In my last post, I talked about how the scarcity of resources is arguably the biggest challenge that hospitals in low-resource settings face. There are many different needs pulling hospital funds in various directions, which further increases the need for affordable healthcare technologies; the devices don’t simply need to be low enough cost to fit into the hospital’s budget, but they need to be worth the dollars that as a result won’t be spent on medication, supplies, or human resources. This is part of why the research phase of design (which I talked two about two blogs down) is so crucial: a thorough understanding of what technology attributes will best set a design up for success—and what traits add cost but not practical value—enables the creation of devices that are worth the allocation of hospital funds.

Through my time in the Rice 360 program, conversing with nurses and doctors at QECH and observing a bit of ward practices, and working this summer at the Polytechnic designing new health technologies, I’ve noticed a few common attributes that string together many of the successful devices. Here are a few of those traits:

• General Qualities
  • Low cost. This is perhaps the most obvious quality on this list, but also one of the most important. To give a few examples, the commercial CPAPs in the States can cost $6000, while the Rice bCPAP costs under $400; the States’ gold standard phototherapy dosing meter costs $2000, the one we’ve built costs under $50; commercial phototherapy lights in the US cost over $1500, the Polytechnic BabyLights costs around $100; American commercial ophthalmoscope costs $300, while the one we saw in use at QECH is $4—the list goes on and on. In the meetings I’ve been at with physicians, when we show them technologies in development at Rice to gather feedback, one of the first questions asked is often “how much does it cost?”
  • Durable. In the busy and crowded wards at QECH, devices need to be able to withstand a good bit of wear and tear. Machines tend to be stacked onto one another; tubing is coiled, pinned, and draped into the proper position; power cords and adapters lie in corners and can be splashed with mop water. Without proper storage space, devices and components often must be fit into small spaces on top of cabinets or into cramped packing boxes.
  • No consumables. The continuous cost of consumables is a drain on hospital funds that is difficult to sustain. If a machine requires consumables to run properly, whenever there is a lapse in supply or an inability to purchase new materials, the machine becomes effectively useless.
  • Easy to replace parts. It’s very difficult to get machines fixed once broken (as discussed in a previous PAM blog). Since devices sent off to be repaired often never make it back to the wards, there’s a pretty common of practice of simply setting aside broken equipment, where it sits unattended and unused. In order to mitigate this practice, machines with locally available replacement parts are great; providing a machine with the components that are frequently needed to be replaced is also convenient. For example, if a circuit component blows, supplying an extra circuit that can pop into the broken circuit’s slot requires only a simple few steps that a nurse could execute. As another example, the bCPAP provides a small bag with replacement parts within every device, to ensure broken devices are not so easily discarded.
  • Transportable. High risk patients often must travel a lot within the hospital—from labor to the neonatal ward to the X-Ray machine to the high risk unit and back to the neonatal ward, for example. Making devices, such as incubators, that are small and light enough, or have wheels, to transport with the patient between wards marks them both more attractive to the hospital and more useful.
  • Backup power source. Power can be a bit unreliable in low resource settings. In clinical settings, this can be life-threatening. Making a device capable of running on its own for short periods of time between power outages—or at least provide enough backup power to give nurses time to offer alternative, electricity-free care—can save lives.
  • Easy to clean. Not only does sterilization need to be quick and easy, as the wards are so busy, but thorough as well. Devices can come into contact with a lot of blood, feces, and infectious disease while in use, and with the large number of patients requiring treatment in combination with the often short periods of time between the treatment of different patients, devices must be quickly but methodically sterilized.
  • The simpler, the better. This mentality has been repeated to me many times from professors, doctors, nurses, and other interns. The simpler a device is, the more likely it is to be successful—often because simplicity requires it to have the above attributes. Sometimes as engineers, we get sidetracked by the possibility of designing a really “cool” device with complicated circuitry and fancy features. However, that often decreases the likelihood of long term success for global health technologies. Complicated devices usually require more time to understand and use—time that nurses don’t have free to devote. They also tend to have many parts, which are just more things that can break and cause the device to be discarded. Simple devices with few parts, however, have a greater likelihood to be “figured out” and repaired when necessary. They also tend to not be as “scary” looking, which is a common problem when mothers don’t understand what a device does and is thus afraid of it being used on her baby.
• More Specific Features
  • Solar power. I’ve noticed that solar panels are really well received here, as they require no costly resources and are reliable. There’s a lot more faith in solar panels than in an AC power cord or a battery pack, and healthcare workers I’ve talked to are quickly excited by and convinced to support a technology when it’s powered by solar energy. This is another big benefit to using solar—if the users are already behind it, implementation and sustained use are inherently smaller barriers.
  • Size: wristbands, necklaces, clips, and pockets. This is another attribute I’ve noticed that quickly garners healthcare worker support and generates excitement. The doctors and nurses here are busy; they have many patients to attend to, and their work is very difficult. There are already dozens of machines they must learn how and when to use, so sometimes a new machine can seem like more of a burden than a help (especially in a place where confidence in machines can be pretty low, considering how often they malfunction). Devices need to not only cater to the doctor’s needs, but in some cases also to their convenience. Techs that can easily fit into a pocket, or be slipped around a head in the form of a necklace, help to lessen the load on the healthcare workers. That way, the device is readily available, and has less of a chance to being lost. Of course, this isn’t applicable to all technologies, but for machines commonly used on rounds—respiratory rate calculator, ophthalmoscope, heart rate timers—this can be enormously useful.
  • “On” indicators. While this may not seem like a vital component for a device, it can be very useful for busy doctors. Machines that don’t have an easily visible, bright LED to indicate when the device is and isn’t on (sometimes the switch is on the back, sometimes there is no LED, etc.) make it difficult to know whether a device is still treating a patient when it is supposed to be. If an outlet is accidently switched off or if a battery runs out, the nurse needs to be easily aware of this change in status.
  • Internal transformer. Unfortunately, many commercial machines require specific plugs to adapt the wall voltage to the voltage the device runs off of. The problem with this is that in the case the particular plug is damaged or lost, it’s difficult to replace. New parts straight from the manufacturer are often unreasonably expensive (for example, a manufacturer-provided battery replacement on a machine we were repairing cost $1000, but could be obtained at the market for $20), but finding suitable substitutes requires some electrical background knowledge that the hospital staff often don’t have. The better solution is to put the transformer within the device itself, so that the machine can be connected straight to the AC wall voltage with any old power plug. If the cord is lost or damaged, they’re easily bought at the market for around $10.

There are many features of design that are hard to consider without seeing the context or talking to clinicians directly about what devices they do/don’t need, and what they do/don’t like about existing devices. Designing so close to QECH this internship has given us the opportunity to develop our technologies in line with what the hospital needs, as well as given us a far better foundation from which to design new healthcare technologies in the future.