Koalaa launches pilot project in Sierra Leone

Ambition took a significant step forward in 2021, when we embarked on our first pilot project in Africa.

At Koalaa, we are on a mission to make prosthetics accessible and affordable for everyone on the planet.

We had mainly been working in the UK, but we’ve always known there is a huge need for affordable and comfortable prosthetics all over the world. This is particularly true in areas that have had a recent conflict and within lower/middle income countries.

We were lucky enough to secure a grant as part of the Assistive Technology Impact Fund (ATIF), under the banner of AT2030, which aims to increase access to assistive technology of all kinds, all over the world. The ATIF grant focuses on Africa, so we picked Sierra Leone as the first country we’d try working in.

Why Sierra Leone?

As a country, Sierra Leone has a disproportionately high number of amputees; mainly because of the country’s recent history of civil war but also due to other factors, such as road traffic accidents. So, there is a huge need for prosthetics. However, this is coupled with a major lack of access.

We had previously conducted a feasibility study looking at Sierra Leone, having secured a grant from the Global Challenges Research Fund, which was awarded to us by Innovate UK, and it confirmed a clear need.

We were confident that our Koalaa prosthetics could offer a solution, so it was the perfect place to launch our first pilot study.

Fact finding and testing our ‘clinic in a bag’

We knew we didn’t want to try and tackle the problem, or to make too many assumptions, while sat behind our laptops, so we headed out there in person in September on a 10-day fact finding mission.

Our trip saw us meeting with representatives from the government to discuss how we might work together. But most importantly, it was a chance for us to speak with potential users about our prosthetics and support services.

We took two suitcases with us, filled with everything we needed to fit a number of users with a tailormade Koalaa sleeve. We were keen to explore the idea of a ‘clinic in a bag’, to see whether the concept worked and could be used to fit people with our prosthetics and provide them with a follow up service.

Over the next 10 days, we tested the process and validated it by fitting around 20 people. The result being that it worked really well!

We quickly saw that this was an approach we could scale up to help people across the country, as it didn’t require infrastructure or too much technical expertise on the ground and local people could be trained to deliver it. As a model, it offers a way to make our prosthetics accessible for anyone, anywhere.

Collaborations and Partnership

Fitting a prosthetic arm in Sierra Leone

Another important result of our trip was that we formed a relationship and started working with the National Rehabilitation Centre, which is part of the Ministry of Health in Sierra Leone. The centre has several clinics across the country and offers rehabilitation and care, including prostheses.

Working with the local government in Sierra Leone means we will be able to pass on our skills, in terms of our service, how we fit prostheses and all the follow up that goes with that.

With local health care workers involved and able to manage the process on the ground, it becomes a sustainable project that can carry on helping people at scale.

Feedback and Key Learnings

Koalaa has always been a user-focused company. Our prosthetics have been created with the involvement of our end users at every stage of the process. Their feedback and ideas are what guides everything we do.

To date, this feedback had mainly been from users in the UK, so we were very interested to gather insights from users in Sierra Leone, regarding what they thought of the current design and how they might use our prosthetics.

One of the key learnings from our trip was that the design of our current prosthetics needed to change for users in Sierra Leone. Users told us that the choice of fabrics and colours didn’t work for them.

While they loved the functional aspect and could see the many ways they might be able to use our prosthetics, they told us they wouldn’t be comfortable wearing them outside the home environment. This was a problem we needed to solve.

Users in Sierra Leone wanted something that would blend in with their skin colour and to have the option of a cosmetic attachment (which looked as close to a human hand as possible). This is because the limb different community in Sierra Leone faces a lot of stigma.

As for use, we had assumed that the way people may want to use our prostheses would be different in different cultures, but it was actually very similar. People wanted support with day-to-day tasks. For example, they wanted to be able to grab things, to eat, to drink, to hold a hairbrush and brush their teeth.

Our Second Visit to Sierra Leone

When we were back in the UK, our design team set about prototyping a cosmetic hand and a cosmetic sleeve that was skin tone matched, ready for a return visit in December.

The other thing we knew we needed to do, was to get people on the ground in Sierra Leone comfortable with fitting our prosthetics. This was the natural next step to scaling up the process and making it sustainable.

We set about designing a training course, covering how to fit them, what the tools do, the kind of Limb Buddy/customer service support we offer in the UK and how that might translate to Sierra Leone. It was the first time we’d ever done anything like that before.

When we returned to the country for our second 10-day visit, we took our new sleeve design and delivered the training we had prepared to a prosthetist and a rehabilitation worker. The results of which have been amazing!

The two people that we trained, accompanied by other staff from the National Rehabilitation Centre and the Clinton Health Access Initiative, went on to visit an amputee camp in Freetown. They fitted eight people with Koalaa sleeves and took down their contact details so we can engage with them for feedback and to provide a Limb Buddy service.

This was a huge moment for us, as it was the first step in creating a truly sustainable service in Sierra Leone.

The Power of Partnership

Overall, our pilot project has been a great success and we’re really excited about what comes next!

Finding good people, who are so committed to the cause of increasing access, has been key. We couldn’t have done it without our partners and all our fantastic users - some of whom travelled more than two hours to come and see us.

We are now in the planning stages, looking at how we are going to take what we’ve learned so far and start building it out across the country, to reach and impact on as many people as possible.

Reflections from the Koalaa team

“A standout moment for me with this project has been how key people in Sierra Leone have really embraced our vision and committed their expertise to help make it a reality. It’s been a genuine collaboration and partnership.

“Seeing the amazing commitment that people have to increasing access to assistive technologies of all kinds is really inspiring and we’ve been lucky enough to work with those people on this project.

“We’re trying to do something that hasn’t been done before and that comes with huge challenges, unknowns and uncertainties. But because of our end goal - creating a nationwide service for Sierra Leone and other places where prostheses are desperately needed - it makes you want to take on any challenge you may face and to overcome them. I’m so proud to be part of this project.”

Niall Marshall, Head of Future Projects, Koalaa

“It’s really difficult to pick just one standout moment, as the whole experience has been phenomenal. From the moment we first got off the plane, to the people we met and the feedback we’ve received, it’s something I’ll never forget.

“One thing I was struck by was just how similar people are in Sierra Leone and how familiar things felt. They may have had wildly different backgrounds to us back home, yet so much of what they wanted to do was similar and familiar. People are people, wherever they happen to be from, and it was so enjoyable to see that and experience that.

“Kids just wanted to be kids. To play, to ride their bikes and hang out with their friends. And while the adults had worked out their own way of doing things, they were interested to see if the Koalaa sleeve could support them to try new things, or to make their everyday tasks a little easier. For example, we fitted one gentleman with a Koalaa sleeve and when we looked back he’d already picked up his chisel and started carving an exquisite statue.

“In Sierra Leone, there is huge stigma regarding those with limb difference, which is why we were blown away by one young girl we met. She was around 15 years old and told us she didn’t care what people thought, she knew she could do anything! That level of self-confidence is something that’s hard to find anywhere but to have it in a place like Sierra Leone is amazing. And with younger generations thinking like that, the future looks bright.”

Nate Macabuag, Founder, Koalaa

“My standout moment from the project was seeing the products we make being used by locals first hand whilst in Sierra Leone. Being able to fit them with an updated design, including skin tone covers and cosmetic hands, based on their feedback felt especially great.

“The whole experience has been eye opening; I’ve learnt so much about the different factors that affect various limb different communities. These can be on a micro scale including the traditions and lifestyles of each of our Sierra Leonean users but also on a macro scale including stigmas associated with limb loss and medical infrastructure.”

Sanish Mistry, Product Design Engineer, Koalaa