Hack-a-thon 2017

Compiled by: Gerald Oola, Rhina Nabwire, Jonathan Kigozi and Sunday Abiria

The Hack-a-thon brings together participants across disciplines and sectors from Uganda, the USA and India to discuss and innovate appropriate medical technologies for low and middle income countries.
Theme of 5th Annual Hack-a-thon: Innovating to improve neonatal and Maternal Health.

Description of Event:
Location: The event took place at Mbarara University of Science and Technology, with some activities taking place at the Massachusetts General Hospital (MGH) Guest House and the Oxford Inn in Mbarara town. Clinical visits were conducted in four hospitals in and around town.

People (Attendees): The event included doctors of varied experience, students (including P7 pupil, and 2 senior students). Most attendees were associated with MUST and had medical backgrounds. The attendees were classified into Judges, Mentors and Participants. The event was also attended by the Minister of Science, Technology and Innovations (Hon. Elioda Tumwesigye), the Minister for ICT and National Guidance (Hon. Frank Tumwebaze), the UCC commissioner and the commissioner for maternal and child health. The vice chancellor Prof. Celestino Obua, Dean of Elect of School of Medicine, Dr. Data Santorino (Country of manager, Camtech Uganda), Dr. Kristian Olson (Director of Camtech) and Dr. Ryan Caroll (Director of MGH-MUST Collaborative)

Organization:
Activities: There was a clinical summit at Oxford Inn on Friday morning, followed by clinical visits and a business workshop.
The clinical summit was led by a panel of pediatricians, nurses, midwives, obstetricians/gynecologists. They discussed challenges they experienced in the work settings. These included: poor communication between hospitals and patients; Staffing challenges; lack of heating/Cooling technologies; infections resulting from use of untested local herbs on chords; preference of traditional birth attendants (TBAs) by village women; lack of support for village health teams; sepsis-related complications; infection control at homes; bloody C-sections; scarcity of inexpensive probes for cervical cancer detection and lack of methods to enable women to self-screen (cultural attitudes prevent women from getting screened); lack of aids for mothers to monitor their own pregnancy; poor communicating between doctors (especially with referring doctors).

The purpose of the clinical visits was to enable participants to directly observe the challenges in the hospitals and clinics. The participants identified some of the problems discussed by the clinical panel. They also noted other problems such as patient presentation after conditions had become advanced, complicated and hard to manage.

The business workshop was about design thinking: how to define a problem, ideate, storyboard and prototype solutions to problems, as well as how to develop a business model to implement the solution. It was led by Jacob Fohtung(an MBA student at Babson College in Massachusetts) and Nambogo Nuriat of CAMTech Uganda.
Friday evening was capped with a cock-tail party at the MGH Guest House. Some of the innovations at CAMTech were showcased, including the Augmented Infant Resuscitation (AIR) device, the SANI Drop hand sanitizer and Protecting Infants by SMS (PRISMS) mobile application. Welcome remarks were made by the vice chancellor, some entertainment and dancing, dinner and refreshments and cake cuttings also too place. Participants were able to meet and know one another at the cock-tail. The cock-tail ended at about 11 PM.

The actual Hack-a-thon began Saturday. The event was kicked-off by welcomes from Camtech Uganda Board Chair, Dr. Kris Olson and the Chief Guest (Hon Tumwesigye). After the event format and judging criteria were announced, the pitching session started. The pitches are brief, 1 minute descriptions of the problems identified by the participants. The pitches were numbered registered. Teams were formed around problems of common interest. Team formation or alteration continued until 8 pm, when registration started. The teams started working on their challenges/solutions immediately after formation until 24 hours later, when the final pitches were made. The teams could request mentors at any time, using table cards.

Hacking continued through Sunday morning, when team pitching practice presentations were done. These were three-minute rehearsals in front of judges, who gave feedback on the presentations. Other events that took place on Sunday included Judge briefing, and the final pitches. 33 groups formed around the initial 59 problems, and each made their final pitches (17 groups presented in one room and 16 in the other). The top 3 scoring groups from each room advanced to the second round of pitches, from which the top 4 were selected for awards. These were:

Team Kangaroo+ (which had one of Muni’s Students; Oola Gerald) received $782 USD(2,500,800 UGX) and six months of acceleration support as the grand prize winners. Their affordable medical technology, Kangaroo+, modifies traditional kangaroo care by combining a thermometer and skin-to-skin contact.

Judges gathered at Mbarara University of Science and Technology (MUST) to also name Team Safe and Dry as First Runner-Up, Team MBT as Second Runner-Up and Team 54 as Third Runner-Up.
Team Safe and Dry received $625 USD ($2,000,000 UGX) for innovating a fistula collection tool, Team MBT received $469 USD (1,500,800 UGX) for a device treating menstrual cramps and Team 54 received $219 USD (700,800 UGX) for a low-cost infant warmer.

In addition to receiving prize money, CAMTech UGANDA offered the winning teams access to webinars and peer-to-peer learning engagements. Each winning team will also compete in a 90-day post-hack opportunity for membership in the CAMTech Accelerator Program (CAP). An initiative on the CAMTech Innovation Platform, the CAP provides milestone-based funding, a CAP Coach, participation in the CAP Cohort, expert match-making and six-months of acceleration support.
Timing: The events were organized at the beginning of the semester and therefore convenient for students since they were already on campus and the work load is still low.
Meals: 2 lunches and the cocktail were the only meals provided. Coffee, milk, tea and hot chocolate were available throughout the event. Snacks were also provided.
Facilities and Amenities: The facilities were relatively comfortable, accessible and secure. There were some minor plumbing issues.
Equipment: Equipment was available at the Hack store, or could be ordered by CAMTech.
Communication: There was free WIFI internet connection most of the time, and the speed was reasonable.
Cost: Approximately 300 people participated in the event either as organizers, Hackers or mentors and judges. The event likely cost close to $100 million shillings.

Lessons Learnt
Hack-a-thon Organization: We got a glimpse of how to organize such an event. We appreciated the power of people getting together to solve a problem; time keeping and strict monitoring; public evaluation of the pitches and of the event organization; close interaction of mentors and different group teams; the ease of application and registration. Some areas for improvement included: Selection—very few programmers (4); few bioengineers; few business experts. Judging: 3 judges 1 business, 1 medical, 1 engineering. Judging: Judges should not have been mentors because they could easily be biased by the prior experience. Similarly, judges should not have been on the practice pitch panel. Judges should only show up at the final pitches. Time management: Due to time limitations, only 6, instead of the initially planned 12 pitches, were selected from the next round, leaving several exciting innovations unpresented. Presentations of the first rounds of pitches were performed on laptop computers because the second room did not have a projector, a problem that should have been anticipated.

The Pitches
Team 54: Developing the heat generation, circulation system to warm babies.
MBT—developed a belt that reduces menstrual pain/cramps by heating/cooling.
Safe and Dry: they developed a special underwear for fistula patients.
Kangaroo Plus –low-cost neonatal Jacket with temperature monitoring capabilities and an alert system(Top Prize)
Foot-operated ventilation/resuscitation device
Bilirubin level detectors in pre-term babies
Smart-breast: a bottle that warms milk.
Mama-Care: providing pregnancy/maternal information to mothers, with a provision for asking questions.
Oxygen Concentrator: developed a low-cost oxygen concentrator that runs on batteries.
VioCare: a tool for reporting gender-based violence on women.
Software for maintaining donated equipment.
Toto-warmer: A low-cost jacket to keep preterm babies warm.
PREDRA: Pre-Eclampsia detection in Rural Areas, by empowering village health team (VHT) members to monitor blood pressure.
Sponsorship: The students were sponsored by Muni Labs. The organization hopes to continue sponsoring student development through similar events.

Outline of Plan for Similar Events at Muni University
We propose to engage students, lecturers and members of the Arua/West Nile community in similar events. The open-day at Muni University would be suitable for such events. In the 2 weeks prior to Open Day, participants would pitch various challenges and develop solutions to the challenges. The two weeks would allow participants to develop more advanced models of their innovations. Since this would be the first event of its kind we propose to form less than 20 teams. Demonstration of innovations and judging, awards presented as part of Open-day. Bazaar with stalls will be built to demonstrate innovations. (Tentative date is October 28th). We also propose to begin weekly innovation cafes.

Possible participants: Muni University Departments of Nursing, Education, IT-IS, in collaboration with MUBS-Arua/CAMTech Uganda/Muni Labs/Reprohealth/ARRH
ATN20171

APPENDIX

Challenges
Miscarriages and Abortions
This is where a woman willingly or unwillingly loses her pregnancy. This happens normally due to poor planning for the pregnancy at family level or unwanted pregnancies, especially in young ladies. This is due to fear of the complications that result out of the available family planning methods. Therefore, an innovation is needed for these ladies to easily monitor their menstruation cycles well that it can be implemented as an affordable family planning method and with minimal complications.

Infertility
Infertility usually happens during preconception, that is failure to conceive. There is a need to innovate how to lower the costs of investigating and treating infertility.

Confirming Pregnancy
There is a need to get better ways how a mother can confirm that she is pregnant earlier and even how clinicians can confirm pregnancy earlier before HCG testing.

Premature Babies
This is where mothers give birth before the normal date of delivering. Measures should be put on how to improve outcomes of premature babies without using a surfactant during ANC and into labor.

Malformation of the Fetus
This is where the fetus is wrongly positioned. Normally the back of the baby’s head, or occiput, is at the front, or anterior of the pelvis. However, sometimes the baby’s back is at the back of a mother’s pelvis. This has to be discovered in the active phase or second stage of labor so that it can be resolved. If not discovered in time, a pregnant woman will experience prolonged labor and likelihoods of caesarian delivery. These expose a mother to risks of perineal rupture and obstetric fistula. Therefore, innovative measures of how to manage such pregnancies are required.

Eclampsia
This is a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure often followed by coma, posing a threat to the health of mother and baby. Eclampsia usually occurs due to prolonged pre-eclampsia. Pre-eclampsia is a disorder in pregnant women characterized with abnormal high blood pressure. This condition affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.

Anemia
This is a condition in which a pregnant woman has very little blood in her body. Iron deficiency is the most common cause of anemia in pregnancy. This is due to a greater expansion of plasma volume compared with the increase in red cell volume. Therefore, innovative measures are needed to inform the mother or health worker about the reduction in iron in the body of a pregnant mother.

Malaria
Pregnant women are more susceptible than the general population to malaria. They are more likely to become infected. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa (WHO, May 25, 2017). Malaria infection during pregnancy can lead to miscarriage, premature delivery, low birth weight, congenital infection and/or perinatal death. Therefore, innovations are required to prevent mothers from getting infected with malaria parasite.
Poor Relationship Between Health Workers and Pregnant Mothers
This is due to different factors such as language barriers and negative perception of mothers towards health workers. This hinders easy flow of information between the workers and the clients.

Poor Feeding
Pregnant women have to feed well (balanced diet) for the fetus to get enough nutrients during its development. However, in African settings, families are poor and they cannot afford all the food required. As a result, a fetus does not get enough nutrients for normal development which exposes it to congenital malformations. Therefore, an affordable innovation is needed to enable pregnant mothers to access most of the food nutrients needed.

Poor Transport Means
Mothers find it difficult to travel from their homes to the hospital during labor due to poor roads, congested vehicles and vehicles delaying to set off for the journey as they still need to get enough passengers before they start the journey. These make mothers deliver before they reach the hospital, which is associated with a lot of risks such as unrecognized postpartum hemorrhage and likelihoods of death of a mother. Therefore, an innovative way is needed on how to safely transport mothers to the hospitals.

Delayed Detection of High Risk Mothers
Pregnant mothers go for antenatal care but some complications are not accurately diagnosed, such as the position of a baby, because they require special tested machines like CT scans. Since these machines are expensive, they cannot be afforded in the African setting, leading to delayed detection of mothers with such presentations. An innovative measure is needed for early detection of high risk mothers.

Antenatal Care Ignorance
Most mothers especially, in the rural areas, lack knowledge about the benefits of ANC and also delivery from the hospital. An innovative measure is need to sensitize mothers of the benefits of antenatal care and advantages of delivering from the hospital.

Inadequate Medicine
In some health units, there is inadequate health supplies and medicines to manage complications in pregnancy. This delays treatment. An innovative measure is needed to determine the available medicines in different wards for effective supply in time.
Poor Structure for Patient Follow Up
After mothers are discharged from the hospital. There is no special method for follow up on how they are progressing. This leads to late presentations of post-natal complications. An innovative measure is needed to monitor these mothers after they have been discharged from the hospital.

Low Male Involvement
Most males don’t like getting concerned about their wives’ pregnancy. Very few men follow their women to the hospital during labor. This gives makes women feel ignored. This brings a psychological torture to a woman. Leading to loss of pregnancy or require assisted delivery. Therefore, an innovative measure is needed to attract and sensitize men about their contribution as husbands when a wife is pregnant.
Poorly-Conducted, Goal-Oriented Antenatal Care
An innovative, effective and affordable way is needed to achieve the goal of antenatal care services.

Poor Record Keeping in Health Systems
There is no trusted and safe way of keeping records for all the mothers admitted to the hospital. Therefore, an innovative way is needed to have the safe storage of records of all mothers at the health facility, including the day they go into labor, conceive, and birth. This will help in tracing the stage at which a complication occurred for appropriate attention.

Gender-Based Violence
Gender-based violence is great challenge in most families in low- and middle-income countries. There are no clear statistics for exact number of women affected by this violence because these happen indoors and there is no special method to trace all these scenarios. An innovative way is needed to practically analyze how gender-based violence is a great challenge in LMICs.

Poor Health-Seeking Behavior
In African settings, it’s very hard for someone to seek for medical checkups not until he has symptoms for a given disease. This leads to associated complications of symptomless infections. This is more dangerous to pregnant women as such untreated symptomless infections affects babies leading to premature delivery. Special ways are needed to enable people to seek timely medical checkups even if they don’t show any symptoms of a diseases.

Placental Insufficiency
A complication of pregnancy where the placenta is un able to deliver adequate supply of oxygen and nutrients to the fetus. This may be due to placental abruption: detachment of the placenta from the uterus during pregnancy, poor nutrition of a mother or infection of a mother. If discovered in time, health workers can give special attention to this mother to save the life of a baby. the available means of monitoring the placenta functioning is very expensive to afford. Therefore, an affordable innovation is required to monitor the functioning of the placenta.

Teenage Pregnancies
There is an increasing prevalence of teenage pregnancies. An innovative method is needed to inform young girls on the likely causes of early pregnancies and the associated outcomes.
Inability to Detect Fetal Heart Rate at Gestation Ages
An innovative method is needed to easily detect for fetal heart rate when a mother is in labor.

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