As a child growing up in the Ugandan capital of Kampala, Maureen Etuket used a screwdriver to dismantle electronic appliances and toy trucks. "I was around eight, nine years old," she says. "I guess it just excited me."
Slightly over a decade later, this curiosity is driving her quest to find solutions to public healthcare challenges.
Last month, Etuket's Smart PVD device [Postpartum Haemorrhage Volumetric Drape] won the Mandela Rhodes Foundation's award for social impact in Africa - the 2023 Äänit Prize - with a cash grant of $38 000. At the awards ceremony in Cape Town, judges described the device as "a brilliantly practical intervention that can immediately and directly improve outcomes for patients".
Inside the Anatomy Building on the University of Cape Town (UCT)'s Health Sciences campus, Etuket explains that she and her team devised a prototype after spending three months in maternity wards at Kawempe National Referral Hospital in Kampala.
"We went almost every day. We had day shifts and night shifts," she recalls. "I started asking the question to nurses and midwives, how do you know that a woman is likely to get to PPH?" PPH or post-partum haemorrhage is excessive bleeding after a baby's birth, which could cause a severe drop in blood pressure leading to shock and death if not treated.
"Like, how do you tell? What criteria do you use? And the nurses told me that they had been doing this for a long time. They said they just observe and know. And I thought to myself, if that was working, we would have [fewer] women dying from PPH."
Figures presented at the World Health Organization (WHO)'s Postpartum Haemorrhage Summit in March paint an alarming picture, noting PPH as the leading cause of maternal mortality worldwide. "Each year, about 14 million women experience PPH resulting in about 70 000 maternal deaths globally," reads a WHO statement. "Even when women survive, they often need urgent surgical interventions to control the bleeding and may be left with lifelong reproductive disability."
'birthing rush hour'
At Kawempe Hospital, Etuket observed "birthing rush hour" and the understaffed wards. Problems faced way beyond Uganda - also in South Africa and other low-income parts of the world, she points out.
"There would be maybe one or two nurses for every ten beds and they're delivering everyone," she says. "Immediately after they finish delivering one lady, they would move on to the next one. So at what point will they be able to recognise that a woman is actually over-bleeding? It's a silent death of sorts."
She witnessed new mothers suffer PPH first-hand. "This one lady, we wanted to test our device on her. It was around 11 PM. And she said, no. Of course, it's consensual, right? If someone says no, it's fine, you move on. Then at 2:00 AM, we noticed that she wasn't in her right mind. She had literally moved from her bed to another place and she was losing consciousness. I could see it. Then they realised she was actually bleeding a lot. The doctors came in and there's a procedure that they do, a very painful procedure."
Services at the hospital are free, but due to budget constraints, she says pain medication is not always readily available.
"So PPH is usually caused when the placenta detaches from the uterine wall," says Etuket. "And when that happens, the blood vessels there do not close appropriately, so blood keeps gushing out. So, as treatment, the doctor inserts their hand into her vaginal canal, pressing against the uterine wall, while exerting pressure externally as well. I watched it being done and I was like, oh, wow. I prayed for her, and she did survive."
In 2018, Etuket pitched the problem of PPH to students she was lecturing at Kampala's Ernest Cook Ultrasound Research and Education Institute (ECUREI) - Phiona Nannungi and Precious Ainembabazi - and together they came up with a prototype for what would become the Smart PVD device. In 2020, she co-founded Pumzi Devices with Dr Peter Kavuma - a non-profit organisation aimed at providing "innovative biomedical engineering ideas to improve emergency care". The two innovators met at Makerere University where Etuket was enrolled for a Bachelor's degree in biomedical engineering and Kavuma for a Masters in emergency medicine.
How does the Smart PVD device work?
"There's something already on the market - an under-buttock drape bag attached to the bed while a woman is giving birth, which measures amount of blood loss," says Etuket. "[It's] basically a bag where the blood flows into. We then created an electronic module that has a probe and a buzzer, which we put inside this bag, and it gives a beeping sound when the blood has reached a certain level. This alarm alerts a midwife to recognise the need to attend to a particular case. So the blood collection module is disposable. And the electronic module, which has the probe and the buzzer, is reusable."
Etuket declines to share pictures, citing intellectual property rights.
"I really think that this is one of the simplest innovations," she says. "We've been pitching it and talking about it, and everyone that listens is just like it's common sense, right?" Apart from the Äänit Prize, they have received $16 000 from the Makerere University's research and innovations fund and $55 000 from the science and technology secretariat in Uganda.
Moving to Cape Town
Etuket moved to Cape Town in 2021, courtesy of a Mandela Rhodes Foundation scholarship. "I applied for a Masters in health innovation at UCT under the Mandela Rhodes Foundation. So, I'm Christian. I believe in the hand of God in everything I do. I made just that one application. Like, there were options to put three universities, three courses, all that. I just wanted health innovation at UCT, and I got it."
Her Masters supervisor was Professor Sudesh Sivarasu, internationally renowned for medical device innovation and head of UCT's MedTech laboratory.
"There were so many questions we had at Pumzi Devices about how to transition an innovation to the market and no one really had the answers because it's a new space. At a certain point, some of us had to travel to Scotland just to sit with experts to guide us through a protocol design process. No one in Uganda really had a clear picture of [this] so that's what prompted me to do the Masters in health innovation," says Etuket.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Find your purpose
Presently, she is pursuing a PhD in industrial engineering at Stellenbosch University under the supervision of Professor Sara Grobbelaar and Dr Faatiema Salie. Yet she spends most of her time at UCT, where Sivarasu is her external co-supervisor. Etuket's PhD's working title is "Exploring the development of a localisation roadmap for medical devices in South Africa using an Innovation Systems Framework". She explains that this line of study - systems engineering - is drawing her thinking wider to understand the systems around biomedical design and innovation.
Going forward, Etuket will continue to lecture students back home in Uganda - online - while being open to further her learning and practice where it is apt or required around the world.
At 28 years old, Etuket's drive and achievements make her a role model for many. However, she is reluctant to wear the label of "a pioneering young black woman," voicing caution over mantels based on race and gender. "I notice that when we start to have those mindsets, we may end up trampling on people, on men. We have to work together. There is room for all of us," she says.
The first born of four siblings, Etuket's father was a computer engineer and her mother an accountant and businesswoman. Elaborating on leadership, she says, "I think it's important to pray for people. That's where we get guidance on how to lead. I tell people, not everyone should do a PhD, maybe not everyone should do a Masters, but find your purpose and fulfil it."
