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A few weeks ago, in a seminar on identity and power in global politics, a student I teach said something offhand that cut to the depths of an issue the “international development” community has to grapple with.
I’ve been teaching undergraduates this semester at the University of Bristol, while also trying to read everything I can about assistive technology production for my research. At the same time, I’m working on a 3D-printing prosthetics trial through STAND | We Walk Together and trying to figure out how we’ll share the findings once it’s done.
We were talking about the politics of knowledge when she said (paraphrased from its context, because I absolutely hate when people make up quotes to make a point): “Academic debates only matter when they’re in English.”
She’s right. A lot of “global” research is global in topic, sometimes even in its outcomes, but not in voice or tone or the systems that validate it. Even the most international work I read for my PhD, often written by African or Asian researchers, without English as a first language, based on work done in their own communities, is almost always published in English, through Northern journals, and under Northern funding rules, jumping through Northern hoops.
It’s a quiet reminder of how deeply power runs through knowledge. Not because there’s some neo-colonial villain twisting their cartoon moustache wearing an empire hunting hat, but because of a set of structures that everyone, even those trying to change them, ends up reinforcing. You can want to shift power and still be working inside the same architecture that holds it in place. That doesn’t make you a bad person, or like you’re naive or really have much of a choice but to keep doing the best any one person can. It just means the system is bigger than any of us.
A couple of years ago, under the shadow of Kilimanjaro, I visited the Tanzanian Training Centre for Orthopaedic Technologists (TATCOT). Mr Mtalo Longini and his team were running clinical trials on a 3D-printed prosthetic foot for us at STAND: the DC3 foot. Between tests, he showed me a range of other products that had been tested there: the fantastic GO Assistive Technology knee, the well-known International Committee of the Red Cross - ICRC leg, and several other devices made by hand in the workshop.
These other devices weren’t prototypes. They were working, affordable feet and knees, made from local materials, fitted for local patients, used every single day. They just existed outside the international testing and certification systems that define what “counts” as innovation. When funding dries up or supply chains stall, these are the feet and knees that keep people walking.
This is what writers like Kaplinsky and Weyrauch and Herstatt call frugal innovation, or problem-solving under constraint. It’s the kind of creativity that rarely makes it into policy briefs or journal articles but quietly keeps whole systems alive.
The same pattern runs throughout global health. Legitimacy often depends on what can be measured, standardised, and peer-reviewed. Packard describes it as a depoliticised field, one that presents itself as a technical meritocracy, even though every decision about what to measure, and how, is political.
And yet, innovation happens constantly in places the system doesn’t look. But when the spotlight does rarely shine, we get amazing results.
My friend Dr Eric Worlawoe Gaba, PhD from Ghana is one of those people pushing against the grain. He assisted Valeria Adzatia in directing the Smiles of Hope Foundation to help amputees through peer groups, counselling, and community programmes. Alongside that, he developed a way to make prosthetic socket liners from pineapple leaves. Which I think is incredible. Leaves: a renewable local material that cuts costs and dependence on imported supplies. And pineapples are a very tasty byproduct.
Eric is now a postdoctoral researcher in Brussels, doing brilliant work on sustainable materials in prosthetics. You should check his work out. Like many other people working with practical experience in LMICs, his innovations could transform lives, but they aren’t the ones attracting multi-million-pound investments from big tech health companies. They should be! And if anyone reading this has that kind of influence or investment power, I’d love to talk.
Writers like Mormina and Istratii call this epistemic injustice: the quiet ways some forms of knowledge are treated as legitimate while others are sidelined. It isn’t a lack of innovation in the Global South, or of skill. It’s a lack of recognition, investment, and attention.
If localisation is going to mean more than moving money around, it has to mean epistemic justice: valuing the knowledge that grows inside constraint. That means seeing technicians, clinicians, and community partners as thinkers and theorists of practice, not just implementers of someone else’s design. Of course, that’s easier said than done. The least we can do is notice the problem more often, talk about it outside our echo chambers, and give credit where it’s due. But it’s bigger than individual choices.
We also need systems that can see and support this kind of innovation: regional testing centres, South–South research partnerships, and funding models that back ideas proven in context instead of insisting they fit imported frameworks.
We don’t need to reinvent the wheel. We just need to look properly at the one already turning. And help them build a bigger wheel that actually works on their terrain.
Maybe the next frontier in global health isn’t about new technology, it’s about learning to see the knowledge that’s already there, quietly keeping people walking, healing, and building every single day.
By Matt Thomson Project Manager at STAND | Postgraduate Researcher on Localisation & Assistive Technology
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