GLOBAL HEALTH INITIATIVE

Almost one-half of the world’s population—nearly 3 billion people—lives on less than $2 a day and, for them and millions more, access to healthcare is largely determined by economics. Medical needs in low-resource regions are daunting; however, by working with the local people and focusing on critical targets, CIMIT’s Global Health Initiative hopes to make a significant impact in the following ways: • Identify leverage points for technology solutions to make local healthcare practitioners more effective • Develop instruments, equipment and training programs for low-resource settings

CLINICAL PROBLEMS in GLOBAL HEALTH
Maternal and Child Health The Global Health Initiative is focused on improving maternal and child health. In developing regions around the globe, maternal and child health suffer for complex reasons. At-home births are often customary and preferred, usually occurring without the presence of a skilled attendant, and most of the 529,000 women worldwide who die each year in childbirth or post-delivery live in these austere environments. Neonates in such areas are also at great risk—4 million who are born viable die within the first 28 days of life each year, and 98% of these deaths are in under-served regions around the globe. COMMUNICABLE DISEASES Communicable diseases account for 36% of the total deaths in low- and middleincome countries. One third of the world’s population is infected with tuberculosis and approximately 40 million people live with HIV/AIDS. A group of 13 tropical diseases are collectively termed the “neglected tropical diseases” and help comprise the most common chronic infections among the world’s poorest people. Identifying those with these infections and tracking their response to treatment is often inaccurate or impossible, a shortcoming that prevents the optimal use of precious medical supplies.

SEEKING CLINICAL SOLUTIONS
CIMIT is working through its broad network of experts—both in the US and abroad—to identify both key problems and elegant solutions. Midwives, when available, have few tools and little training on methods to stop bleeding, ease complicated births, and ensure clear breath pathways of newborns. But, with relatively simple, clinicallytested interventions, many such premature deaths among mothers and infants are preventable, and new devices can be designed for more optimal performance in these settings. For example, one of the first CIMIT-funded projects in the Global Health Initiative program is the development of a new type of neonatal isolette made from auto parts, a resource that is widely distributed throughout the world. This technology will be far less susceptible to local conditions such as fluctuations in power supply and weather, and parts for repairs will be readily available and lower cost. All too frequently, health providers in the developing world are forced to practice in the absence of diagnostic laboratories. A combination of a lack of infrastructure, high costs, and the absence of trained personnel are all barriers. However, recent innovations in diagnostic technologies hold promise both in the identification of patients in need and monitoring of their response to treatment.

One example is a CIMIT-funded project to support the development of a CD4 cell counter that utilizes microfluidic technology to help align diagnostic capability with those most in need as anti-retroviral therapy for HIV is scaled-up. This technology will require little training to operate, will be of much lower cost than current CD4 counters, and will be deployable in remote settings with minimal infrastructure. These problems cannot be solved with technology alone, but it is an important part of the solution. Equally important are the use of local expertise and a clear understanding of site-specific resource constraints. By including local people- both would-be patients and those who are part of the existing health systems- as consultants in the target communities, new initiatives can overcome problems such as incorrect identification of needs and distrust. Furthermore, training healthcare providers at the local level with optimal tools and techniques is necessary to improve outcomes and instill greater confidence in the healthcare being provided. As local people learn that high mortality rates are not inevitable, healthcare assistance is more likely to be sought when needed.

The INITIATIVE
The Global Health Initiative is led by Dr. Kristian Olson, an internist/pediatrician on staff at the Massachusetts General Hospital. Dr. Olson was a Fulbright Scholar to Australia where he earned a Master’s of Public Health degree in Epidemiology and International Health. Dr. Olson was also the first MGH Thomas S. Durant Fellow in Refugee Medicine and obtained a diploma in Tropical Medicine & Hygiene in London. Dr. Olson has served in some of the most resource-poor settings in the world including refugee camps along the Thai-Burmese border, in tsunami-affected regions of Sumatra, and on health projects in Cambodia, Kenya, and Darfur. He currently serves as a board member of the Cambodian Health Committee. Dr. Olson has worked with governments as well as local peoples to identify needs and develop site-specific solutions designed with the available resource constraints in mind. In his role as Program Leader of the Global Health Initiative, Dr. Olson will assist in the development of innovative devices such as the afore-mentioned isolette for neonates built from car parts. Selected CIMIT Global Health Initiative Projects Car-part isolette for neonates Development of a prototype microfluidic detector enabling CD4 T cell counting in HIV/AIDS Disaster response: a national priority – addressing medical device surge capacity Interdigitated electrodes for disposable HIV diagnostics Integrated microfluidic platform for detection and diagnosis of avian influenza CIMIT
CIMIT fosters and nurtures interdisciplinary collaborations among world-class experts in medicine, engineering and science, in concert with industry and government, to rapidly improve patient care. A non-profit consortium of Boston-area teaching hospitals, engineering schools and laboratories, CIMIT provides innovators with resources to explore, develop, and implement novel technological solutions for today’s most urgent healthcare problems. For more information, contact CIMIT Communications at cimitcommunications@partners.org or call 1-617-643-3830. Please visit www.cimit.org.

Kristian Olson, MD, MPH, DTM&H CIMIT Program Leader Global Health Initiative krolson@partners.org

Global Health Initiative Mission Statement
To improve the effectiveness of health care providers in low-resource settings through the development of targeted technologies and by catalyzing effective training.