Design on a Global Scale

Today, nearly 60 percent of babies develop jaundice in the days after their birth. Caused by a buildup of bilirupin in the blood, the disorder is characterized by a yellowing of the skin and eyes, and if left untreated, can lead to brain damage in newborns. 

In hospitals like the Duke University Medical Center, one of the standard treatments is light-therapy using a specialized incubator or blanket, where a child is placed under blue lights that can break down the excess bilirubin molecules in their blood. But in countries with limited resources, this therapy is rarely available, and parents are often left with ad hoc treatment options––like daily sunlight exposure––that don’t effectively cure the more severe forms of jaundice.

This was one of the problems Duke BME students attempted to solve through their senior design course in the Duke-Makerere University BME partnership, a collaborative program between Duke University’s Department of Biomedical Engineering and the BME Program at Makerere University in Kampala, Uganda. 

Led by William (Monty) Reichert, the Theo Pilkington Professor of Biomedical Engineering and Global Health, the program was created in 2016 after Reichert spent the previous academic year as a Fulbright Scholar teaching courses and revising the BME department at Makerere University.  Upon his return, he proposed the creation of a unique partnership between the schools that would allow Duke students to work with their Makerere counterparts to approach engineering problems with cost-efficient and practical solutions that can be implemented in resource-limited settings.

In the years since the program’s creation, student projects have included a system to improve vaccine transport, a point-of-care screening test for preeclampsia in pregnant women and an oxygen regulator to control the supply of oxygen to newborns in the neonatal ward at the Mulago Hospital in Kampala, Uganda. Students have also tackled the issues surrounding jaundice by creating a ‘jaundice crib’–– a large box threaded with cost-efficient blue LED lights to provide light therapy from above and below.  

“There is no shortage of problems in resource-limited settings that need engineering solutions, and they don’t always need particularly sophisticated ones,” says Reichert. “If you’re looking to see how your work is relevant on a human scale, then there is great value in understanding and devising solutions to these challenges.”

Nimmi Ramanujam, the Robert W. Carr Jr. Professor of Biomedical Engineering and the director of Duke’s Global Women’s Health Technologies Center, has made human-centered design a signature of her course, BME 230: Global Women’s Health Technologies. During the program, which is open to students in the Pratt School of Engineering and the Trinity College of Arts & Sciences, students work with clients across Duke to rapidly prototype tools that can benefit girls and women in energy-poor communities. In addition to teaching practical engineering skills, like 3D printing or soldering, Ramanujam aims to teach students how they can empathetically approach engineering problems to deliver a creative solution that will serve the needs of females in the least resourced parts of the world. 

The main problem the students try to address through the course is light poverty, which affects communities who do not have consistent access to electricity. The issue disproportionately impacts women. During the semester, student teams collaborate with clients who work closely with women and girls in international communities and use their feedback to refine their prototypes and create low-cost, renewable-energy-based sustainable lighting solutions that can be easily made and used in resource-limited areas. 

“The course strives to help students navigate the human-centered design process in a way that helps them contextualize the problem and solution to the needs of the specific community, something that is often overlooked,” says Ramanujam. “Many of the students who have taken the design course travel through Duke Engage, where they teach the curriculum they have just learned to women and girls across the globe, who then teach it to their respective communities. The idea is to create a virtuous cycle of capacity building and empowerment through design thinking. Over the last five years, 37 of the more than 100 Duke students who have taken this course have directly or indirectly impacted more than 1000 girls and women across four continents.”

Robert Malkin, a professor of the practice in BME, uses his design course––Design for the Developing World––to challenge students to think outside the box for their designs while still being realistic about cost and utility. 

Students typically create five to 10 new products a year, which are then used in hospitals in resource-limited settings. One of the more enduring and far-reaching projects created through Design for the Developing World is the Pratt Pouch, a single-serve, ketchup-packet-like container that protects antiretroviral medications when not refrigerated – critical to preventing mother-to-child transmission of HIV after childbirth in warm regions or in places with spotty electricity.

As global health education expands in Duke BME, Reichert, Ramanujam and Malkin are hopeful that the students who participate in their courses are broadening not only their technical, cultural, problem-solving and entrepreneurial skills, but also their understanding about how they can use engineering to help others as they work in resource-limited settings around the globe. 

“If you really want to help the developing world, you need to be in the developing world,” says Malkin. “These programs give students an opportunity to do just that.