When Molly Keenan (BME’11) and her lab partners began adapting a noninvasive oral cancer detection system for use in resource-limited countries, they faced considerable challenges, from powering the optical spectroscopy device with a small rechargeable battery to making it compact enough to fit in a backpack. Even as the BME seniors overcame these challenges, they had no evidence that potential users would view their device as sufficiently affordable and easy to use, repair and carry around. But when they joined a fact-finding trip to Nicaragua over spring break, that evidence began to roll in.
Keenan is one of 11 undergraduates—nine BME and two EE students—who traveled to the Central American nation with Professor Irving Bigio (BME), Associate Professor Catherine Klapperich (BME, MSE) and Professor Selim Ünlü (ECE, MSE) in March to learn about healthcare challenges and needs in developing countries. Representing four projects in a new global health initiative within the BME senior design project program, the students also sought feedback from local healthcare professionals on the viability of their work.
“The intent of the trip was to expose students to what it’s really like to try to deliver healthcare in places with limited resources—to have them see some of those limitations for themselves, learn about the most critical technology needs and get the local community’s response to the technologies they’re working on,” said Bigio. “We also wanted to start building connections with people in various institutions so we could go back and move many of these technologies to the next stage.”
For Keenan, the trip exceeded expectations. “It all is worth it when you meet the people who would use your device and they immediately ask ‘When can we get this?’” she said. “Going to Nicaragua showed me that even simple things are complicated without the right resources, and that as a biomedical engineer, I can make devices that can improve a country’s healthcare system.” (The project also impressed BME faculty judges, who honored Keenan and her collaborators, Alessandra Forcucci and Alison Shaw-Tien Lo, with the year’s Outstanding Senior Project in Biomedical Engineering Award.)
Spearheaded by Bigio, who runs the BME senior design program, and supported by Klapperich, Ünlü and Assistant Professor Muhammad Zaman (BME), the four senior design projects and Nicaragua trip reflect a growing emphasis at the College of Engineering on global health technology innovation. Two of the projects are based at the Laboratory for Engineering Education & Development, an initiative Zaman launched in 2010 to engage students in problem-based learning centered on real-time applications in global health. All four reflect an ethos, exemplified by the BU chapter of Engineers Without Borders, of engineering customized, stakeholder-driven solutions to improve the quality of life in resource-limited countries.
Finding Limitations, Advancing Solutions
To that end, a senior design project team of two BME and two ECE seniors (one of two pilot interdisciplinary senior design projects this year) is building a compact, easy-to-use biosensor platform that provides a definitive, point-of-care diagnosis of dengue fever virus. The team’s robust, low-cost, terrain-ready diagnostic kit combines a scaled-down version of Ünlü’s Interferometric Reflectance Imaging Sensor (IRIS) technology, a microfluidic device to deliver virus samples to the biosensor, and a battery-powered laptop to interpret IRIS images.
“In Nicaragua they take samples at community clinics and send them to one central facility for diagnosis using PCR (a DNA amplification technique),” said Aaron Larocque, an ECE senior participating in the project. “PCR takes awhile and you have to send the samples frozen to the facility, which presents a logistical challenge. Our device is portable: you can take blood right there and put it in our device and test it, making diagnosis faster and more robust.”
While in Nicaragua, a member of another project team, Meredith Duffy (BME’11), observed another limitation of the healthcare system: large disparities in technological capabilities between different hospitals and even different parts of the same hospital.
“While just about any advanced technology or treatment can be found someplace in Nicaragua, that doesn’t mean everyone everywhere can access it,” she said. “Same with the research there; while the HIV diagnostics branch of the Ministry of Health’s National Diagnostics Center seemed well-funded and well-staffed, there was only one parasitologist in the entire place and clearly not much funding to address widespread and potentially fatal parasitic diseases.”
Addressing another major healthcare challenge in Nicaragua and other resource-limited countries—exposure to counterfeit and substandard antibiotics, anti-malarials and other essential medicines that account for thousands of preventable deaths each year—Duffy’s project team is developing a cost-effective, comprehensive method to determine if a drug is counterfeit or substandard. Their design integrates critical tests for counterfeit detection into a single, portable, cost-effective system that exploits microfluidic technology.
For their senior project, Ellen Reavey and Laura Blaha (both BME’11) are optimizing a disease diagnostic device (developed by Klapperich and ME graduate student Jacob Trueb) that extracts and analyzes DNA and viral particles obtained from blood samples. Current disease diagnostic technologies are expensive and require electricity to operate, but theirs is made from inexpensive plastic and is operable using pressure from a bicycle pump. While the target disease is HIV, the students hope to extend the technology to detect other diseases.
The Nicaragua trip afforded the BME seniors with new insights into the technical challenges of delivering healthcare in developing countries.
“We went to a clinic in a rural area, and an engineer showed us some of the clinic’s equipment,” said Reavey. “We asked if it worked, and he said yes, so we asked if he would show us. Then he told us that a couple things on the machine were broken, and that it didn’t really work as it should and would take a long time to get running. While the equipment was deficient, the clinicians made do with what they had. Being in Nicaragua really opened our eyes to their needs and provided great perspective.”
Bigio expects the BME senior project global health initiative to continue in the coming academic year. “Our intent is to again identify projects with strong global health potential,” he said, “and possibly to return to Nicaragua—not to be medical tourists but to continue developing this year’s technologies and testing out new ones.”