The most unique aspect of this class as a part of the Biomedical Engineering curriculum is that it pushed us to encounter both the technical challenges as well as the cultural factors associated with a globally minded collaborative design project. It has been a great learning experience for us to be a part of the DukeMAK partnership, and the connections that we have been able to form with the Makerere students have without a doubt been one of the highlights of our co-design project.
Through the semester, we were able to interact with the MAK students involved with the vaccine cold chain project - Mercy Takuwa, Majid Ayiga, and Mathias Tukesiga - through Whatsapp, which was a great platform to exchange information and initially decide on a basic direction for the project. However, it was only from our week in Uganda that we got to really break the ice and connect with our Ugandan counterparts in an authentic way.
In one short week, we were amazed at how well we were able to get along with our team at MAK and build a sense of camaraderie. From meeting with each other at the lecture hall every day, traveling to meet stakeholders in the vaccine space in Kampala, discussing ideas in person to improve the vaccine carrier design, and finally sharing a last hurrah at the Edge House before we left, there were many memorable experiences that allowed us to forge much deeper bonds that we ever could have had Whatsapp been the only means of communication.
In reflecting on the entire class with the trip to Uganda being a focal point, we came to realize that there are some interesting culturally relevant details that in subtle yet powerful ways shape the overall collaboration between the two institutions.
Work Mindset: Process vs. Results Oriented
Our first meeting with all three of our team members was the night of our arrival, and the connection was immediate as we were able to easily make smalltalk and crack jokes at each other. An extremely relatable part the MAK students is their sense of humor, which is similar to classic American humor: sarcastic, playful, and sometimes dry. Ian Clarke’s assessment in Culture Smart! certainly held true as well in that openness and inclusivity allow for easy formation of relationships to the point where jokes and stories can be exchanged even when familiarity has yet to be fully established.
The team dynamic, we noticed, was also similar to that of ours in the United States as the students’ personalities and passion to do the project dictated their involvement in the project. When discussing our goals, we realized that making a plan that both our teams could follow was needed. With regard to our project, the vaccine cold box, the MAK students were very keen on discussing each individual functional requirement of the carrier. Rather than looking at feasibility, the MAK students were instead focused on making detailed analyses of the individual features of the carrier that they deemed as important based on the criterias of the vaccine carrier they had set at the beginning the semester. Such criterias included ergonomic, temperature, weight, and size requirements for their design to meet above current standards. Thus, these features included adding a different closing mechanism on the box, shoulder straps for convenient carrying capability, and a rack-like organization system for vaccine dispensing within the carrier. Ultimately, what we didn’t realize before the Duke team arrived in Uganda was that the MAK team wanted to redesign the entire vaccine carrier without considering manufacturing, pipeline, or market analysis.
In contrast, our team was very focused on the deliverables and overall feasibility of our project. As a result, we fixated our efforts on coming up with the temperature and GPS location tracking (which we see as the most valuable and impactful facet of the project) as well as figuring out a physical design that was possible to actually create and iterate on. For our team, we wanted to be able to design a product that could also be 3D-printed and fully modeled before the end of the semester. Therefore, rather than redesigning the entire vaccine carrier, the Duke team was much more focused on how to optimize the carrier in a meaningful way that could hit the market immediately and be of use without recreating the system.
MAK’s process-oriented and criteria-based approach was initially at odds from our end-goal focused approach to design. As such, we were talking about the project without really making any progress in tangible design choices. One of the biggest discussions we had during our trip was whether to create a new carrier or modify the existing one. For the Ugandan students, their mindset revolves around optimizing each and every design decision with regard to the criterias they had formulated, but our vision once again was about producing a high-quality end deliverable that could be used immediately in the market. After a back and forth, we realized that there is merit to both our working styles and came to a compromise by not completely changing the vaccine carrier but rather coming up with a modified design of the existing box that was feasible and adhered to the MAK students’ design standards.
In retrospect, we see this difference in mindset and approach as a product of two different educational systems. In the U.S. and specifically institutions like Duke University, the academic culture that is implicitly taught and carried forward is centered on results and producing something tangible in order to achieve success. We come from a background where test scores, final projects and performance in general is evaluated based on what we deliver and not necessarily on how we do so. On the other hand, we found that in Uganda, the methodology is the point of emphasis - not submitting a functional final deliverable. This dynamic became clear during one of our first team meetings when we, as MAK and Duke, were trying to come up with a concrete design and direction. We spent an hour discussing how we could optimize the physical design; it was only until we asked for the ideas to be drawn out that it became clear that some of the functionalities that the MAK team requested were not possible. We discussed this idea with Kenneth Rubango, a former MAK undergraduate and Duke Masters student, upon returning to Duke as well. He concurred that the system in Uganda is definitely more focused on sticking to a proven process rather than being driven by end results. From our experience, this definitely makes sense considering the detail of problem statements, design requirements, and thought behind each design decision that we have seen from the MAK side, while we at Duke build our design through CAD modeling, 3-D printing and circuit design to establish a working prototype.
Moving forward, these two mindsets need not be a source of friction. Instead, we feel that they can actually become a strength if used in a complementary manner. As a part of the Duke team, it is our duty to recognize the merits of the process-oriented approach and take a step back when needed to fully analyze each design task rather than rushing towards an end goal. Moreover, the MAK team could also benefit from prototyping and iteration by incorporating a slight results-based focus into their learning experience as well.
With increasing means of cross-continental communication through technology, this semester has taught us the power of globalization and shared academic interests. However, after many conversations, it became a reminder to our Duke team the dangers of preemptively, while unintentionally, creating a hierarchy in resources, brain build, and individuals.
The genesis of our collaboration started when the MAK team shared their statement of interest. Our interest to work together became apparent during our preliminary emails in which both sides expressed enthusiasm about the vaccine delivery system. Upon establishing our shared interests, the early conversations were often characterized by the MAK team stating their criterias of design and us asking questions about the reasoning behind the chosen framework. Once the landscape of the Ugandan healthcare system became clearer to us though, it became less of a FAQ session but a conversation of what we could engineer together across different continents.
Yes, shared academic interest is important to innovate and indeed, merging of resources is priceless. However, were we truly doing the latter? We realized that from a big-picture standpoint, the MAK students were offering their analyses and backgrounds on these medical projects while what we bring to the table is the financial and technological resources that we are privileged to have here at Duke. While the idea of a cross-continental collaboration is exciting and offers a mutually beneficial learning experience, the question is if it creates an unequal playing field when it came to group dynamics.
From our side, we came to MAK with a fairly expensive microcontroller to track temperature and location of the vaccine carrier and high-quality 3-D printed trays from Duke’s Innovation Co-lab. While in Kampala, we also were able to purchase two vaccine boxes, one to take back to Duke and one to leave at MAK for testing. With such a one-sided monetary investment, sometimes we wondered if that took away from the sense of ownership that the MAK students had in the project. We asked ourselves if such a financial stake could have had an effect of influencing the MAK team to go with our ideas rather than fully offer their perspective when making decisions.
Undeniably, our relationship with the MAK team was incredibly fruitful and the progress we made after just two weeks in Uganda was substantial. Our team interviewed 18 individuals and key stakeholders (including pharmaceutical directors, manufacturers, NGOs and doctors) and all of us were able to gain incredible insight into the vaccine delivery system that was not transparent through the emails we shared with MAK or available through academic literature. The intentions between the two teams were definitely pure hearted as both sides have a strong belief in the project and have a shared enthusiasm towards developing a working solution. The only concern though, is that we are building a relationship that inherently is tipped in our favor due to the resources that we as Duke students bring to the table.
In the future, perhaps a more equitable system would be to have funding for both the class here at Duke as well as the design class at MAK such that monetary expenditure wouldn’t be a factor in terms of driving project decisions and allow for a more open-ended collaboration.
Women in STEM
On a broader scope, a topic that we were able to gain more of an understanding through casual conversation and daily observations was the positive strides taken towards the education of women and the resulting emergence of women in STEM fields. Going in, we did have an understanding that the historic change in policies have favored the education of women. One of the biggest reforms, as mentioned in Children and Health in Uganda, was the Universal Primary Education (UPE) program introduced by President Museveni in 1996. It has produced a significant impact in terms of gender parity in primary schools which is now essentially 50-50 increasing overall enrollment for girls by 10% from the 1970s and 2001.
Our biggest window into the current state of women in STEM was Mercy, the only female student on our MAK vaccine cold chain team. She has been an instrumental part of our design collaboration and unequivocally the MAK team leader. Her calm demeanor and quiet determination have been a driving force in building a connection to the MAK team and validating our design decisions. All of us were able to build a close friendship specifically with her as she accompanied us on several trips to visit the various cold chain stakeholders and spent much of the daily work time with us as well.
In conversing with Mercy, we were able to get more of a sense of how women like her have more opportunity and freedom to study in a field like Biomedical Engineering and find success. She told us that while girls have not always been favored to pursue a STEM education, governmental policies in Uganda have taken a turn for the better with a growing number of scholarship opportunities specifically for girls and even a changing cultural attitude towards women having more independence. This sentiment was echoed by some of the other MAK BME students, namely Samiha and Nathipher, whom we befriended during the final dinner party with all the Duke and MAK students at the Edge House. In talking to both of them at length, they also agreed that more girls are seeking to find careers in areas like medicine and engineering. Along with policy reform, they mentioned that universities like Makerere have incorporated affirmative action policies to establish quotas for women, which has also been a positive influence in women having the freedom to choose from multiple career paths. Speaking from their personal experience, they mentioned their affinity with the field of biomedical engineering and expressed optimism in continuing in the healthcare sector.
Furthermore, we perceived a subtle yet powerful sense of empowerment from women like Mercy, Samiha and Nathipher that substantiate Ian Clarke’s assertion in Culture Smart! that many girls brought up in the cities do not adhere to the traditional roles that have historically been ascribed to women, which revolve mostly around housework and submission to male figures. In contrast, from our interactions it seems like they have cast aside these traditional norms in favor of an independence to pursue success in the same way that any man would. In fact, it was amazing how similar their collegiate experiences as engineers have been to those of female students at Duke in terms of access to educational resources, opportunities to take on leadership roles, and having support for finding technical jobs upon graduation. Hearing how analogous their job search process has been to ours as graduating students actually became a subject for all of us to bond over, as we discussed the importance of connecting with the right people in industry and applying in the right venues to get to interviews and job offers. Overall, this reality is consistent with Clarke’s depiction as well, as he states that there are a growing number of women in influential positions around Uganda with many women now rising to senior level management positions in commercial companies.
Overall, this trend definitely plays a positive role in the MAK-Duke dynamics as it has resulted in more gender parity as opposed to teams that are predominantly comprised of male students. Consequently, there is more of an inclusive learning environment in which diversity is encouraged, which definitely benefits the overall design process.