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Nebulizer Project

Nebulizer Project. Matthew Lawrence Brockman Daniel Puthenpurayil George Nathan Joseph Hankins Marissa Kathleen McHugh. Outline. I. What’s a Nebulizer, Needs Assessment & Scope of Work - Matthew II. Our Design – Matthew III. In-Country Implementation – Nathan

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Nebulizer Project

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  1. Nebulizer Project Matthew Lawrence Brockman Daniel Puthenpurayil George Nathan Joseph Hankins Marissa Kathleen McHugh

  2. Outline I. What’s a Nebulizer, Needs Assessment & Scope of Work - Matthew II. Our Design – Matthew III. In-Country Implementation – Nathan IV. In-Country Training – Marissa V. Issues Encountered – Daniel VI. Evaluation/Feedback – Nathan VII. Cost Analysis – Daniel VIII. Testing and Results – Matthew IX. Sustainability and Ownership – Matthew X. Entrepreneurial – Nathan

  3. What’s a Nebulizer • Compressor, filter, tubing, cup, mask • Compressor not a medical device, simply supplies air • Cup aerosolizes water with medication

  4. Needs Assessment: Respiratory Problem Causes • Environmental effects • Desert climate • Dryness • Wind • Dusty air/Dust storms • Allergenic trees • Garbage and vegetation burned near homes • Indoor cooking fires • Cockroach infestations Factors contributing to high prevalence of respiratory problems:

  5. Needs Assessment: Nebulizer Availability Problems receiving nebulizer treatment: • Limited availability at local clinics • Only 1-2 nebulizers • Walking distance • Closed on weekends • Open 7AM to Noon • Frequent power outages • Days designated for non-respiratory problems • High cost (about $100) compared to salary

  6. Scope of Work and Needs Assessment • Problem Statement: Deliver a simple, home-made nebulizer and an instruction manual • Costumer: • Resistants of Choluteca, Honduras who suffer from respiratory problems • Larry and Angie Overholt • Needs Assessment: • Large portion of the population suffers from asthma • Environmental causes • Low availability of nebulizers

  7. Our Design • Filter filters to about 10 micrometers, car or motorcycle fuel filters will work similarly • Bike pump acts as compressor • This project uses actual nebulizer cup, mask, and tubing • Soccer ball filters out the duty cycle of the pump as a capacitive element

  8. In-Country Implementation The team’s main goals were as follows: • Source local parts • Treatand take data in health departments and villages • Train people in health departments and villages on how to build and use • Distribute manuals on operation and creation of device • Donate a nebulizer to each village • Gain local feedback

  9. In-Country Implementation: Week 1

  10. In-Country Implementation: Week 1

  11. In-Country Implementation: Week 1

  12. In-Country Implementation: Week 1

  13. In-Country Implementation: Week 1

  14. In-Country Implementation: Week 2

  15. In-Country Implementation: Week 2

  16. In-Country Implementation: Week 2

  17. In-Country Implementation: Week 2

  18. In-Country Implementation: Week 2

  19. In-Country Training • The training process involved: • Demonstration of assembly and operation • Explanation of evaluation forms • Review and distribution of manual • Distribution of posters

  20. In-Country Training • Constructed a user manual • Instructions for assembly • List of materials including pictures, prices, and store names • Directions for usage and sanitation • Reservoir recommendations • Troubleshooting

  21. In-Country Training • Distributed laminated, color copies to public health departments and Dr. Giron’sclinic, the women’s group in Sietede Mayo, and Mr. Carlos from Cambridge. • Distributed black/white copies to woman in Choluteca, woman in La Bonanza, public health departments, Dr. Giron’sclinic, and at Farma City.

  22. In-Country Training • All places visited followed the same basic pattern • Trained doctor(s) and nurses • Trained asthma and non-asthma patients and parents

  23. In-Country Training • Taught nurses how to use peak flow meters • Taught nurses how to complete the pre/post evaluation forms

  24. Issues Encountered • Transportation dependability • Quality of Honduran materials and healthcare • Given “North American Prices” – Prices also varied • Quantity and age of patients • Language Barrier – Quality of our instruction may have varied • Creation of the manuals – Far walk to print

  25. Evaluation/Feedback • Cheap; most who need cannot afford electric nebulizer (L1,800), ours cost L343 • Generally preferred reservoir design • General public eager to learn (passed out over 100 manuals) • “Our country needs this” • A few people were hesitant at first – required additional explanation

  26. Evaluation/Feedback • People were often excited by the design and would tell others - Cambridge teacher had told students and staff members including the security guard • Doctor at Namasigue said it was a useful design because often patients are without electricity

  27. R&D Cost Pre-Trip

  28. R&D Cost During Trip

  29. Total R&D Cost • Mostly from purchasing balls and prototyping materials • Large purchase of the filters to donate

  30. Per Nebulizer Cost – United States • Using a size 5 soccer ball and the cheapest of the other materials, one nebulizer cost the team approximately $30.57 • Without a reservoir, the nebulizer cost approximately $13.75

  31. Per Nebulizer Cost – Honduras • Cost with reservoir: $16.73 • Cost without reservoir: $9.17 • Hondurans can likely get these items for a lower price – One person commented they could get a soccer ball for L. 80.00

  32. In-Country Testing Regimen • Assess situation • Pre-treatment baseline measurements • Qualitative testing • Quantitative testing • Post-treatment evaluation • Qualitative analysis • Quantitative analysis

  33. Pre and Post-Treatment Qualitative Testing • List observations related to breathing (Is patient coughing, wheezing, gasping for air, etc.) • Doctor/Nurse observations or comments

  34. Pre and Post-Treatment Quantitative Testing • Have patient blow into peak flow meter three times, take maximum • Ask patient to rate difficulty of breathing from uno to diez, unobeing perfect lung function

  35. Post-Treatment Quantitative Analysis • Have patient blow into peak flow meter three times, take maximum • Apply Equation 1 to find percent increase • Ask patient to rate difficulty of breathing from uno to diez, unobeing perfect lung function • Report difference

  36. Testing: Results • Treated 14 patients while in country: yielded 8 numerical data points • Honduran Nurse at the private clinic collected 2 control data points and 4 more data points using our nebulizer • The power of the test will be low, will hopefully increase as our contacts continue to take data • Alpha level of 0.05 (medically standard) • Null Hypothesis: The average percent increase in peak flow for the medical nebulizer is the same as the average increase in peak flow for the home made nebulizer. • Alternative Hypothesis: The average percent increase in peak flow for the medical nebulizer is greater than the average increase in peak flow for the home made nebulizer.

  37. Testing and Results • p-value was 0.413 • We therefore fail to reject the null hypothesis that the two means are the same • Little data so far

  38. Observational Results • Treatment had qualitative success • Stopped bronchospasms in one patient • Patients reported less or no difficulty breathing post-treatment • Some children fell asleep while using the nebulizer

  39. Sustainability and Ownership • Made from locally available parts for low cost: sustainable supply of nebulizer • Ownership: instructions for constructing • Trained variety of individuals • Targeted individuals/groups who are most likely to continue using the device and teach others – parents

  40. Sustainability and Ownership • Cambridge teacher will continue to spread the idea • Posters and manuals at health departments • Dr. Giron will make and distribute nebulizers

  41. Entrepreneurial Opportunities • Demand exists • Product: Nebulizer kit and manual • End user: Asthma patients • Costumer: Philanthropic or Social Enterprise • Non-profits such as NGOs • Social entrepreneur • Dr. Girón • Roger Henriquez • Carlos Ferrera

  42. Conclusions • This was a reasonably successful pilot study • There is a need for this project in the developing world • Well-perceived and culturally acceptable device • Future studies should collect more data • Failed to reject the null hypothesis that this method is as effective as the medical nebulizer.

  43. Acknowledgements • Roger Dzwonczyk • Mariantonieta Gutierrez • Angie Overholt and the entire WGM team • Anna K Young • Kathy Stone • Duane Hart • Nationwide Children’s Hospital

  44. Questions?

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