Last week, I had the opportunity to meet with the Tiyanjine Palliative Care clinic at Queens, building on earlier weeks’ progress in field-testing devices that aim to reduce liquid morphine dosing errors–a significant health challenge posed to such low-resource settings. In introducing the devices to the medical team, the nurses, students, and physicians were doubtlessly taken by the simple, yet substantive manner in which they profoundly changed palliative drug delivery. But this enthusiasm did not come without apprehension. No sooner had I demonstrated the technology than concerns of cost arose, even for something so simple. A similar experience was had in going over the SAPHE pads with physicians in the Ob/Gyn department.

In many ways, this back-and-forth–a delicate dance between health innovations and the resource constraints that bind them–has come to define my time at Queens. Indeed, how much is too much; to what extent is even the most medically useful technology simply out of financial reach for the hospital staff? The answer to this question is surprisingly tough to scrounge up. Because device procurement is done here in a top down fashion, by the governing board of the hospital, and over a period of many years, there appears to be little understanding of how a clinican’s need is translated into obtaining a relevant technololgy to address it. And so, too, is there great obscurity in terms of what innovations are out on the market for immediate impact. At the WHO, one of the projects I worked on was developing a “Compendium of Innovative Technologies”–a one stop, agency-reviewed guide for the latest innovations in medical care, such as the Odon Device I mentioned previously. But at least at Queens, such aids seem to be hardly realized by physicians, much less accessed.

This suggests to me that the challenge in improving healthcare technology in developing countries is as much one of diffusion as it is development. To what extent each obstacle proliferates, however, is murky. Yet the barriers each present are anything but unclear.