, and anesthesia.
Vertebral Level Identification It’s often difficult to identify inter vertebral space l3-l4 or l4-l5 especially in fat people and non-cooperative patients leading to frequent piercing.
ERM System for surgical patients There is a lack of computerized tools in Ugandan Hospitals to electronically manage patients’ surgical information, as well as locating the nearest health institutions that carry out surgical practices. This has led to many deaths mostly for the cases where we have had accidents that need surgery.
Locally Developed Underwater Seal Chest Drainage Underwater seal chest drains are a system that allows drainage of the pleural space using an airtight system to maintain subatmospheric intrapleural pressure in which the underwater seal acts a one-way valve. Unfortunately, this improved system is not readily available, can we develop an alternative solutions?
Efficient Suction Mechanism Surgeons in low-resource settings need an efficient suction mechanism for use on surgery wards.
Sterile Blood/Fluid Warming There is a need for an efficient system for warming fluid or blood, without contamination, during surgical resuscitation.
Lighting in Surgical Operations Surgery wards in LMICs need portable and affordable lighting systems for use during surgical operations.
Improving Microscopic Ear Examinations, Evaluations, and hearing aids Microscopic examination of the ears in clinics is cumbersome, due to the need to reset equipment for each ear. The process takes too much time and effort, so there is a need for more efficient tools for surgeons.

In addition, hearing tests are not readily available in clinic and machines are not robust. Hearing aids are very expensive and difficult to obtain and fit.
Airway Forceps for Improving Foreign Body Removal Many surgical wards lack adequate forceps for easy and safe removal of oddly shaped and smooth foreign bodies from the airway.
Pressure Sore Management When a very ill patient is admitted or operated upon, they are prone to developing pressure sores. The sores are a nightmare given the high caloric demand they pose on the already stretched resources. Finding a dressing, bedding or other approaches that can reduce the risk of developing pressure sores or enhance the management when the sores develop is still a challenge.
Antibiotics for Wounds Wound infections have a serious impact on the morbidity and mortality of surgical patients. A number of factors contribute to wound infections, however, microorganisms and bacteria are two major causes. Wound infections can lead to wound sepsis, systemic sepsis and delayed healing, prolonging a patient’s stay in the hospital, which is associated with higher expenses and a higher risk of hospital-acquired infections.

Doctors and surgeons could benefit from a solution that could help doctors and surgeons determine the appropriate antibiotics for patients with wounds, including being able to test their sensitivity to these treatments.
Potassium Blood-Level Management Patients who have elevated levels of potassium before, during or after and surgery face an increased risk of cardiac arrest. There is a need for an innovation or device that can monitor potassium blood levels.
Bandage/Gauze Care for Wound Patients Burns patients are subjected to numerous wound-dressing changes, which are often uncomfortable for the patient, and require significant time/staff for the hospital. Since the bandages must be replaced and changed multiple times a day, it is also an expense to keep buying the gauzes. It would be very helpful to have create a new type of bandage or gauze that could be easily wrapped and unwrapped around the affected area, and that could be sterilized and re-used.
Surgical Chest Tubes Many hospitals lack chest tubes for surgeries. If excess chest fluids are not drained from the patient, the patient will develop breathing problems, which can lead to death. There is a need for reusable tubes and/or multipurpose tubes to help alleviate this issue.
Follow-up Communication and Care Providers need a better way to stay in touch and communicated with patients after surgery. Often, it becomes very difficult for doctors to monitor patients who live in poor, remote areas, especially if they do not have access to proper nutrition and healing treatments.