Designing for a sustainable continent and planet

“A long way from here, in a tiny village called Vettuuvanam near the city of Vellore in India, a fifth child was born to a family of very modest means. The father already declared that the fifth child would be special. The family had an abiding commitment to education, which no doubt allowed that young child’s curiosity to flourish. Sudesh Sivarasu was that child born into the family and The University of Cape Town (UCT) snatched him away in 2011 and our story was changed forever.”

So said the dean of the Faculty of Health Sciences (FHS), Associate Professor Lionel Green-Thompson, in a stirring introduction to what would be an absorbing inaugural lecture by Professor Sudesh Sivarasu.

Professor Sivarasu – the South African Research (SARChI) chair in Biomedical Engineering and Innovation, the director of the Biomedical Engineering Research Centre and the deputy head of the Division of Biomedical Engineering within the Department of Human Biology in the FHS – enthused his audience in his lecture, titled “Engineering Tomorrow’s Medical Devices for Africa’s Unique Needs”, where he shared his insights into the key questions and challenges faced in navigating technological breakthroughs as an innovator.

His lecture was also an opportunity for him to spotlight his experience of the research group he heads in the faculty, UCT MedTech, where postgraduates create and build medical devices and prepare innovations for clinical use.

Sivarasu makes the distinction between a health technology being affordable and it being appropriate. “You can make the technology cheaper by reducing the cost of the materials that are going inside making a device, but that doesn’t make it appropriate.” The entire focus of UCT MedTech has been on creating health technologies that are appropriate because when technologies are appropriate, they are affordable in the long run.

Social responsibility

Referring to the unique health challenges in Africa, Sivarasu pointed out that Africa has the least amount of expenditure and investment going into healthcare, as well as the lowest number of physicians on the ground. The continent needs solutions that take these hard truths into account. As an engineer, Sivarasu believes that it is technology that will bridge and transform healthcare from reactive to proactive means. He cited the use of telemedicine, which has promoted efficiency and revolutionised healthcare delivery, and which soared in uptake during the COVID-19 pandemic.

But appropriate technological innovation requires engineers to consider the unique needs and features of recipient population groups. He cited the example that his team had identified unique structural differences in the shoulder anatomy in people of African ancestry. Following this, the team is in line for making patient-specific, population group-specific implants. Additionally, he and his students discovered a pioneering way to make asthma pumps more serviceable to children and the elderly: Easy Squeezy is a sleeve that is easily slipped over a regular metered-dose asthma inhaler and reduces the amount of force needed to activate the pump. A cartoon character illustration on the sleeve is designed to make it appear less intimidating to children.

“New innovators are trying to solve the problem with the normal intention to save people’s lives.”

As another case in point, he cited the challenges with epilepsy screening among people who have tightly curled hair. When a person goes to a clinic for epilepsy screening, electrodes are placed on the scalp to pick up electroencephalogram (EEG) signals from the brain. Clinicians struggle because the electrodes do not sit firmly on the scalps of people with tightly curled hair. To address this challenge, Sivarasu and his team of collaborators developed an epilepsy screening headset. An additional advantage is that these headsets can be taken directly to rural communities, which are often remotely situated from clinics, to conduct pre-screening assessments. This innovative approach allows medical professionals to reach patients who would otherwise have limited access to diagnostic services and treatment.

The vast majority of innovations fail

Speaking of the challenges faced by the biomedical engineer, he shared how in technological situations, 90% of all innovation fails. And in the field of product innovation — which is what biomedical engineers are interested in — this increases to 95%. One of the reasons for this is that innovators typically do not know what their destinations are.

“New innovators are trying to solve the problem with the normal intention to save people’s lives. They want to change healthcare delivery through new technology, but they have a limited understanding of how to reach that destination,” he said. He provided a map for medical device innovation, similar to the London Tube network, and used the map of the Tube network as a metaphor for the complexity of the innovator’s journey: though everyone’s ultimate destination is the same, where each person begins and how that person proceeds with the route is where they diverge from their counterparts. And more often than not, innovators lack the guidance to reach their final destination.

“Who’s the most important person in the healthcare innovation equation?”, he asked. The most obvious answer, he said, may be the patient, but while the patient is the beneficiary of a health technology innovation, Sivarasu wonders whether the patient has a say in the technologies that get approved for use. A challenging question could be whether the clinician is the party that links the engineer to the patient, or the healthcare facility, or the health insurance company. Despite this fundamentally challenging question, if the clinician, the healthcare facility and the insurance company are not factored in, the innovation has a high probability of failure.

Sivarasu’s undertakings

Sivarasu, however, has much innovation success to be proud of, including the robotic exoskeleton, reScribe, a collaboration with his team that assists in restoring hand and finger movement to patients recovering from strokes. The patient puts their hand on the exoskeleton and the handwriting therapist puts their hand over the patient’s to guide the patient through the writing process.

A unique feature of the night was Sivarasu’s MedTech pupils showcasing their devices outside the lecture theatre. Included in the product range were a below-elbow prosthetic arm to assist trans-radial amputees with their activities, ventilators developed during COVID-19, an orthopaedic fracture fixation system, a walking cane to aid the blind with orientation, and an intrauterine device, FlexiGyn, that enables gynaecologists to diagnose and treat conditions of the uterus without using general anaesthesia. In addition, four startup companies that emerged from Sivarasu’s inventions out of MedTech were present to demonstrate their innovations.