‘You think about how you’ve got this disease that you’re managing and that disease is a challenge, but you have decided to say: ‘You know what, I want to fight this and I want to come out on the other side as a winner,’” Neo Hutiri says, his usually smooth voice crackling with static over the phone from Kampala, Uganda.
“But then you realise that the disease is only one side of the challenge you have to overcome. Because then you get to the queue. When you get to the queue, you just sit there. You have the feeling that your life has had to stop, just because you want to get to a particular point — just because you want to manage your treatment.”
Hutiri, who this week became the first South African to win the prestigious Africa Prize for Engineering Innovation, recounts the often arduous process many patients have to go through to get chronic medication.
“It becomes very tempting to say: ‘I want to give up.’ When you look at TB [tuberculosis] in particular, after a couple of weeks, you start to feel good. The cough is gone. The blood is gone. Your body is starting to respond. And you start to think: ‘Do I actually need this medicine?’” he says, his words becoming clearer as he speaks.
The feeling of defeat that accompanies the life-interrupting task of queuing for medication is what Hutiri wants to stop in its tracks. It’s a feeling that he is familiar with, having been diagnosed with TB in January 2014.
“I guess my journey started as a patient and collecting medication from my local clinic,” Hutiri says.
This is where the Pelebox comes in. The smart-locker system — which nabbed Hutiri the Africa Prize, awarded each year by the United Kingdom’s Royal Academy of Engineering — was designed to dispense medicine to patients with chronic conditions. Developed for the South African healthcare system, the Pelebox consists of a simple wall of lockers controlled by a digital system.
“The idea is to take somebody from sitting for a couple of hours in a queue to a couple of seconds,” Hutiri says.
The 31-year-old explains that the Pelebox allows healthcare workers to stock the lockers with prepackaged prescription refills, log the medicine on the system, and secure each locker. The system then sends out an SMS to let a patient know that their medication is ready for collection at their local clinic.
Pelebox sends patients a one-time PIN, which they use to open their locker and access their medicine.
According to Hutiri, the Pelebox also collects data for clinics, letting them know which patients are sticking to their treatments and collecting their medicine on time.
He says he and his team have focused on making the system as easy for patients to use as possible. “It must be very fast for a patient to come in and be out,” Hutiri says.
Hutiri, who grew up in Mahikeng in the North West, says he has seen the toll the overburdened healthcare system has had on his family and community.
The long waits for medication have a ripple effect on people’s lives, he says. “It touches so many aspects of your life. It is not just the queue, it is the opportunities that waiting costs you. It is the fact that you are missing out on certain things.
“You have spent your money getting to the clinic and if you don’t arrive early, you don’t know how long you’re going to be there. You can’t plan your life.”
During the six months of his initial TB treatment, Hutiri says he was losing more than four hours of his day waiting in long queues.
The World Health Organisation estimates that 322 000 people in South Africa developed active TB in 2017.
Hutiri is concerned that South Africans have become used to having their lives put on hold. “I feel like we have gotten to a point where it’s so normal, that it just becomes something people write about or talk about.”
Some of the leading causes of death in South Africa — HIV, diabetes and hypertension — are treated with chronic medication.
Health department statistics show that 4.3-million HIV-positive South Africans were on treatment by August 2018. Data from the International Diabetes Federation in 2015 estimated that 3.85-million South Africans between the ages of 21 and 79 might have diabetes. A 2017 study by the University of the Witwatersrand found that an estimated 42% to 54% of people were suffering from hypertension in the country.
“In South Africa we have made so much headway in making the medication available. But the inefficiencies in how patients access that medication still need a lot of work,” Hutiri says.
The Africa Prize, which has been running for five years, has a history of awarding engineers seeking out ways to ensure that their country’s healthcare systems better serve patients.
Last year the prize was won by Brian Gitta from Uganda. Gitta and his team at Matibabu figured out a way to test for malaria without drawing blood, making it far cheaper and faster for doctors to make an accurate diagnosis.
In 2016, the prize went to Marc Arthur Zang from Cameroon. Zang’s CardioPad helps medical professionals in rural areas diagnose heart problems and send the results through cellphones to heart surgeons for interpretation.
Hutiri says he feels privileged to be able to see his own invention being put to use on a daily basis.
“It gets me all the time. Every time I go to the clinic and I see my creation being interacted with, people having a relationship with it, it is by far one of the most rewarding feelings … I feel like if I am having a bad day, I can go to the clinic and see people using it,” he says.
“It cures all bad days.”