Engineers at the Addis Ababa Institute of Technology in Ethiopia conduct tests on a CoolComply prototype. Photo: MIT D-Lab |
Tuberculosis
(TB), now largely controlled in the industrialized world, remains a stubbornly
persistent killer in most of Africa, as well as parts of Asia and South America. The spread of multidrug-resistant strains
of TB has slowed progress against the devastating disease, which is estimated
to strike more than 10 million people annually. Now a modified soft drink
cooler, developed by researchers at Massachusetts Institute of Technology’s (MIT)
D-Lab, could make a dent in the disease’s impact.
There
are two big issues that physicians confront in trying to tackle drug-resistant
TB strains in developing countries. First, the drugs used to treat the disease,
which require several doses per day over a course of 18 months, must be kept at
a controlled low temperature—in places where the availability of electricity is
sparse and unreliable. And second, the drugs must be taken regularly, requiring
continuous monitoring by health care workers.
Both
issues could potentially be addressed by the cooler developed by researchers in
the Little Devices Lab, a team of researchers within D-Lab who work to develop
low-cost solutions to pressing medical needs.
D-Lab
is a program of classes, workshops, and laboratories at MIT, launched a decade
ago by senior lecturer Amy Smith. The program now includes 13 classes on topics
in health, mobility, and energy, and is devoted to developing appropriate
solutions to problems facing low-income people and communities around the
world.
José
Gómez-Márquez, the D-Lab instructor who runs the Little Devices group, says the
team’s breadbox-sized cooler was adapted from one designed to keep soft drinks
cool. Dubbed “CoolComply,” it can run on either plug-in power or solar cells,
and contains circuitry to monitor the temperature inside and transmit an alarm
if it rises too high. (Higher temperatures cause a gas to be released inside
the medicine packets, which can make patients violently ill.)
In
addition, to track compliance, each cooler records the exact date and time when
the box is opened, which allows a single dose packet to be dispensed. A
built-in cell phone transmitter sends information on temperature and cooler
activity to a central health facility where the data can be stored and
monitored.
The
CoolComply team won a $100,000 award last fall as a Vodaphone Americas
Foundation Wireless Innovation Project, as well as a $50,000 grant from the
Harvard Catalyst. The awards will see the project through initial development
and testing.
The
idea originated with Kristian Olson and Aya Caldwell, physicians at Massachusetts General Hospital
in Boston, who
told Gómez-Márquez about the pressing need to keep TB medicines cool and to
verify patient compliance with the dosage regime.
At
present, since many of the patients entering treatment lack access to
refrigerators, they are instead provided with coolers requiring daily
deliveries of ice; their compliance with the dosage regime is checked regularly
by visiting health workers. Those constraints severely limit the number of
patients who can be treated, Gómez-Márquez says. The daily ice deliveries cost
$600 a year—about double the cost of the CoolComply system—and “ice doesn’t
send you a message” to show that medicine has been taken, he says.
Since
last September, three prototype devices have undergone field testing in Addis Ababa, Ethiopia; this summer the D-Lab
team hopes to deploy at least 10 more there for further testing. Ultimately,
the team hopes the devices can be produced locally and distributed by a small
for-profit company set up for this purpose, fostering both better health and
the creation of local jobs.
The
wireless reporting system in the CoolComply device “solves the problem of
having to visit the patient every day,” Gómez-Márquez says. But getting to that
point wasn’t easy: The first prototypes built last summer by the team—which
also includes D-Lab instructors Anna Young and Amit Ghandi—worked perfectly in
the United States, but as soon as they arrived in Addis Ababa for field
testing, “none of it worked,” Gómez-Márquez says, because of unreliable signals
from the local cellphone system. “We had to go back to the drawing board,” he
says. “We were in despair.”
One
problem, Ghandi says, was the design of the cooler’s antenna. “You couldn’t
tell what was wrong by looking at it,” he says, “but it wouldn’t work in
certain parts of Ethiopia.”
Finally, after switching to a different type of antenna and devising some
tricks to make up for unexpected gaps in the system (such as the lack of a
built-in timestamp on Ethiopian text messages), they were able to get a
reliable device up and running.
That’s
par for the course for such projects, Gómez-Márquez says. “You want, during the
first trip, for a lot of things to go wrong,” he says. “That’s why you go over
there.” The key thing for this project was enlisting local users to try out a new
system under real-world conditions. “We found amazing engineers” at the Addis
Ababa Institute of Technology, he says, who “did an enormous amount of work” to
help get the system working.
These
local engineers, in fact, were delighted to have the chance to work on such a
project, which they could see was something that could be built and maintained
within the country. Young says one of them told her, looking at an expensive
MRI machine in the local hospital, “Nobody I know will ever use this.” By contrast,
he said of the new cooler, “This is something I can actually see being used by
people I know.”
