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Looing for a "Doctor Without Borders"

Discussion in 'Internal Medicine and IM Subspecialties' started by SBS, May 11, 2007.

  1. SBS

    SBS

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    Hi,

    I was recently intrigued by an article I read about the lack of medical technology in third world and developing countries. The article mentioned that many common medical instruments (ECG, pulse oximeter) are not present in hospitals and clinics in many parts of the world. It was also linked to an article about the $100 laptop that is targeted for these regions.

    As an electrical engineer with experience in measurement devices, I've been thinking about how I can attack this problem. I'd like to develop a low-cost, multifunction portable medical measurement instrument for un-developed countries.

    Although I have experience in measurements, I don't know much about medicine. I would like to have the opportunity to ask some questions to somone who has been a doctor in one of these regions.

    I've tried contacting the Doctors Without Borders program about this but they did not want to give me any help.

    Are you or do you know of anyone who wouldn't mind giving me a bit of direction?

    Specifically, I'd like to know:

    1) What instrumentation do they typically have in these regions? What are the barriers to getting modern equipment? Cost? Training?

    2) What are the most common instruments used that would be beneficial to have in a low-cost, portable, battery powered form factor?

    3) I know about ECG, Pulse-ox, and blood pressure monitors. What other types of useful "life monitors" exist?

    Thanks,
    Sal
     
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  3. deuist

    deuist Stealthfully Sarcastic
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

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    I'm glad that someone is willing to lend a hand. I'm only a medical student, but I have been to Central America a few times and can say that anything---literally anything---you have to offer would be appreciated. In addition to the ECG, pulse ox, and bp monitor, I would add ultrasound, thermometer, and blood chemistry lab. The good news is that portable equipment does exist, but it's all very expensive. An ECG that connects to a computer via USB currently costs about $3,000, which is surprising given that the computer does all of the computational and printing work. Also, chemistry lab called the i-Stat costs about $8,000. If there is anyway to reduce the costs of these devices, you could go a long way in helping people get access to care.
     
  4. koch'spostulate

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    great that you're interested in working on this issue.

    i've spent several years in clinics/hospitals in various locations in Southern Africa and South Asia, will try to give some response to your questions.

    Regarding question 1, as you know there is considerable heterogeneity in developing country health settings/institutions. What may be needed and useful in a tiny clinic in a remote part of rural India isn't the same thing that will be needed in a huge private hospital in Bombay (I apologize if this is a trivial comment, but some people assume that all developing countries are where-there-is-no-doctor settings, which is why some medical supply programs often ship a lot of unusable materials across the world, where they straight to the garbage bin). If you're looking at urban, tertiary centers in many developing countries, most instruments are available, from all the ones you described to CTs, MRIs, fluoroscopy, etc. One big problems is that these break down frequently, and some countries don't have the trained personnel and equipment to service them. In Kathmandu's biggest govt hospital/trauma center with hundreds of beds, the CT scanner was broken for years and the X-ray machine even was out of service for some time, so they had to send (even trauma patients) out to private institutions for these tests. This can be a problem with any medical device in any area that doesn't have trained personnel; I've seen many rural clinics and hospitals with ultrasound machines that have been collecting dust for years due to lack of technicians to fix them. Training and cost are obviously issues, but govts tend to be more able to foot these (since they look good on paper) than to keep devices running, in my experience.

    2/3. in addition to EKG and Pulse-Ox, other equipment used in many resource-limited settings: diagnostic imaging: X-ray machines, ultrasound, echo. All lab equipment: there are good, fairly low-cost automated devices for many parameters: hemoglobin, blood glucose, urine dipsticks, pregnancy (beta-HCG), HIV rapid test, and many others (these five are probably the most commonly found point-of-care (POC) tests in resource limited settings outside of labs). There are MANY more POC devices out there (see: http://www.pointofcare.net/ for a comprehensive listing), but not many available in resource limited settings, perhaps due to cost/maintenance. the previous poster mentioned the i-Stat which would be great but as mentioned is $$$. lab equipment tends to be a huge area for which low-cost (and low maintenance) technologies are lacking. a typical "district hospital" (as WHO envisions it) will also have capability to do sputum AFB smear, malaria parasite exam, stool ova and parasite exam, manual CBC, and gram stains (all manual tests), as well as possibly bilirubin, blood chemistry, RPR/VDRL, and limited other exams. i'm personally a fan of point-of-care tests because they don't require any sophisticated lab infrastructure or trained personnel, so you might take a look at the POC tests out there and see what could be adapted/replicated/combined for resource poor settings.

    hope this helps your efforts.

     
  5. SBS

    SBS

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    Thanks for the responses!

    One of the ideas for this is that it will be a battery powered device that can run in "monitor mode" for several weeks without needing to be charged or have the batteries replaced.

    From what I've seen... people in trauma or ICU's end up many times unconscious and connected to some sort of monitoring device. The all of a sudden the monitoring device goes off with some sort of alarm and nurses and doctors come rushing to save the day.

    I would envision that these monitoring devices wouldn't be standard in un-developed regions.

    So my question...

    1) What exactly do these monitoring devices measure?


    My guess would be ECG, BP and pulse. What about people with fevers? Do modern hospitals hook them up to machines that will signal doctors if their temp jumps too high?

    Are there any other "life signals" that are commonly measured when people are in trauma or ICU's?


    Thanks,
    Sal
     
  6. koch'spostulate

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    Yes, are you said, these are essentially ECG BP and pulse. Only the sickest patients are typically on these devices (in ICU/CCU or major medical sections of ERs). if you google intensive or critical care monitoring you'll find info on how these devices function.

    Continuous temperature monitoring is possible but not as commonly done as it doesn't signal as acute of an event as the others do, so less frequent monitoring is ok.

    If this is the type of device you're looking to work on, you'd want to focus on a mid-lower functioning hospital setting. the most resource-poor hospitals won't have enough staff or capacity to manage critically ill patients to make this worth while, and better off hospitals in urban areas of developing countries would have critical care monitoring units (and usually generators, though sometimes spotty), though often in limited numbers.

    there are more invasive monitoring devices for critical care to enable monitoring of central venous pressure, intra-arterial blood pressure, and pulmonary artery pressures. these require even more advanced infrastructure/personnel for use/monitoring.

    another niche might be for monitoring during anesthesia in minor/moderate surgeries, which are performed in primary care settings or district hospitals, which may not have sufficient equipment for automated hemodynamic monitoring. i worked in a hospital in rural south africa where some non-minor surgeries were being performed by GPs with just a pulse ox (which gives you heart rate also). anesthesiologists could comment much better on what is needed though for monitoring different types of anesthesia and surgeries, but i think this is another deficit in many developing countries.
     
  7. SBS

    SBS

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    Hi,

    You mentioned in your previous post that a big problem is that when medical equipment breaks down in developing countries, there aren't enough trained people to service them. In my research I've come across several articles that say just the same thing.

    Perhaps things may be different in the medical instruments world, but why don't the hospitals just contact the vendors of the medical devices? Surely they must have some sort of warranty? The company I work for (which sells data acquisition devices) has a pretty generous warranty policy. And when things go out of warranty, you can still send them back to us and we'll fix them for roughly 1/3 the cost of a new device (which is basically what you end up with after we fix it).

    Perhaps warranty and service of the equipment is another area that I can improve on.
     
  8. koch'spostulate

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    I think most devices sold internationally are still under warranties, the difficulties are getting them shipped back (expense, time, organizing it).

    Bureaucracy is often thicker and less efficient in developing countries, so when a device breaks down in a district hospital in a rural area, getting the staff to requisition a fix to the govt and then having it approved, funded, arranged for transport to the capital, shipped, returned, shipped, and set back up just doesn't happen.

    The hospitals I've worked in in Nepal can't even get an extra hundred doses of an antibiotic when they run out, which would just be shipped from the capital, b/c of how poorly functioning the ministry of health is. The only CD4 counter in the country sat broken for months in the capital last year because no one could fix it (and I don't know why they didn't ship it abroad, it would have certainly been under warranty). Another time the CD4 counter was shut down for a month becaue they ran out of capillary tubes. The warranties themselves aren't the issue, having a minimally functioning system in place for organizing supply/maintenance is. It's something to work on, but I think the fix has to be from within the system, rather than from the other side (the companies). But that's just my impression--hear from others.

    you might post your questions on the family medicine, international, surgery, general residency, or anesthesia forums as well, as those folks might have different (useful) perspectives on international health and you might get some more responses.
     
  9. ChildNeuro

    ChildNeuro Junior Member
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    I would be interested also what sort of portable equipment could be developed for developing countries. Also, important is the power-source, one widely used source of energy, solar power, is used in developing countries to pump water from wells, solar power will become increasingly important for powering hospitals in the developing world as they will be much harder hit when oil prices hit "peak oil" in about 20 years. You might want to see what volunteer physicians who run mobile hospitals on boats do for setting up portable clinics on shore . . .
     
  10. indiamacbean

    indiamacbean Senior Member
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    I would consider getting in touch with the Partners in Health group based out of the Brigham and Womens Hospital in Boston. Paul Farmer et al. are world famous for their model of long term high quality care in resource poor countries. It seems like this project might be useful to them. Maybe it would be a good idea if you could try and team up with an MD/PhD in engineering or the like. just a couple of thoughts. good luck.
     

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