Hi everybody! This post is a little bit different from all of my others but I wanted to add it because I think its interesting. One of my requirements to get funding for this trip is to write a needs finding report for Mawenzi while I am here. That basically means that I am supposed to interview doctors and keep my eyes open for engineering needs that I think could be improved by biomedical engineers. I came up with a lot of ideas but the one that stood out to me was the need for cervical collars (neck braces). I am still writing the report but this is an update of my progress so far!
Imagine this: It is getting dark on your 45-minute walk home from work in Arusha, and it is too late to catch a public van. A boda-boda driver (motorcyclist) pulls up next to you and offers to drive you home for 1000 shillings (50 cents). It may be tempting to hop on the back to save time, but boda-bodas are really very dangerous.
The drivers rarely wear helmets and they have none for their passengers. There are obviously no seat belts on the motorcycles and there does not seem to be any regulation on who can be a driver. However, in a largely rural country of 50 million people without a lot of infrastructure, boda-bodas are necessary. A man I talked with in Moshi named Rajab told me that he could make around 20,000 shillings (9 dollars) in a day as a boda-boda driver because demand is high. That is really not bad for a country where, according to the World Bank, 28% of the population lives below the poverty line of $1.25 a day. Not surprisingly, a lot of young men in Tanzania without clear job opportunities become boda-boda drivers even without qualifications to drive safely. It is a very complicated issue, but the main point is that there are a large number of traffic accidents involving boda-bodas every year, many of which lead to severe injuries.
In an interview I conducted with a medical student at KCMC named Natal, I was told about a situation in which a man was brought into the ER after a boda-boda accident with a broken neck. It was apparent that there was some damage to his spinal cord because he had no sensation or movement below his abdomen. In developed countries the procedure for handling a damaged spinal cord is universal: it needs to be immobilized until a physician can diagnose. However, in this case at KCMC the man was not immobilized and was even “looking around in a panic after his injury.” This is unacceptable because if the neck is broken then the spinal cord could be damaged even further from his movements, even leading to death from suffocation.
A nurse I interviewed at Mawenzi named Maria told me that they if they have an injury like this they sometimes position pillows on either side of the head and tape across a patient’s throat if they feel there may be damage to the neck. However, she admitted that in such a situation they would be more likely to have a nurse “watch the patient.”
Finally, to really show why I feel that this is a need worth addressing, there are no cervical braces in the whole of Mawenzi hospital. I conducted an inventory of all the medical equipment in wards at Mawenzi as part of my work with EWH, and there were no braces anywhere including in the ambulance, the surgery ward, and even in the physical therapy ward.
The procedure is as follows if a person sustains a neck injury. He is brought to the hospital in an ambulance or a streetcar, often without checking if there is a need for neck immobilization. Then, if the person is lucky and has family they have to go to a pharmacy in Moshi and try to buy one. I have only found braces in three pharmacies in town and none of them would have been large enough to fit me. Further, the most common brace is 65,000 shillings which is $30. This is obviously too expensive for many people considering the $1.25 poverty line in Tanzania.
An approach to this problem is to try to help hospitals in Tanzania obtain the cervical braces they badly need. The main problem then is money. Great cervical braces already exist but are out of reach of hospitals here because they are too expensive to buy or to give away to patients that need them but cannot afford to pay for them. To be able to make braces at much under the $30 standard, the braces will have to be produced locally in Tanzania. So, I have started getting in contact with companies that may be willing to manufacture a brace.
There are several major foam manufacturing mattress companies in Tanzania that I contacted with hopes of having them manufacture cervical braces with their mattress foam. I created the basic model of an idea for a cervical brace seen below and sent it to the companies. This design is a super basic and rough idea that I put together after a few hours… But I’m sure there are engineers at Duke who could make a really great brace that can work with foam.
I designed this brace in such a way that it would be adjustable for a wider range of people and could be manufactured out of the mattress foam available in Tanzania. In interviews with doctors from America and Tanzania, the doctors emphasized the need to not have to move a person’s head when positioning the collar. In this model, the brace will be slid under the person’s neck and adjusted and tied in front using the many small holes. The material to tie with could be something like shoelaces or even the kanga material that is very common in Tanzania.
Of the five companies I contacted, only Panafrica Enterprises ltd was willing to meet with me to realistically discuss producing a brace. So, I traveled to their factory in Arusha to discuss the braces with marketing manager Mr. Choudhry and production manager Mr. Ibrahim.
The Panafrica factory is located in the Themi Industrial area of Arusha and produces their own polyurethane foam at the factory. The whole process is really cool and you can see an example here (they didn’t want me to take pictures inside the factory).
Once they smooth the tops off of the raw foam blocks they can then cut it to whatever size they want as mattresses or pillows at the factory. The mattresses and pillows are then combined with covers made in Dar Es Salaam and shipped to retail outlets.
In my meeting with the two managers they were very willing to manufacture my prototype brace. They believe it will be able to wrap around a persons neck and work effectively using the materials they have at the factory. They can even do the curving cuts I need like this:
More pictures from the factory:
The “Comfy” Brand is all over the place in Moshi and probably most of Tanzania.
The place was loading and making mattresses nonstop. This is the cheapest way to produce the mattresses and why I think a brace can be made cheaply here.
There is still a lot of work to be done and I hope they finish my brace by the time I leave Tanzania (4 days!). The managers indicated that making the brace with Panafrica would be very cheap (around $2.50 for material + labor costs which is cheap in Tanzania) and I’m hoping to hear from them soon.
Even if this doesn’t really work out I still learned a lot from the experience and I’m hoping I can write a good report for the needs for cervical braces here. Thanks for reading!