Low-Tech Medical Devices Save Lives

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For a slide show of Gómez-Márquez’s inventions at utne.com/medicaltechnology.

José Gómez-Márquez’slaboratory at MIT seems to be part toy store, part machine shop, and part medical center. Plastic toys are scattered about, along with a disassembled drugstore pregnancy test, all manner of syringes, and a slew of fake body parts. Coffee filters have been transformed into paper-based diagnostics; a dime-store helicopter provides the design for a new asthma inhaler; even a toilet plunger has been put to use, rigged with tubes and glue to form a makeshift centrifuge.

“Centrifuges break down all the time,” says Gómez-Márquez, spinning the plunger’s wooden handle in his hands. That’s a problem for health care workers, because even simple medical tests rely on them to separate molecules in a blood or urine sample. In rich countries, the broken equipment is quickly repaired or replaced; in the poor countries where Gómez-Márquez works, finding replacement parts can be impossible, rendering the equipment useless. So he has tried to use readily available materials to make simple versions that are either easy to fiddle with, disposable, or unlikely to break in the first place. “This one could work even without power,” he says of the plunger-cum-centrifuge.

Gómez-Márquez, a native of Honduras, is a talented tinkerer: “My mother used to say my toys would last only a few days because I would take them apart, saying I had detected a defect,” he recalls. But he is also an inventor on a mission. “When you grow up in a developing country,” he says, “you get the sense that fancy technology is expensive to replace, so it often doesn’t get replaced.”

Some might say that Gómez-Márquez was born to improve medical technology. In 1976, when prenatal ultrasound was not available to his mother’s doctor in Honduras (it was just catching on in the United States), the physician mistakenly concluded that she was carrying twins and miscalculated how far along she was in her pregnancy. She was induced to give birth in what was actually her seventh month, and Gómez-Márquez–no twin in sight–was born with the numerous health concerns typical of an underweight and premature infant. He escaped long-term damage, but thanks to a childhood spent in and out of doctors’ offices, he developed a profound sense of how important health care is, how capricious access to it can be, and how much medical devices can do to improve it.

Gómez-Márquez left in the late 1990s to attend college in the United States. But his education was sidetracked by Hurricane Mitch, which devastated Honduras in 1998. With his parents in Tegucigalpa no longer able to help pay his tuition, he began working a variety of jobs to support himself, and eventually ended up at Worcester Polytechnic Institute in Massachusetts.

In 2005 the fledgling inventor joined a team participating in MIT’s IDEAS competition, which aims to develop new technologies or programs that will have a positive impact on the world. His team focused on new ways to deliver the measles vaccine; the disease, though nearly eradicated in the United States, still kills more than 500 people a day, mostly children, worldwide. Gómez-Márquez and his colleagues decided to develop a needle-free system for use in poor countries.

Administering injectable vaccines takes training, and the team wanted “a device that would allow any community health care worker, rather than a trained nurse, to give a dose of vaccine,” Gómez-Márquez says. Most needle-free vaccination systems relied on aerosolization technology that is cumbersome and requires electricity.

After examining prototypes of new kinds of devices from drug delivery and engineering firms, Gómez-Márquez quickly decided that existing approaches were much too complicated. “The device was sitting in a fancy box in eggshell foam,” he says of one prototype he studied. “If it needs foam to survive a trip to New England, it’s never going to make it to Central America.”

Taking inspiration from the disposable cartridges used in ink-jet printers, Gómez-Márquez’s team designed individual vaporizers preloaded with the correct dose of vaccine; the devices could be used once and then thrown away. The team also developed a way to stabilize the vaccine within the cartridges, eliminating the need for cold storage.

Other researchers who have worked on vaccine nebulizers have tried to modify asthma nebulizers, which are neither disposable nor cheap. “If the aerosolizing head broke, the machine had to be sent back,” Gómez-Márquez says. “In our case, because it’s just 10 cents, you can throw the broken one away and pull another one out of the box.” Most nebulizers also require a power source to run the compressor, which converts liquid medicine into vapor. Gómez-Márquez’s team made sure their system can be powered by another source–a foot pump, for example–when electricity isn’t available.

The resulting device won an Award for International Technology at the IDEAS competition in 2006. “That gave me the idea that I could really do this for a living,” Gómez-Márquez says. The team is still improving the device, with funding from the U.S. National Institutes of Health.

Amy Smith, cofounder of the International Development Initiative at MIT, was so impressed with Gómez-Márquez that she hired him to run the Innovations in International Health program, also at MIT, in 2007. He has since built a network of collaborators around the world who can tell him about their people’s health care needs. That kind of consultation, which lies at the heart of Gómez-Márquez’s philosophy, reflects a growing trend in the field of appropriate technology: collaborating early on with the people who will use the devices.

“José is really at the forefront of that,” says Catherine Klapperich, director of the Biomedical Microdevices and Microenvironments Laboratory at Boston University. “Who is the customer, what do they want, what are they willing to use? You can’t assume the answers–that’s one of the things José teaches his students and his colleagues.”

Gómez-Márquez aims to encourage physicians and scientists in poor countries to design their own devices. He is creating development kits for medical technology–sort of like Erector sets for medical professionals–that will enable doctors and medical students to devise diagnostics, drug delivery devices, microfluidic chips, and more.

At least, that’s the theory. But will busy medical professionals find the kits helpful? Are they too complicated to use or, conversely, too simple to yield useful technology? Gómez-Márquez and his students take them to Nicaragua regularly, hoping that the kits will help a new culture of invention take root. In the long term, an approach like his could truly revolutionize both medical care and technology in poor countries.

Excerpted from Technology Review (Sept.-Oct. 2009), a tech magazine that’s wonky enough for techies, yet accessibly written for the rest of us. Copyright © 2009 Technology Review.


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