From Evanston to Africa
Global health initiatives reach across campus and around the world
Several years ago biomedical engineering professors Matt Glucksberg and Dave Kelso began to outline an ambitious vision for programs that would apply engineering expertise to the challenges of health care in the developing world. Now a new center and a new undergraduate study abroad program in South Africa have made their vision a reality.
These two initiatives in global health bring together faculty and students from across Northwestern, corporate partners, and international collaborators to address the unique challenges of global health. They provide the framework for Northwestern students and faculty to travel to the developing world and study problems firsthand, then use the resulting knowledge and relationships to develop appropriate and sustainable technologies and solutions.
As Kelso and Glucksberg wrote in a recent op-ed in the Chicago Sun-Times, an important part of the projects is collaboration with workers in the developing world. "There are armies of smart and resourceful Africans dedicating their lives to battling disease and the conditions that make people vulnerable to disease," they wrote. "What they need most from the industrialized world is the technological and organizational equipage to succeed."
These initiatives hope to address what Gluckberg and Kelso describe as an "obligation to help."
A new center for global health
Kelso is the director of McCormick's new Center for Innovation in Global Health Technologies (CIGHT), which recently received a four-year, $4.9 million grant from the Bill & Melinda Gates Foundation. The center aims to design medical diagnostics specifically for the developing world. Though many diagnostics are available for the diseases widely found in developing countries — such as HIV, tuberculosis, and malaria — few have been specifically designed for the clinics and health care centers in which they are needed.
To develop new diagnostics, CIGHT essentially is forming a small nonprofit biotech company. Engineers from McCormick work with existing intellectual property — much of it from corporate partners Inverness Medical Innovations and Abbott — to develop platform diagnostics. While they develop these products, partners from Northwestern's J. L. Kellogg School of Management, led by Daniel Diermeier, IBM Distinguished Professor of Regulation and Competitive Practice, will research the market dynamics, government issues, and distribution channels in the developing world. Richard Joseph, director of Northwestern's Program of African Studies, will consult on the cultural factors affecting these products. The partners will then work together to determine which diagnostics could have the most impact. In the final stages of development, researchers from CIGHT will work with collaborators at Northwestern's Feinberg School of Medicine, headed by Robert L. Murphy, John Philip Phair Professor of Infectious Diseases, to prepare field trials to make sure the designs work under real-life conditions.
While the Northwestern faculty and student participants will spend time in resource-poor environments, it is impossible for them to truly understand the users of their devices from their Evanston base. To ensure that the innovation process takes into account all necessary considerations, the center will rely heavily on international relationships.
"At this time the most important thing that we have is relationships with people in these countries," Kelso says. "As we go forward, we'll be able to work with them to find out what our device requirements are going to be and to get feedback from our ideas."
Using the University for R&D
Very few of the medical diagnostics that work in the developed world are as effective in resource-poor areas. Consider an HIV test. In the developed world, patients visit their doctor for an HIV test or can even take the test at home. The diagnostic is then shipped to a central processing facility and examined, and patients are notified of the results within a few days. If the result is positive, they visit their doctor to begin a drug regimen.
It sounds pretty straightforward, but the developing world is a stark contrast; there many parts of a seemingly simple process prove difficult or even impossible. Sending the results to a central location requires adequate infrastructure. Notifying patients of the results requires accurate patient records and the ability to contact a patient. The latter can prove difficult and time consuming when patients live in overcrowded and impoverished townships with little or no telephone capability.
"We hope to develop technologies that can provide a diagnosis at the point of care," Kelso says. "If a patient could be diagnosed and begin treatment all in one visit, that would be a huge improvement."
The reason for the lack of appropriate technologies is simple: These areas have not had the market potential to warrant the vast research and development costs associated with developing new technologies. If companies were to try to develop appropriate technologies, they would have little to no hope of ever recouping their investments — let alone making a profit.
"Part of the reason that drugs and diagnostics are expensive is because of the research and development costs," Kelso says. "If we can remove R&D from the price, a company can manufacture a product and sell it at cost. They're not losing money on every sale, so you don't have to worry about who's going to pay for this 20 years from now."
With his funding now in place, Kelso is busy hiring 10 to 12 staff members to form his research team at CIGHT. He says this new initiative is a return to the earlier days of his career; he had stints at several medical device companies prior to entering academia. And while he and his colleagues have been very busy, he says he wouldn't have it any other way. "This is the most fun I've had in a long time," he says.
Kellogg's contribution: An understanding of new markets
"Any good business needs to know its markets and its users in order to come up with new designs," Kelso says. But in the developing world, getting to know one's market is a particular challenge. In Africa alone, there are 52 countries — thus 52 different sets of government regulations and processes — and hundreds of languages. In order to guide the engineering team toward effective and appropriate products, students and faculty from the Kellogg School of Management are working to demystify these unknown markets.
Daniel Diermeier heads Kellogg's Global Health Initiative, part of its Ford Motor Company Center for Corporate Global Citizenship. Working with a student organization of the same name, his group aims to take advantage of existing opportunities to study global health problems throughout the Kellogg curriculum. By using class research projects, Kellogg's Global Issues in Management international trips, and student volunteers, the group has been collecting research and will interact with the engineering team to assist in product design.
"We have a wealth of research stored on our servers," says Meredith Wilson, cochair of the student organization. "Now we have to take that research and tailor it and apply it."
Wilson explains that Kellogg students may have several opportunities each quarter to select a class project. For instance, an operations management project may study distribution channels in sub-Saharan Africa, or a market research project may determine the market dynamics for HIV diagnostics in rural India. "It's a great way to bring people into global health, because people can work on projects in their existing classes," Wilson says.
In addition to valuable insight into the innovation process, Diermeier says that the projects provide an excellent learning opportunity. "This gives students the experience of working in a medical device environment from cradle to grave," he says. "They do everything from initial market research to working with the engineering team to dealing with the myriad of implementation problems, all in a protected environment and on projects that have the potential to do a lot of good in this world."
Study abroad: Bringing undergrads into the field
McCormick's new global health care technologies study abroad program is extending the initiative for global health to the undergraduate population. The program is run jointly by Kelso and biomedical engineering (BME) colleague Matt Glucksberg. For Glucksberg, the program provides an opportunity to enhance the type of projects already found in the senior design class.
"As we were teaching the design course, we noticed that the students were more interested in and had more success with projects that served under-resourced communities," Glucksberg says. "Those projects also communicated the design process better than others. Students have to figure out what the client's problem really is, rather than working with a client who knows exactly what they need."
In order to follow McCormick's philosophy of user-centered design, the department set up a phone room for teams to interview their clients in Africa, South America, and Asia . But Glucksberg says it became evident that students actually needed to get to places where they could meet face-to-face with clients and observe them in their workplaces.
While exploring ways to allow students to have firsthand experiences in global health, Kelso and Glucksberg connected with Mladen Poluta, director of the Healthcare Technology Management (HTM) program at the University of Cape Town. This is one of few HTM programs worldwide with teaching, research, and advocacy activities focusing primarily on the needs of resource-poor health systems. The program content covers the acquisition and utilization phases of the technology life cycle. "The most exciting aspect of the collaboration with Northwestern is the opportunity to engage with the innovation phase, allowing us to track safety and performance from development all the way through application," Poluta says.
Working with Poluta and other collaborators at the University of Cape Town, Glucksberg and Kelso designed a quarter-long program that allows students to complete their senior design course in South Africa. McCormick's Murphy Society and Gore Medical Products provided funding to establish the program. Eight biomedical engineering students spent the spring quarter studying in South Africa. In addition to the design component of the program, they took courses in health care technology assessment and planning, as well as African identity, race, and culture. Students were also exposed to health care delivery challenges in resource-poor environments.
Working on design projects in South Africa allows students to gain an understanding of why many of the commonplace technologies in the developed world fail when they are applied to other environments. They benefit from Poluta's insights into African health systems based on his years of experience and research.
"I see my main role as being the 'what if' guy and exploring why things may not work," Poluta says. "People working on these projects come from an environment where things are assumed to work, but the technologies that you are developing and implementing are for an environment where such assumptions do not hold. Power failures, shortages of consumables, untrained health workers, poor maintenance infrastructures, and a lack of electronic information systems all impact the potential of the technology to make a difference. You have to see the bigger picture and build functionality and backup systems into the technologies to make them less vulnerable to an environment that is not enabling. If you do this well, you're on your way to a sustainable solution."
Next spring a group of 12 students, including many from other McCormick departments, will travel to South Africa. As the program grows, Glucksberg hopes that interdisciplinary teams will be able to study both the technical and managerial aspects of health care problems.
Problems with premature infants
Jefferson Jones '06, who participated in the study abroad program last spring and is now in his first year at the Feinberg School of Medicine, learned firsthand how important it is to know the user's needs when designing a new solution.
Jones and classmate James Bekeny '06 chose to adjust a previous BME project, a low-cost incubator for premature infants in Bangladesh , for use in South Africa . But after some initial research, the pair discovered an entirely different standard of infant care in South Africa that is "just as effective as an incubator," Jones says. Called "kangaroo mother care," it gives premature infants constant skin-to-skin contact with the mother's chest, regulating the baby's body temperature and moisture. The only cost is the wrap for the baby.
"We really didn't need to add a costly technology when the baby is already being cared for in an ideal form," Jones says.
With that discovery the two abandoned their initial idea and looked for a related problem to pursue. They found that the primary cause of mortality in premature babies undergoing kangaroo mother care in Africa is apnea, a condition where a baby spontaneously stops breathing and dies. This often happens when the mother is asleep and unable to stimulate the baby to resume breathing. While a baby in an incubator would be monitored for apnea, there is no current monitor proven to work with kangaroo mother care. Jones and Bekeny had found their project.
They researched a variety of apnea monitors but found drawbacks to most of the current technologies — typically the monitor either wouldn't be able to attach to the baby or would confuse the breathing of the mother with that of the infant.
They connected with a South African engineer who was in the beginning phases of testing and marketing an at-home apnea monitor for infants. Although the product was untested with premature infants or with kangaroo mother care, Jones and Bekeny saw promise in it. With only two weeks left in their program, they quickly designed a small clinical trial for the device, obtaining the required approval for human study from the ethics committee of the University of Cape Town. Their experiment compared the new monitor with one currently used in incubators. Their results look promising, though further tests will be needed. Jones hopes that the next group of students may be able to pick up where they left off.
Though it gets much less attention than many of the communicable diseases found in the developing world, tuberculosis remains a serious problem, especially when paired with HIV. Particularly challenging is the lack of any quick diagnostic for the disease — a problem Sam Pickerill '06 would like to solve.
Pickerill began work on a rapid tuberculosis test during the winter quarter senior design class and then continued his work during the study abroad program. His team began by reviewing hundreds of research papers about tuberculosis - research that paid off when it uncovered an interesting characteristic of TB infection.
"We found that there is a particle in the urine that can indicate TB infection," Pickerill says. "If you could detect that particle with a diagnostic, you would be able to tell if someone was infected."
The team was coached by Julian Gordon, an Abbott researcher who pioneered the home pregnancy test. Using his knowledge of lateral-flow diagnostics, the team developed a rapid diagnostic concept. Such a diagnostic for tuberculosis hasn't been developed because, like many of the other problems facing the developing world, it wasn't needed in industrialized nations. A better diagnostic would have a very small market for the company investing in it.
However, in the developing world, the lack of a rapid diagnostic perpetuates the spread of the disease. Those who are tested for TB must return home and wait days for a result. If it's positive, they risk infecting everyone with whom they come into contact before receiving treatment.
Five other students worked with Pickerill on this project, which won first place in the 2006 Margaret and Muir Frey Memorial Prize competition. Though the project shows promise, more work needs to be done, particularly in developing the correct antibody for the diagnostic. The program helped cement Pickerill's interest in global health. He received a Whitaker fellowship to continue research on this project in South Africa as part of a master's degree at McCormick.
— Kyle Delaney