Sarah Rogers

In hospitals in Uganda, there are “graveyards” of Western medical equipment, Duke biomedical engineering professor Ann Saterbak says.

“Like, literally behind the hospital,” she says. “They’re just piles.”

When higher-resourced nations send medical equipment to Uganda, it’s doubtlessly with the best of intentions — but good intentions aren’t enough.

“You mail it over to the other side of the world, and most Americans are like, ‘Oh, well, of course, this is the best in the world. Yeah, it’s gonna work,’” Saterbak says.

But it doesn’t — not in Uganda, where the electrical power supply can be unstable, and it can be difficult — if not impossible — to source parts for repairs.

So the equipment languishes, unused, and in the meantime, the hospitals’ needs for medical devices persist. Given the challenges facing healthcare facilities in Uganda, this can be a matter of life and death.

For Saterbak, DukeEngage — an eight-week program in which students work with community partners to address key issues — became a way to support a collaboration that could address the needs of Ugandan healthcare facilities.

She already had a foundation to build on. A Duke colleague, Monty Reichert, had a longstanding collaboration with Makerere University in Kampala, Uganda, where he spent a Fulbright year teaching in their biomedical engineering department. He had also facilitated a DukeEngage program in Uganda, led by Engineering World Health (now merged with Engineers Without Borders).

Several years ago, when Reichert was approaching retirement and DukeEngage was shifting its program model away from third-party organizations, there was an opportunity to build something different, Saterbak says.

“I was not interested in setting up something that looked like us flying over there and fixing those problems,” she says.

With Dr. Robert Ssekitoleko, head of biomedical engineering at Makerere University, Saterbak proposed a DukeEngage program in which students visit Ugandan healthcare facilities, take note of their needs, and design functional medical devices made only from locally available materials.

But this program isn’t just for Duke students. Through the Duke-Makerere Design Fellowship, it brings them together with an equal number of biomedical engineering students from Makerere University — who Saterbak says understand the Ugandan context better than their American counterparts ever could.

In addition to being great engineers, Saterbak says, the Makerere students understand how to get things done.

“They’re like, ‘No, this won’t work in our context,’” she says. “They know how to get tools and materials from local suppliers.

“This would just never work without them,” she concludes.

Dr. Robert Ssekitoleko is convinced that working with limited resources spurs innovation and creativity. As an example, he points to the no-frills makerspace where the Duke and Makerere students design their prototypes — the Design Cube.

“As you can see, it’s a shipping container — two of them put together,” he says. “We could have invested lots of money in building a bigger building, but we thought, okay, for the resources we have, the time that we have, let’s put something up very quickly.”

The Design Cube has all the key resources that students need. While the space is equipped with a 3D printer, tools, and other devices, Ssekitoleko notes that in the design stage, successful prototypes can be made of even just paper.

“If you have an idea in your head and we need to make it into a physical product, the Design Cube helps you to at least get those ideas out your head onto something that is tangible,” Ssekitoleko says.

Ssekitoleko says that Duke students, coming from a highly resourced country and university, have to increase their creativity to work in the Design Cube.

Saterbak agrees. In fact, to help Duke first-year engineering students learn how to design for resource-challenged communities, she set up a mirror makerspace at Duke. It’s just a bit smaller than its Ugandan counterpart — made of one shipping container instead of two.

In spite of its limitations, many of the devices that originated in the Design Cube are not only functional, but inspiring — like the NeoNest, a warming device that keeps premature infants at safe temperatures while they’re being transported to health facilities.

Along with fellow Makerere student Joseph Okileng and Duke students Sophia Singer and Saajan Patel, Vivian Arinaitwe was a member of the team that developed the NeoNest device. She says the device can be used for up to 24 hours in areas with unstable electric supply.

Arinaitwe now leads a startup to help develop health technologies for lower-resourced areas. She also helped coordinate the Duke-Makerere fellowship this summer.

She says Duke and Makerere students bring different skills and capacities when it comes to addressing healthcare challenges through design.

“The students from Duke University have had the chance to learn and use sophisticated equipment and get very many skills that they could utilize in this program,” Arinaitwe says. “The Makerere University students have the expertise in understanding the context, understanding the healthcare system, and easily collaborating culturally with different healthcare facilities and personnel. So bringing these two together and merging them helps us to build a solution to a healthcare problem that is not only contextually appropriate, but also sophisticated to the context that we are building it in.”

The solutions coming from the Design Cube are manifold. This summer, students prototyped devices to prevent infants from losing oxygen supply, detect jaundice in newborns within 24 hours, and apply negative pressure to help difficult wounds to heal.

Duke engineering student Chris Wyrtzen E’26 says that he was drawn to the DukeEngage Uganda program out of a deep desire to make an impact.

“I’m passionate about developing engineering devices for lower-income settings,” he says. “I’m so glad I came, because we got the really, really special opportunity to…build solutions that will directly be helpful for hospitals here on the ground.”

While these devices offer promising solutions, Dr. Robert Ssekitoleko offers a disclaimer: engineering takes time.

“There are checkpoints to ensure that the devices that we come up with are going to be safe,” he says. In this context, he says, four years is considered a short time to bring a device to market.

But Ssekitoleko notes with pride that three devices from the Design Cube have gone on to win prizes at international engineering competitions, and he connects students with funders so that they can continue to develop them.

The Duke and Makerere students say that they’ve learned that engineering goes beyond the product — it’s also about the process. And connecting with their teammates is an integral part of it.

“I think collaboratively, from the beginning, we’ve been working very well together,” Duke student Siya Jain E’28 says. “Even if someone disagrees with someone else, we’re able to either come to a consensus, understand the other person’s point of view, or come to a compromise.”

“There are moments where I had to adapt to different approaches,” says Makerere student Timothy Otiting, “because maybe what I was thinking was not exactly what other team members were thinking.” In these cases, he says, they first informed themselves about each others’ positions, and then made a collective decision.

“This experience has changed my thinking towards engineering,” says Makerere student Patricia Nagawa. “I’ve learned that teamwork is really one of the main actual reasons to achieve progress.”

And since the Duke and Makerere students don’t just work together — they live together, cook together, and go out into the city together — the program allows them to build relationships that aren’t restricted to the Design Cube.

“I think the biggest thing I’ll take with me is, of course, the people that I’ve met, but also the things that I’ve learned from not just engineering, but personal experiences,” Jain says. “I feel like we’ve all created a really great bond and we’re able to learn and grow from each other.”

Wyrtzen echoes this.

“I hope to take [away] valuing people and relationships more than the product moving forward,” he says, “because I’ve realized how much people really prioritize each other here and love each other really well.”