Design Process

I believe that my background in bioengineering and global health will allow me to establish a design process which is both unique and effective. Specifically, my previous experiences doing bioengineering research have given me the skills to evaluate current products and research, and identify weaknesses and areas for improvement. Additionally, my time studying community health while studying abroad has allowed me to appreciate some of the cultural, distribution, and education challenges which we may encounter as we try to implement our product.

With these skills, I have spent a lot of time with my team looking at other sickle cell anemia diagnostic tools. By observing their strengths and weaknesses, we have been able to start the design process for a test strip. For example, two products, Alibaba and Sickle Scan, are low cost but are also difficult to interpret due to subtle color changes indicating a diagnosis. With this in mind, we were able to decide on a lateral flow test strip, since the absence or presence of a line leaves less room for user error. We were also able to find two other lateral flow test strips for sickle cell anemia. One, Sickle Dex, is commercially available, but utilizes a direct binding method, and therefore requires a dilution step in order to work. A different lateral flow test, a competitive test still in the research phase, is easier to use than the Sickle Dex product since it does not require a dilution step; however, its utilization of a competitive binding method also makes it less specific. By analyzing these two sickle cell anemia lateral flow tests, our team was able to think of a solution which incorporates the specificity of a direct binding test, without the need for blood dilution. Specifically, by incorporating a T-Junction shape, and having the sample and colored beads travel from separate directions, we can theoretically avoid pre saturation of the beads, preventing the need for a dilution step.

Despite that three of these products are commercially available, none of them are available in lower and middle income countries. By decreasing the training required, increasing the specificity, and specifically utilizing our on-the-ground partners, we hope to use our unique backgrounds to complete an effective design process, and actually get the product to the community.

Validation

As we continue with this design process, we will utilize several resources in order to validate our progress. For example, in order to validate our project concept and technology, we will hopefully be able to get feedback from people in industry. Our advisor, Prof. Cheng, has a few contacts who work on commercial lateral flow tests, and will hopefully be able to connect us with them to learn more about what works well, and what doesn’t, with our technical design. Furthermore, we will hopefully be able to validate the usability of our product during our fieldwork this summer. Specifically, we hope to have a working prototype prepared by the time our team goes to Sierra Leone, and will be able to get feedback from community healthcare workers on what is easy and difficult about using our test. Finally, we also hope to start looking at how our product will fit into the Sierra Leone health system during the field work. Although our team is currently very bioengineering focused, we hope to eventually recruit business students to work on the operational/business model, and that they will be able to use our experiences in Sierra Leone, as well as their own expertise with business, to start validating the operational aspects of our project design.

My Philosophy of Engagement

There are several reasons why I am excited about this project, and why I specifically chose to engage with communities in low-income countries.

Although I know that there are socioeconomic and health challenges locally as well as globally, I love learning about cultural differences. Being born in Germany, an English citizen, and an American resident, I have always been very aware of the different cultures surrounding me. Because of this, I have always aspired to work with people from diverse backgrounds.

Furthermore, I love learning. I believe that working to solve challenges in low-income countries presents several unique challenges. Figuring out how to work through these obstacles presents unique learning opportunities, and allows for exciting problem solving.

Finally, I want to make an impact, and to help the communities that I am working with. Coming from a high-income, powerful country, I understand that I have opportunities and resources which are unavailable to many others. Because of this, I want to be able to take my privilege and turn it into something beneficial.

By combining my interests and aspirations, I believe that my philosophy of engagement will help to keep me focused and excited as I continue to work on this project.

Biomimicry

While watching the TED talk on biomimicry, I was especially fascinated by the comment that “there [are] organisms out there that [have] already solved the problems that [others have] spent their careers trying to solve” (3). One interesting example of this is with renewable energy. Although scientists all over the world are trying to come up with good solutions, plants have always been able to produce their own.

Our design for a sickle cell anemia test strip has included this concept without our intention. Specifically, for our test, we are creating a lateral flow test device, which uses a nitrocellulose membrane to run blood samples over test lines. This concept of capillary action, where water is passively moved along a membrane by molecular attractions, is actually seen all over nature. For example, the thorny devil or moloch, an Australian lizard, uses capillary action to collect moisture and funnel it into its mouth (1).

This concept is also something that may impact our product in the future. For example, drones are being considered for the delivery of many medical products to remote villages. If other organizations find success with this method, we may want to consider using drones for our test strip distribution as well. Current drone research is using biomimicry to solve the problem of navigation in the dark, by looking at bat sonar. In this way, biomimicry could serve as a model for our test strip in multiple ways in the future (2).

Life’s Principles

One of life’s principles that I thought was especially interesting is “optimize rather than maximize.” I believe that this concept could apply to our work in many different ways. For example, one concept of this principle is that “social enterprises are designed so that others can build on to them” (4). With our sickle cell anemia diagnostic tool, we are trying to develop a low-cost, easy to use lateral flow device that is sensitive, but does not require blood dilution. Once the basic technology for this goal is established, it could easily be applied to other tests by simply changing the test line antibody.

Cradle to Cradle

Similarly, the Cradle to Cradle design concept can also be applied to our test strip. This concept stresses that everything is a resource for everything else, and that a major goal should be a “healthy and just world, with clean air, clean water, soil, and power” (5). This concept will be especially important for our test strip when we start to think about a test strip case, packaging, and distribution. In each of these manufacturing stages, we should try to integrate clean and sustainable processes, such as by minimizing plastic use in packaging.

Interesting Facts

Over the years, I have learned many interesting facts from my friends. For example, while studying abroad, I spent a lot of time with people who were studying public health, gender studies, and anthropology. One interesting concept that they explained to me was positionality. Positionality is the practice of observing ones own relation to others, and understanding the implications this has on what we observe. This was an especially important concept to understand while studying abroad, since as a white westerner, my positionally gave me access to a lot of unique experiences, while also preventing some locals from ever completely opening up to me. Additionally, I have learned many fun facts about space from my friend, who is fascinated by astronomy. For example, she told me that the nearest major galaxy is 2.5 million light years away, but that the farthest a human being has ever gotten from earth is 1.3 light seconds. I found this fact especially interesting since it puts everything in to perspective, and highlights just how little humans actually understand. Finally, another friend once told me that Coca Cola tastes better in South America. I thought this was very interesting, since the difference in taste is due to different food regulations in South America, preventing some forms of sweeteners. I thought this was interesting since it puts into perspective how much of an influence governments have in our daily lives, and makes you think about just how many artificial ingredients are in everything we eat.

1. https://inhabitat.com/the-biomimicry-manual-what-can-a-thorny-devil-teach-us-about-water-harvesting/
2. https://techxplore.com/news/2018-06-team-biomimicry-drones-dark.html
3. https://www.ted.com/talks/janine_benyus_shares_nature_s_designs/up-next?language=en
4. Samir Patel & Khanjan Mehta; Life’s Principles as a Framework for Designing Successful Social Enterprises
5. https://www.ted.com/talks/william_mcdonough_on_cradle_to_cradle_design/up-next?language=en

Stakeholders

With the long-term goal of implementing a sickle cell anemia screening tool in Sierra Leone, there are several stakeholders with unique motivations which we need to keep in mind.

The most affected by our product will probably be the community members getting tested. Although our goal is to create a screening tests which will impact the entire population, ultimately those most impacted by our device will be the individuals with sickle cell anemia and their families. For these stakeholders, the priority is a highly sensitive test. Because early screening and detection can result in better treatments, the priority for these stakeholders would be to have an accurate test with as few false negatives as possible.

Another important stakeholder for our test strip would be the healthcare providers (doctors or community health workers) who are administering the test. In addition to desiring a highly sensitive test for the well-being of their patients, these individuals probably also prioritize an easy-to-use device. With this stakeholder in mind, one of our primary goals for this test is to make it point-of-care, meaning it is portable, quick, and non labor-intensive.

A third important stakeholder would be the person paying for the test strips. Since early sickle cell anemia diagnosis can improve treatment decisions, we would never want to limit people’s access to the test due to financial constraints. Because of this, we would want to make sure that the test was payed for by the government (if this sort of test is covered through a public healthcare system) or an NGO. Because of this, the primary motivation for these individuals is probably to keep the test as low-cost as possible.

A fourth important stakeholder would be the individuals involved in distributing our product within Sierra Leone. Since we would like to make this product as socially and economically sustainable as possible, the goal would be to hire locals to distribute the product. The primary motivations for these individuals would therefore be to make enough money to provide for their families. Because of that, we would want to make sure to provide reasonable compensation, taking into consideration the local economy (such as the practice of paying for small quantities of things at a time, instead of paying regular, larger bills).

The final major stakeholder would be the producers of the test strip. Although ideally we would produce this product in-country to provide additional employment opportunities and reduce distribution costs, this probably is not feasible. Because of this, we would need to find a company that can scale up our production of test strips for a low cost. Because this company will likely be in the US, their primary motivations will likely be profits. Although this could create challenges with balancing the motivations of different stakeholders, our priority as a team will always be to provide these test strips to as many people in Sierra Leone as possible.

Project Credibility/Validation over the semester

In order to validate our project progress throughout the semester, there are several things which we will try to accomplish. First, since the Ukeweli test strip team has a similar product to ours, but is at a significantly further stage, we should check in with them to see if they have any comments or suggestions on our product and ideas. Similarly, we would like to speak with individuals from industry who can give us feedback and advice on our test strip. Because our advisor, Prof. Cheng, knows people who work on lateral flow devices, these individuals may be able to help us as we optimize our test or overcome a particular challenge with the design. Finally, in order validate our work so far, and reflect on the next steps, our team would like to put together an abstract for the IEEE Global Humanitarian Technology Conference. Not only would an acceptance to this conference validate our accomplishments and ideas, but the process of putting together the abstract will also allow us to reflect on our project so far.

As my team moves forward with designing and implementing a sickle cell anemia diagnostic tool in Sierra Leone, there are several cultural issues which we may have to be aware of; including religious beliefs, concepts of the good life, and gender roles. Specifically, religious beliefs could impact whether individuals choose to utilize our diagnostic tool due to a preference for traditional medicine, or a trust in “miracle services.” Additionally, the concept of a good life might not encourage individuals to seek out our diagnostic services. For example, since sickle cell anemia is not curable, individuals might not want to know their status. Finally, gender roles may impact the utilization of the test strip. For example, in some cultures, women are not allowed to be treated by men, or to go out without their husbands. Because of this, we should be aware of how gender roles and expectations could influence people’s access to our test strip.

I have also observed how these different religious beliefs, concepts of the good life, and gender roles can impact social situations at home in the US. Specifically, for example, religion can impact maternal health through abortion access, and with blood transfusion beliefs among Jehovah’s Witnesses. Additionally, the concept of the good life in the US stresses efficiency and profits. Coming from Germany, I have seen how this culture uniquely affects the work culture, such as through reduced vacation time and maternity leave. Finally, although there has been a huge social movement for increasing gender equality in the US, gender roles and expectations still affect every day life, for example with the gender pay gap.

In addition to these cultural challenges, I believe that there will be some unique challenges presented by the African context specifically. For example, because we are unfamiliar with the healthcare system, economy, and culture in Sierra Leone, there may be some unexpected challenges (such as the unforeseen consequences of the treadle pumps and hybrid corn). Additionally, although English is the primary language in Sierra Leone, the prevalence of different languages among different ethnic groups may create some communication difficulties. And finally, the economy in Sierra Leone, specifically with individuals typically only having small amounts of money at once and no steady salary, may present some unique challenges with figuring out how to pay distributers and getting reimbursed.

Although this unique context may preset some challenges, I also believe that there are some local practices which could be leveraged to address problems. For example, although the “gig economy” may be an adjustment for us, it could allow us to employ many more people for small tasks. Additionally, although the US is a very individualistic nation, a greater focus on community in the culture, for example, could allow for a more cohesive workforce. Finally, since learning is different depending on the cultural context, being in an environment where people learn through imitation instead of reading, for example, could allow us to make a bigger impact more easily.

Within the African context specifically, I believe that there may be several resources which could benefit the implementation of the sickle cell anemia test strip. For example, because Sierra Leone does have a large gig economy, I believe that finding individuals to help us distribute our product will be easy, and open up a lot of employment opportunities for locals. Additionally, because sickle cell anemia is the leading cause of child mortality, our product will be especially well received. And finally, because doctors are well respected in Sierra Leone, most people will choose to utilize our test if recommended.

In this way, I believe that there are many unique local challenges and opportunities we may be observe while trying to implement our test strip in Sierra Leone.