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.

It’s been just over two weeks now that I’ve been here in Blantyre, and after overcoming a brief bout of illness, I’m eager to get as much done as possible in my remaining time. With Bridget and Kathleen returned home safe and sound, the task has been left to me to continue the work they began.

Of course, in carrying out these tasks–which ranges from managing the bCPAP clinical trial, repairing medical technologies, and everything in between–not a day has gone by here that I haven’t learned something new, or at the very least confronted a concept or custom that challenges long-held assumptions. I’m amazed, for one, at how quickly one settles into a routine–how entirely novel experiences become normal in short order, even in such a distinctly unfamiliar environment. Fraying, paper-based medical records bound by strips of yarn now present a (reluctantly) accepted standard. Similarly, that vast families quite literally live on the hospital lawns is something I now notice unperturbed.

However, perhaps what I’ve been awed by most is the ability of the staff at Queen Elizabeth Hospital to make so much out of so little–to be frugal innovators. In some cases, to be sure, this results in less-than-ideal care. But it also allows the physicians here to maximize the use of what they do have, such as with the lawn-seat-turned-wheelchair shown below.  Thousands of Malawians’ lives depend on this makeshift ingenuity–and so, too, might the broader goal of making health technologies accessible in such low-resource settings.

The last few weeks have gone by in a flash, and I now stand at the cusp of the second leg in my journey. By this time tomorrow, I will have joined Bridget and Kathleen in Blantyre, Malawi. After spending two months in a flurry of government reports and policy briefs, I’m eager to bring this birds-eye view of health technology policy to bear on the problems on the ground at Queens.

Of course, with my time at the WHO has come much reflection–a backlog of blog posts, to be sure–and over the next few days, I’ll be catching up with my thoughts and musings from my experiences at the organization, before transitioning to insights directly from Malawi.

The first of these reflections couldn’t possibly be at a more macro level. Earlier in the summer, I had the rare opportunity to hear from Dr. Margaret Chan–the newly re-elected Director General of the World Health Organization–in an agency-wide “town hall” of sorts. In her remarks, Dr. Chan outlined her vision for a reformed WHO–one more adequately attuned to the whims, needs, and desires of a 21st century global health environment. Her talk, in my survey of the audience, appeared to be met with mixed stares and knowing glances: equal parts enthusiasm and apprehension. Not that this lukewarm reception from many of the WHO staff was a surprise. After all, the D.G.’s reformist mandate has already meant the loss of their supervisors, their colleagues, their friends. Namely, with hundreds of employees recently let go in the name of budgetary pressure, her top-down reforms have begun with a decidedly hard-edged fiscal scalpel.

But this change-minded town hall, I have since realized, is hardly a one-off event–far from the singular, iconoclastic efforts of a brazen D.G. Rather, these changes to the operations of the WHO are moored in an inevitability fueled by a rapidly changing international health paradigm. Dr. Chan’s initiatives, if piercing, are the merely symptoms, and not the root causes driving the need for curative measures.

And make no mistake: the WHO is a remarkably sick patient–its proper role in the world of global health in 2012 and beyond is increasingly nebulous. Since the time of its inception in the early 20th century, the organization has stood as the preeminent leader in health policy; the product of an unprecedented coalition of world powers, its leadership was unquestionable.

Some afflictions, however, present a long timecourse. Over the years, the world has borne witness to the rise of powerful nonstate actors in public health. No organization better embodies this worlwide network of NGOs than the Bill and Melinda Gates foundation which commands a budget that dwarfs the GDP of many nations. Such groups now wield considerable power, influence, and prestige in influencing health care policy.

And yet, alongside the ascendance of such NGOs, the WHO’s hold on its own operations has been deeply challenged. For one, with the recent collapse of the global economy (and further European economic trouble yet looming), the agency has become increasingly cash-strapped. Unlike the Gates Foundation, which is powered by a multibillion dollar endowment, the WHO is dependent on conditional funding from donors, which makes its budget unpredictable, and its policy portfolio less a lithe, unified agenda and more a kaleidoscopic mosaic of goals and aims. Moreover, a decentralized organizational structure has proscribed the organization from nimbly remodeling itself in the wake of these obstacles. Dr. Chan’s efforts notwithstanding, even the most radical therapies will take years to produce a tangible change in the sprawling body of the organization.

Nevertheless, during my time at the agency, I have also observed firsthand the resources it marshals second to none–the aspects in which it stands distinctly and preeminently. Though outmatched fiscally, the WHO’s branding, legitimacy, network, and institutional expertise are powerful weapons to wield in the global war against disease. Together, even if the agency can no longer serve as the sole actor, these strengths make the WHO a key international facilitator of . In my mind, at least, the organization’s ability to convene, enable, embolden, and empower the complex ecosystem of agents in international health is critical to progress in advancing human health.

That said, the question of how to best chisel these strengths into a cohesive, agile entity on which the lives of millions rest has no clear, solitary answer. This topic will guide subsequent blog posts. Until then, au revoir, Geneva!

In 2007, Jorge Odon won a bet.

The premise, on the whole, was simple: to remove a cork from inside a glass wine bottle with only a plastic bag. It was an ordinary, wholly unremarkable wager–the quintessential parlor trick. Odon’s friends thought it easy pickings. He walked away with significant bragging rights–and, more importantly, an idea.

Ideas, as Christopher Nolan attests, are often like cancers–they are tenacious, and spread quickly. That night, Odon lay restless, at the precipice of inspiration, unable to shake off the notion that had burrowed itself deeply in his subconscious. By morning, the cancer metastasized. Jorge had forged a vision for radically transforming neonatal delivery.

The story of Jorge Odon is, on the surface, the classic tale of inspired invention–the interweave of technical prowess with inspired application to solve a grand challenge. Except, that is, for one thing: Mr. Odon is not a biomedical engineer. In fact, he’s not an engineer of any kind. Nor is he a scientist, public health activist, or even a serial inventor. Jorge Odon is a car mechanic.

***

The very nature of innovation is an intricate and storied one. Yet the lens through which we view this nebulous and often messy process has been anything but. In 1958, Vannevar Bush published the now-ubiquitously-cited report “Science and the Endless Frontier,” which laid the groundwork for science, technology and innovation policy as we characterize it today. In it, Bush argues for a linear conception of technological innovation–an iterative process in which basic research fuels applied development; an assembly line of transformative ideas.

This paradigm quickly took hold. Today, academics, policymakers, and industry experts alike cling to the linear model of innovation, even as we recognize that invention in practice is chaotic, and cyclical–a feedback loop with neither beginning nor end. Science drives technology, yes, but the reverse is just as often true. The work of Mr. Odon is perhaps the most tangible exemplification of this reality.

I met Odon at the recent “Access to Medical Devices” conference this past week at the WHO–a two-day summit featuring some of the world’s leading experts on medical technology, intellectual property, entrepreneurship, health policy, global health, and technology commercialization across government, academia, and industry. It was a feast of ideas–intellectual carcinogens–on how to ensure that health technologies are made available, accessible, and affordable where they are needed most. But what I was struck by most was how thoroughly Odon’s story bucked the standard narrative of biomedical innovation.

Is there, then, a means of effectively empowering “DIY” solutions to global health challenges? How many other Jorge Odon’s await the deployment of their visions on a grand scale? The question is an open one, but I can’t help but feel that the doors to a healthier world may lie closed without an answer.

For the next ~2 months, I’ll be stationed in the sprawling, byzantine complex that is the World Health Organization (in Geneva, Switzerland) as part of the Diagnostic Imaging and Medical Devices Team within the department of Essential Health Technologies. As an intern at the WHO, I hope to acquire a birds-eye view of how biomedical engineering interfaces with health policy, particularly with regards to the developing world. Afterward, I will join my fellow BTB interns in Blantyre, Malawi at the Queen Elizabeth Central Hospital to facilitate the implementation of global health technologies at the micro level. I thought it may be of some value to catalogue my experiences at the former, given that it may serve to inform the experience in Africa–namely, that the types of work in the two settings are deeply, inextricably interwoven.

There’s something intrinsically humbling about international travel.

I say this as someone to whom humility is no stranger. My recent arrival in Geneva was prefaced by the Truman Scholars Leadership Week (TSLW), during which I had the chance to meet my fellow class of 2012 Trumans–a humbling experience in its own right.

However, my stay in Switzerland, while yet nascent, offers a distinctly different strain of deflation than the one to which we are generally accustomed. Most of us find our egos perforated by way of juxtaposition–it’s difficult, for instance, to glance at a 10-page CV and not wonder whether the last Hot-Pockets-and-Halo marathon was worth its weight in either time or saturated fat.

While abroad, in contrast, it is anonymity that proves to be the ultimate leveler. Stripped of the convenient, easy identifiers of college affiliation (“Rice? Where is that exactly?”), language (“parle vouz ingles” has become the go-to phrase), and custom, I find myself left only with who I am at my most fundamental–the personality, skills and perspectives I most directly bring to the table, bereft of the frills that I take for granted on home turf. Granted, even in this vein, defining one’s niche is far from simple. My group of Medical Devices co-interns alone is comprised of a graduate student in biomedical engineering from Ghana, a journalist-turned-MBA from Canada, and an international relations postgraduate from Mexico–an unfairly talented, eclectic group. (I’d be jealous if they weren’t so painfully friendly.)

Yet it is precisely this inherent anonymity that I’ve found most enchanting about the WHO. Behind its drywall of multilingual bureaucracy, thousands of staff work in relative obscurity for the advancement of common welfare. Indeed, what’s immediately tangible is that there’s a cardinal impetus here–that, beneath the paperwork and protocol, amidst the trappings of international diplomacy, we are all fighting for the belief that health care is a public, global good. Work, here, appears to be embodied in the collective and emboldened by a tangible sense of, well, togetherness. (In short, it is the quintessential Ayn Rand nightmare.)

Of course, how this sentiment bears out in the long term remains to be seen; with work just beginning, stay tuned for many more thoughts and reflections to come.