He has won an international award for his ground-breaking invention, a device that helps women during delivery. However, Arfang D. Faye’s EgAr Device, invented in 2012, is currently being used in only two health centres. In this exclusive interview, the 35-year-old Gambian nurse talks about his invention.
What’s On-Gambia: Briefly describe yourself.
Arfang: My name is Arfang D. Faye and I am 35 years old, born in 1981 in the village of Amdallai in the Lower Niumi District of the North Bank Region of The Gambia. I am Serere by ethnicity and speak my native language in addition to English and Wollof, as well as basic Fulani and Mandinka.
I attended Fass Njaga Choi Primary School in Lower Niumi District but completed primary school in St George’s Primary School in Basse in the Upper River Region of The Gambia. From 1994 to 2000 I attended Fatima Junior then Senior Secondary School in Bwiam in the West Coast Region of The Gambia. I started training as a registered nurse in January 2001 at the Gambia College School of Nursing and Midwifery, Banjul and completed in December 2003. I had midwifery training in the same institution from 2006 to 2008 when I graduated as a registered midwife. Recently I completed a one-year course in advanced obstetric skills in Brikama District Hospital, conducted by the UK based medical Charity, Maternal and Child Health Advocacy International (MCAI).
I got married in 2013 to Mrs. Eggeh Bah and we are blessed with a son named Muhammad, who was born on November 6, 2015.
What made you decide to become a nurse?
Nursing is among the noblest professions in the world, and in my opinion arguably the best expression of the human spirit of love, care and kindness. I remember being very ill at the end of my second year in Senior Secondary School and was admitted for several days when I thought I probably would not survive. During that period I came to appreciate and respect the nurses who took care of not just me but every other patient with so much kindness and love, caring and giving so much with so very little at their disposal. As a student I saw beyond the “caring” that is so much emphasized when people discuss nursing. Through the way those great nurses treated me and the other patients; I recognized deep scientific knowledge, skills, talent and proficiency, which as a science student I greatly admired. Until today, I do remember some of those nurses by name even though I have not seen most of them since after my discharge.
Even in secondary school, I had a deep conviction that I wanted to serve the cause of humanity and my experience during my illness motivated me to choose to become a nurse after I completed senior secondary school. Therefore, immediately after I graduated in the year 2000, I applied for a place in the registered nursing programme and was lucky to be accepted.
In which hospitals/health centres in the country did you work and what were your duties?
I worked in Basse Major Health Centre (now Basse District Hospital) from 2004 to 2006 as a registered nurse and worked in the male and paediatric wards respectively. After graduation as a registered midwife, I taught nursing and midwifery at the School for Enrolled Nurses and Midwives in Bansang, Central River Region from January 2008 to December 2014 and was coordinator of the Enrolled Midwifery Programme from 2009 to 2014. During this period of work as a nurse and midwifery educator, I also worked actively as a registered midwife in Bansang Hospital. From January 2015 to December 2015, I had training in advanced obstetric skills in Brikama Major Health Centre (now Brikama District Hospital) and from then until now have been practicing as an advanced midwife/obstetric clinician with the general functions of an obstetrician excluding abdominal surgery.
According to information reaching us, you recently invented a vacuum extraction device to help women during deliver. Tell us about it.
Vacuum delivery is one of the elements of emergency obstetric care, intended to reduce maternal and new-born morbidity and mortality which are generally very high in developing countries like The Gambia. However, vacuum delivery is grossly underutilized in The Gambia, as highlighted by a 2012 UNFPA and Reproductive and Child Health Unit of the Ministry of Health and Social Welfare of The Republic of The Gambia survey of public and private facilities where emergency obstetric care was expected to available. An estimated 83 per cent of facilities did not perform vacuum delivery because of inadequate training and unavailability of equipment.
I developed the EgAr Device in early 2012 while working in Bansang Hospital when the only functioning standard vacuum delivery set was broken and could not be replaced or repaired. Bansang Hospital is the farthest referral hospital (including for obstetric emergencies and complications) in provincial Gambia with coverage of over 400,000. The primary objective of the EgAr device was to make vacuum delivery more accessible by making vacuum delivery technology and equipment more readily available in low resource settings, with the overall goal of reducing maternal and newborn morbidity and mortality.
The major components of the device are one 60 ml or 100 ml plastic feeding syringe, two valves removed from broken aneroid blood pressure machine inflators, a stethoscope tube and two outflow control units from urine bags. A standard metal or plastic cup is used for vacuum delivery. The aneroid valves are now replaced by self-made valves made from cheap urinary catheters and the stethoscope tube replaced by a transparent tube. The device works as a two pump, able to create negative and positive pressure alternately. A limited trial in 2012 involving 24 vacuum deliveries using the EgAr Device in Bansang Hospital resulted in 22 successful and safe vacuum deliveries and 2 failed vacuum deliveries. From 2012 to date the EgAr Device alone has been used for all vacuum deliveries in Bansang Hospital, and it has been the main tool for vacuum delivery in Brikama Major Health Centre (now Brikama District Hospital) from January 2015 to date. Data obtained from January to October 2016 in Brikama District Hospital, the biggest maternity unit in The Gambia with 6000 deliveries annually, involving 66 vacuum deliveries conducted using the EgAr Device out of a total of 77 vacuum deliveries, show that 64 of the 66 vacuum deliveries were successful.
In addition to vacuum delivery, clinical use in Brikama District Hospital demonstrate that the EgAr device is also very effective for manual vacuum aspiration (MVA) of the uterus, which is useful for treating uterine bleeding resulting from incomplete abortions, retained products of conception after delivery, molar pregnancies, etc. Manual vacuum aspiration of the uterus is also one of the elements of emergency obstetric care with low usage in The Gambia. Similarly, the device can be used effectively for suctioning of secretions from the newborn and very ill patients. Thus, the evidence available indicates that the EgAr Device has the potential to be very useful in maternity care in developing countries. However, use of the device is currently limited to Bansang Hospital and Brikama District Hospital.
What was the response of the Ministry of Health and Social Welfare and your colleagues?
The support from my colleagues, nurses and doctors and even other cadres of health workers have been and is still very strong. Some individual members of the Ministry of Health and Social Welfare have also been very supportive. I have had a lot of encouragement and moral support from these people and this has contributed enormously in motivating me to continue working on this important project.
However, the support from the Ministry of Health and Social Welfare as an institution has been extremely limited. This does not mean that the ministry is not aware of my work. To the contrary, my work has been presented to them on numerous occasions and they are even aware of the international presentations that have been made about the device.
What makes your device different from the ones already in the market?
My device is similar to the ones already in the market in that they are all used for the same function, i.e. vacuum extraction of the fetus.
However, apart from differences in design, there are important differences between the EgAr Device and other vacuum delivery systems already available in the market:
a. The EgAr Device is self-made from common out of use clinical materials. It is therefore a piece of appropriate technology that is effective, safe, inexpensive and accessible. Of course the ultimate goal is to develop the device industrially at a very cheap price while retaining all the advantages of the original device.
b. The devices already available in the market are not very appropriate for poor developing countries. For instance, the standard original glass/plastic jar vacuum set is reusable but large and cumbersome, difficult to move around, clean and sterilize, which is a major hazard because of the risk of infection. Operation of this set requires two people and often a lot of manual energy is required to operate it. The set also is expensive and breaks down easily, thus difficult to afford and maintain.
Some of the newer models available, such as the Kiwi palm pump is an excellent device that is very light and handy, efficient and easy to use. However, they are meant for single use and are quite expensive which means that they are not at all affordable for developing countries. Some vacuum delivery sets are electrically operated, but they are also large and cumbersome like the glass/plastic jar models with similar disadvantages. In addition, they require electricity to operate which is not often readily available in low resource settings.
The EgAr Device combines many of the advantages of the original glass/plastic jar vacuum delivery sets as well as the smaller, single use vacuum delivery sets. The current prototype is very light and compact and can fit comfortably in a small box or pocket. It is very durable and can be used for years if properly maintained. It is easy to disassemble, clean and sterilize. Although it requires two people to operate, it is far less labour intensive than the original glass/plastic jar model. In addition, whereas the other models are used exclusively for vacuum delivery, the EgAr Device is multipurpose and can be used for vacuum delivery, manual vacuum aspiration of the uterus, aspiration of secretions, and potentially other clinical procedures requiring vacuum pressure.
Do you want to make money from your invention?
My primary motivation for developing the EgAr Device is to make vacuum delivery (and also other procedures described above) more readily available in low resource settings by making the technology and equipment needed more accessible. An incredible amount of time, effort and resources have been utilized in inventing and developing this device but always with the view of contributing to improving maternity care and reducing the catastrophic burden of maternal and newborn morbidity and mortality.
My hope is to have the EgAr Device industrially developed at a very affordable cost for widespread use in developing countries.
How many midwives and doctors have you trained to use the EgAr Device?
As mentioned earlier, use of the EgAr Device is limited to only two centres currently. While I was in Bansang two registered midwives and the medical officer working in the maternity unit were trained on operating the device. However, in my absence I am aware that a few more registered midwives who worked there after I left conducted vacuum deliveries using the device and must have been shown how to operate it by those already there.
In Brikama, the device was the main tool for vacuum delivery for the training on advanced obstetric skills. All trainees (six in total including myself), the trainers (four in total) over the past two years have been trained on operating the EgAr Device. As a fact, vacuum delivery is rarely used in The Gambia.
Have you had any international recognition for your invention?
The EgAr Device was presented at the WHO Second Forum on Priority Medical Devices held in Geneva in 2013, and the West Africa Health Organisation (WAHO) First Forum on Good Practices in Health held in Ouagoudou in 2015. The device is also described in a major publication by Maternal and Child Health Advocacy International (MCAI) titled “International Maternal and Child Health Care” 2014.
Recently, as part of the Midwives for Life Award 2016, I received a 5000 euros grant from the Sanofi Espoir Foundation in collaboration with the International Confederation of Midwives (ICM) through the National Association of Gambian Nurses and Midwives, to train a limited number of Registered Midwives in the Gambia on vacuum delivery using the EgAr Device.
What is next?
I am fully aware of the challenges but I intend to continue working with partners to eventually industrially develop the EgAr Device at a very affordable price for widespread use in developing countries. To this end I am working with partners in the UK and the Netherlands to try to achieve this goal. However, we could do with help from relevant institutions and individuals so that our plan can succeed, for the benefit of the women and newborns in developing countries.