Jose Gomez-Marquez

MIT D-Lab
d-lab.mit.edu
twitter: jfgm

jfgm@mit.edu
•2,500-3,000 students participate in annual
service projects
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•200-300 are international settings
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•25 country settings and over 40 projects
•Nicaragua, Honduras, Peru, Mexico, Tanzania, Ghana, India,
Nepal, etc.
Appropriate Technology Participatory Design Co - Creation
“We know what you need” “Tell us what you need, “Let’s design together”
We’ll design it”
Jose Gomez-Marquez

10
80-90%
of all medical
equipment in
developing
countries are
secondhand

80%
fail in the
first
6 months.
IIH Opportunity Sectors
 Vaccines
 Tech for disabilities
 Mom and baby health
 Diagnostics
 Therapy enhancements
 Surgical tools
 Personalized medical devices
 Chronic conditions
 Appropriate Lab Instrumentation
 Information Systems

12
A Global Collaboration
Footprint

13
By the numbers
 2 Years Old
 12 collaborative country sites
 Peru, Pakistan, Nicaragua, Guatemala,
India, Ghana, Nepal, Honduras,
Tanzania, Venezuela, Ethiopia,
Uganda
 20+ PIs working across 7 fields
 22 active technology projects
 3 ongoing field trials

How We Measure the Impact Viability
of our Solutions
Appropriate technology often requires a nuanced approach to design that
combines simple solutions, elegant technologies and robust engineering to
make technologies survive the rigors of the field. This often produces a highly
tailored approach to each solution that is difficult to standardize across sectors
and across individuals.

We have taken steps to identify the most important tensions that exist in
appropriate biomedical technologies seen through the design lens. By mapping
RESOURCE INVESTMENT and IMPACT along a X-Y spectrum, we can anticipate
how appropriate our solution is against conventional approaches. We call this
the Global Health Innovation Compass.

Resource Investment

Impact
15
The Global Health Innovation
Compass
Affordable/
High Impact Expensive/
High Impact

Impact
Investment &
Resources

Affordable/ Expensive/
Low Appropriate Impact Low Appropriate Impact

16
•Backup via
Redundancy
Human Impact

40 measles cases
•

M
•

deaths
•

500,000 •

spent annually on
•

vaccines, delivery

$500 M logistics,
and healthcare
workers
•

•
 The Real Cost of Needles

1/3 of vaccine
injections
in the developing
world are UNSAFE.

This leads to:

•250,000 cases of
HIV
•Millions of cases
of hepatitis
Sources: WHO, USAID, PATH
Simonsen L, et al. Unsafe injections in the developing world and transmission of blood-borne pathogens: a
review. Bulletin of the World Health Organization 1999
Avoiding Needles:
Aerosol Delivery

TARGET ZONE
1–5
MICRO METERS

• The Engineering
Using the Challenge
existing
vaccine, make particles
small enough for lung
absorption without
destroying the vaccine
Drug Delivery
Aerovax
The Aerovax System was designed as a go-anywhere inhalable drug and vaccine delivery technology designed for mass immunization of
remote populations.
Diagnostics
S.N.A.P
Simple Nucleic Acid Processing
A field deployable DNA collection device. An IIH H-Lab team worked on a field deployable solution for Boston University researcher’s bench-
based microfluidic sample collection tool that is now under further development by researchers MIT, Boston University, and designers in
California and Ethiopia.

22
Tuberculosis Incidence Rates
IN 2005:
8.8 MILLION NEW CASES

1.6 MILLION DEATHS

IN 2006:
9.2 MILLION NEW CASES

1.7 MILLION DEATHS

Source: CDC
Diagnostics Patients who do not take their medications
cost the American healthcare system $290 billion

XoutTB
a year in increased medical spending.
--- New England Healthcare Institute, August 2009

A Mobile - enabled diagnostic medication compliance

Aplatform
new penny-a-day test is ensuring adherence to Tuberculosis medications using a smart combination of mobile phones, diagnostics, and
creative incentives.

24
CONFIDENTIAL

Diagnostics Patients who do not take their medications

cost the American healthcare system $290 billion

XoutTB
a year in increased medical spending.
--- New England Healthcare Institute, August 2009

A Mobile - enabled diagnostic medication compliance

Aplatform
new penny-a-day test is ensuring adherence to Tuberculosis medications using a smart combination of mobile phones, diagnostics, and
creative incentives.

25
 Next Up for XoutTB
 Importance of local product development in
Nicaragua
 Flexibility of incentives
 Flexibility of communication vehicles
 Development of distributed manufacturing
techniques

CONFIDENTIAL
 Next Up for XoutTB
 Exploration of additional biomarkers
to expand into other therapies
 Chemical encryption mechanisms to vary
the code using patient inputs
 Form factors

CONFIDENTIAL
XoutTB 2050
Izoniazid 300MG

Ictv: 300
Minute Credit
Intervals
Ringtone N/A
Solar Autoclave
Microfluidic System for Monitoring
Sepsis
at the Point-of-Care

Dr. Catherine Klapperich, an Assistant Professor of Engineering at Boston University

is an IIH affiliate and CIMIT-backed researcher.

Need and Impact

Sepsis is a systemic response to an infection that can be bacterial, viral, fungal or
parasitic in origin and its diagnosis is based on patient’s history and
presentationCurrent standard of care for sepsis require blood cultures that can take
days to completeCurrent FDA approved “rapid tests” have reasonable sensitivity and
specificity, but not the causative organism
•
Solution and Innovation
Develop rapid, point-of-care test to monitor sepsisQuantify nucleic acids in blood by
combining novel microfluidic nucleic acid isolation with on-chip quantitative PCR
Design assay to determine, in parallel, whether infection is bacterial (gram positive or
gram negative) or fungal

30
Diagnostics
Tuberculosis Breath Test

Jose Trevejo, MD, PhD, BIDMC and Preshious Rearden, PhD, Draper

Need and ImpactTuberculosis (TB) remains a major public health problem worldwide with
approximately 8 million new cases and >2 million deaths per yearMajor obstacle is the lack
of point-of-care diagnostics for TB with high sensitivityNo real-time, reliable, inexpensive,
portable detection deviceSolution and InnovationDevelop real-time volatile analysis system
(breath analyzer) for TB detectionLeverage and apply novel differential mobility spectrometer
that has a highly sensitive, portable gas sensors for detection at very low
concentrationsWorld Healthcare Organization (WHO) supported ongoing clinical trials for TB

FAIMS Human Breath Tracing 31

 Microfluidic System for Monitoring
Sepsis
at the Point-of-Care

Dr. Catherine Klapperich, an Assistant Professor of Engineering at Boston University is an IIH

affiliate and CIMIT-backed researcher.

•Need and ImpactSepsis is a systemic response to an infection that can be bacterial, viral,
fungal or parasitic in origin and its diagnosis is based on patient’s history and
presentationCurrent standard of care for sepsis require blood cultures that can take days to
completeCurrent FDA approved “rapid tests” have reasonable sensitivity and specificity, but not
the causative organism
•
Solution and Innovation
Develop rapid, point-of-care test to monitor sepsisQuantify nucleic acids in blood by combining
novel microfluidic nucleic acid isolation with on-chip quantitative PCR Design assay to
determine, in parallel, whether infection is bacterial (gram positive or gram negative) or fungal

32
 Card enabled
community
glucometers
 Biometric driven
patient history


 What’s next
 Open Source
Testing Strips
Disease
Surveillance
Disease
Surveillance
Disease
Surveillance
Maternal and Infant Health
Car Parts Incubator

Dr. Kristian Olson is the Program Leader for CIMIT’s Global Health Initiative and chief
architect of the Car Parts Incubator project.

Need and ImpactEach year over 4 million infants worldwide die within a month of birth due to
pre-maturity, low birth weight and infectionConventionalincubators designed for industrialized
markets can cost over $30,00095% of donated medical equipment ends up broken within
five years and unused due to lack of local training and repair Solution and InnovationBuild a
low-cost, higher performing, safer and effective neonatal isolette for low-resource, rural
settingsDesign and leverage readily locally available automotive partsDevelop and train to
be operated, repaired and maintained with local human resource capacity

37
Portable Biofeedback System

Battery
Tactor
(Samsung)

MCU
Tac
t
or
out Blu
put eto
Main objectives s oth
IMU
-Improve human motor function in patient populations with
sensory and/or motor deficits
-Support multiple patients via wireless or web-based manner
-Provide clinical or motor learning tasks in physical therapy or 6X5X3.5 cm
sports training

38
Global Health Design
Research
 Noninvasive
dehydration
detection
 Approximates fluid loss
on the order of 1-2%
dehydration by
assessing radial pulse
before and after supine
to standing transition
 Cell phone based
maternal health
diagnostic
platform
 Cell phone based
patient symptom
recognition and 39
Portable Obstetrics Exam
Table

James Bradshaw, Adam Gienapp,

Joseph Perosky, Rebecca Rabban
40
Foldable Tricycle
Attachment

Brian Holcomb, Alex Klonick, Michael Swift, and Michael42

Tran
Some Tendencies in
Catalytic Technologies
Rapid Prototyping
Lab-on-a-Chip

Network of microchannels (Agilent)

Open Source Hardware
Medical Simulation
 Drug Delivery
 Diagnostics
 Microfluidics
 Instrumentation
 Mobile Health
 Prosthetic Design
 Imaging
 Empower local medical innovators
 Create a Collaborative Language of
Design
 Stimulate trickle up technologies
 Address stratified gaps among
professionals
 Get devices safely to trials, and to
the
point of care
 Urban
 7,705 pieces of equipment
 9% are operating irregularly
 18% are not in service
 Rural
 1,681 pieces of equipment
 25% not in service
 Technical Personnel
 80% lack formal training
 15% have basic or mid-level technical
 5% have advanced or university-level
education
 Complexity
 Instruction vs. DIY
 Barriers towards innovation
 Fear
 Incremental fixes
 Rural brain drain
Some examples

 Development of in-country manufacturing methods of lab-on-

chip technology
 Xurography brings the cost of microfluidic prototyping down to
$300-400 per lab
Some Examples

 A video conference
discussing auto-
disable syringe
designs with
Nicaraguan and
MIT design
coaches
Some Examples

 Cell manufacturers of tuberculosis compliance diagnostics

using local resources
 Hybridization 
 Vintage Technologies + Smart
Design/Tech = New Solutions
 Taking the improvisation and
engineering solutions 
 Bottom up observation 
 Be trendsetting, not trendy
 Context shifting
 Distributed Systems
 Crowdsourcing

 Hybridization

+
Coca Cola Spacer for Asthma
Inhalers
Example
Innovation in the Field
Índice de Innovación Global
Nicaragu
Pakista a
NICARAGUA
n PAKISTAN

Peru
PERU

Tanzani
a TANZANIA

http://hlabmanagua.ning.co
m/
Ken Endo
Jose Gomez-Marquez
MIT D-Lab
d-lab.mit.edu
Earlier Experiences,
Smaller Space (at MIT)
Tuberculosis Incidence Rates
IN 2005:
8.8 MILLION NEW CASES

1.6 MILLION DEATHS

IN 2006:
9.2 MILLION NEW CASES

1.7 MILLION DEATHS

Source: CDC
XoutTB
Lots of Hats = Better Ideas
KNOCK ON LOTS OF DOORS

TALK TO LOTS OF PEOPLE

ASK QUESTIONS. LEARN TO LISTEN.

Su primer Your first idea is important,
but be confident enough to let it go since
your second, third or fourth may be even
better.
Learn how your target users improvise.
There’s often an invention hidden in
that solution waiting for a bit of
engineering.
Great solutions are often the result of a
mashup of vintage technologies with
modern ones.
It’s not just about what you can cook up
in the lab.

It’s really about what your user need.

Talk to them!
Before Design for the
BoP

Rotary
World Bank
School

Work
 After Design for the BoP
Duke Booze Allen
CURES John
Hamilton T
St. Jude Hopkins I
Medical Industrial
Stanford Liason
Browne
Program
BME SRI International Rudnick

Dow Jones/ VMS

Bioventures
WSJ Emerging TiE Investors AIDG
Ventures Circle
Carnegie- 100K Choate
World Ban
Mellon Commons
Capital
Forbes IDG
Young Media
Stanford Inventors Lab
BASES International Edwards Lab
MGH CSAI
Langer
Lab
Rotary Pulmatrix
BWH
International