Leveraging Technology for Global Health: 3D printing in Rwanda
Photo credit: AA Safaris & Tours
The Government of Rwanda (GOR) has registered some of history's most remarkable gains in economic growth, healthcare, and education. As an early adopter of technology, the GOR has welcomed the advent 3-D printing as a sustainable solution to major public issues. In this essay, I outline achievements primarily in the health sector and several paths forward to realize the potential of additive manufacturing in this rapidly emerging economic context.
In the Spring of 1994 while the O.J. Simpson trial captivated audiences worldwide, a devastating genocide in Rwanda simultaneously claimed the lives of over one million men, women, and children.[i] Millions more were injured and permanently disabled. This legacy led the new Government to establish a strong mission: to build a nation committed to prosperity, equality, and the human right to healthcare and education.[ii] And they would have to build that nation back from scratch, as most public facilities – hospitals, schools, homes – had been destroyed and pillaged.
The Government of Rwanda (GOR) has tenaciously pursued science and technology as main drivers of economic growth, including early adoption of leapfrog technologies. To control HIV incidence, the GOR rolled out a non-surgical male circumcision device in 2011 even before the World Health Organization gave its stamp of approval.[iii] Later, the GOR gained international acclaim when they partnered with Zipline, a drone manufacturer, to facilitate blood bank deliveries across mountainous terrain.[iv]
Now, the GOR stands ready to embrace a technology megatrend: additive manufacturing. As a former research fellow to a senior leader in the GOR, I believe the translation of digital information to physical objects is and will continue to be a tremendous boon to advancing the nation’s mission. While already robust – indeed Rwanda’s reduction in premature mortality has been steeper than any nation’s ever recorded in history[v] – the country’s healthcare system would benefit from additive manufacturing in three important ways: 1) rendering technologies mobile, 2) facilitating the prototyping process, and 3) democratizing ideas for wide distribution.
The GOR in fact has already begun to embrace this megatrend as both short-term and long-term solutions to public sector challenges: in 2016, they partnered with several multi-lateral institutions including the Japanese Government to bring a global 3-D printing program to Rwanda called “The Fab Lab.”[vi] The group has developed digital designs to build prosthetic limbs not only for the recently injured, but also for those with physical injuries related to the 1994 genocide. In a setting of poverty, as in Rwanda, the availability of prosthetic devices is next to zero. Importing prostheses from abroad is prohibitively expensive. Why not print the objects in-country? In doing so, a technology that has historically been confined to countries with adequate resources to build manufacturing plants at economies of scale[vii] could be offered at a major discount in Rwanda even when per unit cost of printing may still be higher.[viii] In a landlocked nation that not only cannot afford premium prices on devices such as prostheses, the elimination of both import taxes and transportation costs is tremendous.
Secondly, additive manufacturing lends itself well to products that may require tweaks or customization in between units. In other words, not only is the prototyping process facilitated with 3-D printing versus traditional batch or single flow-line production, it also enables real-time spec variability. One application that has not yet been explored in Rwanda, but that I could see this being highly valuable is breast prostheses printing for cancer patients who have undergone mastectomy. In Rwanda, there are approximately 600 cases of breast cancer every year.[ix] Given that many are late stage diagnoses (if women get diagnosed at all), many require mastectomy and reconstructive surgery is virtually non-existent. Most women simply do not have any remediative options available to them. When I worked for Dana-Farber, our team occasionally received donated breast prostheses and would lug heavy suitcases from Boston to Kigali to bring a small, unsustainable supply. But with 3-D printing, the ability to tailor-make each prosthetic for each woman’s specifications would capture both the customization and the prototyping value of additive manufacturing.
Lastly, the advent of 3-D printing heralds a new age in the democratization of ideas. More specifically, this megatrend allows the GOR to innovate on products that historically have been inaccessible. In the long term, evidence points toward 3-D printing as an enabler of sustainable solutions to addressing poverty. However, it seems the promise of democratizing ideas through additive manufacturing has not been fully realized yet. There are a few examples in 3-D printing that I would recommend exploring further: 1) point-of-care device 3D printing for decentralized diagnostics, 2) high-impact consumable medical products (e.g. umbilical clamps)[x], and 3) frequent-use non-plastic materials (e.g. formalin for cancer diagnostics). In summary, I believe there is immense potential for 3-D printing in low-income countries like Rwanda where the cost to procure physical objects from overseas could be reduced dramatically.
However, while this megatrend has great promise for the GOR, I see several outstanding questions:
- In which sectors or areas can additive manufacturing measurably undercut the status quo?
- In settings of poverty, we are socialized for scarcity. If resources are poured into 3-D printing, what ends up taking the hit (i.e. gets underfunded)?
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*NB: there is scant data available in standard market research publications concerning the Government of Rwanda vis-à-vis 3-D printing; I chose sources that were reliable in the scientific and public literature.
[i] Walter Goodman, “Of Rwanda and Simpson, Serious and Sensational.” The New York Times. Accessed on 11/12/2018 at https://www.nytimes.com/1994/07/26/arts/critic-s-notebook-of-rwanda-and-simpson-serious-and-sensational.html
[ii] Government of Rwanda. The Constitution of the Republic of Rwanda of 2003. Accessed on 11/12/2018 at http://www.parliament.gov.rw/fileadmin/Bills_CD/THE_CONSTITUTION_OF_THE_REPUBLIC_OF_RWANDA_OF_2003_REVISED_IN_2015.pdf
[iii] Agnes Binagwaho et al., Shared learning in an interconnected world: innovations to advance global health equity. Globalization and health, 9(1), p.37.
[iv] John Markoff. “Drones Marshaled to Drop Lifesaving Supplies Over Rwandan Terrain.” The New York Times. Accessed on 11/12/2018 at https://www.nytimes.com/2016/04/05/technology/drones-marshaled-to-drop-lifesaving-supplies-over-rwandan-terrain.html
[v] Paul Farmer et al., “Reduced premature mortality in Rwanda: lessons from success.” British Medical Journal 2013 346, p.f65.
[vi] Martin Nkosi. “Rwanda’s technology revolution helps country forge new path after genocide.” BBC News. Accessed on 11/12/2018 at https://www.bbc.com/news/world-africa-36285889
[vii] Jeff Kerns. What’s next for 3D printing? The disruptive technology continues to grow thanks to lower costs and greater accessibility. Machine Design 90, o. 1 (January 2018): 36-42
[viii] Elisee Mpirwa. “How 3D-printed prosthetics will help the disabled cope on job market.” The New Times. Accessed on 11/12/2018 at https://www.newtimes.co.rw/section/read/219185
[ix] World Health Organization. Cancer Country Profile: Rwanda. Accessed on 11/12/2018 at http://www.who.int/cancer/country-profiles/rwa_en.pdf
[x] A.M.K. Halewood. Six digital technologies to watch. World Bank 2015. Accessed on 11/12/2018 at http://documents.worldbank.org/curated/en/896971468194972881/310436360_201602630200216/additional/102725-PUB-Replacement-PUBLIC.pdf
Thank you for the interesting take on leveraging new technology not only in our developed, highly innovative world to make fast money, but to actually tackle structural 3rd world problems with it. I think there is a lot of value for established 3-D printing companies like GE to investigate such issues further and work with local governments on cooperations that address this issue. Such cooperations would be valuable for both sides since a) the local community benefits like you outlined, b) the company creates demand for their products and c) even more importantly creates a great case study for their product which they can use to expand such projects into similar environments.
Appreciate you showcasing the use of additive manufacturing in a developing country. Your note clearly outlines why and how this would be beneficial. I truly believe that this technology is the key to helping improve healthcare across the board. This, however, begs the question of cost and attainability. As you mentioned, the costs for 3D printing is still very high and we will need critical mass in order to see those costs drop. To accelerate this, would be helpful for firms with this existing technology to become players in the space. Instead of entering this market as businesses, however, firms could enter under a humanitarian umbrella. Another way to spur innovation on a budget is to create competitions where students or companies have to cheaply manufacture organs. Either way, GOR may not be able to rapidly advance unless a third party helps out.
Thank you so much for sharing your personal perspective on how 3D printing can help Rwanda as a whole. The portion that resonated with me the most was the prohibitive costs to shipping in prosthetic limbs, reconstructed breasts, etc. and how additive manufacturing could help solve this by providing a personalized low-cost option in country. This would be especially impactful for a country devastated by war not so long ago. However, I wonder how prohibitive the unit cost of printing these types of body parts would be. Is this a feasible alternative for a nation with limited economic resources, and to your point, what other necessary projects would have to be foregone to invest in 3D printing in Rwanda?
A common concern I have seen in a number of articles on additive manufacturing, including this one, is cost. In this case, while it is true that the cost to procure physical objects from overseas is prohibitive, per unit cost is still very high, and as far as I understand, because of the customization, there may not be as much economies of scale. For a poor country like Rwanda, it is a tall order to ask the government to pour resources into 3D printing, but I wonder if other well-funded nonprofit organizations (for example the Bill and Melinda Gates Foundation) can see the potential in this technology and thus be willing to put more resources into it. Another possible and more sustainable solution is to invest in tech companies that are actively developing it (with the hope that better technology can bring down the unit cost).
Thank you for writing this piece, and focusing in on how this new technology can be harnessed for good. I see partnering with developing nations like Rwanda as a win-win for both the local communities and the companies funding the projects. Not only does this provide jobs and opportunity for underserved communities, but it also serves as an opportunity for a corporation to boost their brand image and fulfill their corporate-social responsibility.
This is very interesting, thank you for sharing your previous work experience and your perspective.
I agree that 3D printing will play an important role in reducing poverty and it seems that the Rwandan Government is doing an amazing role in promotion science & technology in the country. However, I question if that is the role that a government should be playing. Is the Rwandan Government the appropriate institution to drive this innovation?
I do believe that the government plays a crucial role in attracting innovation and creating the right set of conditions for its development. But I believe that the innovation and implementation should be done privately. I think this directly relates to your second question.
Thanks for a really interesting take on additive manufacturing in the context of healthcare and emerging markets. While being able to print a prosthetic limb when importing one is so expensive could bring tremendous value to patients in Rwanda, I’m curious about the cost of this going wrong. How far along is 3D printing in the medical space? Have they tested its effects on a wide sample of patients? While the upside could be very positive, the costs could be equally as dramatic; and of course, mistakes in printing someone’s limb is substantially more drastic than mistakes in printing a new Nike shoe. I’m hopeful that this technology could take off in the medical space, but would love to know more about its progress to date.