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