There was a deathly sound in the ward, of lungs struggling,
and wheezing. Most of the patients were children, with a variety of
winter respiratory diseases, including but not limited to Pneumonia.
Around
each bed, loved ones stood guard. Fathers and sons, mothers and
daughters. They looked on as their own fought for their lives. And to
make things even more difficult, some of these loved ones, were bent
over a machine, pumping precious air into the lungs of their children.
Dr. Mujeebur Rahman was one of them.
"My nephew had been brought in from Sahiwal, and as his condition went
from bad to worse, there was no ventilator available for him."
"What
we were given instead was an ambu bag which is generally used as a stop
gap arrangement to save a patient’s life. Me and three other people
took turns on this bag to make sure the child got his body’s requirement
of air."
The lack and state of ventilators in public
hospitals across the province is nothing new. According to a leading
newspaper, a report recently filed by the Provincial government in the
Supreme Court alleges that out of the 885 ventilators available across
the province, at least 122 are dysfunctional.
That is
nearly 14%. The same report claims that while many faults have been
repaired locally, major defects cannot be resolved in the short term due
to the unavailability of certain high tech parts which have to be
imported from manufacturers and/or agents.
A lack of working ventilators means patients are given ambu bags for manual ventilation. Dr. Rahman's version aims to removes human error from the process ─ MIT review Technology
Numerous deaths have also been attributed to these
damaged ventilators. Just last December, at least ten children died in a
leading public hospital in Lahore due to dysfunctional machines.
With
the number of working ventilators low, it is a challenge for most
people to get access to the life saving machine. Especially in public
hospitals. And that’s where the ambu bags come in.
Even for a person with no medical background, it is easy to see that this manual ventilation method is a recipe for disaster.
The
human heart is a perfect engine. It regulates the pace and pressure of
air into the lungs. But when the heart is unable to pump enough air into
the lungs, intervention is necessary, and that’s where the ventilators
come in.
Most private hospitals have a much better
ventilator to bed ratio as compared to public hospitals, but since they
are business oriented, these private hospitals charge exorbitant rates
for the use of the machines. Rates that most of Pakistan cannot afford.
And
so, Dr. Rahman’s young nephew fought for his life, for three days and
three nights, in a public hospital, breathing through an ambu bag. And
soon faded away.
An electrical engineer from the
University of Engineering and Technology (UET), Lahore, Dr. Rahman had
recently returned from the United States after completing his Masters
and PhD from The California Institute of Technology (Caltech), one of
the world’s leading institutions in the field of science and technology.
Now, he felt helpless.
“As an engineer, I couldn’t
reconcile myself with the state of affairs in the ward, that too in the
21st century,” says Dr. Rahman, who is now an Assistant Professor of
Electrical Engineering at Lahore's Information Technology University
(ITU).
"I now had a choice to make: either I could sit and fume, or I could use my engineering acumen and look for a solution."
The good doctor chose the latter.
The
idea was not to reinvent the wheel, but to create a product that could
at the very least, take out the human errors involved in using an ambu
bag as a ventilator. So the decision was made to automate the ambu bag.
"It’s
much easier to accept something familiar," Dr Rahman says, "if we’d
gone out and built something completely different, there would be
challenges in getting it accepted."
At the heart of the invention is a motor regulating flow rate and tidal volume ─ MIT review Technology
With a mechanical engineer from UET, the process of
invention began, and as with most such efforts, it all started on paper,
with some preliminary sketches. From there, they moved towards
mechanical designs, and soon enough, the design was ready.
At
this point, Dr. Rahman felt that a full time resource was needed, which
is when his associate Saad Pasha came on board, as a research associate
provided by ITU.
Together the two have put together what is version 0.1 of the low cost ambu bag ventilator system.
Both parameters can be monitored via sensors connected at both ends ─ MIT review Technology
"Clearly there is a lot of optimisation that can happen,
in the weight, size and form of the device," says Dr. Rahman. "And as
with all things medical, this needs to now go into a testing phase after
which it can be rolled out."
At the heart of the
invention is a motor, that regulates the flow rate and the tidal volume
of the ambu bag. Both these two parameters can be monitored via sensors
connected at both ends, the motor and the ambu bag.
These
sensors not only help in ensuring that the correct parameters are being
delivered, but also come in handy when and/if the device develops a
fault. A standard 12 volt battery powers the device. "At the end, we
want this to be a handheld device," says Dr. Rahman. The money needed to
build the prototype came from ITU's research fund, which is made
exclusively for such projects.
There are at least two
major challenges ahead. The crucial step is testing. For the device to
be accepted, it needs to go through a rigorous process where it is first
tested and monitored on animals, and then human testing may begin. Then
if it meets certain regulatory standards, it can be allowed for mass
scale production.
However, in in-house testing, the
device has performed remarkably well: where human input has been
terribly scattered, the device has been exactly on point.
The
other challenge is scalability. This prototype is handmade. Most of the
components are locally sourced, from areas like Hall Road and Brandreth
Road, which are more renowned for their audio and spare parts shops
than components for lifesaving equipment. If the ventilator is to be
mass produced, it will need to be an assembly line production.
As
a start, Dr. Rahman believes that his team can hand make up to ten
ventilators, which can be installed at a single hospital. There, both
the doctors and his team can work together to monitor the devices for
effectiveness, precision and faults.
"One problem with us engineers is that we build something and then put it away on the shelf to gather dust," admits Dr. Rahman.
"I don’t intend on letting this happen to the ventilator."
This piece first appeared on MIT Technology Review Pakistan and has been reproduced with permission.
