Mentor with a nose for innovations

Cosmas Mwikirize, the associate principal investigator at the iLabs@MAK Project, Makerere University, was only an ordinary student the other day. However, his intrigue and passion for technological innovations have seen the master’s graduate roll many innovations up his sleeve.

First, was the automated forklift developed by Gayaza High School students in 2010 that won the first ever robotics challenge, and here, he played a key role as a mentor; has never looked back since.

Also, under his mentorship, the same students worked on a burglar detector for security in homes and its success was closely followed by the widely publicized EOD robot that was made by senior five and six students of St Mary’s College Kisubi. All these innovations were courtesy of the iLabs@MAK Project of which Mwikirize was one of the pioneer founders.

“As a mentor, I am tasked with overseeing students’ work to ensure that it conforms to the design of the programme,” he says. 

Mwikirize during the interview

Students under his mentorship are tasked with creating models, implementing them and programming them into meaningful applications in health, security, agriculture, automations, among others.

Alvin Kabwema, a first year student of Electrical Engineering at Makerere University, is full of praises for Mwikirize who has mentored him since high school.

“As you see I do not even call him ‘sir’ because he is a friend and he continued mentoring me in my vacations and introduced me to iLabs so that I can continue with robotics,” Kabwema says.

Under Mwikirize’s mentorship, he has worked on a chemical dispenser to carry dangerous chemicals, the EOD robot and a scooter.

STARTING OUT

When Mwikirize joined Makerere University to pursue a Bachelor’s degree in Electrical Engineering in 2005, he was in for a rude shock − more theory than practical lessons. In fact, the laboratories were hardly used.

“This was a real turn off for me and shockingly, at one time, the university administration had to suspend the release of our results because we had not done a lab component as there was no equipment,” he recollects.

However, things changed when he got to third year − a drive to root technological innovations started at the College of Engineering, Design, Art and Technology (CEDAT). This was the genesis of the iLabs@MAK Project, an initiative to help students’ access labs online in order to solve the issue of inadequate lab equipment.

“Being one of the best students in my class, I was handpicked by Prof Sandy Stevens Tickodri-Togboa to join the iLabs and can proudly say that I contributed to solving a crisis of labs at the faculty,” he says.

With iLabs, an unlimited number of users can now connect to a single lab as long as they have access to the internet. The iLabs@MAK Project started in 2005, under the broader iLab-Africa Project, supported by the Carnegie Corporation of New York, as a collaboration between Makerere University, University of Dar-es-salaam, and Obafemi Awolowo University (Nigeria). The three were

supported by Massachusetts Institute of Technology, USA.

With the success of the first iLab, many more applications have been developed.

After the success of iLabs, Mwikirize thirsted to inspire students into innovations.

“I was mentored and have been able to create something that is helping others and now I am out to mentor students to mentor others. When I mentor someone, I expect him or her to be an avid researcher at the end.”

Together with others in the iLabs@MAK Project, they started an initiative dubbed ‘promotion of science and technology innovation in secondary schools’ in 2010. This initiative focuses on identifying and involving young talent in robotics. He says the challenge was to change the status quo of students to make them more practical than theoretical.

His foresight has indeed paid off. Today, the initiative has grown from two to 18 secondary schools across Uganda.

These include Ntare School, Mary Hill, Makerere College, King’s College Budo, Lira Town School and Lango College which have all formed science and innovation clubs being supervised by a patron.

 Machine prototypes have been, and are still being developed, the latest being an automated disinfectant chamber that is being developed by first year students of Electrical Engineering at Makerere University. Its function is to ensure the disinfection of one’s whole body against infectious diseases like Ebola and Marburg.

“Not long ago when Marburg broke out, I saw people walking out of the isolation unit areas and step in a basin of water to disinfect the feet,” he explains,

“However, there might be pathogens all over one’s body and this is where the idea of this machine comes from − to be able to disinfect the whole body.”

The machine can also be used to disinfect animals. 

Mwikirize (R) looks on while one of his mentees explains how an automated disinfector works

“I appeal to government and different industries to look at these innovations and fund them so that they can be made into usable applications,” he says.

THE ACADEMIC AND TEACHER

Before his graduation in 2010, Mwikirize won a $12,500(Shs 31m) grant from the Carnegie Cooperation of New York under the iLabs Africa project to continue the work of developing iLabs.

This grant gave him an edge over his classmates as he was immediately admitted at Makerere University on a master’s programme. He graduate in 2011 and now holds a Master of Science in Electrical Engineering.

He juggled his studies with giving lessons in Introductory Electronics and Applied Computing to Computer Engineering students. He has been teaching since he graduated in 2009.

He says he is now looking at doing a PhD in the USA.

80 women benefit from free fistula repair-no more shame

Christine Katusabe slightly lifts the curtain at her hospital bed to confirm if the morning is here. When the first ray of light shoots through the window, she slowly turns her grey blanket and sky-blue sheets over to the other side, sits up and throws her head into her palms and looks at the other patients.

Her grandmother, having woken up 20 minutes earlier, peers into her 17 year granddaughter’s eyes, probably not seeing the beauty and innocence of a young girl, but trauma and shame. Katusabe passes urine uncontrollably because of an obstetric fistula. 

Christine Katusabe relaxes with her grandmother during the camp

A fistula is a tear between the birth passage and the bladder or rectum caused by obstructed and prolonged labor.  Dr Rose Mukisa Bisoborwa says during this time, the soft tissues of the pelvis are compressed between the baby’s head and the mother’s pelvic bones. The lack of blood flow causes tissue to die, creating a hole between the mother’s vagina and bladder or between the vagina and rectum, or both resulting in leakage.

Although Katusabe survived the fatal child birth experience where she had obstructed labor for a day and a half, she was left with a still born baby and trauma. 

“I would want to go back to school, study and become a nurse but because of my condition, I cannot. I have difficulty in walking and sitting and all the time, I want to eat,” the rather jolly Katusabe, who has borne this condition for two months, says. 

She gets off her bed and slowly motions towards the door. She is slightly bent and keeps her hands tucked in her brown shirt as if hiding something. Outside are more than 100 women crowded with basins, pieces of torn cloth and mats. The smell of the urine in their environs is unmistakable.

Like Katusabe, they too have obstetric fistulas and have come to Hoima Regional Referral Hospital to receive free fistula surgery courtesy of Engender Health and United Nations Population Fund (UNFPA). Engender Health is a global reproductive health organization working to improve the quality of health care with funding from USAID.

Dr Rose Bisoborwa, the country director for Engender Health-Uganda says ordinarily, fistula repair costs $ 400 (Shs 1m). 

Patients line up to receive treatment numbers during the camp

The camp is running for two weeks till 31^st May.

Consequences of damage resulting from obstetric fistula include depression, physical injury where a woman’s birth canal and bladder is ruptured thus frequent passing out of stool or urine or both and mental health dysfunction.

“Left with choric leaking of urine and stool, women with obstetric fistula are abandoned or neglected by their husbands and families, unable to work and ostracized by their communities,” Dr Peter Mukasa Kivunike, an obstetrician with UNFPA says. 

A fistula patient (L) being led to the theater for repair

A fistula patient for 40 years carries her 'weapon'-a basin at the camp where she hopes to be repaired

To contain the leakage, Katusabe uses two scarves interchangeably as pads. But she is met with yet another challenge; that of taking five liters of water daily which she cannot access. Her counselor, Betty Mujenje says this helps reduce the acid in the urine which may injure her skin. 

Counsellor Betty Mujenje(L) counsels Christine Katusabe, a fistula patient

The beginning of her woes;

In an area touched with poverty at every side, Katusabe, an orphan dropped out of school in Senior One at Kigolobya High School after her grandmother could not handle the school expenses any longer.

While working in her friend’s grocery store, she met Robert Amanyire, 29 who lured her into sexual intercourse.

“I knew I was not supposed to sleep with him but it happened accidentally,” she says in a timid voice further explaining that she even moved into his home in Nkondo village.

 But in the ninth month of her pregnancy, she moved back to Kigolobya, her grandmother’s home. Through the first day of her labor, Katusabe suffered a high fever and loss of a lot of blood but the quickest resort was a traditional birth attendant (TBA). Nevertheless, the labor and blood loss persisted that she was rushed to Kigolobya Health Centre IV.

She had a still birth and with little control over her system, she was left wet and dirty. Although she received support from her husband, she is battling depression and contemplating her future, she wonders when she will ever return to school. The day I met her, she was more than ready to undergo the fistula repair surgery after a comforting hour of counseling.

Like Katusabe, any woman is at risk of fistula if not assisted by a skilled health care provider. Young girls are particularly at risk because of pelvic bone immaturity and a small birth canal.

Fistula Repair and prevention;

Use of the partograph; 

A partograph is a low-tech tool that can substantially reduce the incidence of prolonged labor.

“Through its use, midwives and nurses can be alerted to the need to take action. This has the potential to reduce obstructed labor and its adverse consequences, including fistula,” Dr Odong Emintone Alyena a senior consultant obstetrician and gynecologist at Lacor Hospital explains. 

Immediate Catheterization

If a woman with obstructed labor arrives at the hospital and is believed to be at risk for obstetric fistula, immediate catheterization can help to prevent the fistula from developing. The catheter should remain in place until the end of labor.

Caesarean section (C-Section)

Timely C-Section is critical for women with obstructed labor.

“Doctors performing a Caesarean delivery must be competent so that they create an iatrogenic fistula where the bladder is accidentally cut resulting in an abnormal opening through which urine leaks,” Dr Bisoborwa says.

Community-based prevention

Activities include social mobilization and awareness raising campaigns, dramas and broadcasts about the importance of antenatal care and assisted delivery and support for transportation and referrals.

Sr Stella Kachope a counselor of women suffering with fistulas says there is need to sensitize men to get involved in birth preparedness and the importance of delaying first pregnancy up to 18 years.

The challenges;

The over 100 women at the camp have travelled from as far as Buliisa, Nangwali, Kyankwanzi, Apac, Bugweri and Kiboga that are at least 100 KM and at most 400 KM away from Hoima.

Dr Francis Mulwanyi Wambuzi the director, Hoima Regional Referral Hospital says travelling long distances are a common obstacle for these impoverished communities where proper healthcare and facilities are rare. Therefore many women live with this condition for years. For example Sarah Akugizibwe, 38 has lived with an obstetric fistula for eight years after losing her first set of twins. 

Sr Stella Kachope counselling fitsula patients at Hoima Regional Referral Hospital

Also, the hospital has inadequate emergency capacity in terms of supplies and medical staff compared to the backlog of patients.

“Hoima’s Health Centre IVs do not have doctors and at this hospital, we are only nine doctors and yet we are supposed to be 40 and there is only one senior obstetrician with no consultant in that field,” Dr Mulwanyi says.

Also, Hoima has a big migrant population from DRC and Kabale District who are unfamiliar with where to access medical services and end up facing delays in the community.

Unlike other regions like Masaka District that have private not-for profit, Hoima region does not have one and it is marred with power irregularities.

Fistula burden in Uganda;

The 2011 Uganda Demographic Health Survey (UDHS) estimates that 140,000 to 200,000 women in Uganda have the problem and 1900 new cases every year. Between 1500 and 2000 cases are repaired every year.

 The western region is leading in fistula rates with 5.4%, followed by that north at 3.6%, Central 3.4%, Eastern 1.1% and Karamoja with the least at 0.1%.

UNFPA has however over the past 10 years directly supported over 34000 women and girls to receive surgical treatment for fistula.

Uganda to conduct another HIV vaccine trial

Makerere University Walter Reed Project (MUWRP) is this July launching another third Phase I trial attempt to develop an HIV vaccine since 1999 when the first trial was launched.

Phase I is the first stage in developing a candidate HIV vaccine and involves a small number of uninfected participants at a low risk of acquiring HIV.

This year’s trial, according to the MUWRP’s Executive Director Dr Hannah Kibuuka, will be multisite, including Thailand and U.S.A –with 120 volunteers, 60 of which are Ugandans.

“In continued effort to develop an HIV vaccine, we have to undertake this trial and others until a safe and effective vaccine is found,” Dr Kibuuka said. 

Dr Hannah Kibuuka

Volunteers have to be free of illnesses such as hypertension, sickle cells and diabetes and undergo intense HIV counseling and follow-up during the trial.

Currently, MUWRP is undertaking a vaccine trial involving 42 volunteers from Uganda to determine the body’s immune response and vaccine safety. Other participants in this trial have been recruited from Kenya, Tanzania and USA.

Dr Fatim Jallow, MUWRP’s deputy laboratory director says the lab is well equipped for the July trial.

On going activity at the MUWRP lab where the trial will be held

Stages of Hiv vaccine trials;

At the early stages of development, Phase I and II trials, scientists test to find out how the body responds to the vaccine. After a person is vaccinated, their blood is sent to the laboratory to identify whether his/ her body has generated a response that can fight HIV.

“The only way to identify if the vaccines actually protect against HIV/Aids is in a large Phase III trial with thousands of volunteers who are at risk of HIV infection,” Dr Francis Kiweewa, head of research and scientific affairs at MUWRP said.

Phase III trials can last three to five years.

Currently the World Health Organization (WHO) and UNAIDS are working to facilitate trials in African countries through the African AIDS Vaccine Programme (AAVP), an initiative adopted in 2001 by African Heads of State at the African Summit on HIV/Aids, Tuberculosis and Malaria in Abuja, Nigeria.

Challenges;

Currently, one of the challenges is developing a single vaccine that will effectively deal with the different HIV subtypes. There are at least nine Hiv subtypes circulating in the world.

Most research to date has focused on a vaccine for Hiv subtype B, which is the main subtype in the Americas, Australia, Japan and Western Europe.

“There is still a challenge for a common vaccine that will prevent Hiv among all the strains especially A, C, D and E common in sub-Saharan Africa and Asia,” Dr Kibuuka said.

Earlier trials in Uganda

In 1999, Uganda launched Africa’s first Hiv vaccine trial, a small Phase I safety study involving 50 volunteers at the Joint Clinical Research Clinic (JCRC). However, this generated massive public criticism with misconceptions that the vaccine would trigger new infections and debate whether volunteers would be compensated in case of harm.

In 2003, Uganda launched its second vaccine trial with support of the International Aids Vaccine Initiative (IAVI). This was also a Phase I study which tested a combination of two vaccines based on the Hiv subtype A. The study enrolled 50 volunteers and ran until February 2005.  

A researcher displays preserved blood samples collected from volunteers at the MUWRP laboratory

Trials worldwide

In 2009, a Phase III trial vaccine RV-144 in Thailand yielded modest results of a 31% efficacy meaning that it reduced the risk of acquiring HIV by 31%.

This is the first study that indicated that it that a vaccine could work.

But in the latest trial failures, researchers in the US according to an article in the Los Angeles Times, ‘HIV vaccine trial shut down’ have stopped a trial after the experimental vaccine failed to both prevent HIV transmission and to reduce viral load in those who contracted the virus.

The article, published on April 25 2013 reports that the trial started in 2009 and enrolled 2,504 men who have sex with men (MSM) and transgendered people who have sex with men in 21 sites in 19 U.S. cities. Of the 1,250 participants who received the experimental vaccine 27 became HIV positive during the study.

HIV/Aids burden in Uganda

According to the 2011 Uganda Aids Indicator Survey (UAIS), about 7.3% (about 1,390,000 Ugandans) of adults aged 15 to 49 are living with Hiv. There is an estimated 20,000 to 25,000 pediatric HIV infections annually and currently new infections are about 145,000 up from 124, 000 in 2009 and 128,000 in 2010.

Treatment options

Current treatment in Uganda involves the use of several antiretroviral drugs, termed Highly Active Antiretroviral Therapy (HAART), which can extend the life expectancy of people living with Hiv and decrease viral load without eradicating the virus.

Other treatment options include safe male circumcision, Option B+ one of the four prongs of the elimination of mother to child transmission (EMTCT), pre and post exposure Prophylaxis.

With giant steps being made in research and development of a vaccine, scientists hope to develop a feasible vaccine to reduce risk of acquiring the virus.

Tobacco-related illnesses will cost you Shs 5m every 3weeks

Born and raised in tobacco-growing district of Arua, Emmanuel Ojapi learnt how to smoke at 17.

Now 38, Ojapi smokes between 26 and 30 sticks of locally woven tobacco daily – which is probably why his teeth are steadily changing colour from white to deep yellow.

When he smiles, the change is evident with the teeth of his lower jaw. Ojapi has easy access to tobacco because he works on tobacco farms for a living.

“I have worked on these farms since I was a child. It took me less than a month to learn how to chew the leaf and my friends taught me how to smoke,” he confidently says as he goes about his daily routines on a tobacco farm in Maracha district.

He is, however, oblivious of the health – and cost – implications of smoking and chewing tobacco.

Dr Fred Okuku, a medical oncologist at the Uganda Cancer Institute (UCI), says there are various types of cancer and other diseases associated with smoking that are costly to treat.

For example, cigarette smoking is a major risk factor for developing small cell lung cancer (SCLC), the commonest lung cancer associated with smoking.

This is treated using chemotherapy, with anti-cancer drugs injected into the vein or taken orally.

“We administer chemotherapy in cycles and these generally last about 3 to 4 weeks. Initial treatment is in four to six cycles, which costs about Shs 5m to Shs 6m,” Dr Okuku says.

Each cycle costs Shs 700,000 to 800,000. And all the six cycles are a prerequisite because SCLC spreads fast to the brain and liver.

Before undergoing chemotherapy, other money-drenching tests are conducted such as a CT scan of the chest, which costs about Shs 200,000, blood, Hepatitis B, urine and abdomen tests which cost a minimum of Shs1m.

Meanwhile, lobectomy, where a section (lobe) of the lung is removed is another treatment option although it is rarely used as the main form of treatment. This costs Shs 25m. Other operations cost Shs 10m to Shs 15m.

Dr Okuku says of the 50 patients admitted to the institute with SCLC, only five benefit from the treatment options because majority come when the cancer is in its advanced stages.

According to an article titled “Do you know tobacco?” by the Centre for Addiction and Mental Health, when tobacco is burned, a dark sticky “tar” is formed from a combination of hundreds of chemicals, including poisons that cause cancers and bronchial disorders. 

Tar is released in tobacco smoke in tiny particles that damage the lungs and airways and stain teeth and fingers. Tar is the main cause of lung and throat cancers.

Globally, the World Health Organisation estimates that tobacco causes about 71% of lung cancer, 42% of chronic respiratory diseases, 20% of global tuberculosis incidence and nearly 10% of cardiovascular diseases.

Smoking is also associated with Chronic Obstructive Pulmonary Disease (COPD) where lungs lose their elasticity, making it difficult to breathe. Coughing up mucus is often the first sign of COPD.

“When one is diagnosed with COPD, you spend a minimum of shs 300,000 a week for treatment and when it becomes severe, one needs oxygen for life,” Dr Okuku says.

TOBACCO BURDEN

Currently, Uganda loses an estimated 13,000 people to tobacco-related illnesses annually. Statistics also indicate that 75% of the cancer patients at Mulago hospital have had a history of smoking (actively or passively) between two and 33 years. Currently, UCI needs Shs102bn annually to treat patients.

Last year the anti-smoking lobby made some progress, moving the Tobacco Control Bill that seeks to increase taxes on tobacco products, bans tobacco advertising and prohibits the sale and importation of duty free tobacco products among others.