Circle of Life

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 & Project Credibility

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.

Cultural Challenges & Opportunities

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.

Introduction & Eyeglass Access

Introduction

As an aspiring physician, I have dedicated my studies to exploring the many external and interconnecting factors which can influence an individual’s wellbeing. Because I hope to understand and appreciate these forces in order to best care for my future patients, I specifically chose to focus my undergraduate degree on exploring the impacts bioengineering, policy, and community factors play in healthcare. Furthermore, I choose to continue my studies with the HSE masters program in order to better understand how complex healthcare systems can impact quality, efficiency, and access in patient care.

I believe that the Global Social Impact Fellowship will therefore be the perfect complement to all of these interests. Specifically, not only has my recent work on the sickle cell anemia test strip combined my bioengineering research and global health interests, but the implementation of this device into healthcare systems in Sierra Leone will also allow me to apply my HSE studies. For example, as the sickle cell anemia test strip continues to develop, my group will need to start discussing some of the considerations for introducing the product, such as looking at delivery and finances. As I am currently taking HSE classes in financial management, optimization modeling, and information technology, I hope that not only will my courses allow me to better the project, but the application of these topics into a low-cost, limited-resource setting abroad will also allow me to expand my learning. In this way, I believe this fellowship will be a perfect addition to my aspirations, interests, and education.

Eyeglass Access Case Study: The WHO estimates that over one billion people who need eyeglasses do not have access to them. The vast majority of these people live in developing countries like Kenya where there is barely one optometrist per one million people. Given the high poverty levels, access to eyeglasses is almost non-existent. Lack of proper eyeglasses severely impacts people and their livelihoods by decreasing their productivity at work, limiting or eliminating new opportunities, affecting their quality of life, deteriorating their general health and possibly leading to preventable blindness. What solution do you propose to address this problem?

I believe that the greatest challenge when trying to address the problem of eyeglass access in developing countries is with creating a long-term, economically and socially sustainable solution. In other words, the goal of the project should be to fix the underlying causes (such as high poverty levels), which are preventing individuals from getting the education needed to become optometrists, and others from having the money to get the medical attention they need.

With these long-term goals in mind, I think a good starting point would be to employ locals: training some individuals on conducting basic eye exams, and employing others for distributing and selling basic eyeglasses. By empowering individuals with the tools to run their own business, and providing the supplies at a low cost, not only will members of the community have access to cheap glasses, but the individuals dispensing them will also have a meaningful source of income. Additionally, since a lack of eyeglasses can limit work opportunities, this model could theoretically also help others gain valuable employment indirectly.

Although this solution would not “fix” the problem, or address the shortage of optometrist, it could significantly improve the lives of many, and move the community in the right direction. Additionally, if many individuals are able to access these basic eyeglasses, fewer people will need to utilize optometrists for help, therefore allowing a greater proportion of people who need optometrist care for more serious concerns to access it. Furthermore, the increase in employment could hopefully allow more individuals to get educated, and therefore possibly increase the number of optometrists in the future. In this way, by providing tools for individuals in the community to start addressing the problem (i.e. training in basic eye exams and supplying with low-cost, simple glasses to sell and distribute), the problem of eyeglass access can start to be addressed, while also working towards a greater, long-term solution.