Engineering and medicine in the developing world - challenges and opportunities

From the earliest walking aids and prostheses to the latest, cutting-edge medical devices, engineers have always made major contributions to improving the quality of people’s lives. Alongside these medical advancements, however, other engineering developments have had important health benefits for people in developing countries. At the recent ‘Sharing Skills with the Developing World – How You Can Help’ event in Limerick Institute of Technology, Sr Miriam Duggan MD sent a pre-recorded video presentation to the engineers who attended the event. From her base in Kenya, she praised the contribution of engineers to improving life in these countries, noting, in particular, the importance of solar installation. The event was hosted by Engineers Ireland. “In Africa, there are many areas where there’s no electricity or where there are frequent power cuts. But when people there have solar energy, work can continue,” said Sr Duggan. “We were often affected by power cuts [in Kenya] and it meant that computers were at a standstill and mobiles couldn’t be charged. But installing solar panels means that our work can now continue regardless. This also goes for clinics, with their fridges, water heaters and other machines.”

A lifetime of service to others

Limerick native Sr Miriam Duggan has spent most of her life in Africa as an obstetrician and, more recently, in the field of HIV/AIDS prevention and care. The Franciscan Missionary Sisters for Africa graduated from University College Cork with a degree in medicine in 1964. She studied obstetrics in Birmingham, receiving her MRCOG qualifications in 1969 and FRCOG in 1982. She spent thirty years at St Francis’ Hospital in Uganda, first as head of department and in later years as medical superintendent where she was also involved in the training of midwives and doctors. In response to the HIV/AIDS pandemic, which became manifest in 1987, she helped establish clinics and mobile home-based care programmes to care for those with HIV/AIDS and to help those children orphaned as a result. According to UNHCR, the United Nations Refugee Agency, sub-Saharan Africa hosts more than 26 per cent of the world’s refugee population. Over 18 million people in this region are of concern to UNHCR. That number has soared in recent years, partly due to ongoing crises in the Central African Republic, Nigeria and South Sudan. It has also grown as a result of new conflicts erupting in Burundi and Yemen. Sr Duggan described the issues surrounding the setting up of refugee camps and outlined the three main components necessary for a camp to run smoothly and to ease the stress levels of those living therein:

Good water supply;
Good sanitation; and
Good methods of cooking.

“If toilets are poorly located, they can become dangerous areas, particularly at nighttime,” she said. “And if there are no shaded communal areas, then there’s nowhere for people to leave their tents and go to, which relieves a lot of tension. Even simple playgrounds can help this greatly.”

Development of the individual

From her experiences as a missionary, Sr Duggan learned the importance of “really focusing on the development of the person”, in order for further development of economies in Africa to happen. “We need to educate people; we need to empower them with skills. We need to build up their characters and give them their self-esteem. When I was working in Uganda, many people were dying of AIDS because it was during the days before ARVs [antiretrovirals]. Many thousands of children were being orphaned and it put a huge strain on the country to cope with so many orphans and losing a lot of the ‘breadwinners’.” This led her to reflect on the question: what is the real answer to AIDS? In response, a programme called Education for Life was devised by Sr Duggan and Sr Kay Lawlor, from the Medical Missionaries of Mary. The programme is based on the ‘helping skills’ model of psychiatrist Gerard Egan, which is a behavioural and problem-solving approach. “We needed to look at the root cause of why HIV was spreading and to tackle that. This programme has three stages and is based on the work of Gerard Egan. The first stage looks at the reality on the ground. What is happening in the area? What are the behaviours that are dominant in the area? What are the hardships? What are the difficulties people are facing? What are the livelihoods of the people like? How are people making their money or not making it? “So you look at those questions and debate them. And then you consult with the young people in the area and ask, ‘Is this what you want to continue doing, or is there an alternative? What alternative is there so you can improve your economic condition, come out of poverty and live a different kind of life?’ “The third stage is setting goals, having a commitment to those goals and putting them into action. You don’t go into a group and tell them they need to change their behaviour – you help them to discover where they need to change, in order that they may succeed in life.” The programme was a resounding success, with HIV levels among younger people falling from 21 per cent to 6 per cent. “Many people afterwards said that it really changed their lives – it helped them to have goals and to have a vision for the future,” said Sr Duggan. This programme has now been extended to 21 African countries.

The Education for Life programme today

Sr Duggan is currently working in Kariobangi, a low-income residential estate in northeastern Nairobi, in Kenya. “Some 75 per cent of young people there have no jobs, and those who do have meagre jobs with very poor pay. Most people live in a one-room house or in a shanty – a 6 x 10 foot room made of tin with very poor sanitation. A hopelessness sets in, and they lose their dignity and their self-worth. “We gathered some of these young people together and said, ‘Let’s begin to show them a different picture – that they can succeed in life.’ In the beginning, we put them through the programme Educate for Life to look at the behaviours in their life – to see whether crime, prostitution or something else was preventing them from achieving their goals and being successful in life. “Then we looked at alternatives – what else could they do in order to get the money they needed to survive? It meant hard work. It meant commitment. It meant getting up and believing in themselves. We drew up an action plan whereby they set goals for themselves and they tried to put it into action.” The missionaries also ran workshops on character formation. One of these workshops was on motivation. “The motto we had for the group of young people was Obama’s motto: ‘Yes we can.’ It very quickly became: ‘Yes we will.’” This was followed up with workshops on time management, commitment and values like respect, honesty and caring for others. The young people also received help with practical skills such as interview preparation and money-saving skills. The series of workshops serve to “help build up their character and believe in themselves and their own self-worth”, said Sr Duggan. At the end of the eight-week programme, the participants are introduced to different vocational skills such as catering, plumbing, hairdressing and more, so help them source employment. The success is the numbers. Of the 450 programme participants so far:

256 have already got employment;
25 are jobseeking; and
114 are in training.

Sr Duggan said she was very hopeful of securing sponsorship for another fifty of those who have taken part. “It’s hard work getting there, but it’s worth it. It’s wonderful to see young people opening up, having hope in life and having a new vision of themselves,” she added. “It costs about €300-600 to sponsor somebody’s training, but it’s a very good investment because you’re giving someone back their dignity and getting them into employment. Most of the sponsorships have actually come from people in Ireland, and for this I’m very grateful.”

Conclusion

“During the Idi Amin regime [1971-79], I worked in Uganda as a doctor and we saw some terrible injuries in the hospitals there. It was great to have the walking aids and prostheses developed through the skills of engineers. When you see the suffering and the trauma, I think guns are not the answer to anything. They only add to problems. “Let’s try and be agents of peace, even as we do our other work,” Sr Duggan concluded. For more information on the work of the Franciscan Missionary Sisters for Africa, please click here.