TULIZA KIT

Tuliza kit is a specialized simulation tool designed for training medical practitioners with limited experience/access to training in neuraxial (epidural and spinal) anesthesia (specifically in low-resource settings), and as such are seeking to improve these psychomotor skills. The kit is comprised of a physical simulator/phantom and a complimentary mobile based application. Using affordable and locally available materials, the physical simulator is designed to mimic all the anatomical tissues involved in epidural and spinal anesthesia, so as to give a "real feel" experience to the trainee. This negates the need for training with patients as is the current practice which reduces the risks that patients are exposed to. Beyond this tactile feedback, its integrated circuitry, using sensors and indicators, will give further feedback to any user.  A self-assessment application will complement the tool giving quantitative feedback to the trainee (such as what could be improved, level of skilltransfer and retention). 

The proposed solution is a low-cost multi-layered epidural and spinal simulator that is designed to mimic the human body tissue structure during neuraxial anesthesia administration. According to its description, the simulator is not intended to be a medical device but rather a support tool to medical practitioners for training in administration of epidural anesthesia.

Features

The design features a soft porous spongy outer layer to represent the skin and subcutaneous fat layer of the human body , a mid layer made of tougher sponge to represent the supraspinous and interspinous ligaments. It also features a silicon/rubber layer that mimics the ligamentum flavum between L1 to L5 of the (L=lumbar vertebrea) of the spine structure. The ligamentum flavum is a tough 5 mm thick layer. The silicon/rubber layer represents the increased resistance to penetration of the spinal needle. The epidural space is an empty space 6 mm wide between the “ligamentum flavum” and is connected to a reservoir to drain the liquids.

Two 3D printed simplified vertebrae models are included. They contribute to add a real feel to the model and help the trainee to guide the needle between the vertebrae. Complimentary to this is a mobile based self-assessment application. 

Tuliza kit will allow anesthesiologists and of non-physician anesthesia providers in training to become confident and competent in performing neuraxial anesthesia as part of surgical procedures necessitating epidural & spinal anesthesia but more fundamentally performed in obstetric care.

Surgical Anesthesia and Obstetric (SAO) care plays a significant role in maternal health because it is critical for the prevention of death, disability and development of a resilient healthcare system.  However, many health facilities in LMICs remain under-resourced with inability to provide SAO care due to the anesthesia workforce gap in these countries, with most of them having less than 1 anesthesia provider per 100,000 population, a far cry from the baseline 5:100,000 anesthesia provider to population recommended ratio by The World Federation of Societies of Anesthesiologists. 

Furthermore, the lack of specialists in neuraxial anesthesia(epidural and spinal anesthesia) in LMICs not only limits optimal patient care, but has also  been a hindrance to fundamental anesthesiology training and practice improvement. This has resulted in limited opportunities in apprenticeship, and continuing medical education which are necessary for workforce reinforcement in SAO care.

There is need to to improve the training of anesthesiologists and  non-physician anesthesia providers. This will improve surgical outcomes in developing
countries.

Tuliza Kit is designed for anesthesiologists, non-physician anesthesia providers as well as anesthesiology students in developing countries. These categories of people are our target users because they normally work independently in resource constrained environments, under a lot of pressure and lack access to continuing medical education for their professional development. For those with access to some form of training, there is little/no supervision by a qualified anesthesiologist. Based on their needs, they would greatly benefit and take advantage of this simulation kit to increase their skills in giving epidural and spinal anesthesia to aid in obstetric surgeries.

Experienced anesthetists who want to monitor their skills and/or improve them can also use the simulation tool. In case of necessity, the tool can also be used to train and instruct other healthcare workers (e.g., general doctors, nurses etc.). Moreover, it can be used by non-specialists who have an interest in anesthesiology and who would want to acquire skills in the area. The technology could be used either in training institutions, at anesthesiology departments in health institutions or even at home.

Team lead

Name; Lynette Kicoonco Mutungi

Role; Team-lead

Country; Uganda

Degree; BSc. Biomedical Engineering, Cert. Engineering Project Management

Expertise;  Human centred design, Product development & management

Technical Expert

Name; Davide Piaggio

Title; Engineer

Country; United Kingdom

Degree; Bsc and Msc in biomedical engineering, PhD candidate at University Of Warwick.

Expertise:  Medical device design,standards and regulations; Computer Aided Design & 3d printing

Educator  

Name: Cornelius Sendagire

Title; Doctor

Country; Uganda

Degree; MBChB, M.Med Anesthesiology, Fellowship in Simulation medical Education

Expertise; Simulation medical education for low resource settings

Clinical expert

Name; Andrew Kintu

Title; Doctor.

Country; Uganda

Degree; MBChB, M.Med Anesthesiology, Fellowship in Obstetric Anaesthesia

Expertise; Obstetric Anesthesia, simulation medical education

Other team members  

Name Lewis Gathua Kamindu 

Title; Engineer

Country; Kenya

Degree BSc. Biomedical Engineering

Expertise Fabrication skills, embedded systems.

Name; Francesco Paolo D'Alessio

Title; Doctor

Country; Italy

Degree; Medical Degree

Expertise; Anesthesiology 

Name Ananias cyrus zulu

Title; Engineer 

Country; Malawi

Degree; BEng (honours) biomedical Engineering

Expertise; microprocessor programming, software development

Name Adam Chileshe

Title Engineer 

Country; Zambia

Degree; Master of Philosophy (Mechanical) engineering

Expertise; Design thinking

Name; Nicolò Poggetti

Title; Graphic Designer

Country; Germany

Degree; Art Direction & Copywriting Portfolio Program @ Miami Advertising School

Expertise: Graphic Design, Art Direction.