In September, the World Health Organization hosted their First Global Forum on Medical Devices in Bangkok, Thailand. Conference participants included winners from the Call for Innovative Technologies, policy makers, researchers, and clinicians. I had the chance to attend this event on behalf of Salud del Sol, Inc.; Innovations in International Health at MIT; and the solar autoclave research team. It was an incredible conference to be a part of and an honor for the solar autoclave to be recognized among such creative technologies as the remote anemia monitoring system from Biosense and Mark Zimmerman from Nepal, who is developing a simplified anesthesia unit for remote settings.

Dr. Margaret Chan, Director General of the WHO, captivated the group of 300 plus conference participants with her inauguration address, which I would describe as the most inspirational locker room speech for global health:

We are here, in part, because of concern about runaway health care costs and pressure to contain these costs. As noted in a 2007 World Health Assembly resolution, health technologies, and medical devices in particular, represent an economic as well as a technical challenge to health systems.

That resolution expressed concern about the waste of resources caused by investments in medical devices that do not meet high-priority needs, are incompatible with existing infrastructures, are irrationally or incorrectly used, or do not function efficiently. This tells us some of the pitfalls.

But we are also here because the unquestionable benefits of medical devices are so unevenly distributed. I wonder if there is any other area that illustrates so profoundly the great difference in the ability of wealthy and developing countries to reap the benefits of advances in medicine and technology?

We are looking forward to continued conversation and relationship-building opportunities from this conference!

In 2004, Aceh, Indonesia was the site of one of the most devastating tsunamis which took the lives of 230,000 inhabitants.  Five years later…during December 2009, I had the opportunity to experience how this developing economy is struggling to recover from the natural disaster and the indestructible will of the local population to thrive in their homeland. For two weeks, I participated in a Young Leaders Program sponsored by the Hong Kong-based think tank, the Global Institute For Tomorrow (GIFT). I was among a group of 18 academics, corporate employees and NGO workers from Malaysia, China, Thailand, Australia and India learning about and experiencing the international business environment of Asia and the application of social enterprises.

The program began in Hong Kong with a week of MBA-style classes. My time in Hong Kong was quite similar to how I envisioned learning about Islamic banking and the entrepreneurial environment in Asia.  We had a special lecture given by Hugh Evans who leads the UNDP’s (United Nations Development Programme) APED (Aceh Program for Economic Development) on the complex ecosystem of aid in Aceh and how market opportunities can enhance the aid that is given in Indonesia.

Three flights later, our team headed to Aceh, Indonesia to apply what we had learned in the classroom to the cocoa industry. Through a series of interviews with local farmers, government officials, and NGO leaders, we learned that there was a substantial market opportunity in a global demand for cocoa that could be aligned with poorly equipped local farmers who lack bargaining power in cocoa prices and access to local markets. The rugged SUVs which brought us from the cocoa farms to the centralized collection centers brought to reality the transportation constraints of the famers in Aceh and why they are disconnected from the market. To address this, we researched a business plan for an enterprise which would connect cocoa farmers to the market. The core goal of the business plan was to increase the quality of cocoa beans being produced and harvested by the farmers, empowering the farmers to move up the supply chain through various solar technologies that can be used in the drying process and in turn, directly connect the farmers to international cocoa exporters to allow them to realize a majority of the profit.

 Here’s a quick picture of the current cocoa drying process in Aceh: 

• Farmer grabs bucket of cocoa pods from the field behind his house.
• 4 hours later, the pods are shed and the cocoa beans are exposed.
• The cocoa beans are required to dry for 1 day before the fermentation process begins. Ideally, this is done inside of a processing facility. However, in Aceh, farmers do not have access to such technology and instead lay the cocoa beans outside on a tarp usually in the same vicinity as the chickens or next to the road.
• At the convenience of the collector, the cocoa beans are collected from the farmers for a price dictated by the collector—the price decreases based on quality of bean and if they have not been dried long enough.
• The cocoa beans are brought to a processing facility where they spend 8-10 days in the fermentation and drying process.
• These dried beans are then sold from the collector to an international exporter at a price determined by LIBO (what is this?).

Due to a lack of transparency in the system and a lack of appropriate tools at the farmer level, the farmers in Aceh rarely see any of the premiums received by the collectors for the cocoa beans. How can we change that? As part of the supply chain and operations team, we explored:

• Simple technology and agricultural techniques that can be implemented at the farmer level to produce high quality cocoa beans and increase production.
• Distributed processing centers equipped with solar driers for low operating cost, to be used by a group of 15-20 farmers.

After 6 days of developing a business plan, we presented the opportunity at an Investors Conference in Medan, Indonesia, where cocoa collectors, exporters and NGO leaders were present.  I came back from Indonesia with an incredible experience of working in multi-cultural teams, a new appreciation for M&Ms, and plenty of ideas for how simple solar technologies can support cocoa farmers!

Lori Hanna was interviewed by Nancy Scola of WorldChanging.com to describe the solar autoclave and the application to rural clinics in undeserved areas. The article highlights the solar autoclave for Nicaragua and FrontlineSMS:Medic of Malawi, Africa as two examples of social innovations that are closing the gaps in healthcare delivery.

Two projects led by US students and their international allies are helping to fill gaps in health care gaps in the Global South. Though one project involves cell phone text messaging and the other equipment sterilizers powered by the sun, they have the same inspiration: using simple technology to build on the value of existing social capital.

These innovations are developing in Malawi and Nicaragua, both counted amongst the all-too-many places on the globe where the holes in the net of public health are so gaping that many people slip right through. Numbers tell that story. Of the fifty thousand Malawians who contracted tuberculousis last year, for example, an estimated 70% of them are also carry HIV. And that’s just a small portion those with HIV; nearly one million of Malawi’s 14 million people are infected. Yet in all of the country, there are just 250 or so doctors. Nicaragua is somewhat better off, yet nearly half of all of births happen there with no medical professional in attendance. Into those breaches have, in many cases, stepped community health workers (CHWs), local laypeople who work with the local health care system, often as volunteers. The two projects profiled here are equipping those CHWs with simple, appropriate ways to shrink the holes in their country’s health care nets.

You can read more of the article at the Worldchanging website, http://www.worldchanging.com/archives//010007.html

WorldChanging.com is a nonprofit media organization headquartered in Seattle, WA, that comprises a global network of independent journalists, designers and thinkers. We cover the world’s most innovative solutions to the planet’s problems, and inspire readers around the world with stories of new tools, models and ideas for building a bright green future. We have brought awareness to issues like refugee aid, renewable energy and innovative solutions for improving building, transportation, communication and quality of life. Our readers are ready to change the world, and Worldchanging connects them with the latest ideas on how to do that.

The D-Lab Health class is very similar to the ETHOS course offered at UD, so it has been enlightening to see how a different University teaches students about the philosophy of appropriate technology in developing countries. My personal interest in global health and work with Salud del Sol make this class a perfect opportunity to learn from other students and professionals in the field and coincidentally, the D-Lab Health class is working with partner organizations in Nicaragua!

I spoke with Jose and his co-worker from IIH, Amit Srivastava about the scope of the field of global health. There are many pieces to issues of global health, including the large scale burden of the lack of infrastructure, the brain drain of medical professionals from developing countries to the US, poor training for community health workers, and the lack of appropriate diagnostic equipment. D-Lab Health educates students on the larger picture of challenges in global health, and then applies this knowledge to the research and design of innovative solutions to address these challenges.

During the classes that I was able to attend last week, the students were learning about complex medical devices, such as ultrasound machines and optometry instruments. The students were tasked with evaluating how these product designs could be altered to be more appropriate for use in developing countries, by asking questions about the parameters of the product design such as the cost of replaceable pieces and the training is required to use the devices.

Another class with D-Lab Health involved a trip to the Operating Room of Shriner’s Children’s Hospital, to experience the conditions of an operating room in a developed country. This trip at the OR gave a point of reference to compare the resource deprived healthcare settings of developing countries.

This week, the D-Lab Health students are traveling to Nicaragua to observe healthcare workers and patients in a field assessment of the challenges in health care equipment and delivery that these professionals face on a daily basis. The students will be bringing these challenges back to the D-Lab for the remaining part of the semester to develop a medical technology kit to address some of the underlying issues that the discover within the clinics. They will be traveling to different locations around the country, including Ocotal! Over the weekend, I was able to talk with the students and Jose about my experience living in Nicaragua last summer, everything from practical financial and travel advice to not leaving the country with out trying ron con pasas ice cream from the Eskimo man and having a cup of coffee from locals. Essential for truly experiencing the culture!

D-Lab Health branches from the over arching D-Lab course of MIT, which uses engineering design principals to improve the lives of the bottom billion in developing countries. Along with attending the D-Lab Health courses last week, I was also able to participate in a product design review for the D-Lab class. It was a brainstorming session for students working on a range of products, including a chlorine dispenser, a cell phone enabled baby scle, a portable hydro powered lantern, an energy storage solution for communities in Tibet,a strong maker to recycle plastic bags, and an interlocking stabilized soil block maker.

His lecture, “Medical Simulation and Training for the Developing World” will explore the convergence of open-source architectures, micro-controllers, pervasive connectivity, and affordable fabrication technologies that are poised to introduce medical simulation into poor countries. Leveraging systems he has developed for the U. S. Army for the past 10 years, he will discuss how a well-designed simulation infrastructure can serve as a powerful platform for deploying medical expertise, assessing provider competency, and adapting training resources to meet local medical needs. Medical simulation will be the fourth computing revolution to hit global health on the heels of low-cost computing, wireless telecommunications, and medical information systems.

The lecture will be held from 6:00-7:30pm at the MIT Museum, located at 265 Massachusetts Ave in Cambridge, MA. For more information, please contact jfgm@mit.edu.

Bill Gates, co-founder of Microsoft Corporation, and his wife Melinda Gates provide various programs to fight disease, poverty and other health and social issues, and improve education through the Gates Foundation, which also disperses grants to researchers with help from Warren Buffett and Gates’ father William H. Gates Sr. Lee listed that, according to Dahl, the Global Health Program of the Gates Foundation receives about 50 percent of the Gates Foundation’s funds, while the Global Development Program and U.S. Program receive 25 percent each.

In Africa and other developing regions, people, especially children, are dying from common ailments, such as diarrhea and measles. Not to mention, HIV/AIDS affects millions of people in developing countries, especially those in Africa. The Global Health Program is currently focusing on nutrition by improving food and water quality to decrease mortality rates in children. The distribution of vaccines and drugs is another focus.

The following text provides the main speaking points from Dr. Dahl as written in Lee’s article,

Developing countries have a difficult time dealing with public health issues due to inadequate technology and poor infrastructure. Many health problems in the developing world are found in villages where there is a lack of health clinics and electricity to efficiently operate medical devices and monitoring systems.

 

The main obstacle to improving global health in developing countries is cost. The transfer of medical supplies from wealthy to impoverished countries is expensive.

 

The Gates Foundation Web site reports that the Global Health Discovery team targets fundamental scientific and technological advances in global health. These advances allow the group’s research to lead to new ways to prevent, treat and diagnose disease.

 

Focusing on diarrhea, HIV/AIDS, malaria, neglected diseases, nutrition, pneumonia, polio, tobacco, tuberculosis, vaccine-preventable diseases and the category of maternal, newborn and child health concerns, the Global Health program hopes to create vaccines for developing countries. Developing countries have a difficult time dealing with public health issues due to inadequate technology and poor infrastructure. Many health problems in the developing world are found in villages where there is a lack of health clinics and electricity to efficiently operate medical devices and monitoring systems.

 

The main obstacle to improving global health in developing countries is cost. The transfer of medical supplies from wealthy to impoverished countries is expensive.

 

Dahl stated that there is an urgent need for more innovations to solve global health issues in the developing world.

 

Another major challenge in tackling global health is the diagnosis of diseases. In developed countries, a sterile lab for blood tests and stool samples are commonly used to diagnose diseases. However, in developing countries, an inadequate environment and poor resources make it very difficult to utilize expensive medical equipment to diagnose diseases.

 

“We need a common diagnostics platform,” Dahl said.

 

To explain, Dahl mentioned that diseases are diagnosed individually based on symptoms. Instead, she said that a common symptom, such as a fever, should be utilized by medical staff as an indicator for serious diseases such as diphtheria, malaria and pneumonia.

 

Dahl suggested a demand on the cost between diagnostic tools and disease intervention, adding that it is important to “keep in mind that the diagnostic has to be cheaper than the intervention.”

 

Global Health Program seeks to develop technology that can provide accurate tests, earlier diagnosis and simpler easy-to-use tests.

 

Dahl suggested that technology should be portable and manageable because, for example, people in Niger typically live 28 kilometers from the nearest health clinic. In addition, many developing countries lack efficient waste management systems that can properly dispose of medical waste, especially needles and syringes, which can harm children if exposed.

 

Dahl mentioned that the foundation focuses on research and development, not the creation and distribution of bioengineered products, such as vaccines and drugs, which is done by humanitarian organizations and biomedical companies.

 

“There really is no bigger test for humanity than the crisis of global health,” Dahl said, quoting Gates.

Read more about the work of the Global Health Program of the Gates Foundation here, http://www.gatesfoundation.org/global-health/Pages/overview.aspx

The content for this post was gathered from the New University publication of the University of California, Irvine, http://www.newuniversity.org/main/article?slug=how_we_can_afford182

During the Physicians for Human Rights Conference, Donna Barry of Partners In Health presented on the topic of Food and Health Safety and how this applies to the health and economic development of developing countries. She explained how Partners In Health is addressing this crisis of malnourished children and families through their work in Haiti, where they are providing  food supplements and lunches to the children in the community. While current food programs are providing meals for those in need, the majority of the time the foods provided lack the general nutrition required by malnourished people. Not all food aid delivered to developing countries is good. For example, Haiti has become a food dependent country, where 92% pf the families are in food security programs. The staple to this program is a simple peanut butter like supplement called Nourimil. Now I cannot imagine how appealing it would be to eat peanut butter every meal of the day, however by providing children in Haiti with Nourimil,people in the community have experience dramatic health improvements. While it is a more expensive option, people in Haiti are spending less time in the hospital, which in the long run is saving money for the local health system.

Another benefit of Nourmil, is that it is locally produced. PIH has partnered with local agricultural farms to create a vertical supply chain to produce the Nourimil peanut butter product. In this way, they are providing jobs for local people and stimulating the economy. This is an important aspect of development programs, the ability to work with the local community while addressing crucial issues of health and economic development. Below is a summary of this collaborative project of PIH.

Community-Based Treatment of Severely Malnourished Children

According to UNICEF, almost a quarter of Haiti’s children suffer from chronic malnutrition, as evidenced by their stunted growth. Our nutrition program meets the immediate needs of severely malnourished children through a nutrition treatment which uses two products called Nourimamba and Nourimil – both produced through our Zanmi Agrikol program – given to children identified in our clinics and by our accompagnateurs, or community health workers. In cooperation with Zanmi Agrikol, PIH and ZL treated nearly 3,464 malnourished children in 2007 across Central Haiti and the Artibonite District, and created opportunities for agricultural training and production for over 100 Haitian farmers and families. We are also providing meals to over 9,000 children daily through our school lunch program.

Treating Childhood Malnutrition

Through nine clinics across Central Haiti and the Artibonite District, ZL clinical staff plays a key role in improving the health of our malnourished patients. In addition to patients who arrive at our clinics, our community health workers (whom we call accompagnateurs) also encounter children suffering from malnutrition during home visits in the community. They refer these children and their families to our clinical sites, where children receive medical care and nutritional support until they regain a healthy weight.

For our most severely malnourished patients, PIH and ZL have been using a therapeutic food treatment program since November 2006, called Nourimanba. Nourimanba, a “Ready to Use Therapeutic Food” (RUTF), is made from a peanut butter base combined with milk powder, vegetable oil, sugar and a specially formulated vitamin mix for malnourished children. Because of its oil and peanut butter base, Nourimanba has a low water content, which resists bacterial growth and allows it to be safely stored for months. As it is “ready to use,” no cooking is required, allowing parents to easily feed it to their children at home, eliminating or reducing the amount of time children need to spend in the hospital. Although used in Africa and Asia, ZL was one of the first organizations in Haiti to begin treating severely malnourished patients with RUTF. Moderately malnourished children are prescribed a food supplement made from a cereal-legume blend made of beans and either rice or corn, called Nourimil. Once severely malnourished children have responded to Nourimamba, they receive Nourimil as a part of their treatment plan. Based on the results of our initial trial in November 2006 (where 30 children at two of our sites saw significant weight gain after just two weeks) in 2007 PIH/ZL scaled up the use of these two foods to eight of our nine sites, which benefited 3,464 malnourished children in 2007.

Producing Nourimanba and Nourimil

Through a program called Zanmi Agrikol (“Partners in Agriculture”), we produce Nourimanba and Nourimil at our main site in Cange, and when ZL first began using these products for the malnutrition program in late 2006, we purchased all of the necessary ingredients. The initial success of Nourimanba/Nourimil treatment and our subsequent scale-up has created a unique opportunity for poor farmers: once we saw the effectiveness of the RUTF, we began growing the main ingredients—peanuts, corn, and beans—at a 35 acre production farm that Zanmi Lasante operates at Corporant, located near our main site in Cange. In 2007, 45 Haitian farmers were employed at the production farm in Corporant. Because of the growing need for the ingredients of Nourimanba/Nourimil, in addition to the production farm, PIH/ZL also purchases crops from local farming families. In 2007, PIH/ZL provided the seeds and use of our tractor to 40 local farming families in Corporant. We then bought the crops they yielded for our Nourimanba/Nourimil production.

Both Nourimanba and Nourimil are prepared and packaged in our processing center in Cange, where we have employed and trained local men and women in the roasting, mixing, packaging and distribution of these products. In 2007, we employed 13 local women and 3 local men who produced and packaged 22,280 kilograms of Nourimanba and 87,200 lbs. of Nourimil for use in our clinics.

Providing Daily School Lunches

An important component of our solution to the short-term consequences of malnutrition among poor Haitians is to offer daily lunches to school-children through our education program. For years, parents in central Haiti have faced a terrible choice. They could send their children to school with empty stomachs, in the hope that they might gain the skills to someday escape poverty. Or they could keep them at home to help produce or secure much-needed food and water for the family to survive. PIH and ZL saw this need, and in 2006 we launched a lunch program at schools near our clinic sites.

In each of the communities where we provide school lunches, PIH employs local women to prepare the meals from hundreds of giant sacks of rice and beans. The benefits of this program are enormous, and yet the cost is minimal – just 27 cents per child per school day. Now that parents no longer have to choose between education and food for their children, school attendance has increased significantly, and so have the attention spans and classroom performance of the children once they get to school. In 2007, 9,315 children and 266 teachers received daily school lunches free of charge through the program, as we increased our reach to include 27 schools, up from the 21 schools we served in 2006.

It costs only $125 to treat a severely malnourished child with Nourimanba, only $60 to supplement a moderately malnourished child with Nourimil, and a mere $49 to provide a child with an entire school year’s worth of daily lunches. Currently, PIH and ZL are able to use these immediate interventions to meet the combined needs of approximately 12,800 children.

Key note speakers at the event included, Stephen Lewis, Co-Director of AIDS-Free World and former UN Special Envoy for HIV/AIDS in Africa and Julio Frenk, current dean of Harvard School of Public Health and former Minister of Health for Mexico. Stephen Lewis set the tone for the conference with his speech addressing the over arching issues that are contributing to the healthcare violations in developing countries. Lewis talked about U2 singer Bono, who asked why is it possible for the US and other nations to find $700 billion in 3 months to help bail out Wall St. but not $250 million over 3 years for the agreed upon Millenium Development Goals from the 2000 UN Summit.

Julio Frenk spoke about the ethical framework in which he used to guide the development and implementation of a national health insurance reform during his tenure as Minister of Health in Mexico. Frenk strongly stated that health is a second generation human right, meaning it transcends citizenship. This implies that it is unethical to limits healthcare services for immigrants in the United States.

Along with the keynote speakers, there were sessions that developed skills in advocacy and also sessions that covered topics in the cross section of human rights and health, custody, and conflict. Out of the 40 sessions available, conference participants only had the opportunity to attend 4 different sessions. Tough decision! I tried to vary the topics of the sessions I was attending. The following are brief summaries of the different sessions I attended,

Health Workforce Shortage: Problems, Solutions and Opportunities for Change:
Eric Friedman, PHR Senior Global Health Policy Advisor presented on the devastating workforce crisis that creates a barrier for developing countries who are striving to achieve health goals, including universal access to HIV services and the health-related Millennium Development Goals. Eric discussed the depth of this issue and presented examples of successful models in Malawi and Haiti which have addressed these issues by creating programs which provide investments to the local health systems and the health workers as well as changes in local policies.

A Day in the Life of a Darfur Woman: A Refugee Camp in Chad:
Dr. Lin Piwowarczyk, MD, MPH, Co-Founder and Co-director of the Boston center for Refugee Health and Human Rights and Karen Hirschfeld, PHR Sudan Campaign Director discussed their recent investigation in Chad, part of a four-person team interviewing 90 female survivors of the genocide in Darfur. They explained their research about the long-term psychological and physical effects of the rape suffered during attacks on the village in Darfur, as well as the physical insecurity that the women live with today. The session provided incredible insight to the functioning and – disfunctioning – of the world’s largest humanitarian effort to end the crisis in Darfur. It was during this session that I spoke with a volunteer from the Jewish World Watch about their efforts to teaching women in refugee camps how to make and use solar cookers as a means of improving their quality of life.

Food Security and Health:
Donna Barry, NP, MSN, MPH, Director of Advocacy & Policy at Partners in Health, discussed the connections between poverty, malnutrition and poor health. These are the major obstacles to improving health outcomes in TB and HIV patients and meeting the Millennium Development Goals in developing countries. Donna explained how current food aid policies actually hinder progress in improving agricultural output in the countries meant to benefit from the aid. As a counter to the current programs, she explained how possible improvements to these policies to foster agriculture development, reduce poverty in the poorest regions and ultimately improve health and livelihoods.

National Healthcare: How to transform a Commodity to a Right?:
Anya Wallack, Executive Director of Massachusetts Medicaid Policy Institute and David Himmelstein, MD, Physicians for a National Health Program, debated about the most effective path for the United States to achieve national healthcare as a human right. The discussion of different models that would make healthcare an indispensable right in the United States was explored through the lens of Massachusetts’s pioneering universal healthcare policy.

Promoting Your Cause: The Essentials of Publicity and the Art of Persuasive Speaking:
Frank Donaghue, the dynamic CEO of Physicians for Human Rights, used the stories of students in the room as an example of how to effectively tell stories about the causes you are advocating for. He offered suggestions for how to effectively and passionately articulate the stories of your respective cause in a way that captures the imagination, mind, and heart of listeners. I appreciated his approach to putting faces on these issues of healthcare and human rights that everyone at the conference is working dilligently to address.

It was an enlightening weekend – great speeches given by leaders in the field of international healthcare and informational sessions about issues that intersect with health as a basic human right. Most importantly, the weekend was an incredible opportunity to meet students and other healthcare professionals who share the same passion as the members of Salud del Sol for reaching out to underserved communities and being a voice for health as a human right.