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Enevra in Uganda

Gulu

On the 16th of April our group of four split up and two members went to visit the orthopedic workshop at Gulu hospital in the north of Uganda. We aim to enable more partners in Uganda to produce our prostheses independently. The goal is an evenly distributed access to prosthetic care across the whole country. In comparison to Kampala, Gulu is less busy and has way better infrastructure. The hospital is the largest we visited this year and is still too small for the number of patients that seek medical care. The workshop itself has 9 employees and over 300 people on the waiting list for just a new lower limb prosthesis.

Maria in front of the orthopedic workshop of Gulu Hospital

We introduced our system and especially the fitting of our prosthesis. Furthermore, the staff in Gulu measured two patients with the help of an instruction manual and send us the data beforehand. We then printed their individualized prosthesis and brought them with us to Gulu. During the next day, the staff fitted the prosthesis to the first patient under our supervision and gave it the final touch with some brown leather coating and padding. They are very interested in future collaboration and are looking forward to seeing us again.

Maria and Johannes together with an of the employees of Gulu’s orthopedic workshop

The northern region of Uganda was highly affected by the civil war. The now oldest still working orthopedic technicians in the country founded it back then. They mostly take care of lower limb amputees and rarely upper limb amputees, because the protheses costs are 5 to 10 times higher than a leg prosthesis depending on functionality. After being sceptical at first, they were more than satisfied with the outcome. It convinced them with its lighter weight, faster fitting, and less workload. And for most patients, functionality has not the highest impact. They want to feel “complete” and “normal” again, as one patient put it. So, they get treated like “normal” people with new opportunities. Functional upper limb prostheses look very robotic and need regular charging, which often cannot be provided on the county side. Therefore, the demand for cosmetically pleasing prostheses with long duration is higher in rural settings

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Enevra in Uganda

Potential associates for our project

Next to the three fittings in the last couple of days, we had two Interviews with potential associates to support us locally in Uganda. We hope to introduce them to you next week when all the agreements are settled and signed.
Meanwhile, Johannes upgraded the software with a feature to install updates if necessary so we can keep our partners always up to date. We also analyzed the feedback the patients gave us after they received their prostheses and evaluated the new input. A brighter variety of colors and forms of the hand to choose from were the most frequently proposed ideas. The feedback from both the patients and the staff we work with is necessary to further improve the system and to meet their individual needs.

A picture of the workshop from the outside

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Enevra in Uganda

Recent fittings at CoRSU

In the last three days, we provided three patients with their prostheses. The patient with the short stump came back to try the newly developed method with the inlay socket. It worked out even better than we expected, so we can now also offer a solution for shorter residual limbs Additionally, a twelve-year-old girl and a middle-aged women got their prostheses as well.

Wearing our newly developed prosthesis for short stumps




Wilko also found time to explain and teach the staff at CoRSU the basics of designing and manipulating their own 3D models on the computer. In the field of 3D printing, Uganda is still at the beginning. However, we do not only try to implement our 3D printing system but also try to help and offer training to the staff, so they understand the general ideas of 3D printing. It is especially of interest for medical engineers to fix broken equipment with self-created structures because it is often hard to import the necessary spare parts.

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Enevra in Uganda

The Ugandan Health Care System

On Sunday we met with the head of the orthopedic workshop from Gulu. He gave us very interesting insights about the health care system in Uganda and the work environment in his workshop. So, we decided that we will visit Gulu hospital in the following week. The time we planned at CoRSU is nearly over, but after visiting potential new partners we will return for the last 10 days of our stay in Uganda to offer the staff training in the 3D printing software.
The problems we face in Uganda: Many patients cannot afford a prosthesis on their own and especially the once for the upper-limb are rarely fitted individually to the patient. Through 3D printing and supplies, you can buy locally. Our vision is to give amputees access to an affordable and individualized upper-limb prosthesis. The health care system in Uganda is quite a challenge because most of the hospitals are private, funded by non-governmental organizations, and the government is not providing enough money, especially for rehabilitation programs.

from left to right: orthopedic head of Gulu, Wilko, Maria, Kaja
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Enevra in Uganda

A very busy day

Today was a very busy day! We saw 3 patients in total, one of them was a 12-year-old girl who came for her measurements. Then the patient we measured on the 6th of April got his prosthesis and felt very confident wearing it in combination with his sunglasses and leather jacket. When our patients are happy, we are thrilled. The third patient, which was the one with the conical and short residual limb came also for his fitting, but, as we expected, it was not easy at first. The prosthesis tended to slip of the stump on the edges. We tried everything we could think of, and then one of the staff had a great idea: They made a plaster cast and produced an inlay-socket to provide a better fixation for the prothesis to the stump. He will return on the 12th of April, and we will try out the new adjustments for the perfect fit.
On the the weekend, we enjoyed our free time after a very busy week and welcomed our fourth team member Wilko to the group.

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Enevra in Uganda

A long journey

Many patients, including the ones we treat, come from all over the country to CoRSU to receive the care they need. Upper limb prostheses in Uganda are still rare and CoRSU tries to fill the gap by also working with different organizations. As Christine Tusiime, the head of the rehabilitation at CoRSU, said: “We want to work with different organizations because what works for one patient, does not necessarily work for another, e.g. Maria gets a prosthesis that works for her, but it does not for Kaja.” Today we measured a patient and will provide him with his first prothesis ever, after he took a 7h trip to us from Lira in the North of Uganda. He not only lost his left arm during a car crash, where multiple people were injured, he also suffered burns and broken extremities. Being a husband and also a father of two children, his life was completely turned around after the accident. To quote his father: “He cries a lot, it’s a challenge”. He was not able to work as an mechanic any longer and could not longer drive his beloved motorcycle. 

We will pay for the first 5 patients, so we can help them to start a new life stage with their brand-new prosthesis. But dealing with money in Uganda is different from Germany. The people here use mostly cash and „mobile money“, which you can exchange via phone number. Nearly everyone has a mobile phone and that is why it gives them access to the digital finance system, even if they do not own a bank account.

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Enevra in Uganda

Arrival of two new team members

Kaja and Maria are on their way to Uganda to join Johannes for the project at CoRSU. Today Johannes gave another workshop for the staff with deeper insights in the software and the production of our product, so that the technicians can try it by themselves for the first time under our supervision. On the fifth of April, we treated a new patient who lost his hand in a car crash. Because of the shorter and more conical anatomy of the residual limb, we faced new, unforeseen challenges. However, with ingenuity and improvisation together with the staff, we will be able to provide him with his individual prothesis. In the afternoon we went for a walk to see the Victoria Lake, the worlds largest tropical lake. The nature on the shoreline around the lake was stunning. We saw a monkey, big termite hills and a beautiful moorland with reeds and papyrus.

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Enevra in Uganda

Teamwork

Johannes is currently working full time for the project and is improving our self-developed software whenever he has some spare time. On the 31th of March, he gave a workshop to the staff showing them the whole manufacturing process and our new idea to fixate the prosthesis to the stump. The next day, a second patient arrived for taking measurements of his affected limb. The patient is a seven year old boy and currently lives in foster care. Johannes started the printing process together with the staff and introduced them to our software. Two days later, the patient tried out his brand new prothesis and gave a highfive to CoRSU’s head of rehabilitation with a big smile on his face.
Currently it is very difficult in Uganda to import medical supplies from Europe or other countries. To avoid this issue, instead of importing a prosthesis, one can import filament for a 3D printer which doesn’t fall under the medical supplies term. This way the patient can still be treated and provided with their individual prothesis. Furthermore, the hospital can print other important accessories, e.g. faceshields.

CoRSU’s orthopedic workshop near Kampala (for more information about CoRSU have a look at our post from the 30th March here)

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Enevra in Uganda

Our first patient

We saw our first patient already during our trip last year and were very excited to meet him again. Unfortunately he has some trouble with sensitive spots on his stump and phantom pain, which makes it hard for him to wear any prothesis at all. Nevertheless Johannes took his measurements and was able to start the first printing session after he solved some problems with the filament.
Here are some insights into the orthopedic workshop at CoRSU (https://corsuhospital.org/index.php): For example, at the moment they provide patients with a prosthesis after lower limb amputation, shoes for clumb foot and casts for broken bones or deformations.

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Enevra in Uganda

Uganda again!

On the 24th of March Johannes travelled alone to Kisubi, near Kampala, in Uganda. It was quite a challenge, but he managed everything very well. The next day, he visited CoRSU for the first time and introduced himself to everyone. CoRSU is a private, non-profit organization in Uganda. CoRSU provides help to people with disabling physical conditions, by ensuring accessibility of preventative, curative and rehabilitative services in Uganda and its neighboring countries. Johannes was able to set up our system in a lab of CoRSU’s orthopedic workshop facility that is specifically for 3D printing. CoRSU already works together with other organizations which use various 3D-printing techniques and therefore has some experience. In the next days Johannes is going to meet the first two patients!