{"id":1040,"date":"2011-09-15T10:35:58","date_gmt":"2011-09-15T14:35:58","guid":{"rendered":"https:\/\/engineering.jhu.edu\/magazine-archive\/?p=1040"},"modified":"2017-08-02T10:36:04","modified_gmt":"2017-08-02T14:36:04","slug":"lifesaving-solutions","status":"publish","type":"post","link":"https:\/\/engineering.jhu.edu\/magazine-archive\/2011\/09\/lifesaving-solutions\/","title":{"rendered":"Lifesaving Solutions"},"content":{"rendered":"

For Biomedical Engineering students working in the world\u2019s poorest regions, necessity is the mother of invention.<\/em><\/p>\n

Related Stories:<\/strong>
\n\u00bb A Promising Partnership<\/a>
\n\u00bb Making the Rounds<\/a>
\n\u00bb Video: Antenatal Screening Kit<\/a><\/p>\n

When Creighton Petty, a student in biomedical engineering at the Whiting School of Engineering, visited Ethiopia last summer as part of his yearlong master\u2019s program, he thought he had prepared himself mentally for the challenges facing the country\u2019s health care workers.<\/p>\n

\"Sean<\/a>
Jhpiego fellow Sean Monagle, here with a baby, traveled to Nepal to test a promising protein pen that screens for dangerous health conditions in pregnant women. Photo by Geta Sharma\/Nepal<\/figcaption><\/figure>\n

He had traveled extensively through Guatemala and Peru as an undergraduate, and he had seen the constraints of poverty. Still, the lack of resources in the African country startled him\u2014rolling electricity blackouts in hospitals, overcrowded waiting rooms packed with patients, shortages of essential medical supplies.<\/p>\n

At a top health outpost, for example, health care workers struggled to provide even the most basic care under dire conditions. \u201cMost posts don\u2019t have water or power because they are made of trees and mud. This one had a water heater and a sink,\u201d Petty wrote, in the team\u2019s daily blog. \u201cBut there was one problem: It wasn\u2019t connected to electric or water sources, so many of the features were unusable.\u201d<\/p>\n

In a nearby hospital, Ethiopian administrators were trying to make sense of 1,000 different pieces of donated medical equipment, manufactured by 300 companies, made in 22 countries\u2014without any repair manuals. \u201cWhen you explain to a hospital administrator that you are an engineer,\u201d says Petty, \u201cthey automatically think you can fix all this broken equipment. But in many of these countries, the problems are much, much larger.\u201d<\/p>\n

Petty and 15 other Hopkins master\u2019s students were in Ethiopia, Tanzania, India, and Nepal as part of their course work at the Johns Hopkins Center for Bioengineering Innovation & Design (CBID), an outgrowth of the Department of Biomedical Engineering\u2019s undergraduate medical device design program developed by faculty members Artin Shoukas and Bob Allen. The yearlong MSE program, which runs from June through May, includes an eight-week rotation with doctors at Johns Hopkins Hospital (see Making the Rounds) as well as a summer trip abroad to understand the health care needs of developing countries.<\/p>\n

Now back stateside, the students are working in teams throughout the year to invent a handful of medical devices for markets in both the developed world and in developing nations.<\/p>\n

Today, U.S. companies dominate the $350 billion global medical device industry, but that trend is shifting to emerging markets. Medical innovators are turning to value-driven engineering, or frugal engineering, to help meet the staggering burden of care for the world\u2019s poorest\u2014and often sickest\u2014people.<\/p>\n

In May 2011, CBID further strengthened its global health initiative by entering a new partnership with the Baltimore-based Jhpiego, a Hopkins affiliate, and the Norwegian nonprofit Laerdal Global Health. The alliance is aimed at tackling health problems facing mothers and newborns in the first hours of life (see A Promising Partnership).<\/p>\n

\u201cYou cannot be a true leader unless you innovate for the world,\u201d says CBID\u2019s graduate program director, Soumyadipta Acharya. \u201cThat means getting out of your U.S. comfort zone and thinking about the very large unmet clinical and public health needs that result in millions of deaths each year.\u201d<\/p>\n

\"solutions_delivery_room\"<\/a>
\u201cI was struck by the bareness, but also the beauty,\u201d says CBID student Geoff Russell, who photographed this delivery room in a tribal region of Jharkhand, India.<\/figcaption><\/figure>\n

W<\/strong>hen Petty and fellow students fanned out across Tanzania, Ethiopia, India, and Nepal, they were jolted into an immediate understanding of the differing needs in developing countries. \u201cYou couldn\u2019t help but be shocked,\u201d says Lauren Smith, who traveled to Ethiopia.<\/p>\n

In Tanzania, for example, the largest health care facility in Dar es Salaam was admitting between 1,000 and 1,200 patients daily. Its two OB-GYN surgical units handled as many as 20 to 28 surgeries each day.<\/p>\n

\u201cWe were surprised to learn that there are between 70 and 100 births per day at this facility,\u201d wrote Luke Jungles, in his team blog from Tanzania. \u201cOne nurse helped to deliver more than 600 babies in three months. We also found out that sometimes up to three pregnant women have to share a single bed.\u201d<\/p>\n

But beds were not the only resource in short supply. The students noted a lack of reliable electricity, inadequate methods to clean or sterilize equipment, enormous piles of broken devices, a lack of basic diagnostic care, inadequate waste disposal methods, and widespread shortages of basic medicine. In rural areas, students honed in on the need for simple, easy-to-use diagnostic kits for everything from anemia to cervical cancer to infant jaundice. With doctors in short supply, many countries are \u201ctask shifting,\u201d or moving the responsibility for general health care to nurses, midwives, clinical officers\u2014even volunteers. The engineering challenge is to design tests that are easy to use but provide enough valuable information to enable users to decide whether patients need a higher level of care.<\/p>\n

In many countries, for example, women do not give birth in hospitals. A key problem is determining whether an expectant mother is experiencing serious complications, such as obstructed labor, which can be fatal. Jhpiego estimates that 380,000 women die from pregnancy complications and childbirth each year; 4 million newborns die in their first month; and more than 95 percent of stillborn births occur in developing countries.<\/p>\n

In India, students observed the need for treatment of postpartum hemorrhage especially. Says Harshad Sanghvi, Jhpiego\u2019s medical director: \u201cPostpartum hemorrhage doesn\u2019t occur often. But when it does, it kills.\u201d Marton Varady, in his team\u2019s India blog, wrote: \u201cOften the hemorrhage starts at a peripheral hospital, where doctors are unable to control it. At that point, the mother only has about two hours or so before the hemorrhaging has to be stopped; this leads to as many as half the mothers dying in transit.\u201d<\/p>\n

<\/p>\n

\"solutions_Luccie_Wo\"<\/a>
Luccie Wo, left, shows health care workers the E-Partogram, which provides early warning signs of danger during labor. Photo by Lauren Smith\/Ethiopia.<\/figcaption><\/figure>\n

In their blog from Ethiopia, Smith and fellow student Luccie Wo met a 23-year-old woman in the town of Arba Minch who was emblematic of another challenge facing African women.<\/p>\n

At 22, this patient had labored for four days with her first baby\u2014a classic case of obstructed labor. Finally her family provided the necessary money to travel, likely by donkey cart and bus, to a regional hospital.<\/p>\n

By that time, the patient\u2019s baby had died in utero. The young woman had sustained so much internal damage from the obstructed labor that fistulas, or tears, had occurred internally, rendering her unable to control her bowels. She returned to her family but was unable to heal completely. By that time, her husband had abandoned her, and her community ostracized her.<\/p>\n

\u201cBut the saddest part of the story,\u201d says Wo, \u201cis that it\u2019s not uncommon.\u201d<\/p>\n

Three CBID master\u2019s students from the Class of \u201911\u2014Sean Monagle, Shoval Dekel, and Peter Li\u2014and one BME graduate, Sunny Chen, now on one-year fellowships with Jhpiego, traveled with the 2012 class to Nepal and Tanzania to field-test products they worked on last year. Their simple, cost-effective devices have attracted interest from nonprofit groups, foundations, and corporations for having the potential to save lives.<\/p>\n

Monagle is spearheading the partnership\u2019s efforts to market a low-cost antenatal kit to screen women for complications that develop during pregnancy. He began working on the project with a team of biomedical engineering undergrads. The idea has taken off in the last year, landing him on CNN Newsroom and in Time magazine, and garnering a $100,000 grant for the project from the United States Agency for International Development (USAID).<\/p>\n

Simply, his team innovated on the idea of a urine dipstick to test for dangerous maternal health conditions such as preeclampsia and diabetes. They created a set of pens, like Magic Markers, that can be used on special paper and contain reagents to test for elevated protein levels in urine.<\/p>\n

In August, Monagle field-tested the device in two rural health facilities in Nepal with Jhpiego. Local nurses prepared the test by marking filter paper strips with the reagent pen. The team interviewed 600 consenting women who had used the strips to test their own urine for high protein levels. \u201cFrom the initial reactions, they loved it,\u201d Monagle says.<\/p>\n

Project sponsor Jhpiego hopes to keep production costs to as little as a half-cent per test, compared to as much as 50 cents for standard dipstick tests. \u201cOur ultimate goal has always been to get these to community health workers, who can take them house to house to women who aren\u2019t receiving any prenatal care,\u201d Monagle says.<\/p>\n

\"Solutions_baby_weighed\"<\/a>
In Tanzania, an infant at a crowded health care facility is weighed using an age-old method. Photo by Peter Li\/Tamzania<\/figcaption><\/figure>\n

In Tanzania, Dekel and Li were testing the E-Partogram, which they hope will provide the early warning signs of possible complications during labor. Traditionally, health care workers use a paper partogram to chart labor by plotting variables such as heart rate, cervix dilation, and contractions. Widely used in developing nations after being backed by the World Health Organization, the partogram requires more than a basic level of medical knowledge.<\/p>\n

\u201cI read graphs all the time, and it\u2019s complicated for me,\u201d says Dekel. Imagine being a semi-skilled provider doing this in the middle of an isolated rural area while monitoring a difficult labor, she says.<\/p>\n

Dekel is working with Jhpiego\u2019s medical director, Sanghvi, an international expert on obstetrics and gynecology, to develop an easy-to-use electronic partogram.<\/p>\n

She envisions a handheld device that receives data about maternal heart rate and fetal well-being. The device then charts the progression of labor. If a woman shows signs of complications, the device signals alerts. If complications occur, it signals an alarm to seek a higher level of care.<\/p>\n

The challenge is keeping the E-Partogram affordable. Right now Jhpiego is trying to develop a prototype for a target cost of $50.<\/p>\n

In July, Jhpiego was awarded a $250,000 \u201cSaving Lives at Birth\u201d grant, sponsored by USAID, the Bill & Melinda Gates Foundation, the World Bank, and others, which enables Dekel and Li to refine the design and continue field-testing.<\/p>\n

Back in Baltimore, the Class of 2012 CBID students spent much of the fall sifting through ideas from their trip abroad as well as their summer rounds at Hopkins Hospital. They will devote this year to working on proprietary prototypes that they hope will be well received by the marketplace and nongovernmental agencies.<\/p>\n

Since the launch of the biomedical design program at Hopkins nearly a decade ago, undergrads and master\u2019s-level students have participated in roughly 50 medical device projects for external clients, filed for more than 25 provisional patents, and applied for 12 full patents.<\/p>\n

Students alone have gone on to form six startup companies, and the 2011 class earned over $160,000 in prize money and in-kind donations to aid startup ventures. That came on the heels of a CBID group winning the 2010 Wharton Business Plan Competition, which earned them $20,000 and an invitation to ring the NASDAQ Closing Bell. In addition, CBID\u2019s global health projects have attracted nonprofit money from organizations such as USAID.<\/p>\n

\"adam_clark\"<\/a>
CBID Student Adam Clark gives small gifts to a child outside a dispensary in rural Tanzania. Photo by Divya Maxwell\/Tanzania<\/figcaption><\/figure>\n

CBID Executive Director Youseph Yazdi has the job of overseeing the program, which runs at a dizzying pace. He teaches and
\nmentors students. And he spends time raising money to expand the program and get innovations such as the antenatal testing kit and E-Partogram off the ground.<\/p>\n

Yazdi joined Hopkins from Johnson & Johnson (J&J), where he was the corporate director in the Office of Science & Technology. He was drawn to CBID, he says, because Hopkins has \u201call the essential ingredients to be a world leader in medical innovation.\u201d<\/p>\n

He wasted no time. So far, he has raised $350,000 from J&J; Becton, Dickinson & Co.; GlaxoSmithKline; and others for a Technology Accelerator Fund that provides funding for CBID projects before and after students graduate.<\/p>\n

In addition, Elliot McVeigh, chairman of the Department of Biomedical Engineering, recently tapped Yazdi to oversee a new Coulter Foundation Translational Partnership Program that will provide Hopkins biomedical researchers and students with $5 million in bridge financing over five years. Approximately six projects a year will be funded, with grants ranging from $25,000 to $120,000. The money, awarded in May, will be aimed at translational research.<\/p>\n

What\u2019s more, CBID will continue to partner with groups like Jhpiego. In the last several months, for example, CBID has teamed up with Jhpiego on partnerships with both USAID and GE Foundation. McVeigh, from his Clark Hall office, says this investment in value-driven engineering products\u2014simple, safe, and cost-effective\u2014will pay off abroad and at home.<\/p>\n

\u201cLook,\u201d says McVeigh, \u201cwe\u2019re spending 17 percent of our GDP on health care in this country. \u2026 That\u2019s a huge number. We don\u2019t need to spend more money. We need innovation that is more efficient, performs better, and costs less money. That\u2019s where the winners will be over the next half century.<\/p>\n

\u201cWe are building a program that will improve health care delivery not just in developed countries, but it will benefit developing countries, too.<\/p>\n","protected":false},"excerpt":{"rendered":"

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