Waste 2 Watts to Power Medical Devices

A project by engineering students to power medical equipment during power outages.

Friday, July 02 2010 by Rose Hoban

The Cell Saver

You can read more about this story at the Global Health Connections Blog

Eric Hodge: In the past, global health work tended to be limited to doctors, nurses and other health care professionals. But engineering plays a role in health care around the world. From infrastructure projects, to supporting medical equipment, engineers are becoming an essential part of the global health landscape.

Now more engineering students are getting involved, thanks to a local volunteer organization. And some local students have found creative ways to improve healthcare overseas while creating a viable career choice for themselves.

In this last installment of North Carolina Voices, Global Health Comes Home, Rose Hoban reports on some young people who hope to contribute to the future of global health.

Rose Hoban: Cheap electronics are changing the world – even in poor countries. In Africa, governments or a private companies are erecting cell phone towers. Now, many developing countries have more cell coverage than the U S.

The effect of this was brought home for James Molini last summer, traveling in a local-style taxi across northern Tanzania.

Molini was in Tanzania as one of 23 students scattered across the country volunteering with the Durham-based non-profit Engineering World Health.

Engineering World Health is one of a handful of small non-governmental organizations that have emerged in the past few years to encourage Western engineers to share their knowledge and expertise in the developing world. Melissa Beard directs the program.

E-W-H was inspired by a sabbatical Duke professor Bob Malkin took overseas in the 80s. During his time away, he saw that people had color TVs and VCRs, but they no access to decent health care. Malkin is a biomedical engineer. He saw that part of the problem with health care had to do with electronic equipment that didn’t fit the setting. Maybe the machines have the wrong voltage, or they’re too expensive to maintain. For example, Malkin describes a seemingly simple device to treat babies with jaundice using blue light.

So, at Duke, Malkin started classes and an engineering lab to study technology that’s appropriate to health care in the developing world. And students have flooded his program.

About a decade ago, Malkin started bringing students abroad for the summer to work on medical equipment in developing world hospitals. That program evolved into Engineering World Health. Right now, dozens of engineering students are in Tanzania and Central America repairing medical equipment in rural hospitals.

Adam Kurzrok is a mechanical engineering student at Duke. He was one of 23 who went to Tanzania last summer. He says after a crash course in electronics repair, he and the others were sent to rural hospitals to fix what they could

Kurzrok says much of the equipment at these hospitals had been cast aside. He says at first, the Tanzanians were skeptical college kids could repair the complicated electronics. But the E-W-H kids had been provided with tools and they’d grown up around complicated electronics and understand them

Kurzrok and the others quickly learned why there were so many broken electronic devices – the unreliable power supply, both blackouts and fluctuations in current. And that has consequences.

That’s James Molini the student from the beginning of this story, narrating a video about what he saw in Tanzania.

Molini says there were backup generators at the hospitals, but the gas to run them was too expensive.

So, Molini, Kurzrok, and some other volunteers started talking about some way to support medical devices during blackouts. Commercial back-up power supplies already exist, but they’re expensive. So the group came up with an idea to create a low cost one…

sound of the faint whirr of the fan.

They call it the cell saver.

That charging circuit is a yellow plastic circuit board, about 3 inches square

That’s right, recycled. Most of the pieces of the power supply have been thrown away. They use the same power supply found in most desktop computers. Costs about 5 bucks new… maybe a dollar used.

And there’s the device. Only two new parts needed, the rest can be found locally. They plan on selling it for about 10-12 bucks. And the battery???

Molini, Kurzrok and 2 other guys entered the device into the annual Dell Social Innovation Prize competition. Out of more than 700 entries, they won the second prize worth ten thousand dollars. It was the only entry that relied on recycled materials. They’re using their prize money to start a business making the cell savers. Melissa Beard from Engineering World Health says this what the program is designed for.

Rose Hoban, North Carolina Public Radio, WUNC.

This story is part of the North Carolina Voices series.

Durham Workers Test Condoms for Worldwide Distribution

North Carolina Voices - Global Health Comes Home

Thursday, July 01 2010 by Rose Hoban

FHI worker Joseph Galloway detects holes in condoms by filling them with water.

View a slideshow tour of FHI's product quality and compliance lab

And, you can read more at the Global Health Connections Blog

Eric Hodge: When people think of global health, they might picture heroic doctors or selfless nurses. But many others work behind the scenes in global health, doing work that’s much less sexy, but equally essential.  Some of those people work here in the Triangle in a lab that tests life-preserving and life-saving products shipped around the world. Central to their work is testing condoms for safety and effectiveness.  In the next installment of our series, North Carolina Voices, Global Health Comes Home, Rose Hoban takes a visit to F-H-I’s product testing lab.

Rose Hoban: Even with the prospect of AIDS people keep having unprotected sex. So, since the start of the AIDS epidemic, condoms have been a central part of H-I-V prevention campaigns all over the world. That’s because condoms are the best – some would say only – way to prevent the transmission of HIV during sex.

Eli Carter is one of the world’s foremost experts on condoms. And he works in Durham for the non-governmental organization, F-H-I.

F-H-I was an early contractor with US A-I-D – the Agency for International Development. That’s the government agency providing assistance to poor countries. A-I-D was buying condoms from one main supplier, and they were getting a lot of complaints from the field.

Carter is an industrial chemist who had done quality assurance work. He was asked to start an independent quality control lab to test condoms and other health related goods distributed through A-I-D’s programs. Carter recently gave me a tour.

Enormous boxes of condoms are arranged on shelves near four people sitting around a table. They tear open condom packages and unroll out them onto trays. They go through thousands a day, enough so the wrappers fill a big plastic garbage can.

In just the four years between 2004 and 2008, the U S government provided more than 2-point-2 billion condoms to health programs around the world. The Durham F-H-I lab does random sampling of up to 2000 condoms from much bigger batches made by single manufacturers.

Visiting the lab can lead one to marvel at the resilience of latex. Lab workers measure them, they stretch them, Bring up and run water running sound underneath. And they fill them with water to detect holes.

And then there’s the airburst test. I have to confess, I looked forward to seeing the condoms get blown up like balloons.  Carter says the condoms should be able to take between 35 and 40 liters of air before they burst.

Popping condoms aside, the work done at F-H-I’s quality and compliance lab is deadly serious. A faulty condom can contribute to the transmission of HIV or other sexually transmitted diseases. And to the 36 million people a year who receive services from US AID – that’s no laughing matter.
Rose Hoban, North Carolina Public Radio, WUNC

This story is part of the North Carolina Voices series.

Cross-Cultural Research Provides Links to Durham

North Carolina Voices - Global Health Comes Home

Wednesday, June 30 2010 by Rose Hoban

Study Coordinator Randy Rogers at Juneteenth Festival with research associates Kim Gibson and Alexandria Horne

You can read more at the Global Health Connections Blog

Eric Hodge: Drug treatments for HIV have given new hope to patients with the virus. But the Holy Grail for researchers is finding a way to prevent HIV from being transmitted in the first place. Scientists are testing vaccines, drugs, gels that kill the virus – all without success. The only way to prevent HIV transmission – still – is to convince people to change their behavior. And that’s not easy.  A group of people in Durham are trying to find better methods for H-I-V prevention – and they’re using techniques refined by researchers working in other cultures. In the next installment of our series, North Carolina Voices, Global Health Comes Home, Rose Hoban explores how cross-cultural research can inform the process of working with people in North Carolina.

Rose Hoban: Last Friday was a busy day at Lincoln Community Health Center in Durham. It was also National H-I-V testing day and volunteers were in the lobby recruiting incoming patients to get tested.

About 30 patients accepted the offer of free H-I-V testing Friday. Sandra Gomez is a nurse with Lincoln who organized the day.  She says they need to reach out to everyone…

And Durham needs that outreach. Durham County has one of the highest rates of H-I-V acquisition in the state. In 2008, 102 new people were diagnosed, and now there are more than two thousand people living with H-I-V in Durham. And the people getting H-I-V at fastest rate are young black men and women between 18 and 30 years old.

Reverend Rhonda Royal Hatton is the Lutheran campus minister at North Carolina Central University. She says there are number of things driving the spread of H-I-V in young African Americans – they might feel ashamed about their sexual behavior… they might feel invincible… and they might a need to look like they’re doing all the right things…

So that drives their behavior underground. And Royal Hatton says prevention messages directed at this population have been too preachy, and so haven’t hit the mark. That’s why she decided to join a working group for the LinCS 2 Durham project.

Kate MacQueen is an anthropologist who works with the non-governmental organization, F-H-I. She’s one of the leaders of the LinCS 2 Durham project. Usually, she works overseas, helping scientists understand the communities where they’re doing research.

Essentially, it’s cross-cultural research. MacQueen says scientists and researchers don’t understand the lives of the people they study. That’s why it’s important to engage those people up front. MacQueen says too often, researchers take a top down approach, looking for the one group that meets their needs.

The study or the intervention lasts maybe a year or two, the researcher gets his or her data, and leaves. And who benefits? The people who gave their blood, or who filled out the questionnaires? Or the researcher who studied and published and then moved onto other things?

MacQueen has done this before, working abroad in a number of countries. But for this project, she’s working in her back yard. She’s collaborating with Randy Rogers, from the Durham Health Department. He says studying H I V prevention in Durham will be a long, slow process of building relationships. One reason is… people have seen it all before.

And community members haven’t seen the results… when they don’t get any benefit… they end up feeling used. Rogers says people in the black community are sensitive to that. It’s happened before – infamously – with the Tuskegee study, where black men were allowed to have syphilis for years, so researchers could see how the disease progressed over time.

Now, Rogers and the others have to get the word out about the project. He says that can be a challenge in a place like Durham… because there are few places in Durham where everyone in the African American community goes – there’s no one bar or restaurant or club where people go every weekend. Instead, what Rogers and the working group realized is that Durham’s social life is driven by events.  Like the Juneteenth festival in downtown Durham a few weeks ago. Research assistants Alexandria Horne and Kim Gibson sat in a tent on CBC Plaza talking it up.

It’s all an attempt to find out what will work to reduce the rate of new HIV cases in Durham. AND… if down the road… there’s a clinical trial for a vaccine, or for a medication, then, maybe people in Durham would be more willing to participate. Because there’s trust that’s been built up. Rogers says the conclusion the working group reaches might also be that Durham isn’t the right place.

For now, the working group is starting by creating a questionnaire… and they plan to roll it out in the community this summer.   Rose Hoban, North Carolina Public Radio, WUNC.

This story is part of the North Carolina Voices series.

Overseas Orphan Research Rocks the Conventional Wisdom in the US

North Carolina Voices - Global Health Comes Home

Tuesday, June 29 2010 by Rose Hoban

Dr Phyllis Crain and one of the residence counselors talks with a boy outside a cottage at Crossnore.

Check out a blog post on this story at the  Global Health Connections blog 

Eric Hodge: When you say the word ‘orphanage’ what comes to mind for many people, are gloomy places of abuse and neglect, where kids are warehoused after losing family. For years, the assumption has been that foster families provide better care for kids in need than any institution could. But new research from overseas is challenging those beliefs – findings that kids in orphanages can do as well or better as kids taken into families. Now, that research is being embraced in the U S. And it’s starting to influence the policy dialogue about what to do with kids who need care outside their homes.  Rose Hoban reports for our series, North Carolina Voices, Global Health Comes Home.

Rose Hoban: Images of orphanages recur throughout literature. From Dickens’ Oliver Twist to Lil’ Orphan Annie, the enduring message is that orphanages are places of deprivation and despair, where kids do hard labor without love or reward.

June Tibeleka’s a medical student at Duke now. But when she was growing up in Uganda, her father died of AIDS. In much of the world, kids who lose one parent – especially a breadwinner father – are considered orphans. Tibeleka’s mother was left destitute after his death. To survive, she sent eight-year-old June and two of her sisters away to a school where the girls had to fend for themselves… like hauling their own water for bathing and drinking.

Amazingly, though Tibeleka says she’s grateful for the experience.

It’s estimated there are about 45 million kids worldwide who’ve lost either one or both parents…or who have little social or financial support in their immediate families. Kate Whetten is a global health researcher who heads the center for public health policy at Duke University. Last year, she published results of a long term study looking at how kids in five poor countries fared over time. She looked at kids placed with foster caregivers in the community as well as kids who ended up in so-called orphanages. Almost all of the 3000 kids she followed lived in extremely poor communities.

Over time, kids in institutions did better on health and emotional outcomes, cognitive development and educational attainment. Whetten says care in those orphanages – didn’t look like the stereotype, with harridans as caregivers.

Whetten says she didn’t go looking for a comparison of orphanages versus foster care, even though that’s what she found. She published her paper last year and started work on a follow up study.  Then Whetten started hearing from people in this country who run residential care facilities. They saw her data as affirming what they’re doing here. Crossnore is one of those residential care facilities in the mountains of Western North Carolina. It was started ninety seven years ago but current director Phyllis Crain, says little has changed.

Since coming to Crossnore a decade ago, Crain has raised money to improve the grounds and build new cottages for residents. She also started a on-site school that has therapy facilities in the same building. She says education is key for helping these kids succeed.

Entrance testing at Crossnore has shown that kids arriving there are, on average, two and a half years behind their peers in school achievement.

Walk into the sun-lit cafeteria at Crossnore and you’ll meet dozens of kids who have big dreams and want to tell you about them. Most of the older kids go on to college or other post-secondary education. 17-year-old Anthony will finish high school this summer. His dad has been in and out of prison, and his mom has substance abuse issues. Anthony was way behind when he arrived at Crossnore about three years ago, but he’s heading to a technical college this fall.

Only about a quarter of teenagers in foster care ever graduate high school and they have all kinds of problems as young adults. But policy in the US has, for years, favored foster care over residential settings. And that’s where the money goes too.

Fred Wulczyn does research at Chapin Hall, an institute at the University of Chicago that focuses on child welfare issues. He says kids don’t do as well with hired caregivers who come and go.

Wulczyn and other researchers say evidence indicates kids don’t get those kinds of stable relationships in residential care. Plus, it’s more expensive than foster care. But when pressed, Wulczyn and others admit no one really knows what works best for kids who’ve been neglected or abused, and who need to live outside their families. Wulczyn says in the U S, we’ve underfunded the child care system, and we’ve haven’t put the resources towards finding out what does work…

And that’s part of the reason Whetten’s research on orphans in other countries has been reverberating here. It contradicts what’s been the accepted wisdom driving child care policy in the U S for years. Whetten is gearing up for a continuation of her study of kids in residential care. But this time, she plans to include American kids in the study groups as well.   Rose Hoban, North Carolina Public Radio, WUNC.

This story is part of the North Carolina Voices series.

<<North Carolina Voices>>