Tuesday, July 7, 2009

Thinking outside the box

Transforming health care delivery around the world


Thinking outside the box is nothing new for 38-year-old Massachusetts General Hospital pediatrician and internist Kristian Olson, MD MPH, of the Center for the Integration of Medicine and Innovative Technology (CIMIT) Global Health Initiative. Long before Olson began leading the program in 2007, he had made it his mission to enhance the health care in developing countries around the world by offering not only compassionate hands-on clinical care but also pioneering new low-cost, sustainable, innovative technology and solutions.

The 2003 inaugural recipient of the Thomas S. Durant, MD, Fellowship in Refugee Medicine, Olson has since served in medical programs in areas including Darfur, Sudan; Aceh, Indonesia; Cambodia; Ethiopia; and the Thai-Burmese border. His experiences providing care in these settings, combined with a personal milestone of the birth of his triplets in 2006, inspired him to focus on the improvement of neonatal care in rural countries founded on local partnerships in the regions.

The parts

Olson has led major health initiatives based on innovative medical devices — a handheld neonatal resuscitator that was implemented in Aceh and a car-part neonatal incubator. These pieces of equipment are inexpensive, simply constructed, easily maintained or replaced and, most importantly, are life-saving.

“Approximately one million newborns around the world die each year from asphyxia,” Olson says. “These babies die in their first day of life, often rurally and with no skilled birth attendant. Sadly, there is little programmatic focus on this often easily preventable cause of death.”


In focusing on improving neonatal health care in developing regions, Olson carefully considered not only the resources in the local areas but also the caregivers’ resources within the communities and the training required to use and maintain the new types of tools and equipment.

In Aceh, he realized that by and large, the primary health providers for expectant mothers — local midwives — could not afford to purchase or replace any medical tools that were to be used relatively infrequently and for a one-time use. One tool, in particular, the bag valve mask, helps to resuscitate asphyxiated newborns. At $30 each, the bag valve mask was too expensive for midwives to have on hand in cases of newborn asphyxiation, and often babies who simply needed a little assistance in taking their first breaths would die. Olson and his team realized that there was a critical need for a low-cost resuscitation device that was both inexpensive and reusable.

Considering these factors, Olson discovered a locally manufactured, reusable alterative to the bag valve mask. At only $8 each, the Tekno-Tube — a plastic tube with a small mask fitted on one end — allows the midwife to safely blow into the baby’s mouth and help it breathe if asphyxia presents at birth. To promote the adoption of the Tekno-Tube by the Aceh midwives, Olson and his team established a simple yet comprehensive and successful training program. Nearly 500 midwives have been trained and have the opportunity to take refresher training every four months.

“We realized that early on in the process of addressing our goal to improve neonatal health care in rural areas, we needed to partner with local caregivers overseas,” says Olson. “The Tekno-Tube is such a simple device that has worked and saved lives mainly because it has been accepted and used by the midwives.”

Olson describes how the midwives in Aceh proudly take him to meet the young children who they’ve saved using the Tekno-Tube.

Making the honor roll

Olson also has led his team in the development of another neonatal life-saving device that has received much acclaim; even leading to Olson’s being named to Scientific American’s Top 10 Honor Roll. This distinction recognizes individuals who have demonstrated leadership in applying new technologies and biomedical discoveries for the benefit of humanity.

Similar to the Tekno-Tube, the neonatal car-part incubator stands to enhance the effectiveness of health care providers in rural countries by offering the local caregivers a low-cost, effective and easily maintained medical device.

“We were determined to create an effective incubator whose cost to maintain did not exceed the caregivers’ means,” says Olson.

Olson considered materials that are generally ubiquitous in countries around the world. The solution was car parts. By using the car’s headlights for heat, the fan for circulation and temperature control, the air filter system for cleaning the air and the car door alarm for signaling emergencies, the simply constructed and easily repairable incubator is now in its initial stages of development, but is poised to soon help reduce the number of premature birth-related deaths around the world.

“We were not just focused on immediate needs,” says Olson of the Tekno-Tube and car-part incubator. “Instead, we hoped to promote the success of the local providers’ by offering both targeted training and medical technologies so these community caregivers could offer the best care possible.”

Olson plans to continue his work focused on transforming health care delivery around the world through the development of new, innovative technologies; effective training; and by stimulating local economic development. “We need to work with providers overseas,” stressed Olson. “As the most valuable sources, our partners in these countries ultimately will be the ones to advance the local health care, its delivery and health technology innovations.”

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