Classroom inventions that help save lives

Devex
By Sophie Edwards

The Pratt Pouch was created by graduates, undergraduates and postdoctorate students at Duke University’s Developing World Healthcare Technologies Lab, to address the difficulties in getting ARV medication to newborn babies in developing countries.

Sometimes what happens in college is not just practice for the real world, it can actually have a real impact beyond campus. Several student-led product development teams are saving lives through innovative healthcare designs.

Cellscope, which converts smartphones into microscopes so that healthcare workers in remote areas can diagnose diseases, and the Pratt Pouch, which stores antiretroviral medications that help protect newborn babies against infection from HIV-positive mothers, are two inventions designed and developed by U.S. students supported by the USAID-backed Higher Education Solutions Network.

Devex spoke to the the students and professors behind the development of both innovations, to find out more.

Transforming smartphones into microscopes for portable diagnoses


CellScope, a device which turns the camera of a mobile phone or tablet computer into a high-quality microscope, is making it easier, faster and cheaper to diagnose a range of illnesses in developing countries without patients having to leave their village.

The invention started out as a design project at University of California Berkeley 10 years ago, when professor Dan Fletcher challenged students in his optics class to create a microscope from a mobile phone camera. Assuming this had already been done, Fletcher said he was shocked when he discovered that it hadn’t. So began the CellScope project.

CellScope is now used in a number of developing countries including Cameroon, Vietnam and the Ivory Coast to diagnose tuberculosis, river blindness, intestinal worms, and even oral cancer. Trials are also underway to apply the technology to malaria, diabetes and cervical cancer, Fletcher said. The project’s expansion is down to support from the U.S. Agency for International Development, UC Berkeley, and the Bill & Melinda Gates Foundation.

The CellScope technology aims to address a number of barriers affecting accurate and timely diagnoses in developing countries, Fletcher said. CellScope enables community health workers to carry out “clinical imaging” that would normally be done in a hospital, in a field setting, he said. The invention also allows for rapid, real-time diagnoses without the need for a specialized doctor since the phones or tablets are programmed to detect certain infections.

“CellScope is portable, lower cost than devices normally used in hospitals, and it’s automated so you don’t need health professionals to diagnose in the traditional way,” Fletcher said.

In turn, this means people can be diagnosed more quickly and “incorporated faster” into health care systems. That also means infectious diseases are less likely to spread.

One of the first applications of CellScope was in Cameroon to screen for the loa Ioa parasitic worm which causes river blindness (onchocerciasis). Fletcher’s team were tasked with detecting the presence of Loa Ioa worms in the blood in order to determine whether the patient can safely take ivermectin, the standard treatment for river blindness. Fletcher explained that previous health programs were giving the treatment to everyone, but those with high levels of the worm could suffer serious health problems if given the drug.

To make the diagnosis, the operator takes a drop of the patient’s blood and puts it on a slide which is then inserted into a slat on the side of the CellScope device. They then press the phone’s camera button to start filming a sequence of videos which are then automatically analyzed by the phone and the results displayed.

Matthew Bakalar, a Ph.D. student who worked on the project, explained: “We got a sample of whole blood mixed with loa loa microfilaria, placed it on the sample stage, and noticed right away that we could detect the worms by watching them swim through the blood, pushing around blood cells as they move.”

This method was quicker and easier than traditional methods, he said. “Instead of preparing a sample by staining it with a dye, waiting for it to dry, and then mounting it on a microscope, we were using motion as a contrast agent directly on live samples,” he added.

Bakalar, who traveled to Cameroon last summer for the first deployment of CellScope Loa, said it was “rewarding” to see how excited patients were to be directly involved in their own diagnosis by seeing their blood “on the screen of the phone in real time,” and were also happy to be able to get a diagnosis on the spot.

The CellScope technology can be applied to other diseases by analyzing different samples, for example the tuberculosis diagnosis requires a phlegm sample, while in India, researchers are trialing diagnosing oral cancer using cheek swabs.

Fletcher said they are also exploring a new CellScope device which looks at the eye as opposed to samples, and has potential to say whether patients have diabetes.

However, the technology is only as good as the health care system in place around it, Fletcher warned.

“What we are hoping to do is drive demand for care by helping people understand what they have, but the ultimate positive impact will only be realized once health care systems are strengthened in the countries where we are working,” he said.

The technology would not have existed were it not for the UC Berkeley students, Fletcher said.

“CellScope has been very much driven by the creativity of students and their willingness, interest and enthusiasm at realizing with relatively simple technology they could have an impact on the world,” he said.

In terms of the future, CellScope has commercial domestic health applications and Fletcher said students had formed a startup company to run this side of the business. Their current application is for parents to diagnose their children’s ear infections at home by capturing images on their phones and sending them to a doctor.

In developing countries, Fletcher said they will continue to collect clinical data to prove the validity of the approach and hope to one day eliminate diseases such as river blindness.

A new way of delivering antiretrovirals to newborns

Another student-led health invention with the potential to save lives is the Pratt Pouch, which was created by graduates, undergraduates and postdoctorate students at Duke University’s Developing World Healthcare Technologies Lab under the guidance of Dr. Robert Malkin.

The DHT Lab only works on medical devices which are “uniquely focused” on the developing world. If the product has any application for the developed world then they won’t work on it, Malkin said.

The Pouch, which took seven years to develop and is now being used in Ecuador, Tanzania and Zambia, was created to address the difficulties in getting ARV medication to newborn babies in developing countries. Babies whose mothers are HIV-positive need the medication within 24 hours of birth otherwise they risk contracting the infection.

According to the United Nations, mother-to-child transmission in the developing world leads to 260,000 new HIV infections in children every year.

However, previous attempts to give the medication to newborns using syringes, cups and spoons, were failing because the ARV was degrading before it could be administered. By packaging the drug in the Pratt Pouch, the medicine avoids contact with the air and can be preserved for up to a year.

The Pouch’s packaging, which looks similar to a ketchup packet but actually consists of five different layers, enables a mother to give an exact dosage by squeezing the contents into her baby’s mouth. It is designed to be robust enough to be easily transported in a pocket or purse and is also easy to open without spilling the contents, Malkin said.

Katie Gelman an undergraduate majoring in biomedical and electrical engineering who worked on the project, said the experience had been very different from traditional undergraduate lab work because the students “feel like the project is their own.”

Working on the pouch challenged many of her preconceptions about designing health care technologies for low-income countries, she said.

“Everyone assumes when you’re making a device for the developing world that the key thing is making it simple to use, but the people we are targeting go through a seven-step process just to get water, they’re used to going through complicated processes to get what they want,” she said.

Working at a university lab and not for a commercial product design lab, means the work is driven by a different motivation, according to Gelmann.

“For us, we know that the sooner our product is commercialised, the more lives we will save, and that’s a much better motivator than profit,” she said.

The invention has already achieved results. In Zambia, the introduction of the Pouch increased access to medication from 35 percent to 92 percent, which equates to an almost tenfold drop in the number of children becoming HIV positive, Malkin said.

The invention has been such a success in Ecuador, where it is being distributed by the VIDHA foundation, that the Pouch is likely to be rolled out across the country by 2018, Malkin said.

In Uganda, where the Elizabeth Glaser Pediatric AIDS Foundation is administering the Pouch and where rates of HIV infection are much higher than in Ecuador, Malkin said he hopes to reach 40 percent of HIV-positive mothers.

“If the Ugandan implementation goes well then I think it will take off, it’s the only tool which markedly reduces the number of kids who are HIV-positive a few days after life begins,” he said.