How 3D printing is boosting health services in Kenya

The purring of machines ushers us into a well-designed lab, one of many office spaces inside the sleepy LakeHub tech incubation centre in Kisumu’s leafy suburb of Milimani.

Some 18 units of three-dimensional printers have been beautifully placed on shelves, with each humming to the rhythm of additive manufacturing, all coming from a command from a laptop resting on a table.

At one corner of the room are dozens of face shields, tens of packs of ear savers and contactless door handles while on another one, various medical equipment parts are well arranged on a table.

Daisy Achieng, who has just come from a delivery errand Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), tells us she has delivered more than 3,000 3D printed medical units in the past week alone.

“Hospitals and health centres in this region place orders every day. Our job is to manufacture and supply,” she says.

David Oginga, the firm engineer, reveals that in the past five months the startup — Kijenzi 3D — has churned out more than 10,000 face shields and 5,000 ear relievers in the ongoing war on Covid-19.

“Using our 16 Prusa 3D machines and two Mechboards we print a variety of personal protective equipment (PPE) of any design as well as spare parts for medical equipment, models for body organs and equipment for occupational therapy,” the 27-year-old biomedical engineer expounds.

He adds that Kijenzi 3D also uses the technology to produce parts for dialysis machines, microscope knobs, clutches, incubator latches and finger clamps, but on demand.

The beauty of 3D printing, David says, is the ability to manufacture customised items for hospitals faster while achieving enhanced quality and production volumes.

To a great extent, compared to imported equipment that are expensive and take months to reach the country, the innovation helps keep hospitals processes running once parts of crucial medical equipment wear out and need urgent replacement.

“We have also been supplying these products to Aga Khan Hospital, St Jairus Hospital, Kisumu Specialist Hospital, Siaya County Referral Hospital, Star Hospital, Kisumu County Hospital, Kenya Medical Research Institute and Acacia Medical Centre,” says Ms Achieng.

While most prototypes for 3D printing have been placed online for free downloads to help innovators around the world to print solutions for Covid-19, most of them, according to Elvis Ogweno, the production engineer, are just general designs for medical items that are common.

“What we find online is actually not what doctors ask us for. They request for specific parts or items that have unique features and those need to be designed from scratch,” he explains and adds that he does that using the Fusion 360 3D software.

It takes one machine 20 minutes to print a face shield, and prints at least 150 pieces each day. For the 16 machines working concurrently, they meet the production capacity of 2,400 units with each going for Sh250.

The World Health Organisation recommends the wearing of face shields on top of face masks for people who work for long hours in high concentration jobs like surgeons, nurses, dentists, lab technicians or construction workers, to keep off droplets or liquid splashes from the face.

For ear relievers, each 3D printer produces six pieces every 35 minutes, which they sell at Sh45 each. Also called ear savers, they are placed at the mask straps on the ear to relieve the strain caused on the ear by long use of face masks.

In Katoloni, 2.6 kilometres from Machakos town, we found Nehemiah Mutie busy packaging ear savers and face shields as two of his four 3D printers’ nozzles moved left and right, printing more savers.

The other two machines, he said, were awaiting clients who want to print their equipment and parts from their homes, and he was putting a casing on them.

Mr Mutie, who graduated from the University of Nairobi last year with a bachelors in mechanical engineering, joined the 3D printing industry back in 2016 and has since grown his experience to the level of manufacturing the printers himself.

“I aim to give people the freedom to make what they want from their homes at a very affordable price. In the past four years, I have sold over 100 machines each at Sh46,000. All I need to make one is a motor, Liquid Crystal Display (LCD) screen for commands and the filaments for printing. From my engineering classes, I can handle the rest with ease,” says the 26-year-old innovator.

To print any object, design or prototype is first created on a computer and the file saved on a memory card. The card is then inserted into a slot in the 3D printer after which the machine is commanded from a small LCD screen to print the file.

The material used for the printing is called a filament and is made of soft plastic, which is melted into a fine liquid through heat produced by the machine.

Continuous addition of tiny drops of this liquid on a board to ultimately create the desired object is what makes experts call 3D printing additive manufacturing. For huge objects, they are first allowed to cool off before removing them.

During the visit to Mr Mutie’s workshop, we found a consignment ready for shipping to Germany for consumers who want to sample products made in Africa.

“I have also supplied face shields to Greece but locally I have delivered to the Ministry of Health and Nairobi Hospital,” says Mr Mutie, who is also the managing director of AB3D, one of the pioneer 3D printing startups in Kenya along with Kuunda 3D, which is also using the technology to help the country meet the demand for PPEs.

He tells us that he trains school children on how to use the technology because “future populations will need this technology to boost their export capacity”.

On Nairobi’s 95 Limuru Road, we enter into Mehul Shah’s offices and find him working on a prototype on his large screen. Gleefully welcoming us into his space, he mentions to us the various trials he has done to test the prowess of the technology.

Before resting on printing face shields and ear savers back in March, he used to print industrial objects including the tails of aeroplanes. His printers were the biggest this writer saw in all four counties visited.

“When Covid-19 landed in Kenya, I decided to take it as my responsibility to help the government produce face shields and ear relievers as a lower cost,” he tells us.

But at one point, in his ambition to print Y-splitters for air ventilators, he was stopped by medics in the Ministry of Health who warned him about the dangers of going ahead with the project.

“I had thought it was a nice idea to for a two or four splitter to allow one ventilator to be used by two or four patients but doctors advised that every air ventilator is meant for one patient and splitting the oxygen puts the lives of patients at great risk,” narrates Mr Mehul, who is the chief executive of Ultra Red Technologies, a startup he founded in 2014.

But since that day, he has produced more than 7,000 face shields and hundreds of ear savers using his four powerful 3D printers that make 50 ear relievers each in under one and a half hours. Every shield is printed within six minutes.

He sells directly to distributors, who supply to hospitals and health centres in Nairobi, rural areas and even crosses borders to Somalia, Ethiopia and South Sudan.

In Eldoret town, just past the Moi Teaching and Referral Hospital, you find St Lukes Orthopaedic and Trauma Hospital. Here, 3D printing is under critical utilisation in making prosthetic arms that are fitted to victims of violence who lost their hands or those born without them.

The initiative, which is being carried out in conjunction with Victoria Hand Project, a Canadian organisation, aims to help amputees regain function to improve their quality of life.

In a pandemic period where many families in developing countries are committing their economic resources to food leaving little savings for healthcare, the hospital, through the technology now charges only Sh20,000 for the entire procedure while normal rate remains at Sh200,000 in other hospitals.

Dr Kibor Lelei, chief executive and a senior orthopaedic surgeon at the hospital, says an arm printed using the technology can be used for holding, grasping, cooking and lifting a weight of up to two kilos.

“I love this technology because it takes a shorter period to make a prosthetic limb and you can make the exact size needed by the amputee. You can also customise it, for instance, by taking a photo of your foot and get it created,” he says.

But Annah Koinei, the lead technician at the 3D printing department at the hospital who handles two super-machines explains that the process of making an artificial arm involves six steps, which takes only five days compared to the normal process that takes two weeks.

“The first step is screening the patients to determine whether they are below elbow or knee amputation. After that, measurements are taken for a cast,” she says.

A photometry procedure that involves taking between 60 and 80 photos follows, and this, she points out, is meant to guide in finding the correct 3D angles.

“Using our Agisoft software, these photos are then aligned on the computer. The Meshmixer software is used to create a socket while the Curer software now interprets that for use by the 3D printer,” she expounds.

The fifth step in the actual 3D printing and time taken depends on the size of the socket created. Fingers and palms have standard sizes for children and adults. Ms Koinei says this process takes between 18 and 40 hours.

“The fingers, palm, wrist and thump are printed separately with each taking eight hours, nine hours, four hours and one hour respectively. That makes assembling all into one arm the last step,” she notes and discloses that since February, she has printed and fitted nine amputees, with seven scheduled for the process.

Wesley Korir, an orthopaedic technologist and expert in both below-knee and above-knee prosthesis as well as above elbow procedures says once an amputee is fitted the artificial arm, they can use is through body movement via a string that runs through the middle of the casing and connected to the flesh.

“The prosthetic arm is connected to the flesh or the humerus bone using the string and thus the micro electric movements enables the amputee to an extent, flex or twist the arm. But other movements are body-powered,” he clarifies.

However, this technology comes with its own set of hurdles, which holds back its wide adoption as Kenya gears up for the technological disruption in the medical arena.

The cost of filaments, according to Mr Mutie, is one drawback that innovators face, as they still have to be imported to support the industry.

Having discovered the same, Mr Mehul has gone into an experimentation spree, testing various designs to print the filaments in Nairobi, thereby reducing their cost.

“This would, in turn, lower the cost of products we produce every day. We no longer have to wait for them to be shipped from abroad because that can delay work and even contribute to the death of patients as doctors bet on us to print crucial medical equipment parts,” he says.

For Ms Koinei, apart from the required checks and maintenance, the fact that most of the small parts printed end up with unwanted plastic that cannot be recycled is a hindrance to cost efficiency.

But even as the 3D printing industry in Kenya undergoes teething problems, the biggest stumbling block to the future of manufacturing, according to the innovators, is the Kenya Bureau of Standards, which they accuse of taking too long to approve products that are in high demand.

“This industry needs care from the government. We expect their officers to inspect our products and technology and give us approvals in a shorter period. Not the three months that we are used to,” says Mr Mutie.