Almost five years ago, a bunch of Rice students did something pretty incredible. They’d designed a simple, easy-to-use and rugged clip that caregivers could use to dose liquid ARV’s for children. Misdosing can be dangerous for any patients and any drug, but inaccurate dosing of ARV’s can lead to fatal drug resistance.
The part that awes me, though, two weeks into our eight here in Malawi, isn’t the elegance of the design. It’s what happened next. After demonstrating the technology for the Swaziland Ministry of Health in summer 2010, by 2011 BTB had turned around and engineered a coalition of the Clinton Health Access Initiative (CHAI), the Swaziland Ministry of Health, and manufacturer 3rd Stone Design to get the clips made and included in a nationwide Prevention of Mother to Child Transmission (PMTCT) of HIV/AIDS program. Now, over 213,000 of the clips the Rice team designed are being used by almost 12,000 people in Swaziland.
It’s an almost fairytale success story– elegant design, appropriate national scale up, the right architecture and smart enough donors to allow the technology to make a difference. Unfortunately, though, outside the scale of a major national scale up device-specific technologies can be tricky to make universally useful.
Last year, BTB sent St. Gabriel’s prototypes of similar clips and matching bottles rescaled for morphine dosing. They’re designed so that you fill the bottle with liquid morphine, screw on the syringe, insert the clip, invert the bottle, and draw the correct amount of morphine.
Yet last week I posted a picture of a patient taking home morphine in a water bottle, and this week we were a bit chagrined to note that when we asked to see the Doseright™ clips, they had to dig them out of a box at the bottom of an old supply closet.
A big barrier to developing detailed dosing technologies in the developing world is supply inconsistency. When Tara, Teresa, and Kamal brought the clips last year the hospital was using syringes that worked with the bottle caps and access to patient bottles wasn’t a major issue. Because funding sources have shifted slightly, though, now the hospital uses a different kind of syringe and many patients bring home their medication in plastic water bottles with imprecise dosing caps that came with bottles of an antibiotic that the hospital recently got in stock.
To effectively implement this kind of dosing technology, we need a design plan more than a single device: something that is adaptable and integrable enough to be truly sustainable, rather than a clip that is suitable for only one size or brand of syringe. The hospital seems to have a consistent supply of 25mL syringes with the slip-tip tops in this picture, and Comfort assured us that if we had a sustainable, functional prototype that they could distribute to all their patients, it would be a better option than the current cups.
Dr.Richards-Kortum, Dr.Oden, and MK visited us at St.Gabriel’s this week, and we brainstormed some ideas for water bottle cap/syringe innovations that could just slightly modify what the hospital has to make the dosing clip concept work here. The store-bought water bottles work well because the hospital can reliably get them and they’re easy for the patients to transport on bicycle, so anything BTB would bring to the table needs to be similarly integrated. We’re planning to play around with some ideas for on-site punching slip-tip sized holes in the water bottle caps so they can be inverted, maybe with secondary caps attached by the bottle neck for easy transport. We’ll also be bringing home a syringe for future GLHT classes to try their hand.
DoseRight™ has, by all accounts, been a pretty incredible success thus far as a device. The next step is to adapt the concept to make it even more integrable and sustainable as a design.