The Role of Academia in Improving The Role of Academia in Improving

Access, Quality and Affordability of Access, Quality and Affordability of

Medical Devices to ResourceMedical Devices to Resource--Poor Poor

NationsNations

Herbert F. Voigt, Ph.D.Herbert F. Voigt, Ph.D.

Professor, Biomedical EngineeringProfessor, Biomedical Engineering

Boston UniversityBoston University

President, International Federation for Medical and Biological President, International Federation for Medical and Biological

EngineeringEngineering

2

“Appropriate technology for developing communities is usually characterized as being small scale, energy efficient, environmentally

sound, labor-intensive, and controlled by the local community. It must

be simple enough to be maintained by the people using it. Furthermore, it must match the user and the need in complexity and

scale and must be designed to foster self-reliance, cooperation and responsibility.

Studies by the World Bank and the United Nations have shown,

however, that appropriate technology is critical to bringing more than 3

billion people out of poverty.”

http://www.ewb-international.org/solutionofmonth.htm

Introduction

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Academic Organizations can provide a variety of opportunities for students to contribute to improving access, quality and affordability of

medical devices for resource –poor nations through:

• Faculty-initiated Projects

• Senior Design Projects (required element of ABET accredited programs – also required in programs around the world)

• Thesis requirements• Engineers Without Border Chapters at Universities

• Engineering World Health - International

Academic Organizations

Biomedical Engineering StudentsBiomedical Engineering Students

�� Engineering students studying Biomedical Engineering are Engineering students studying Biomedical Engineering are among the brightest students in college today.among the brightest students in college today.

�� In addition, the percentage of women pursuing Biomedical In addition, the percentage of women pursuing Biomedical Engineering is > 40%, relieving a major human capital Engineering is > 40%, relieving a major human capital resource issue.resource issue.

�� The skills, aptitudes and youthful idealism of these The skills, aptitudes and youthful idealism of these students (as well as other engineering and medical physics students (as well as other engineering and medical physics students) make them ideal candidates to participate in students) make them ideal candidates to participate in projects aimed at improving access, quality and projects aimed at improving access, quality and affordability of medical devices for resourceaffordability of medical devices for resource--poor nations.poor nations.

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Engineering World HealthEngineering World Healthmeeting challenges in developing countriesmeeting challenges in developing countries

� Helping the world’s poorest with healthcare technology

�� They work with They work with

�� universityuniversity--based biomedical engineers, based biomedical engineers,

�� industry professionals, industry professionals,

�� charities that manage donated medical equipment, charities that manage donated medical equipment,

�� the international health community and the international health community and

�� developing countries developing countries

to combine innovation in appropriate technology with to combine innovation in appropriate technology with direct support to medical technology management, direct support to medical technology management, maintenance and repair. maintenance and repair.

http://en.wikipedia.org/wiki/EWHhttp://en.wikipedia.org/wiki/EWH

Engineering World HealthEngineering World Healthmeeting challenges in developing countriesmeeting challenges in developing countries

Engineering World HeathEngineering World Heath’’s BMET Training Programs BMET Training Program

Engineering World Health began the Biomedical Engineering World Health began the Biomedical

Engineering Tech. (BMET) training program in late 2009 to Engineering Tech. (BMET) training program in late 2009 to

provide a training course for 45 biomedical equipment provide a training course for 45 biomedical equipment

technicians in Rwanda. The program is funded by the GE technicians in Rwanda. The program is funded by the GE

Foundation with the goal of providing enough trained Foundation with the goal of providing enough trained

technicians to service every hospital in Rwanda within technicians to service every hospital in Rwanda within

three years.three years.

http://en.wikipedia.org/wiki/EWHhttp://en.wikipedia.org/wiki/EWH

There are 16 BMET students representing 16 hospitals in the

first class in Rwanda.

Engineering World Health is now

expanding its training program to

Cambodia, Honduras and Ghana.

Malkin and Keane, 2010 Malkin and Keane, 2010 Duke UniversityDuke University

Of 210 nations listed by the World Bank, 98 are classified as Of 210 nations listed by the World Bank, 98 are classified as resource poor.resource poor.

Malkin and Keane examined the maintenance records for broken Malkin and Keane examined the maintenance records for broken medical devices in 60 hospitals in 11 resourcemedical devices in 60 hospitals in 11 resource--poor countries.poor countries.

Using summer students and volunteers, they were able to return Using summer students and volunteers, they were able to return more than 70% of these devices to use in the hospitals using more than 70% of these devices to use in the hospitals using minimal resources.minimal resources.

Malkin and Keane recommend creating a program to train High Malkin and Keane recommend creating a program to train High School graduates to become Biomedical Technician Aids (BTAs).School graduates to become Biomedical Technician Aids (BTAs).

These hospital employed aids would get onThese hospital employed aids would get on--thethe--job training and job training and learn important skills for fixing broken medical devices, thus learn important skills for fixing broken medical devices, thus improving the local infrastructure.improving the local infrastructure.

David Kelso and Matt GlucksbergDavid Kelso and Matt GlucksbergNorthwestern UniversityNorthwestern University

BME Design for the Developing World (two examples shown)BME Design for the Developing World (two examples shown)

��Center for Innovation in Global Health Technologies (GHTs)Center for Innovation in Global Health Technologies (GHTs)

David Kelso, DirectorDavid Kelso, Director

��M.S. Program in BME with GHT CertificateM.S. Program in BME with GHT Certificate

��Undergraduate Senior Design in Cape Town, South AfricaUndergraduate Senior Design in Cape Town, South Africa

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(www.who.int)

~ 1 cm

Flex PCB

Rigid PCB

Batteries

Alarm

Micro-controller On/off LEDs

Filters & Amplifier

PEF

Instrumentation for Kangaroo Mother CareApnea Monitoring

Problem: KMC is effective treatment for premature birthIn the developing world, but apnea monitors are not designed to work under these conditions.

Solution: A self contained, flexible, miniaturemotion sensor and O2 Sat secured to the infant with a hydrogel-based adhesive.

Implementation: Prototyping at Northwestern University and Digital Cube (S, Africa) and tested at Karl Bremer Hospital, Cape Town

Partners: Infantrust LLC (Stellenbosch), Cape Biotech

Low-Cost Digital Imaging

Problem: Basic radiological services are lacking in much of the developing world.

Implementation: World Health Imaging Alliance founded to deploy systems in South Africa and Guatemala, (so far).

View from Crossroads Clinic, Cape Town, SA

Solution: Proven x-ray technology linked to CR- or DR-based digital image capturewith a single simple graphicalinterface. Technical training and serviceare included in the cost of the system.

BME MS student Parmede Vakil at the Crossroads installation

Partners: Merge Healthcare, Sedecal,Carestream, Rotary, Western Cape CHC

> 90 % of BME programs have the elaboration of a

thesis obligatory

• 46 Countries in Europe investigated

• 40 Countries have BME program

• ~ 150 Universities across Europe

• 297 BME programs

– 77 Undergraduate - BSc

– 220 Postgraduate - 161 MSc, 59 PhDIn percentages

26 % BSc, 54 % MSc, 20% PhD

TEMPUS Review of the BME programs in 2010

Tempus is the European Union’s program which supports the modernization of higher

education in the Partner Countries of Eastern Europe, Central Asia, the Western Balkans

and the Mediterranean region, mainly through university cooperation projects.

DESIGN AND MANUFACTURE OF A

ROBUST SOLAR-POWERED PULSE

OXIMETER FOR USE IN ZAMBIA

Max Condren

Matthew FlemingBryan Lublin

Faculty Advisor: Professor Muhammad Zaman, PhDCo-Advisors: Donald Thea, MD and Jonathon Simon, PhD

Senior Design Project, Department of Biomedical EngineeringCollege of Engineering, Boston University

Friday, April 30, 2010

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Motivation:Motivation:

�� PneumoniaPneumonia�� Leading killer of children under fiveLeading killer of children under five

�� 5,000 5,000 infants and young children deaths/dayinfants and young children deaths/day

�� 1.81.8 million deaths/yearmillion deaths/year

�� 8080% of children do NOT receive medications they need% of children do NOT receive medications they need

World Health

Organization.

"Pneumonia." World

Health Organization:

Media Centre. Aug.

2009. Web. 8 Oct. 2009.

<http://www.who.int/med

iacentre/factsheets/fs33

1/en/>.

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Background Background -- PneumoniaPneumonia

�� The DiseaseThe Disease

�� Bacteria or Virus affecting lungsBacteria or Virus affecting lungs�� Streptococcus pneumoniae, InfluenzaStreptococcus pneumoniae, Influenza

�� InflammationInflammation

�� Alveoli fill with fluidAlveoli fill with fluid

�� SymptomsSymptoms

�� LethargyLethargy

�� Increased Respiratory RateIncreased Respiratory Rate

�� Fever/VomitingFever/Vomiting

�� LOW BLOOD OXYGEN LEVEL, <LOW BLOOD OXYGEN LEVEL, <9090%%

"What Is Radiology? Presentation - Slide 1 Introduction." Lakeridge Health - Home. Web. 27 Apr.

2010. <http://www.lakeridgehealth.on.ca/patient_care/interven

tional_radiology/presentations/radiology/>

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Pulse OximetryPulse Oximetry

�� ScienceScience

�� HbO2 (red) vs. HbO2 (red) vs.

Hb (blue)Hb (blue)

�� Transmittance Transmittance

to Saturationto Saturation

�� TechnologyTechnology

�� Two LEDsTwo LEDs

�� PhotodiodePhotodiode

�� MicroprocessorMicroprocessor"Index of /medicaldevices/album/Ch 8 Ventilation/slides." Förstasida. Web. 27

Apr. 2010.

<http://www.medtek.ki.se/medicaldevices/album/Ch%208%20Ventilation/slides>.

Jalan P, Bracio BR, Rider PJ, and Toniolo H. (2006) ‘Rapid Prototyping of PulseOximeter’, paper presented at Proceedings of the 28th IEEE EMBS Annual International

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The ProblemThe Problem

�� Need device to measure SpO2Need device to measure SpO2…… but there are limitationsbut there are limitations

�� No electricityNo electricity

�� CostCost

�� Fewer trained professionalsFewer trained professionals

�� Adult or infant specificAdult or infant specific

World Health Organization. "Pneumonia." World Health Organization: Media Centre. Aug. 2009. Web. 8 Oct. 2009.

<http://www.who.int.mediacentre/factsheets/fs331/en/>.

Our SolutionOur Solution

�� Design and build a pulse oximeter:Design and build a pulse oximeter:

�� Measures pulse and SpO2Measures pulse and SpO2

�� Both infants and adultsBoth infants and adults

�� SolarSolar--poweredpowered

�� Costs under Costs under $100$100

�� RobustRobust

�� Easy to useEasy to use

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MethodsMethods

�� Consult experts in the field (CGHD)Consult experts in the field (CGHD)

�� Reverse EngineeringReverse Engineering

�� Battery and Solar Cell TestingBattery and Solar Cell Testing

�� Finite Element Analysis (FEA)Finite Element Analysis (FEA)

�� Materials SelectionMaterials Selection

�� EaseEase--ofof--Use and AccuracyUse and Accuracy

�� ProofProof--ofof--ConceptConcept

�� Devon Medical 300Devon Medical 300--CW modelCW model

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The Power SourceThe Power Source

�� Solar Cell TestingSolar Cell Testing

�� Sufficient in direct sunlightSufficient in direct sunlight

�� Not SustainableNot Sustainable

ThereforeTherefore……

�� Utilize Rechargeable BatteriesUtilize Rechargeable Batteries

�� Use AAAs?Use AAAs?

�� Not easy to find in ZambiaNot easy to find in Zambia

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Cellular Phone BatteryCellular Phone Battery

�� Major CarrierMajor Carrier

�� Zain MobileZain Mobile

�� Common BatteryCommon Battery

�� Nokia BLNokia BL--5C Battery5C Battery

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�� Africa, Africa, 20032003::

�� 2 2 cell phones per cell phones per 100 100 peoplepeople

�� Africa, 2008Africa, 2008

�� 3333 cell phones per cell phones per 100 100 peoplepeople

�� Zambia aloneZambia alone

�� 3.4 3.4 million cell phones!million cell phones!

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Design OverviewDesign Overview

�� Two Components:Two Components:

�� Pulse OximeterPulse Oximeter

�� Solar Charging UnitSolar Charging Unit

Solar Charger DesignSolar Charger Design

�� Functional DesignFunctional Design

�� Battery CompartmentBattery Compartment

�� Two Cellular Phone BatteriesTwo Cellular Phone Batteries

�� Solar Cell CompartmentSolar Cell Compartment

�� Satchel ClipsSatchel Clips

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Does it Work?Does it Work?

�� Pulse Oximeter:Pulse Oximeter:

�� Benchmark: Prince 100D2Benchmark: Prince 100D2

�� 11% relative error% relative error

�� Solar Charging Unit:Solar Charging Unit:

Charge Time:Charge Time:

�� One battery: < One battery: < 55 hourshours

�� Two batteries: < Two batteries: < 88 hours hours

Device Usage:Device Usage:

�� 1212 Hours ContinuousHours Continuous

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Ease of UseEase of Use

�� 33 Test GroupsTest Groups

�� Verbal instructions most effectiveVerbal instructions most effective

�� Training time less than Training time less than 55 minutesminutes

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Design AchievementsDesign Achievements

��One Device: One Device: $90.60$90.60

��RobustRobust

��TransportableTransportable

��SustainableSustainable

��VersatileVersatile

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AcknowledgementsAcknowledgements

�� Professor Muhammad Zaman Professor Muhammad Zaman Biomedical Engineering, Boston UniversityBiomedical Engineering, Boston University

�� Professor Donald Thea Professor Donald Thea Boston University School of Public HealthBoston University School of Public Health

�� Professor Jonathon SimonProfessor Jonathon SimonBoston University School of Public HealthBoston University School of Public Health

�� Dr. Phil SeidenbergDr. Phil SeidenbergDirector of CIHDZ Director of CIHDZ -- ZambiaZambia

�� Dewi Harjanto Dewi Harjanto Ph. D candidate Ph. D candidate -- Zaman LabZaman Lab

�� Dave LepzelterDave LepzelterPost Doc Post Doc -- Zaman LabZaman Lab

�� Daniel RyanDaniel RyanBoston University Electrical Engineering UndergraduateBoston University Electrical Engineering Undergraduate

�� Dave CampbellDave CampbellBoston University Mechanical Engineering Machine ShopBoston University Mechanical Engineering Machine Shop

�� Professors Irving Bigio, Roscoe Giles, Catherine Klapperich & Professors Irving Bigio, Roscoe Giles, Catherine Klapperich & David MountainDavid MountainBoston University College of EngineeringBoston University College of Engineering

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Engineers Without Borders - International

Ingenjörer och Naturvetare utan GränserIngenieros Sin FronterasIngeniører uden GrænserIngénieurs Sans FrontièresIngenieurs Zonder GrenzenIngenieure Ohne GrenzenEngineers Without BordersEngineers Without FrontiersEngenheiros sem FronteirasIngegneria Senza FrontiereInzeneri bez GraniciΜηχανικοί Χωρίς Σύνορα

מהנדסים ללא גבולות

http://ewb-international.org/

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What is a Partner Organization of Engineers without Borders - International?

Engineers Without Borders - International works in collaboration with various national and international groups affiliated with its member organizations. Partners may include: •(1) universities, technical, and vocational schools; •(2) engineering companies; •(3) humanitarian organizations; and •(4) NGOs.

http://ewb-international.org/

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Mission

“Engineers Without Borders - International facilitates links and collaboration among its member groups toward improving the quality of life of disadvantaged communities worldwide through educationand implementation of sustainable engineering projects, while promoting new dimensions of experience for engineers, engineering students, and similarly motivated non-engineers.”

Vision

“The vision of Engineers Without Borders - International is to be recognized and respected as an international organization whose members deliver sustainable solutions to developing communities worldwide and make use of their diverse technical expertise to solve critical problems affecting the health of our planet.

Engineers Without Borders -International sees a world where ALL people have access to the knowledge and resources with which to meet their basic human needs and rise out of poverty.”

http://ewb-international.org/

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“EWB-I describes each month a type of sustainable and appropriate solution to problems faced by communities worldwide. Unique tools

(technologies, software, books, etc.) or cutting edge programs and initiatives are presented.”

Solution of the Month

http://www.ewb-international.org/solutionofmonth.htm

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May 2010The Mac 400 hand-held electrocardiogram (ECG) designed for the Indian market. The technology has reduced the cost of an ECG test to just $1 per patient.

June 2010Lone Star Drills: One person drilling systems for drilling remote village wells.

July 2010The Novatank: a fully collapsible and portable 5,000 liter water tank with a potable water approved bladder contained within a highly engineered steel and plastic housing.

August 2010The Uber Shelter project. A remarkable way of building rapid shelter in emergency conditions.

http://www.ewb-international.org/solutionofmonth.htm

Solution of the Month

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Summary and ConclusionsAcademic Organizations (especially Biomedical Engineering and

Medical Physics departments, but others too) are becoming

increasingly aware of Global Health issues and Development and are uniquely positioned to play a major role in delivering improved access,

quality and affordability of medical devices to resource-poor nations.

Faculty-initiated projects, senior design and/or thesis projects (both home and abroad), Engineers Without Border Chapter at Universities

and Engineering World Health – International Chapters at Universities

are providing multiple opportunities for engagement by undergraduate and graduate students alike.

These students are among the most talented in the world and when

this is coupled to their idealism and altruism, I suspect we will see

remarkable results.

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Way forward…The WHO should determine and make available to Academic Organizations (Biomedical

Engineering and Medical Physics departments) opportunities in resource-poor nations

to address improving access, quality and affordability of medical devices.

The WHO should provide incentive s for undergraduate and graduate students to conduct

their Senior design project or theses on projects related to improving access, quality and

affordability of medical devices.

The professional organizations, such as the IFMBE and the IOMP, should assist WHO in

identifying and making available to Academic Organizations opportunities in resource-

poor nations to address improving access, quality and affordability of medical devices.

WHO, Professional and Academic organizations should promote and fund participation of

undergraduate and graduate Biomedical Engineers and Medical Physicists students in WHO

workshops and professional organization conferences regarding medical devices for resource-

poor nations.

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Acknowledgements

Slides 7-8: courtesy of Robert Malkin, Duke University

Slides 10-12: courtesy of Matt Glucksberg,

Northwestern University

Slide 13: courtesy of Ratko Magarivic, President, IFMBE

Slides 14-28 courtesy of Cordren, Fleming and Lublin,

Boston University