The possibility of making an artificial limb for someone she loved was something Prisca Nikuze never wanted to face. While still in high school, Nikuze watched a family member live with diabetes. She initially thought studying medicine would give her an opportunity to help treat the condition, but she did not get the chance to join medical school. Instead, she enrolled in prosthetics and orthotics at university, where she learnt to fabricate artificial limbs and assistive devices, including insoles for correcting flat feet and other deformities. At first, she struggled to see how the course connected to the problem she wanted to solve. “I was like, how is this related to what I wanted to do? But I didn't realise that that's where my purpose was,” Nikuze says. ALSO READ: More Rwandans diagnosed with diabetes as care expands It was during her training that she learnt that diabetes is one of the major causes of limb loss. The lesson changed how she viewed her field. “I was very scared at that moment and I couldn't picture myself fabricating an artificial limb for a family member. So I was shocked,” she says. Nikuze, now a licensed prosthetist and orthotist, had also developed an interest in technology. During university holidays, she taught herself about the Internet of Things, artificial intelligence and data analytics. She began thinking about how those skills could be used to address the problem. But it was her clinical internship in 2025 at the University Teaching Hospital of Kigali (CHUK) that made the idea urgent. Ten patients, six with diabetes During the internship, Nikuze assessed patients and prescribed and fabricated artificial limbs for them. Of the 10 patients she received, six had diabetes. “I don't know why it happened to me personally, but from the 10 patients I received during that clinical internship, I fabricated artificial limbs for 10 patients and six of them had diabetes,” she says. The experience made her question why patients were reaching the point of losing limbs when some complications could potentially be detected earlier. “That was so urgent, and I was like, I don't want to see any more patients losing their limb from something that can be detected and that can be prevented,” Nikuze says. ALSO READ: Diabetes and the risks of high blood glucose That became the thinking behind NEEM, a health-tech initiative co-founded by Nikuze and other young innovators. The team began exploring how technology could detect early warning signs before a diabetic foot problem becomes severe. Detecting what patients may not feel One of the major complications of diabetes is diabetic neuropathy, which can cause patients to lose sensation in their feet. This means an injury can occur without the patient feeling pain. At the same time, impaired blood flow can make it difficult for wounds to heal. Nikuze says these are some of the problems the smart insole is designed to address. The insole contains pressure and temperature sensors, as well as a sensor that measures blood oxygen saturation. “When you're about to have an injury, the pressure changes. When there is inflammation, the temperature in the feet changes. When the blood flow doesn't reach the lower extremity, the oxygen blood saturation changes,” she explains. The sensors collect measurements and send them to a microcontroller, where the information is analysed. An alert can then be sent to the patient and healthcare provider, allowing them to respond to potential problems. The technology is still undergoing testing. The team has worked with consenting patients who agreed to participate in the testing, providing them with the insoles and monitoring the information collected. Nikuze says some of the work has involved patients at Sayashika and Muhima Hospital. ALSO READ: The daily challenge of raising a child with Type 1 diabetes But she is clear that more research is needed before the technology can be widely deployed. “This is a capital-intensive initiative because it needs a lot of research, a lot of trials, to be able to validate it, to be able to say that it really works,” she says. Still, the experience so far has given the team confidence that the technology has potential. “We have been able to at least work with some people and get to see the signs that this can be something that can really change,” she says. The human cost of losing a limb The urgency is not only about the technology. Nikuze has seen first-hand what diabetic complications can mean for patients and their families. She recalls one woman she interviewed during her internship who did not know that she had diabetes. The woman had been experiencing symptoms including dehydration, tiredness and weight loss. She later noticed a wound on her foot but did not feel any pain. When she went to a health facility, healthcare workers discovered that she had diabetes. By then, the damage had become severe and her limb was amputated. Her other limb was also being affected. ALSO READ: Walking 7,000 steps prevents heart diseases, cancer and diabetes, study finds “She didn't know that she had diabetes. She lived with these signs and symptoms, having dehydration, being tired, losing weight, and one day she realised that she had some wounds on her feet. She didn't feel the pain,” Nikuze says. “She went to the clinic and that's when they realised. They amputated that patient, and the other limb was also being affected. All of this happened before she could even realise that she had diabetes.” The experience remains one of the moments that has stayed with her. Nikuze says the consequences extend beyond the physical loss of a limb. Prosthetic limbs can cost millions of francs, creating an additional financial burden for families. They also do not fully replicate the function of a natural limb, creating challenges in certain activities. For people who provide for their families, she says, losing a limb can affect their ability to work and support those who depend on them. “It is not a matter of diabetes only being urgent, but diabetes and NCDs as a whole are really urgent. We really need to put more effort in these diseases,” she says. From rough prototype to wider solution The smart insole has also evolved since Nikuze and her colleagues began developing it. When they took the prototype to Hanga Pitch Fest, it was still a rough product built using locally sourced components. ALSO READ: From grief to action: A mother and daughter’s fight against diabetes in Rwanda “It was not something that you can wear in society. It was just a prototype that gives information,” she says. The Hanga bootcamp helped the team refine both the idea and its business potential. “They showed us how to really build and how we can turn a solution into business,” Nikuze says. After winning Rwf20 million at Hanga Pitch Fest, the team began improving the quality of the prototype and sourcing better components, including some from China and silicone materials. They also began exploring research collaboration with the University of Rwanda. The work has since expanded beyond the insole itself. Nikuze says the team has moved from working with one or two people to engaging more patients and supporting them in other aspects of managing their condition, including nutrition and education. They have also developed an app dedicated to patients. “We moved into thinking not only about the product, but actually how we can influence the product but also help the people,” she says. ALSO READ: Lifestyle control: The key to managing and preventing diabetes Young innovators need a chance For Nikuze, developing a health innovation is only part of the challenge. Finding people and institutions willing to work with young innovators can be difficult. She says some potential partners remain hesitant when presented with solutions developed by young people, questioning their experience, expertise or knowledge. “I do believe in my solution, but people don't believe in my solution,” she says. Her answer is not to create a separate movement, but to work with people already involved in the sector. “All I need is just to not start my own movement but to join the people who are already involved,” she says. Nikuze acknowledges that caution around new health technologies is understandable, particularly when patient safety is involved. But she believes young innovators need opportunities to demonstrate what their solutions can do. “There is a concern that maybe we need to be cautious about the solution that we're bringing, but that doesn't mean that we don't need to give it a shot. We don't need to be so hesitant about the solutions,” she says. For her, trust cannot be demanded. It has to be built through opportunities to work, test and collaborate. “Trust is built. We need a chance to build that trust,” she says. And that, ultimately, is how she sees the path ahead for NEEM and other young innovators working to solve healthcare challenges. “You can't win in isolation,” Nikuze says. “If we want to go far, we need to move together.”
