To develop medical devices that address the complex challenges of global health, we have studied how conventional engineering design processes can be supplemented by methods derived from social science fields such as anthropology. Design ethnography, which encompasses processes for gaining a complete understanding of
stakeholders’ actions, behaviors, words, and thoughts, provides a framework
for acquiring tacit information from stakeholders that would not be obtained
through commonly used methodologies in engineering design and market research. ¶ Although this technique is applicable to a broad range of global health
technologies, we chose to highlight its application to traditional adult male circumcision given the unique design context and constraints. This study, among
others performed to date, indicates the need for engineers to understand the
broader context in which a medical device will be used, as well as the need for
global health design decision-making processes based on rigorous studies that
generate quantitative outcomes rather than anecdotal evidence.
AMIR SABET SARVES TANI is a PhD
candidate in the design science
program at the University of
Michigan, Ann Arbor. He is pursuing
his graduate work at the Laboratory
for Innovation in Global Health
Technology. He has been a consultant
to the Medical Devices Unit at the
World Health Organization.
KATHLEEN SIENKO is a Miller Faculty
Scholar and an associate professor
in the departments of mechanical
and biomedical engineering at the
University of Michigan in Ann Arbor.
She directs the Sensory Augmentation
and Rehabilitation Laboratory (SARL)
and the Laboratory for Innovation in
Global Health Technology (LIGHT).
Male circumcision is a culturally significant
procedure in many parts of the world. For
instance, traditional adult male circumcision
( TMC) is an important cultural practice in parts
of sub-Saharan Africa, and a rite of passage for
boys between the ages of 10 and 18.
Recently, several randomized clinical trials have shown that clinical adult
male circumcision is an effective medical
intervention for the prevention of sexually
transmitted HIV, reducing the rate of transmission by 60 percent among heterosexual
men [2, 3, 4]. This is an important result for
sub-Saharan Africa, where more than two-thirds of the 22. 5 million people in the world
living with HIV reside [ 1].
Traditional adult male circumcision is not
without risks. Cutters and their assistants,
typically with limited or no formal clinical
training, perform TMC in non-clinical settings.
While evidence supports TMC’s effectiveness
against HIV transmission when adequate
foreskin is removed, rates of life-threatening
risks and health complications for this practice
are as high as 48 percent [ 5]. Infection,
delayed wound healing, glans amputation
and injury, bleeding, loss of penile sensitivity,
excessive removal of foreskin, and even death
are the major complications reported [ 6].
There are medical devices that accommodate clinical adult male circumcision (AMC),
but none of them are suitable for TMC due
AS AN ENGINEERING TOOL 01 Currently the design, development, and implementation of medical devices insufficiently address health care needs in low-resource settings. Most existing medical devices are
simple adaptations of devices designed for high-resource
settings. However, the spectrum of needs in low-resource
settings is often beyond the scope of such simple
adaptations, resulting in products with limited impact.