Tag Archives: medical

FreePulse: Testing In Nepal

Editorial note: this post is post-dated to December 28th. Poor internet connectivity prevented me from posting this until now!

FreePulse is a low-cost patient monitor designed for use in resource-constrained hospitals. I’ve been developing this monitor for about three years now, and I’ve been working closely with Access Health Care to design our first on-the-ground test in Nepal. I’m very excited to see where we’ll go and the lessons we’ll learn!

What We’ve Done So Far

The GoFundMe for FreePulse received a humbling and overwhelming response this summer, raising $1000 more than the projected goal. This generosity allowed me to push forward prototyping the fully functional model of FreePulse, which led to steady improvements in the design as well as a steady increase in the amount of wires sprawled out across my desk.

Messy Wires

There were four major areas of improvement that version 1 of FreePulse entailed, so I’ll give a quick overview of the work that was done over the latter part of 2016. Each of these topics could be a blog post in their own right, and I aim to expand on them in more detail in the future.

Improvements to the Software

The software of FreePulse was completely revamped during the summer to use a new modular, sandbox-like approach to displaying graphical elements like signal traces and buttons. You can check out much of the progress on that front in this PR (and on that note, you can always be up-to-date on the latest software progress by checking out the FreePulse GitHub page!). More work is still to be done here, but these modifications have laid the groundwork for expanding FreePulse’s capabilities to display many different kinds of modules and signals.

Addition of Pulse Oximetery

Using a sophisticated and efficient analog front-end chip from TI, a low-cost and hardware-efficient pulse oximeter module was added to FreePulse. This module accepts a standard DB-9 port probe, meaning it is compatible with a wide array of existing pulse oximeter clips.

Pulse Ox

The software algorithms for calculating percent oxygen content are all available on the GitHub page. These algorithms were determined empirically by testing against gold-standard reference pulse oximeters and fine-tuning calibration parameters.

Addition of Semi-Automatic Blood Pressure Measurement

Using a standard connection hose that will fit virtually any existing blood pressure cuff, the non-invasive blood pressure (NIBP) unit was built to provide simple blood pressure measurements at minimal cost and complexity. I added a DC control valve and pressure sensor to control the release and detection of pressure fluctuations in the cuff, and the extraction of pulse rate and blood pressure were performed in software. What this means for the user is that in order to take someone’s blood pressure, you simply have to hit “Start” and pump the cuff up to 200 mmHg with a hand pump. After the cuff is inflated, the deflation and pressure detection is completely automated, making it a very hands-off procedure.

NIBP System

Development of a Printed Circuit Board

After spending so much time with this mess of wires on my desk, it was time to translate that into a clean printed circuit board (PCB) that would be used in the prototype devices. Working with Mrs. Barbara Burcham, an incredibly talented (and patient!) PCB layout professional, we designed and revised a circuit board that saved as much space as possible while retaining full hardware functionality. I’m thrilled with the result, and the biggest testament to Mrs. Burcham’s talent is that the fully assembled board was able to be programmed on the first print! That doesn’t happen very often.

PCB Flashable

Preparing for the First Hospital Test

While improving the technical aspects of FreePulse, I also began working with contacts in Nepal to organize on-the-ground tests of FreePulse’s capabilities. Two organizations played critical roles in supporting this effort: Access Health Care and Innolitics, LLC. In addition to this, an incredibly generous donation from Yujan and Mekha Shrestha was the final gift that covered the rest of the budget for the proposed test trip. With the support of these donors, the testing and evaluation was set for this coming winter.

In preparation for this opportunity, a copious amount of background research and testing was performed to ensure safety compliance and hospital readiness. I began reaching out to doctors in Nepal and gauging community interest in the project, and eventually I determined what hospitals would be optimal fits for FreePulse’s first on-the-ground test. After determining the hospitals, the full weight of effort became preparing a prototype that would be functional both in its operation as well as its form factor. I needed a PCB, and I needed a case!

PCB Flashable

PCB Flashable

For the former, I used the PCB design that Mrs. Burcham and I were developing and fabricated it using OshPark, a community-driven PCB manufacturing site. I then modeled a case for the monitor in Solidworks and fabricated it using an ABS 3D printer. Although the schedule was tight, two functional FreePulse prototypes are now on the ground in Nepal!

What We’re Up To Now

Videographer and media guru Madeleine Dunaway and I are on the ground beginning our visitation of the three hospitals from which we will be testing FreePulse: Amppipal Hospital, Okhaldhunga Community Hospital, and the Annapurna Neurological Institute. Our goal is to demonstrate FreePulse’s efficacy and receive user feedback from doctors and nurses that will guide the development of the next iteration of FreePulse. We are thrilled at the opportunity to work with the doctors and nurses at these hospitals! We hope to build relationships that will help us to better understand what needs are experienced by medical professionals in the developing world and how we can design better medical equipment to satisfy those needs.

I will be blogging about our experience here and sharing the lessons we are learning, as well as sharing some footage of FreePulse in action in the field. Stay tuned here or at my blog to get the latest updates as we begin our adventure in Nepal!

Open Road Nepal

AHCN in Rukum #4 – Getting there and Team Profiles

As some of you may have read, the current AHCN effort in Nepal is comprised of three phases:  1) documenting the health care needs of rural Nepal, 2) conducting rigorous in-field medical, biomedical engineering and public health research 3) providing sustainable solutions for rural health care services and financing hereof in regions of interest.

Of these, our project in Rukum makes up the first phase. In the following days we will post about from our work in Rukum. This first post is a collection of photos of getting from Kathmandu to Rukum. This took three days as we had several stops on the way: the first day we visited Chitwan Medical College Teaching Hospital and agreed to collaborate in this project and in the future. The second day we visited the Nepal Youth Foundation nutrition centre in Dang and that night we would arrive in Musikot/Jumlikhalanga, the administrative centre of Rukum.

Before we start writing about our actual work, we wish to present out team. Hereby short profiles on each member of the in-field team that conducted phase one of our project:
Dr. Justin Jung Malla, M.B.B.S, Licensed Doctor: N.M.C no. 11941. Position at AHCN: Founder and Field Clinical Expert.
Experience:

  • Emergency Dept. Besi Sahar Hospital, Lamjung, Nepal (6 months)
  • Emergency Dept. Chitwan Medical College Teaching Hospital, Chitwan Nepal (6 months)
  • Emergency Dept. Norvic International Hospital Nepal (14 months)

Dr. Saujan Shrestha (M.B.B.S),  Licensed Doctor: N.M.C-no.12162. Position at AHCN: Field Clinical Expert.

Experience:

  • Chitwan Medical College Teaching Hospital, Emergency Department , Chitwan, Nepal (6 months)
  • Neuro Cardio Multi-speciality Hospital, Biratnagar, Nepal (6 months)
  • Emergency dept. and General medicine dept., Biratnagar Hospital Pvt. Ltd. Biratnagar, Nepal (14 months)

Mr. Rajkumar Silwal, MBA graduate from University of West London with great enthusiasm to support and improve health care in rural Nepal. Good management skills with a combination of leadership, communication, strategic planning and effective decision-making attributes. Experienced semi-professional photographer.
Position at AHCN: Director of Finance and Administration. Photographer. 

Mr. David Kovacs, B.Sc of Biomedical Engineering from the Technical University of Denmark and University of Copenhagen. Position at AHCN: Founder and President. 

Experience:

  • President of Engineering World Health at the Technical University of Denmark (10 months)
  • DUKE-EWH Summer Institute in Tanzania 2014 participant (2 months)
  • Volunteer at Chitwan Medical College Teaching Hospital (4 months)
  • Research Assistant at Rigshospitalet, Copenhagen University Hospital (12 months)
  • Accepted as On the Ground Assistant at EWH Gutatemala Winter Institute 2014/2015 (to be 1 month)

The following gallery is a collection of pictures of our team on our way to Rukum.

ACCESS HEALTH CARE IN RUKUM NEPAL #2

It’s not always easy to conduct health projects in a country with an infrastructure like Nepal.

The last two days the AHCR has had meetings with Professor at Chitwan Medical College, Dr. Harish Chandra Neupane and Mr. Nirmal Rimal, project coordinator at AMDA Nepal. Both have shown a great support of our work. We are truly thankful for the guidance of Dr. Harish and Mr. Nirmal Rimal!

Furthermore AHCR has initiated a collaboration with Mr. Nirmal Rimal of AMDA-Nepal and through them, we will assist the Nepali Red Cross in Rukum to perform HIV/AIDS tests of the people we will treat.

See more about AHCR on our page.

Paediatric Size Blood Pressure Cuffs and Pulse Oximeters

Paediatric Blood Pressure Cuffs and Pulse Oximeters, KCMC, Moshii, Tanzania
Sister Petrolina, Head of the Paediatric Department at the KCMC with paediatric size blood pressure cuffs and clip-on pulse oximeters.

Shortly before we left the KCMC this August, we found out that it was not rare for hospitals to be lacking various equipment in paediatric size. In consequence it would not be possible to measure the oxygen saturation and blood pressure of children. In some cases lack of paediatric size tubes made it impossible to intubate children in need of a ventilator to assist their breathing.

Most of these products could probably be made pretty easily with a bit of creativity. This should give ideas for some design projects for most biomedical/design engineers.

We had a small budget for our various projects from the EWH and we decided to spend what we had left to buy blood pressure cuffs in paediatric size and clip-on pulse oximeters for the paediatric department at KCMC.