A nurse cradles a newborn at the obstetric and neonatal emergency hospital in Port-au-Prince, Haiti. Image: Doctors Without Borders
Preventable illness and injury are the leading causes of death in the developing world. In the poorest nations, diseases all but eradicated or contained in the West continue to claim lives because modern technologies are out of reach.
“Each year, millions of people die, and millions more suffer needlessly from diseases that can or should be prevented and treated,” says Unni Karunakara, former international president of Doctors Without Borders. “We need a sea change in our approach to ensure that scientific advances are consistently translated into better care for patients. This is a global crisis, which is being exacerbated by diagnostic tools and medicines that are outdated and hugely expensive.”
Engineers, governments, and humanitarian groups are working to bridge the gaps in global access to medical care, and to spark innovation in point-of-care medical technologies designed for resource-limited environments. Here’s what engineers are doing about five of the most urgent solvable challenges in global health:
The Xpert HPV test capable of reporting high-risk Human Papillomavirus (HPV) infection in captured cervical cells. Image: Cepheid
1. Drug-Resistant Infections
Problem: Tuberculosis (TB), malaria, and HIV/AIDS are the three most potent viral killers in the developing world, and they are on the rise in many nations. As new drug-resistant strains appear, and as many patients suffer from some combination of the three diseases, early and accurate detection tools are needed to contain their spread.
Response: This is a complex problem, made worse because the state-of-the-art in diagnostics is different for each disease. The World Health Organization (WHO) has applauded new molecular tests for multiple-drug resistant TB that reduces testing times from months to days.
Cepheid, Sunnyvale, CA, produces a cartridge-based nucleic acid amplification test (NAAT) for rapid diagnosis active TB and drug resistance. While the Xpert MTB/RIF assay delivers accurate and fast results, according to WHO studies, the quest continues for a true noninvasive point-of-care test that requires no skill to administer. Cepheid has also announced a new collaboration with AstraZeneca, Cubist Pharmaceutical, and GlaxoSmithKline to fight drug-resistant bacterial infections. The team is working to extend Cepheid’s Xpert Carba-R test to work with multiple types of biological specimens. The test looks for pathogens in rectal swab samples. By refining it to process samples collected from other parts the body–for example, respiratory samples–the companies envision an impact on diseases such as pneumonia.
The GE VScan handheld ultrasound machine. Image: GE Healthcare
2. Perinatal Mortality
Problem: Maternal and neonatal mortality during childbirth strike 62 out of every 100,000 people in low-income nations. Pre-term delivery, perinatal trauma, asphyxia, and other tragic complications have many causes, but all of these hazards can be minimized through diagnostic technologies.
Response: Handheld battery-powered ultrasound machines can reveal fetal position, movement, heart function, and amniotic fluid levels while also visualizing the mother’s uterus and ovaries. The Vscan system, from GE Healthcare, Wauwatosa, WI, is one of several new tools bringing a new level of diagnostic capability to remote health clinics. By providing a quick look inside the body, doctors can make on-the-spot decisions about appropriate treatment or additional testing, and can make voice annotations in the individual image files. The flip-phone design fits in a pocket and can be operated with one hand. Its battery delivers about one hour scanning time on a full charge, which can be performed conventionally or by solar power in off-the-grid locations.
A portable solar-powered vaccine refrigerator. Image: LIGTT
3. Vaccine Safety
Problem: The thermostability of vaccines is essential to their safety and effectiveness. Vaccines are required to be stored at carefully controlled temperatures between 23 and 45 degrees Fahrenheit. That level of constant refrigeration is not feasible in resource-limited nations, especially those with hot climates. As a result, preventable viral diseases go unchecked in remote areas and spread beyond.
Response: Off-the-grid refrigeration technologies designed for reliability in the field offer a solution while vaccine makers pursue more durable formulations. Government engineers at Lawrence Berkeley National Laboratory have adapted a solar-powered chilling system specifically for vaccine thermostability. The cooler can be carried by two people or hauled on a bicycle, which is often how medicines reach their ultimate destination in field. The lab said it stays between 2 to 8 degrees Celsius for up to five days on a full charge, without the use of refrigerants or toxic materials. The device integrates a thermoelectric heat pump alongside high-density vaccine vial packaging.
The RoughRider is an affordable wheelchair designed to handle rugged terrain with ease. Image: Whirlwind Wheelchair
Problem: Living and making a living with limited physical mobility is especially challenging in remote, low-income countries with steep, rough terrain. WHO estimates about 20 million people in low-income countries need wheelchairs, but either can’t get one or can’t use one on their rugged local terrain. Although donated wheelchairs help some people, others can’t use them safely because they don’t fit correctly and aren’t durable enough.
Response: The Rough Rider,from Whirlwind Wheelchair International, Berkeley, CA, supplies 25 countries with specialized chairs for rough terrain. The chairs are highly adjustable to a patient’s prescription and can be assembled with basic hand tools. The Rough Rider features a long wheelbase for stability and shock-absorbing wheels for a smooth ride over grass, mud or other soft surfaces. The company is also developing a hand-cranked front-wheel tricycle that could open business and employment opportunities for wheelchair users. With push rims mounted on the back wheels, riders can switch to manual rear-wheel operation when they need extra oomph on steep terrain or better maneuverability in crowded spaces.
The Universal Anesthesia Machine allows delivery of anesthesia safely and economically. Image: Gradian Health Systems
5. Surgical Care
Problem: WHO states that more than 2 billion people—nearly one-third of the world’s population—have no access to surgical care in the event of a medical emergency. Modern surgery requires modern anesthesia, and that requires a highly reliable source of power and a local supply of compressed oxygen. Without these tools, remote clinics often rely on ketamine, an anesthetic related to phencyclidine (PCP), with the same negative neurological complications. More than 35 million operations with sub-standard anesthesia take place annually.
Response: Gradian Health Systems, New York, NY, makes a battery-powered ambient-pressure anesthesia machine that works with or without electricity and compressed gas, and now serves hospitals in at least 15 countries. The Universal Anesthesia Machine features an integrated concentrator that produces up to 10 liters per minute of 95% oxygen. If no other source of oxygen is available, the system automatically brings in and filters room air. A low-resistance draw-over vaporizer delivers calibrated flows of either isoflurane or halothane anesthetic.
Michael MacRae is an independent writer.
This is a global crisis, which is being exacerbated by diagnostic tools and medicines that are outdated and hugely expensive.
Unni Karunakara, former international president, Doctors without Borders