Between January 6 and January 20, six engineering students from RPI, led by professor Eric Ledet of the department of biomedical engineering, traveled to Cape Town, South Africa, in order to assess the unique needs of under-resourced medical clinics in the area. The findings from this trip are currently being used as the basis for the students’ senior design project—a low cost cushion to prevent and monitor the development of pressure ulcers for use by paralyzed patients living in South Africa’s rural areas—and sparked other research initiatives taking place at the Institute. In addition to learning about South African health care, the members of the expedition learned about life in South Africa as a whole, and gained insight into the struggles of underprivileged South Africans.
Ledet and students Nadeel Ali ’12, Matt Dion ’12, Mark Guirguis ’12, Amanda Johansen ’12, Alexandra McGregor ’12, and Josh Peterson ’12 were hosted by Stellenbosch University, a major South African research university near Cape Town, which collaborated in organizing the trip. Every day during the two-week venture, students would wake up to get breakfast, meet their driver for the day, and then travel to two or three clinics or hospitals. Twenty-six medical facilities were surveyed in total, spanning the entire breadth of South African medical care.
South African health care consists of two hospital systems—one public, and one private. The private system is very similar to the one present in the U.S.—individuals purchase insurance, gaining access to top-notch facilities and services as per their insurance contract. According to Ali, the private hospitals are “as nice or nicer than the ones here in the U.S. Everything is state-of the art.”
Citizens who choose not to buy insurance, or cannot afford it, have free access to the public health care system. The public system is organized in a pyramid structure. At the bottom level are clinics, dispersed throughout the cities and more rural areas, typically staffed by a few nurses. The next level of the pyramid consists of district hospitals, followed by primary hospitals, secondary hospitals, and tertiary hospitals at the top. Each level represents a higher level of medical expertise and sophistication of equipment. Patients are typically admitted into clinics and then referred up if their problems are more severe. Emergency cases gain admittance to higher tier hospitals without the need for referral.
The students witnessed an astounding dichotomy between the two systems. “Inside of a private hospital, it’s almost like a Hilton,” said Dion. “Inside major public hospitals, there’s paint peeling off the walls and massive wards short on staff.”
Members of the group pointed out that major problems for tertiary public hospitals are infrastructure and a shortage of resources and personnel—not the quality of doctors and equipment that the hospitals do have access to. To illustrate, Ledet described a trip to a large, public hospital. “[It was] massive. [There were] 110 beds in prenatal, three times the size of Albany [Medical Center]; state of the art equipment for every baby. But it was one-hundred-some degrees outside, and there was no air conditioning,” said Ledet.
Ali was particularly impressed with the ability and perseverance of public care system doctors in light of the extreme demands placed on them by the personnel shortage. “They are very passionate and caring physicians. There’s lots of demand and not enough professionals. Physicians work really, really hard, and have deep knowledge in many fields of medicine.”
Many of the hospitals visited by the team had major sanitation issues due to the scarcity of available resources. Equipment which would never be reused under any circumstances in the U.S. was commonly reprocessed. In tertiary hospitals, catheters were reprocessed in-house. “They have a different standard for reprocessing than we do. For someone from a well-resourced system, that’s a scary thought, but that is what they have to do,” Ledet stated.
In one scenario, the team examined sanitary conditions at a busy dental clinic, one of very few. In spite of high demand, the team discovered that the clinic only had two sets of dental instruments. To keep up with the crowd, the clinic would sterilize instruments by cold sterilization—dropping equipment into a bowl and pouring a pathogen-killing liquid on it—rather than autoclaving. The Rensselaer team expressed concern to the dentist, questioning whether the clinic could unwittingly use cold sterilization after extractions for patients with HIV. As it turned out, there was no way to know if a patient was HIV-positive without the patient declaring themselves to be such, and the dentist herself did not know how many patients of hers could have had HIV. While she reassured them that those who did identify as HIV-positive had tools cleaned by autoclave, the team was still surprised at the risks being taken.
“The methods are not equal,” said Ledet. “What they need is a faster autoclave—it comes down to a resource issue.”
In addition to getting the opportunity to investigate the medical challenges faced by South Africans from a biomedical engineering standpoint, members of the expedition also learned valuable lessons about life in the difficult conditions of rural South Africa, and about themselves. On one occasion, the group spent an afternoon in a rural township. “There were thousands of shacks. The nice ones were made of pallet; the not-so-nice ones, tarps and garbage. There was no plumbing and no sanitation. Generations of a family were living in the same dwelling the size of a college dorm. We felt very out of place—not only because the color of our skin was different. The fact that I had shoes was different. Conditions were abysmal, and it was difficult to walk,” reflects Ledet.
In the shanty town, the group and interacted with a small group of children they came across. Ledet described the experience as remarkable: “We couldn’t speak to them, so we started goofing around. Some of the students made faces at them, and they made faces back. We took pictures on our camera and showed them, and they got excited. We shot a video of them and showed them—they were completely spellbound. It was clear that none of them had ever seen a video recording of themselves before.
“We communicated to them through our guide. Four of them had never owned shoes. They were very different from us, and very curious. They had no preconceived notions of us, and just followed us around,” Ledet said.
This experience gave some students extra drive to pursue their career goals. “It was eye-opening,” said Ali, “to see people live in poor conditions and still be happy. It gave me genuine drive to alleviate [them] with my expertise.”
The group also had the opportunity to experience some of the natural wonders of South Africa. “We saw some incredible, breathtaking things. We went on a hike and when we came back, there was a troop of baboons in the parking lot. Another time, we went on the beach and were walking next to penguins,” said Ledet. Upon reflection, Ledet pointed out the dichotemy in the emotional experience of the journey. “We experienced a range of emotions, from penguins on the beach and baboons in the parking lot to walking around in a shanty town; both good and bad.”
The findings from January’s trip are currently being used as the basis for the students’ senior design project—a low-cost cushion to prevent and monitor the development of pressure ulcers, for use by paralyzed patients living in South Africa’s rural areas. Their main objective was to design a device that can be assembled quickly and cheaply, and be easy to repair, so that manufacturing and maintenance would not put too much additional strain on the already-stressed public medical system. Dion explained that the device would be made out of as many local parts as could be found, using bicycle parts, for example. “We’re trying to keep it as low-tech as possible so people in rural areas can fix it all on their own,” said Dion.
Additionally, information from the South Africa trip is being used to spearhead several research initiatives at the Institute. The students were challenged to design a portable solution, to enable delivery for South Africans in rural locations. Ledet explained that there was a need to make simpler things to bring to the patient, rather than expect them to go to a hospital. “We’re not in a position to make mass transit, but we can help make equipment more portable, robust, and sustainable,” said Ledet. The project is currently still in preliminary stages.
Ledet hopes that contacts in the chemical and biomedical engineering and games and simulation science department, among others, at Rensselaer will find these research challenges interesting, stating, “We’ll have broader impact if we can get others involved and leverage the power of the entire institute.” For example, the RPI team had visited other South African schools during their trip; including the National Institute for the Deaf. The school had given the students iPads to use as teaching tools, but no one had any applications. Now, the team hopes to investigate working with GSAS students to create learning and teaching applications.
A large part of the recent trip was organized by the Office of International Programs, and was made possible largely because of RPI’s efforts to promote international exchange programs. Ledet believes the experience is beneficial, and a great opportunity for anyone considering study abroad. The team also contacted the Advising and Learning Center about forging connections for pre-med and pre-health students to become volunteers in South Africa in the summers.
“I made good connections with physicians over there. It was inspiring how they were working not for wealth, but from the [desire] to help. I’m going into the medical field, and this really helped shaped my outlook on how I want to pursue that endeavor,” said Ali. “It was eye-opening for sure,” Dion added.