Engineering in Medicine: a Synergy for Effective Healthcare Delivery in Nigeria

1. Engineering in Medicine: a Synergy for Effective Healthcare Delivery in Nigeria Dr. Taiwo A. Lawal, MBBS, MSc, MD, FWACS, FACS Senior Lecturer/Consultant Surgeon Department of Surgery, University of Ibadan & University College Hospital, Ibadan

2. Outline • Definitions • Healthcare delivery in Nigeria • Healthcare indices • Engineering in healthcare • Cancer care as an example • Collaborative case • Way forward

3. Health and Healthcare • Health – state of complete physical, mental and social well-being • Health – not just absence of disease or infirmary • Healthcare – field concerned with the maintenance or restoration of the health of the body or mind. • Healthcare – any procedure or methods employed in this field

4. Healthcare delivery in Nigeria • 3 levels of care • Primary (PHC facilities), clinics, maternity and faith based • Secondary (General hospitals) • Tertiary (Teaching hospitals, FMCs, Specialist hospitals) • 3 organs • Local Governments • State Governments • Federal Government

9. Where are we?

10. Nigeria Egypt

11. Compare with Germany: IMR in 1966 – 26/1000 and in 2015 – 3/1000

13. Life expectancy at birth – 224 countries (CIA)

15. Challenges of sustainable healthcare system in Nigeria • Poor financing and sustainability • Increased out-of-pocket expenditure • Inadequate basic infrastructure and equipment • Inadequate supply and inequitable distribution of drugs • Inadequate consumer awareness • Poor remuneration and compensation • Shortage of personnel • Corruption and bribery • Oyibocha EO et al., 2014. IOSR Journal of Economics and Finance

16. Engineering in Healthcare • Central role in functionality of healthcare facilities • System engineering • Health records • Disease surveillance, mapping and deployments • Screening • Diagnosis and investigations • Treatment • Rehabilitation • Monitoring of health and wellness

17. Engineering in Healthcare • Biomechanics • Biomaterials • Biomedical optics • Bioinformatics • Tissue engineering • Genetic engineering • Hospital engineering • Neuroengineering • Pharmaceutical engineering • Medical devices • Medical imaging • Implants • Bionics • Clinical engineering • Rehabilitation • Prosthesis • Prosthodontics • Orthodontics • LASERs • Industrial • Haptics

18. Challenges of healthcare facility maintenance • Ineffective maintenance • Maintenance reactive rather than proactive • Inefficiency • Poor response rate to facilities breakdown • Inadequate resource allocation • Very few professional qualified staff • Oladejo EI et al., 2015. International Journal of Civil Engineering Construction and Estate Management

19. One major example • Cancer care in Nigeria

20. Cancer • 2nd leading cause of death globally (1 in 6 deaths; 9.6million deaths in 2018) • Cancer causing infections – responsible for 25% of cancer cases in LMIC • Hepatitis and HPV • Late stage presentation, inaccessible diagnosis and treatment are uncommon • 90% of HIC vs. 30% of LIC have treatment services available • Economic cost is significant and increasing ($1.16 trillion in 2010) • World Health Organization

21. 70% of deaths from cancer occur in LMIC : an issue of human equity : equity gap 5% of the resources spent on cancer are spent in LMIC

34. Challenges of sustainable healthcare system in Nigeria • Poor financing and sustainability • Increased out-of-pocket expenditure • Inadequate basic infrastructure and equipment • Inadequate supply and inequitable distribution of drugs • Inadequate consumer awareness • Poor remuneration and compensation • Shortage of personnel • Corruption and bribery • Oyibocha EO et al., 2014. IOSR Journal of Economics and Finance

35. The way forward

39. The way forward • Sustainable solutions to healthcare challenges • Locally adaptable • Ease of deployment • Resources and personnel • Maintenance culture • Budgetary provisions • End users and industry interaction • Appropriate legislation and regulation

41. Northwestern/Ibadan: Biomedical Engineering Collaboration • Biomedical Engineering 3-day workshop done at Ibadan in 2012. • Two concept ideas accepted for further development: • Surgery infant warmer • Electrical stimulator • Prototype developed by faculty and students. • Prototype workshop planned for Ibadan workshop by Northwestern post-graduate students and Ibadan faculty/students

42. Finding a Solution for Surgical Treatment of Anorectal Malformations in Nigeria Medical Education Partnership Initiative Nigeria Fogarty International Center/National Institutes for Health Electrical Stimulator For Pediatric Surgery Oversight: Northwestern University: Matt Glucksberg, Dave Kelso, Guillermo Ameer, Rob Murphy University of Ibadan: Taiwo Lawal, Akinwale Coker

43. Background • Anorectal malformation occurs in 1:600 to 1:5000 births • Treatment is surgical: Posterior sagittal anorectalplasty (PSARP) or pull-through anorectal reconstruction • Complications can be debilitating, including fecal incontinence • Identification of perianal musculature is critical in order to most effectively place the new anus • The Pena Stimulator is effective, however it is very expensive – US$12,000 and generally not available in resource-limited settings

46. MS Nerve Stimulator DS7A PSARP Muscle Locating Electric Stimulator

47. Device Layout

48. Device

49. MS Nerve Stimulator Test

50. Device Specifications