Telemedicine Brings Low-Cost Medical Care to Africa

Technology is playing a bigger role in medicine throughout the globe, but its impact is dramatically different in industrial countries and developing nations. While U.S. patients rarely get a test that doesn't cost $200, product developers who target Africa's underprivileged population are creating complete systems that cost less than $200.

Telemedicine is being utilized by physicians who want to help the many Africans who can't afford medical care. Remote access lets doctors provide assistance from their homes instead of only helping during sabbaticals when they can travel. Programs like these address a compelling need: the ratio of one doctor to 50,000 people in East Africa compared to a one per 390 people ratio in the U.S.

The Mashavu Project is bringing telemedicine to Kenya and Tanzania by tapping the creativity and social activism of college students, keeping equipment costs down. A team at Penn State developed a number of inexpensive medical devices for Mashavu, a name that comes from the Swahili word for chubby cheeked, which is a colloquialism for good health.

A variety of disciplines are joining together to create business plans and technical schemes being used by Mashavu's parent entity, Children and Youth Empowerment Centre, which is partially funded by the Kenyan government.

On the technical side, the student teams created a number of medical instruments that connect to PCs so data can be sent to doctors at remote sites. They provide students the type of hands-on project that have become a mainstay as universities struggle to provide a steady supply of skilled engineers.

"I was searching for something junior-level students could design, and this is one way to apply finite element analysis," says Peter Butler, associate professor of bioengineering at Penn State. "Students model the processes they need, like modeling the beating artery."

Heartbeats and the sounds of lungs while breathing are the two parameters being measured by a stethoscope designed by a team led by Genevieve Miller, a senior majoring in bioengineering. The team's FEA project was to model the frequencies carried by the stethoscope, as well as the way the ear picks up sounds.

A first step was to determine the frequencies of the sounds made by the heart and lungs. Once that was determined, Miller and her team had to make sure they had a microphone that would pick up those sounds.

That wouldn't be a huge challenge for engineering students whose projects will be used in the U.S. if they're ever put into use. But pricing and availability are quite different when the end product is to be made and used in Kenya, where the average income is under $500 and manufacturing capabilities are limited.

"We were trying to use materials that could all be located in Kenya, including the microphone," Miller says.

Simplicity is mandatory. The price target for all peripheral devices is less than $10, which will help keep complete system costs below $200. For example, the stethoscope has only four parts other than the computer that nurses use to gather and transmit data. The conical chest piece and two types of tubing that provide amplification and reverberation were critical but fairly straightforward design aspects. The microphone was another story.

"We needed to find the frequency of the heart and lung sounds and figure out how to filter out noise," Miller says. "Then we had to find a microphone that works and meets cost requirements."

Two options that can pick up frequencies ranging from 30 to 15,000 Hz were selected. Both had low power requirements so USB cables could be used to link the sensor to the computer and eliminate the need for batteries that would drive costs up and availability down.

Once the microphones were picked, protecting the stethoscope microphone from moisture and dust were key concerns. That challenge is easily handled by enclosing the microphone in the polyvinyl tubing. This approach also makes it simple to sterilize the system by simply wiping it down with a range of cleaning materials.

Understanding the problems and exploring a number of different solutions quickly was critical for the students, who had to finish their projects during a semester that ended with a trip to Kenya. Modern design tools played a key role in meeting this goal.

"The way to bring costs down is to harness virtual instrumentation to design the products," says Khanjan Mehta, co-director of Penn State's Humanitarian Engineering and Social Entrepreneurship Program. "We want to minimize the hardware and move as much as possible into software, which is cheaper."

Most of the design and programming for both the medical peripherals and Mashavu's overall system architecture was created with National Instruments' LabVIEW. Penn State students are also using LabVIEW to design thermometers, blood pressure monitors, scales and a spirometer.

When the students took their equipment to Kenya, results were good, with performance that matched time-tested devices. "We have three clinics in Kenya where we compare devices. Nurses with skill handling conventional stethoscopes found reasonably good correlation between student devices and their units," Mehta says.

However, other goals weren't met. Students didn't have a way to figure out what the local infrastructure provides. "In Kenya, they realized their dream of building things there with products that are readily available was not realizable," Butler says. "We still believe that we can manufacture it there and stay at the same price point, and our plan is to hand off some production to people in Kenya."

Though there are still challenges to overcome to get the system working in Africa, telecommunications isn't one of them. Business Monitor International predicts that mobile phone penetration in Kenya will reach 100 percent in 2013.