ENG Students Study Health Care Challenges in Nicaragua

When Molly Keenan and her biomedical engineering lab partners joined a fact-finding trip to Nicaragua over spring break to learn about health care challenges and needs in developing countries, they got more than they had bargained for.

Through the College of Engineering senior design project program, Keenan (ENG’11) and fellow seniors had been working on adapting a noninvasive oral cancer detection system for use in resource-limited countries, facing 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 they overcame these challenges, they needed evidence that their device was affordable and easy to use, repair, and carry around. During the Nicaragua trip, that evidence began to roll in.

Keenan is one of nine biomedical engineering and two electrical engineering students who traveled to the Central American nation in March with Irving Bigio, an ENG professor of biomedical engineering, Catherine Klapperich, an associate professor of biomedical engineering and materials science and engineering, and Selim Ünlü, a professor of electrical and computer engineering and materials science and engineering. The 11 students, representing four projects in the biomedical engineering senior design project program’s new global health initiative, run by Bigio, sought feedback from local health care professionals about their work.

“The intent of the trip was to expose students to what it’s really like to try to deliver health care 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,” says 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 says. “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 health care system.”

Spearheaded by Bigio and supported by Klapperich, Ünlü, and Muhammad Zaman, an assistant professor of biomedical engineering, the four senior design projects and the trip reflect ENG’s growing emphasis on global health technology innovation. Two of the projects are based at the Lab for Engineering Education & Development, launched by Zaman in 2010 to engage students in problem-based learning centered on real-time applications in global health. All four projects 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 biomedical engineering and two electrical and computer engineering 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,” says electrical and computer engineering major Aaron Larocque (ENG’11). “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.”

Meredith Duffy (ENG’11), a member of a different project team, observed another limitation of the health care system in Nicaragua: 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 says. “It’s the 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.”

Another major health care challenge in Nicaragua and other resource-limited countries is exposure to counterfeit and substandard antibiotics, antimalarials, and other essential medicines, accounting for thousands of preventable deaths each year. Duffy’s team is developing a 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 project, biomedical engineering majors Ellen Reavey (ENG’11) and Laura Blaha (ENG’11) are optimizing a disease diagnostic device, developed by Klapperich and graduate student Jacob Trueb (ENG’11), 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 uses pressure from a bicycle pump. While the target disease is HIV, the students hope to extend the technology to detect other diseases.

The biomedical engineering seniors say they gained new insights into the technical challenges of delivering health care in developing countries from the Nicaragua trip.

“We went to a clinic in a rural area, and an engineer showed us some of the equipment,” says 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 to continue the biomedical engineering senior project global health initiative in the coming academic year. “Our intent is to again identify projects with strong global health potential,” he says, “and possibly to return to Nicaragua—not to be medical tourists, but to continue developing this year’s technologies and testing out new ones.”

Mark Dwortzan can be reached at dwortzan@bu.edu.