Engineering for the Under-Resourced

Engineering for the Under-Resourced 150 150 IEEE Pulse
Author(s): Nancey Trevanian Tsai

What does it mean to advance technology for humanity? Does it beg us to ask, “Define technology?” and “What segment of Humanity?” As we peruse through the plethora of publications in the various EMBS journals, there is clearly no shortage of innovation using the latest and greatest technology. It seems that if there is an idea with a potential return on investment (ROI), some of which are general and others more niche, it is worth pursuing. As part of a physician group that is involved in Global Health and Surgery, serving individuals in under-resourced areas, our challenge is finding low-cost, portable, sustainable medical technology that can be used where infrastructure for electricity and clean water are limited.

After EMBC 2023, I asked colleagues in the Global Health and Surgery space for their wish list of technologies that would make a difference in terms of their efforts in under-resourced areas. Some of them were very specific, such as very low-cost spinal instrumentation. Some of them were more general, such as a sterilizing unit or autoclave that did not require electricity. A mobile operating room (OR) had an enormous operative theater light that took almost all of the overhead space in the van and a long-arduous process to reuse the electrical connection for the cautery. Their ask was to streamline equipment to make more room and decrease prep time. Nearly everyone brings their own special tools or technology that is specific to the local needs and/or their specialty.

There have been efforts to repurpose and/or utilize differently. For example, old shipping containers have been made into procedure rooms and makeshift clinics that can be transported. That mobile OR is a van conversion in use in South America. Instead of using surgical mesh, flexible screen material that has been “sterilized” is cut into small pieces for use in hernia repairs at the cost of around $1 a piece. A company in Taiwan was able to make spinal fixation screws for about $1 a piece, but that was still far too expensive for individuals who only make a few cents a day.

While at EMBC, Carolyn McGregor, Ph.D., a professor at Ontario University, mentioned that she had a solar-powered cooking capsule (GoSun Solar) that got up to over 300°, a temperature high enough to kill nearly all micro-organisms that may contaminate surgical tools. While this was not specifically engineered to address sterilization techniques out in the field, it is potentially a solution when performing procedures in sub-Saharan Africa or other less developed areas of the globe. The GoSun Solar cookers are far more portable and less expensive than an autoclave, but they are not necessarily affordable and are prone to being stolen, since they are left out in the open to absorb the sun’s heat. Having said this, it is better than simply boiling instruments for a “clean” field. The aforementioned portable OR van has a regular operating light fixture installed in its tiny workspace. It prompted me to ask why they had not considered an LED headlamp that follows the movement of the head or one of those super bright garage lights that I see for sale under $10 USD at hardware stores. The limitations include battery life, but it does solve the space issue.

As we continue to engineer in the medicine and biology space, I would like to propose a challenge to create technology that is affordable, portable, sustainable, and within reach for the least-resourced of individuals on our planet. To do this, those on the Global Health and Surgery side will need to identify those items that are highest yield or make the greatest functional and/or productivity difference to the most people. In response, engineers are asked to consider the cost of production, maintenance, and “reach” of their creations in this collaboration.

Cutting costs benefits everyone. The results obtained in low-resourced areas match, if not exceed, those obtained stateside. Furthermore, patient satisfaction is extraordinary. Of course, this is as much dependent upon their expectations as it is the actual technology and technologies utilized. Of course, some of the cost-cutting measures are not as acceptable in the United States where medical malpractice has everyone practicing and inventing defensively, but that whole other discussion. Is it time we consider reasonable expectations in the technology and practice of medicine and surgery, rather than allowing opportunistic litigation to flourish at the expense of reasonable care and procedures?

We are recognizing the value of equality and diversity, which includes those in harsh environments and scarce resources. By engineering low-cost biomedical technologies that vastly improve health and/or function for those who have limited access to high-tech, we create viable solutions toward equalizing opportunity. Let’s find sustainable solutions that work for those with the least access to high tech. Together, let’s make a difference.