How do you test for malaria when you don’t have access to specialised diagnostics equipment? How do you care for premature babies when your hospital can’t afford the necessary equipment? How do you monitor patients during surgical procedures if you’re expecting power surges? Sadly, questions like these come up all too frequently in developing countries, where healthcare workers face a daily struggle to care for their patients.
It’s easy for us in developed countries to expect the latest technology in our hospitals. However, for millions of people around the world this is not the case. With limited budgets and limited resources, doctors and nurses working in these areas must learn to use cheap tools and materials to solve their problems. These may not look pretty, but in some cases, they’re the only solution.
It can’t get any cheaper than paper. Inspired by field visits around the world where they often encountered broken equipment, or none at all, a team of bioengineers from Stanford University created a microscope made out of bits of paper. For less than $1, this device can provide 2,000x magnification. It weighs less than 10g, is small enough to fit in a pocket and, crucially, does not require electricity to work. It’s not often that you find the words optics and origami in the same sentence, but that’s how the authors describe their creation.
However, the team quickly realised the microscope alone wasn’t enough for diagnosis. Looking under the microscope for parasites in a single drop of blood is like looking for a needle in a haystack. “It’s critical that when you say to a patient that they’re negative for malaria, [you’re] really sure that there isn’t even a single parasite in that sample,” said team member Saad Bhamla.
“I remembered playing with my grandmother, who used to give me buttons and strings”
“You need other tools,” added the researcher, “and a key one is a centrifuge.” After weeks of testing everything with a spinning mechanism, from salad spinners to egg beaters and yo-yos, one evening Bhamla had a eureka moment. “I remembered playing with my grandmother, who used to give me buttons and strings [to make a whirligig toy]. I put it in a high-speed camera and, to my astonishment, it was spinning at about 12,000rpm.”
After a few months of prototyping, they created a cheap paper-based centrifuge capable of speeds up to 125,000rpm, allowing them to separate blood in less than two minutes. There is still much to be done, but the team hopes this new device will become part of their basic diagnostic kit. “When we want to do diagnostics in a remote place without any electricity – literally under a tree – we have to have all the infrastructure needed in a backpack,” said Bhamla.
For such a simple material, paper is proving to be an extremely useful tool. A team from Purdue University is also capitalising on its versatility after they found a way to make it resistant to liquids. The treatment basically acts like a Teflon coating on a frying pan, so that the paper can’t be made wet by oil or water. Like Bhamla’s whirligig, the inspiration came from the need to use diagnostic tools in areas with no access to potable water or electricity. “Paper happens to be low-cost, it’s easy to manufacture, it’s lightweight, it’s very easy to transport,” said team leader Ramses Martinez.
(Above: Stanford Medicine’s paper centrifuge)
Each sheet of treated paper also comes with virtually invisible channels that lead to chambers with specific reagents. “A simple drop of blood can be extracted from the patient and then put in contact with the paper device, which can automatically distribute the blood through the microchannels using capillary forces,” explained Martinez. “The blood reaches test zones loaded with reagents capable of providing a quantitative or colorimetric or electrochemical measurement for a variety of bioanalytes.” So far, the team has developed reagents to test malaria and tuberculosis and, in collaboration with hospitals in Kenya, is now working on tracing toxins, viruses and nutritional deficiencies.
Coping with power cuts
Of course, paper may be good for field diagnostics, but hospitals need sturdier technology. For large-scale equipment, a common approach to bringing devices to developing countries is to strip down unnecessary functions in existing machines, in order to make them cheaper and easier to operate.
General Electric (GE) is one of the many companies that is now discovering the market for these frugal innovations. Crucially, the company is developing new products taking into account the conditions in which they’ll be used, including ways to cope with power cuts or voltage fluctuations, high temperatures, pollution and intense use. One of its most successful devices is the Lullaby Baby Warmer, used to help premature babies adjust to room temperature, which is currently available in more than 60 countries. It may not be as cheap as a paper device but, at $3,000 per unit, it’s 70% cheaper than traditional models. This device has tremendous life-saving potential. Five hundred babies born underweight die every hour, most of which could be avoided by simply keeping them warm.
(Above: GE Healthcare’s Lullaby Baby Warmer)
In another bid to help premature babies, a team from Rice University in Texas has developed a low-cost device to help newborns breathe. “We developed it in response to a need that was identified by our paediatrician collaborators working at Queen Elizabeth Central Hospital in Blantyre, Malawi,” said professor of bioengineering Rebecca Richards-Kortum. “With 18% of babies born too soon, Malawi has the highest rate of preterm birth. More than half of preterm babies struggle to breathe because their lungs are immature.”
The authors speculate it can increase survival rates up to 70% in premature babies with breathing difficulties
The device can be built for less than $200, but is capable of the same pressure levels as the ones used in developed countries. What’s more, because it only uses off-the-shelf components, maintenance is cheap and easy. The authors speculate it can increase survival rates up to 70% in premature babies with breathing difficulties, which means in Africa alone it has the potential to save almost 200,000 lives every year.
A third example of this type of approach is the work done by biomedical engineer Reece Stevens, while working with Engineering World Health (EWH), an organisation specialising in design and repair of medical equipment for low-resource environments. After working as a volunteer in a hospital in Rwanda, the student experienced firsthand the frustration of not being able to monitor patients during and after surgical procedures due to a lack of equipment. “The hospital had a lot of issues with patients waiting for surgeries, since they only had five working patient monitors for 400 beds,” said Stevens. “I felt that this was one of the biggest issues facing the hospital and I wanted to do something about it when I came home.”
(Above: FreePulse patient monitor)
In response to this problem, Stevens came up with FreePulse, a cheap and easy-to-use medical device with multiple probes to measure oxygen levels, heart rhythm and blood pressure. “Our first preclinical trials were in Nepal this winter, and I am very pleased with the results,” said Stevens. “The goal is to be ready for a full clinical trial within the next two years, so there’s a lot of product development going on now based on the data we got while in Nepal.”
Toys designed for hacking
One of the main problems that healthcare workers in developing countries face is what to do when equipment breaks down and there is nobody around to fix it. In the developed world, this is easily solved with a phone call to the technical department. However, in the middle of nowhere, healthcare workers may have no option other than to have a go themselves. This can be a scary process.
To support this approach, a team at MIT is developing the basic tools to encourage “medical tinkering” by using toys. “When we use toys, it demystifies the process of medical technology. You may not have the courage to hack a $1,000 device, but you have the courage to hack something that is $5, and with a little ingenuity, it can become as powerful as a $1,000 device,” said Jose Gomez-Marquez in an interview for The Next List.
(Above: DIY tools from MIT Little Device Lab)
The team has put together a series of kits to make the hacking process a little easier. The kits contain medical supplies, such as syringes, nebulisers, inhalers and patches, but it also comes with somewhat unexpected items, such as springs, plungers, compressors, tilt sensors, buzzers, timers and bicycle pumps. “We make parts so that anybody can make their own medical technology,” said Gomez-Marquez. If these kits help doctors to become more confident to build, modify or repair their own devices, then the team feels it’s done its job.
Of course, makeshift kits like these can only achieve so much. What’s important is that this approach to repairing equipment translates to the durable devices these hospitals need. Luckily, there is now a vibrant and active community of scientists, engineers, doctors and hackers working on a variety of projects, from a portable device for screening eye problems to a reliable way to disinfect open wounds. What’s more, some universities, including Stanford and MIT, as well as EWH, have recognised the need to train the next generation of bioengineers to be ready for the situations facing developing countries. As EWH’s director of student programmes Ben Fleishman explained, volunteers working with the medical organisation learn to repair medical equipment and “are encouraged to assess needs of the hospitals that can be better met by innovative design”.
“We need to excite the younger generation and make them think about urgent health challenges,” concluded Stanford’s Bhamla. “It’s very important to get people to think out-of-the-box solutions for the big problems in our society.”
Image credits: Stanford University, GE Healthcare, FreePulse, MIT Little Device Lab