When you think of global health, who comes to your mind? I bet you thought of doctors, nurses, public health specialists, disease detectives and academic researchers. You probably did not think of engineers. That is because they generally stay out of the limelight, but silently keep things powered and running in the background – from water and sanitation systems in the community, to ventilators and biomedical devices in hospitals.
Global health engineering may not be sexy, but it saves lives. Take the Covid-19 pandemic as an example. During this crisis, engineers have made huge contributions by delivering oxygen, oxygen concentrators, pulse oximeters, ventilators, rapid tests, high-filtration masks, air purifiers, vaccine cold chains, logistics, supply chain management, mobile apps, data dashboards, among others. In some places, engineers have built Covid-19 field hospitals within days. But we rarely see them on national television.
Engineers are unsung heroes of global health, and I interviewed 27 engineers, from various corners of the world. I wanted to better understand the work they do, figure out what motivates them to take on global health challenges in resource-limited settings, and uncover some of the barriers they face in doing global health work.
All engineers are not the same
The first thing that struck me is the incredible diversity of engineering backgrounds. The engineers I interviewed had trained in chemical engineering, electrical engineering, electronics engineering, bioengineering, biomedical engineering, civil engineering, environmental engineering, computer science, structural engineering, communications engineering, materials science, and industrial engineering. Apparently, every branch of engineering has something to offer the field of global health and development.
What motivates engineers to focus on global health?
Most engineers do not work in global health. They make more money in the corporate, big tech, and industrial sectors. So, it is the exceptional engineer who decides to dedicate their lives to global health. I asked such engineers about their motivation and inspiration.
Most spoke about the need to work on something that can be impactful and meaningful. Global health, it appears, gave them purpose in life. Some were inspired by their early experiences in resource-limited settings. Some see social justice as their goal and use engineering to fight for it. Others are trying to help their local communities with their engineering skillset.
“Health is a right,” said Mimi Alkattan, an environmental engineer, and a Fulbright Student Researcher, and former Peace Corps volunteer. “It is important for me to work on impactful and global problems and to stand in solidarity with communities that experience health inequities,” she explained. Right now, she is measuring antimicrobial resistance pathogens and antibiotics in surface waters in India.
“I dabbled in a few tech startups, even spent some time on Wall Street, but really connected with the challenge of improving global health,” said Jonathan Jackson, founder of Dimagi. “The idea of building tech that was directly tied to impact for underserved communities immediately clicked for me,” he added. Dimagi builds high-impact digital solutions that amplify frontline workers and programs.
Elizabeth Tilley is an Associate Professor of Global Health Engineering at ETH Zurich. While she was doing her her bachelor’s in environmental engineering, she has the opportunity to work with an NGO in rural Mexico. A nurse practitioner there showed her a big jar of preserved parasitic worms that she explained had come out of a young girl. “Realising that people, children, could die from not having a toilet seems very cliché now, but at the time it was mind blowing,” said Tilley. “I don’t have a religious background, but I definitely felt that I had a karmic obligation to use my very expensive, tax-funded education to give back to people who didn’t win the birth lottery,” she added.
Edgar Landivar, an electrical engineer in Ecuador, was inspired to work in global health because of the pandemic. “My country was hit severely because of the lack of a good health system. Insufficient ventilators and the impossibly of rushing manufacturing made me think we have a problem in the industry,” he said. During the pandemic, Openventi, the project he was involved in, delivered 200 low-cost ventilators in Ecuador and Peru.
Some were inspired by individuals. Eric Buckley is the Director of Oxygen Engineering at Build Health International (BHI). “My motivation for stepping away from my career in the corporate engineering world and joining BHI came from reading about the incredible work our founder Jim Ansara was able to accomplish with his work with Partners in Health after the 2010 earthquake in Haiti,” he said.
Jonas Twizeyimana, a biomedical engineer, is a Simulation and Biomedical Technician at the University of Global Health Equity (UGHE) in Rwanda. “Having read about the incredible work of the Late Dr. Paul Farmer, Partners in Health, and UGHE, I was inspired. I felt like I had found my purpose in promoting health on a global scale,” he explained.
Some were driven by the need to help their communities. Anpotowin Jensen is a Oglala Lakota and was born and raised on the Pine Ridge Indian Reservation. “The Lakota People on our Reservation face rural healthcare issues, food deserts, limited access to water and electricity and our health disparities are some of the worst and unattended in the nation,” she said. After doing her civil environmental engineering training at Stanford university, she is now working for the International Indian Treaty Council, a nonprofit, Indigenous organization, and helping tackle water quality concerns.
Manu Prakash, a professor of bioengineering at Stanford University, did his undergraduate engineering training in India. After graduate training at MIT, he had the opportunity to visit Sevagram and Gadchiroli in rural India. “This experience shaped my thinking around working with communities,” he said. “Growing up with health desparities and seeing the scale of the problems we face, I made an explicit decision to build low-tech solutions that can actually scale,” he added.
Some found their passion during fieldwork in resource-limited countries. John Paul Mugo is a civil engineer, currently based in Nigeria as the WASH Sector Co-Lead with Norwegian Refugee Council. “My first encounter with a cholera outbreak in South Sudan in 2013, gave me first-hand experience, of how lack of access to clean water, sanitation and knowledge in hygiene impacts people,” he explained.
Nithya Ramanathan did her graduate field work in rural Bangladesh, using sensors to detect arsenic in the groundwater. Her team decided to go beyond measuring arsenic. They worked with engineers to actually build a deep well for the community. “That experience motivated me to build tech and information systems that keep lifesaving solutions in off-grid places connected and supported for the long haul,” she said. Ramanathan is CEO and Co-Founder of Nexleaf Analytics, a non-profit technology company.
For Rebecca Richards-Kortum, a Professor of Bioengineering at Rice University, a visit to a hospital in Malawi in 2005 changed everything. “I saw many pieces of critical equipment that had failed because they weren’t designed to meet the needs of a low-resource environment. At the same time, there were many babies and children who needed treatment with that same equipment. I came back to Rice and told my group, we are changing how we think about technology design,” she said. She is now part of NEST360, a team of engineers and clinicians from 16 different organizations (12 in Africa), working together to improve newborn survival in African hospitals by developing and delivering a bundle of affordable, effective technologies and services for newborns.
How do engineers add value in global health?
By interviewing engineers, I’ve learnt that there is pretty much no area of medicine, healthcare, and public health that does not require engineering. Global health, in particular, requires frugal innovation to design and make things work in tough, under-resourced conditions. Everything is done on a tight budget, and often under great time pressure.
“Engineers have always contributed directly or indirectly to health,” said Bernard Amadei, Professor of Civil Engineering, University of Colorado, Boulder, and Founding President of Engineers Without Borders – USA. “Progress in life expectancy over the past 100 years can be attributed to many disciplines, including engineering. The question now is how to contribute to the betterment of 3-4 billion people whose job is to stay alive at the end of the day,” he asked.
“Engineers keep people from getting sick in the first place,” said Mimi Alkattan. “Engineers work on the environment around us, be it the built environment (buildings), infrastructure (water, wastewater, transportation, electricity), or natural environment (water, air, soil). By designing ways to keep these spaces clean and safe, engineers are directly involved in public health,” she explained.
“Being an engineer means being a problem-solver and an innovator,” said Tojan Rahhal, President & CEO of Engineering World Health (EWH), a non-profit. “Global health encompases some of the greatest challenges we face; underserved communities around the world lack basic necessities and functional equipment to treat patients in need,” she explained. EWH is a global organization that offers university students and young professionals in STEM fields with life-changing educational experiences repairing medical equipment in low-income countries, create locally-sustainable training programs for biomedical engineering technicians around the world, and engage the next generation of engineers to improve global health.
Anoop Jain, an environmental engineer, also emphasized the problem-solving ability that is inherent in engineering. “Engineers are trained to solve complex problems, and global health is a series of complex problems,” he said. Jain is Founding-director, Sanitation and Health Rights in India, and a postdoctoral fellow at Harvard Medical School. His group aims to end open defecation and provide clean water to communities in India.
For Chandrasekhar Nair, an engineering in India, affordable diagnostics was a way to add value. He developed Truenat, a point-of-care molecular diagnostic platform for detection of infectious diseases in resource limited settings. This platform was recently endorsed by the WHO for rapid detection of tuberculosis, a disease that kills 1.5 million people every year. This platform was widely used in India for Covid-19 as well. “Engineering is going to play a definitive and important role in medicine,” he predicts.
For Prashant Warier, another Indian engineer, leveraging artificial intelligence for healthcare was a path to impact. He helped start a company called Qure.ai, a healthcare AI firm that uses AI in radiological imaging to help physicians diagnose diseases quickly and accurately. “Radiologist knowledge is in short supply, expensive, and unevenly distributed. As a result, not all patients receive an appropriate and timely diagnosis. This is the gap that Qure.ai is filling,” he explained. Their X-ray AI technology can automatically interpret X-rays for TB within seconds, and was also endorsed by WHO.
For Linsey Marr, a Professor of Civil and Environmental Engineering at Virginia Tech, addressing air pollution, a global problem, was the way to add value. “Clean air and clean water are among the most basic necessities for good health. Engineers are the ones who know how to deliver clean air and clean water to the global population,” she said. Her research group focuses on understanding the mechanisms by which influenza virus and other pathogens are transferred from one host to another and what factors affect the efficiency of transmission.
Jean Luc Mpamije, is the Biomedical engineering lead at Partners in Health, Liberia. “Our work is based in improving healthcare technology systems, capacity building of local biomedical technicians in rural and hard-to-reach areas to ensure that essential equipment and tools can be maintained and upkept,” he explained. It is well known that maintenance of biomedical equipment is a major issue in low-income countries, and it is never easy to find engineers to fix x-ray machines, ventilators, or baby incubators. “All patients everywhere deserve access to high-quality care, and engineers are a core component of high-quality service delivery,” Jean Luc said.
For Manu Prakash, ‘cost conscious engineers’ grounded with an understanding of context of a health care delivery system have a key role to design solutions that can be delivered at scale. His lab works on a broad range of global health problems such as diagnostics, disease surveillance and education, focusing on diseases such as malaria, TB, sexually transmitted disease, and Covid-19. He has also popularized the ‘citizen science approach’ – including a cellphone-based approach for citizen driven mapping of mosquito species.
The Covid-19 pandemic exposed the critical shortage of oxygen in many countries. It is not easy to forget the images of people gasping for oxygen during the Delta wave last year. Eric Buckley of BHI is leading a team of over 20 staff members in their effort to increase access to life saving medical oxygen in communities that have been hit hardest by the COVID-19 pandemic, with a focus on Sub-Saharan Africa, The Caribbean and South America.
Oghenetega Iortim, a communications engineer, is the CEO and founder of Gricd, a Nigerian cold chain technology company. “Our work aims to improve access to life saving vaccines that are temperature sensitive,” he said. They build real time temperature trackers and cool boxes that preserve and assure the quality of temperature sensitive medications.
Amy Pickering is an Assistant Professor in Environmental Engineering at UC Berkeley. “Our lab studies enteric pathogen environmental transmission pathways in high disease burden settings and collaborates with community partners to develop effective, equitable, and scalable technologies and interventions to interrupt them,” she explained.
Francine Umutesi is Medical Technology Division Manager, Rwanda Biomedical Centre, which ensures availability of healthcare infrastructure and equipment. “My contribution was and is to ensure availability of infrastructure and equipment when and where needed to set up new Covid-19 isolations or treatment centres across the country,” she said.
Imran Cheema is an assistant professor of electrical engineering at the Lahore University of Management Sciences in Pakistan. His Bio-Agri-Photonics lab is working on optical sensors for detecting diseases such as TB.
Georgia Tech Associate Professor Shannon Yee, a mechanical engineer, has developed a new, affordable toilet — the Generation 2 Reinvented Toilet (G2RT) — as a solution to the world’s sanitation problem.
What barriers do engineers face in doing global health work?
The engineers I interviewed identify several barriers for their global health work. Some of them were due to lack of recognition. Engineers are seen as ‘fixers’ doing routine maintenance, and not as innovators or essential members of the healthcare team. Some spoke about challenges in securing funding for developing or scaling innovative solutions. Some pointed out the need for engineers to have broader training (beyond just engineering), as well as stronger collaborations with clinicians and public health experts, to succeed in global health.
Most identified weak infrastructure (e.g. lack of tools, electricity, water, roads, reliable internet) and harsh conditions (e.g. heat, dust and humidity) as a chronic issue they all faced. “You know what to do and how to do it but you lack the appropriate tools,” said Jonas Twizeyimana.
“Most clinical teams comprise of doctors, nurses, anesthetists, but rarely do we hear about a biomedical engineer who contributed to saving a life,” said Umutesi. “Yet, we have seen some of them doing extraordinary things especially in crisis times. She really believes greater recognition, better pay, and empowerment of engineers will go a long way in building capacity in low-income countries.
June Madete is Senior Lecturer, Department of Electrical and Electronic Engineering, Kenyatta University. She did her engineering training in the UK before returning to Kenya. “When I came back to Kenya, biomedical engineering was all about maintenance. There was no capacity for innovation or problem solving. This is when I embarked on the field of capacity building in R&D which was lacking in the region,” she said.
Afua Gyaama Kissi Ampomah is a program officer at the Aquaya Institute overseeing activities in Ghana for the Hilton Africa Water Quality Testing Program. She spoke about lack of resources as a big barrier. “Some engineering solutions require huge amount of capital to deploy which most developing countries don’t have,” she said.
Edgar Landivar raised concerns about regulatory processes for medical devices. “Regulations are set for well stablished big corporations. Companies from developing countries don’t have even a chance against big global companies when they need to get approval for their new devices. So, there is an entry barrier for innovation coming from developing countries trying to sell globally,” he explained.
Rebecca Richards-Kortum spoke about crossing “the valley of death” between a promising prototype and an actual product. “Unfortunately, there is a big difference between need for a new product and a market of customers who can pay for that product,” she said. “If engineers are going to make a difference in global health, we have to figure out how to not just how to make promising prototypes but how to make products that actually reach and help the patients who need better medical devices,” she argued.
Low cost, scalable solutions require tremendous efforts and focus over long period of time. Manu Prakash says such work is “either not supported or not at the scale we need, when compared to high margin products that are very well supported by the venture capital funding community,” he said.
Imad H. Elhajj is a Professor of Electrical and Computer Engineering, American University of Beirut. He is engaged in their Humanitarian Engineering Initiative. According to him, funding channels for global health are different than typical ones in engineering field, and it is not easy to hire engineers to work on global health projects. “Global health is not currently a career path that is visible to engineering students, although it should be,” he said.
“Good engineering is messy and boring and repetitive – getting trash off the streets, getting shit out of pits, and getting a bit of chlorine into water,” said Elizabeth Tilley. She said such work is not likely to get funded, while everyone is keen to fund high-tech, glitzy stuff. “One of the best “interventions” I funded, but had to hide from the funder, was to buy new tires for the garbage truck in Blantyre. If I had proposed a robotic drone to collect trash and prevent disease from spreading from the waste piling up on the streets, I probably would have gotten the money,” she said.
Linsey Marr has similar thoughts. “I think there is a lack of understanding of the value that engineers can contribute toward global health because most engineers do not have medical-related training and because there is an association of engineers with whiz-bang technology, rather than with issues that do not appear overtly to be technologically challenging,” she said.
Will Moyo is the Innovation Design Studio Manager, Malawi University of Science and Technology & Rice 360 Institute for Global Health Technologies. “There are still too few women in engineering,” she said. “Not only are young women underrepresented in engineering, they also face significant challenges in navigating the workspace. There are also very few pathways for informally trained engineers to prototype and test their inventions,” she added.
“We need to do better at including women and men of color, especially those that have lived experiences of the issues that our work addresses,” said Mimi Alkattan.
Daniel Acosta is an industrial engineer from Colombia, currently a PhD student at the Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, where he is working on veterinary vaccine supply and value chains. He highlighted that engineers often lack training in social sciences. “If engineers are blind to issues such as gender and intersectionality, our work could inadvertently end up exacerbating inequalities in access to health,” he said. Indeed, there are examples of AI solutions that worsen gender and racial biases.
Anoop Jain had similar concerns. “Global health is a series of complex problems. But not all of them have technical solutions. Engineers need to get better at understanding the social, political, and economic determinants of these complex problems, and design solutions that account for these determinants,” he explained. He gave India’s sanitation crisis as an example. It is not a technical problem, but a problem rooted in cultural and social determinants, he argued.
“We need T-shaped engineers that have depth of expertise in an engineering field (e.g. mechanical or biological engineering) but also have broader experience in other disciplines such as epidemiology, global health, product design, economics, urban planning, complex systems, ethics, human-centered design, and community engagement,” said Amy Pickering.
Inspiring the next generation of engineers
It is clear that engineers have so much to offer and add tremendous value in all areas of global health and medical care. And there are a million problems to solve, from pandemics to global warming. Surely, global health is a dream opportunity for engineering students who want to see impact in their lifetimes?
But most students in STEM have little idea about how they can get involved in solving huge problems like pandemics or climate change. Even if they wanted to, engineers aren’t encouraged to pursue global health, said Tojan Rahhal. “Frankly, it isn’t usually the best paying job,” she said. Corporates and industries headhunt good engineers and not many see a career path in global health.
“If money is your number one motivator, the global health field is likely not a fit,” said Jonathan Jackson. “You need to be intrinsically motivated by social impact, more so than financial gain,” he explained.
Today, many young people are excited about social impact and are looking for meaningful career pathways. Engineers like Manu Prakash are inspiring scores of young STEM students via initiatives like Foldscope, and Frugal Science courses. Young people are naturally drawn to hackathons and crowd-sourced, open science platforms, keen to help where they can. Prakash argues that it is critical that engineers focused on global health are exposed to field context early and truly understand the challenge at hand. This requires collaborations between global North and South partners, he says.
And dedicated groups such as Build Health International, Humanitarian Engineering Initiative, Engineering World Health, Engineers Without Borders, Partners in Health, Doctors Without Borders, Dimagi, Nexleaf Analytics, Rice 360, and Prakash Lab are inspiring young engineers to roll up their sleeves and get engaged in solving real-life problems that impact millions of people in remote and under-served areas.
It will be very impactful if mainstream engineering schools created special concentrations in global health engineering to grow the pipeline of young people entering global health. Programs in high-income countries should equitably partner with engineering schools, medical and public health schools in low and middle-income countries or under-served areas, for students to learn from people solving real problems on the ground. But, Mimi Alkattan aruges that this needs to be done carefully. “Engineers need to examine and address how their work might be intersecting with saviorism, colonialism, and racism,” she emphasized.
As I wrote in my previous post, young people are unhappy with how the world is tackling big crises. Global health engineering offers them a terrific opportunity, quite literally, to not only repair the broken world they are inheriting, but design a better future for humankind.
Note: I have no financial investments or conflicts with any company, individual or entity featured in this piece. I have no industry affiliations or disclosures.