A clinic worker in Mali has a problem. She needs to disinfect the equipment and contaminated supplies in her clinic with a bleach-based solution. If she uses too much bleach some parts of the equipment will soon begin to disintegrate. But if she uses too little the clinic’s equipment and contaminated supplies will not be adequately sterilized. The solution is unstable and must be mixed by hand every day. The person mixing the solution doesn’t have a formal education, or even a calculator to help her work out the required proportions.

Heidi Chang, Arjun Madan-Mohan, and Brittany Zick might be able to help. These Duke University students developed a Bleach Solution Measuring Device that can show whether there is too much or too little bleach in a disinfection solution, so a worker can easily determine if the solution will work effectively. The items sterilized with the solution will neither spread infection nor be prematurely destroyed by the cleansing agent.

This was just one of the projects Dr. Robert Malkin’s students developed last fall. Dr. Malkin is a biomedical engineering professor at Duke, as well as one of the founders (along with Dr. Mohammad Kiani of Temple University) of Engineering World Health. In February, 2007, Dr. Malkin brainstormed with some of IntraHealth’s staff on technological innovations for developing countries. This helped lead to several ideas developed by Dr. Malkin’s students, from the disinfectant measuring system described above to a hand-powered cold box and an infant ventilation device.

Many medicines, such as vaccines, require cold storage to stay effective. Areas that suffer from intermittent power supplies can lose refrigeration, rendering their temperature-sensitive medications unusable. Transporting medications at the proper temperature to health care providers in developing nations, especially those in rural areas, can be difficult. Some large clinics have only one refrigeration area, and medicines can change temperature while being moved to parts of the clinic where they are needed. And many health centers lock their pharmacies and the refrigerators that hold temperature-sensitive medication at night, making life-saving medications such as oxytocin unavailable. To meet this challenge Kidus Asfaw, Pricilla Chyn, Eric Josephs, and Matt Rinehart have developed a human-powered cold box. Small enough to be easily transported, this cold box can keep medications cool as long as someone occasionally turns the hand crank.

Premature babies and newborns with respiratory complications can often benefit from a type of ventilation called continuous positive airway pressure (CPAP). CPAP helps maintain adequate oxygen levels as well as fostering healthy breathing rhythms and lung function in neonates. While a number of CPAP machines are currently available, many babies are born in developing nations where there is no access to oxygen tanks or reliable power from an electrical grid.  These babies need ventilaltion support at least until they can reach the hospital, as much as five hours away.  They need a small, portable, inexpensive CPAP machine. Drew Braucht and Sara Hinds have developed a CPAP machine to address these issues. With  components costing under $100 and an innovative battery-operated pump, their version of this machine holds promise for low-resource health care environments.

Each of these projects was displayed at Duke University’s CIEMAS atrium on December 11, 2007. The student developers will move on to other work next semester, but their projects will be available for refinement and development by the next group of biomedical engineering students, by Engineering World Health and IntraHealth.

In collaboration with Duke University, Engineering World Health brings engineering students from several US universities to low-resource health care centers. While generous donors have given millions of dollars worth of medical equipment to health centers in developing countries, a large amount of the equipment is not used. Some of it breaks quickly under the challenging conditions frequently encountered in low-resource environments. Some equipment requires regular replacement parts that aren’t locally available. Some of it simply requires a power source that isn’t available.

Duke-EWH member students can see the conditions under which the equipment will be used and the supplies available for maintenance.  They can repair some of the machinery, explore how to adapt locally-available materials to the machines, and show their hosts how to maintain them in the future. IntraHealth and Dr. Malkin are currently exploring the idea of sending selected Duke-EWH members to IntraHealth-supported health care centers to identify gaps and needs that have biomedical engineering solutions.