Medical basics still needed in Developing World

Despite all the progress and promise of modern medicine, most of the world is still struggling to get the fundamentals of medical care: simple diagnostic tests, affordable medicines, and efficient supply distribution, several Harvard specialists said today.

During the AAAS symposium “High-Tech, Low-Cost Medicine: A New Paradigm for Global Health,” the doctors and researchers pointed to small bits of progress, while emphasizing the huge amount of work and investment that is still needed. The problems are huge, expensive, and widespread, they said, especially in places like Rwanda, Cambodia, and Haiti.

“We need to bring together the people who sit in the laboratories and develop these things with those in the field,” said William R. Rodriguez, an Assistant Professor of Medicine at Harvard Medical School (HMS) and infectious-disease specialist Massachusetts General Hospital. Workers in the field, who are not necessarily physicians, need access to simple, rugged, reliable,  low-cost diagnostic systems, inexpensive drugs, and simple record-keeping systems. They also often need additional training.

Rodriguez showed photos of a Haitian patient who was skeletally thin because of HIV infection. But within nine months, given proper treatment and care, he looked robust and healthy, and had also trained himself to give medical advice and help to other Haitians. He had become a full-time health worker, showing what can be accomplished even in poorly supplied areas.

In the African nation of Rwanda, Rodriguez said, people who recently experienced a horrible episode of genocide are struggling to put together an effective medical care program. But despite huge increases in funding aimed at combating HIV in Africa, progress is hampered by high costs, the difficulties of diagnosis, and simple lack of communication among health centers. It costs about $140 a year to treat a patient for HIV infection, for example, while that patient’s annual income may be only $75.

According to Shiladitya Sengupta, an HMS Assistant Professor of Medicine and specialist in health sciences and technology at Harvard-affiliated Brigham and Women’s Hospital (BHW), about 90 percent of the world’s investment in medical research benefits only the most affluent 10 percent of its population. “That translates into 5 billion people” who are essentially left out, he said, and inadequately served. Most of them live in developing nations in Africa, Asia, and Latin America.

Sengupta said the way forward is to “generate future leaders who can bridge the challenges.” And the result has to include medical care that is low cost but highly innovative. “We must use technology to improve the efficacy of existing drugs and develop point-of-care diagnostics” that can be used reliably under difficult circumstances.

In one example, Sengupta showed drawings suggesting how drugs might be combined, so more than one drug can be delivered in a single dose. Such treatments might include large particles with nanoparticles trapped inside; for example, a chemotherapy drug could include a smaller steroid compound, providing an anti-angiogenesis drug aimed at controlling cancer.
Sengupta also pointed to existing developments, such as the Jaipur leg, an artificial lower leg developed in India that restores mobility to amputees. He showed pictures of one patient easily climbing a tree, jumping out of it safely, and then riding a bicycle.

Utkan Demirci, an HMS Instructor in Medicine at BWH, added that there are numerous challenges facing those who provide medical care abroad. Among the needs are inexpensive disposable syringes, drugs that can be delivered in small amounts, and blood-cell-counting systems to measure HIV infections. Ideally, there should also be “point-of-care” diagnostic devices, such as a blood-testing system that goes “direct from finger to device. They must be high-throughput and low cost, for use at the point-of-care.”

Demirci urged that research be done toward developing simple and robust systems based on technologies such as micro-fluidics, fluorescence, and optical devices. Of course, they must also be inexpensive and easy to use.
Such work, if successful, he added, would help “solve some of the biggest problems of the developing world.”

Rodriguez has been working on Third World medical problems for almost a decade. As a result, a new hand-held blood-testing device has been created that should be of great use in poor regions. It is small enough to be hand-carried, and is sturdy and reasonably accurate.

He said progress was accelerated when the people designing medical devices were actually taken to Third World sites to see the conditions under which medical care is given. Thus the engineers learned they must make devices that work reliably in wet, humid, and dusty conditions, after perhaps being carried for miles on the back of a motorbike.

“We’re not trying to be perfect,” he said. “But [this device] is pretty good; it is acceptable. It means we don’t have to wait days or weeks” for blood test results to be sent back from a distant laboratory. “We’re also looking at particle-separation devices” to catch and identify microbes such as bacteria and viruses so they can be identified before treatment.

He added that critical work is still needed in aligning the activities of funding agencies, manufacturers of devices and drugs, distributions systems, and government regulatory agencies. “We need to have clear alignment” that could lead to “transparency” among the companies, agencies, and the workers involved. “There’s no clear way to get everyone together, although a few agencies are trying to do that. Companies and NGOs [non-governmental organizations] are working on the distribution processes.”