By Kara Baskin

In Sierra Leone, war and illness have left up to 40,000 people requiring orthotics and prosthetics services, but there is a profound lack of access to specialized care, says Francesca Riccio-Ackerman, a biomedical engineer and PhD student studying health equity and health systems. There is just one fully certified prosthetist available for the thousands of patients in the African nation who are living with amputation, she notes. The ideal number is one for every 250, according to the World Health Organization and the International Society of Orthotics and Prosthetics.

The data point is significant for Riccio-Ackerman, who conducts research in the MIT Media Lab’s Biomechatronics group and in the K. Lisa Yang Center for Bionics, both of which aim to improve translation of assistive technologies to people with disabilities. “We’re really focused on improving and augmenting human mobility,” she says. For Riccio-Ackerman, part of the quest to improve human mobility means ensuring that the people who need access to prosthetic care can get it—for the duration of their lives.

In September 2021, the Yang Center provided funding for Riccio-Ackerman to travel to Sierra Leone, where she witnessed the lingering physical effects of a brutal decade-long civil war that ended in 2002. Prosthetic and orthotic care in the country, where a vast number of patients are also disabled by untreated polio or diabetes, has become more elusive, she says, as global media attention on the war’s aftermath has subsided. “People with amputation need low-level, consistent care for years. There really needs to be a long-term investment in improving this.”

Through the Yang Center and supported by a fellowship from the new MIT Morningside Academy for Design, Riccio-Ackerman is designing and building a sustainable care and delivery model in Sierra Leone that aims to multiply the production of prosthetic limbs and strengthen the country’s prosthetic sector. “[We’re working] to improve access to orthotic and prosthetic services,” she says.

She is also helping to establish a supply chain for prosthetic limb and orthotic brace parts and equipping clinics with machines and infrastructure to serve more patients. In January 2023, her team launched a four-year collaboration with the Sierra Leone Ministry of Health and Sanitation. One of the goals of the joint effort is to enable Sierra Leoneans to obtain professional prosthetics training, so they can care for their own community without leaving home.

From engineering to economics

Riccio-Ackerman was drawn to issues around human mobility after witnessing her aunt suffer from rheumatoid arthritis. “My aunt was young, but she looked like she was 80 or 90. She was sick, in pain, in a wheelchair— a young spirit in an old body,” she says.

As a biomedical engineering undergraduate student at Florida International University, Riccio-Ackerman worked on clinical trials for neural-enabled myoelectric arms controlled by nerves in the body. She says that the technology was thrilling yet heartbreaking. She would often have to explain to patients who participated in testing that they couldn’t take the devices home and that they may never be covered by insurance.

Riccio-Ackerman began asking questions: “What factors determine who gets an amputation? Why are we making devices that are so expensive and inaccessible?” This sense of injustice inspired her to pivot away from device design and toward a master’s degree in health economics and policy at the SDA Bocconi School of Management in Milan.

She began work as a research specialist with Hugh Herr SM ’93, professor of arts and sciences at the MIT Media Lab and codirector of the Yang Center, helping to study communities that were medically neglected in prosthetic care. “I knew that the devices weren’t getting to the people who need them, and I didn’t know if the best way to solve it was through engineering,” Riccio-Ackerman explains.

While Riccio-Ackerman’s PhD should be finished within three years, she’s only at the beginning of her health care equity work. “We’re forging ahead in Sierra Leone and thinking about translating our strategy and methodologies to other communities around the globe that could benefit,” she says. “We hope to be able to do this in many, many countries in the future.”