Santa Clara University

STS Nexus

The Affymetrix Health Award

Craig Stephens

craig stephens

Introduction

This year we considered 60 applications for the Affymetrix Health Award, hailing from 20 countries. The applicants worked on a diverse range of technologies addressing many globally significant health issues, and the diversity and quality of the pool created welcome challenges for the selection panel. We were excited by technological novelty and creativity, but we also took very seriously the Tech Awards mantra: “Technology Benefiting Humanity.” Many projects sound like great ideas, but never make it out of the laboratory for practical implementation in the real world. We looked for projects that were successfully translated from concept to operational reality, with documented tangible benefits to human health upon implementation.  Most of the projects honored in the Health category this year would feel right at home in Silicon Valley.  Two of the Laureates, SATELLIFE and the Fritz Institute, are leading the way in using some of Silicon Valley’s favorite Information and Communications Technologies (ICTs) to connect relief workers and healthcare providers around the world. Another of this year’s honorees, the LSTAT trauma care platform, integrates streamlined medical technology and state of the art ICT into a uniquely portable patient care platform. LSTAT and the fourth project honored this year, the Infrared Fever Screening System, a sophisticated thermal imaging system, are undeniably cool—and what more could a Silicon Valley technophile want? By comparison, the final project honored this year, the UV Waterworks water treatment system, might be considered “low-tech,” but this deceptively simple, elegantly engineered device probably has saved thousands of lives already, and may save millions more in the future by reducing waterborne disease in the developing world.

 

Fritz Institute, San Francisco, California, U.S.

A daily glance at the news is enough to remind us that the world is continuously beset by humanitarian disasters. Humanity is powerless to prevent devastating acts of nature, from earthquakes to hurricanes, floods, and drought. Sadly, we also cannot seem to find ways to stop the man-made humanitarian crises of wars and civil strife. Technology can, however, reduce human suffering in times of upheaval. Organizations such as the International Federation of Red Cross and Red Crescent Societies (IFRC) are early responders to humanitarian crises in the third world. Rapid and effective direction of relief supplies and personnel to crisis sites is a daunting task.

The Fritz Institute, a non-profit organization based in San Francisco, has developed logistics management software tailored for relief organizations, allowing them to operate more effectively and respond more quickly to crisis situations where time is of the essence. The Fritz Institute was founded by Lynn Fritz, the founder and former CEO of Fritz Companies, which specialized in international shipping and logistics management until it was acquired by United Parcel Service in 2001. Fritz realized that sophisticated logistics management practices could be extremely useful for international relief agencies, just as they are for shipping companies and far-flung international corporations. The Fritz Institute was founded with the mission to “enhance the operations capabilities of humanitarian relief organizations, by mobilizing resources and expertise from the corporate and academic communities.”

Humanitarian Logistics Software (HLS) was created by the Fritz Institute after reviewing the logistics needs of the largest humanitarian organizations in the world, including the IFRC. HLS is a globally-accessible, Web-based system that operates from a “General Framework Module” incorporating organizational structure, geographic information, a comprehensive relief supply database, currency exchange rates, delivery and payment terms, and other data. Coupled to the general framework module are Mobilization, Procurement, Logistics and Tracking, and Reporting modules. Working together, these modules streamline operations of the relief organization, allowing it to quickly direct resources—food, water, shelter, medicine, generators, whatever may be needed—to critical sites. Added benefits of HLS include waste minimization, enhanced transparency to donors and partners, faster post-crisis recovery, and improved training for future events.

The Red Cross, the primary implementer of HLS to date, estimates that HLS can expedite delivery of supplies to crisis sites by up to 33%. Shorter response times can literally make the difference between life and death. Although detailed data are not yet available, the IFRC emergency relief operations team felt that HLS significantly improved their performance in response to a major earthquake in Morocco in April, 2004. The Fritz Institute is currently working to implement HLS with other relief agencies, including the European Community Humanitarian Office, in hopes of further reducing human suffering through more effective disaster responses.

                For more information see,  http://www.fritzinstitute.org.

 

Dr. Ashok Gadgil, Lawrence Berkeley National Laboratory, Berkeley, California, U.S.

The World Health Organization (WHO) estimates that more than a billion people lack regular access to safe, clean water for household use. The consequences are devastating. Waterborne diarrheal diseases kill thousands of children every day around the world, and sub-lethal infections by waterborne bacteria, viruses, and parasites cause untold suffering. Increased global investment in water treatment and sanitation is imperative to reduce this terrible toll.

In 1993, a severe outbreak of cholera in the Bengal region of India recalled to Dr. Ashok Gadgil, a physicist and engineer at Lawrence Berkeley National Laboratory (LBNL), painful childhood memories of five cousins killed by cholera. Gadgil grew up in Bombay, but came to the University of California at Berkeley for doctoral studies in physics. His career at LBNL has been dedicated to exploring practical applications of the physical sciences, and the Bengal cholera epidemic galvanized Gadgil to investigate technological solutions to improving water quality that could be sustainable in resource-poor environments. 

What are the options? In poorer parts of the world, boiling water is one strategy for small-scale disinfection, but fuel for cooking fires often is limited. Chlorination works well, especially for larger volumes of water, and this strategy is cheap if appropriate chemicals are available. But, hazards associated with chlorination mean it must be carefully monitored, making this approach most suitable for organized municipal distribution systems. Interestingly, the taste of chlorinated water is also enough to make many rural people reject this option. Stand-alone filtration systems up to the task of removing bacteria and viruses are not yet economical for most of the world.

Gadgil concluded that ultraviolet (UV) light had the most potential as an effective and environmentally benign water treatment technology. UV irradiation can fatally damage the DNA of microorganisms, and it leaves behind no harmful byproducts. In fact, UV water treatment systems were already on the market in the U.S., but a number of limitations—cost, maintenance requirements, energy use, and engineering designed for pressurized water supplies—prevented ready transfer of the technology to a resource-limited environment.

Working with a graduate student, Gadgil spent months experimenting with inexpensive UV lamps, mirrors, and flow configurations to create an effective, gravity-fed water disinfection device. The resulting design, no larger than an average-size suitcase, moves water at remarkably high flow rates—up to four gallons(15 liters) per minute—across a broad pan over which a UV-emitting bulb is suspended, backed by an aluminum mirror. The “UV Waterworks” water treatment system has since been tested and certified by numerous independent laboratories to reduce bacterial and viral loads in water by greater than 99.99%, and to be effective against parasites such as Giardia and Cryptosporidium, meeting safety standards set by the California Department of Health, the U.S. Environmental Protection Agency, and the World Health Organization. How does that translate into real world benefits? In the southern Mexican state of Guerrero, local doctors reported a 90% reduction in gastro-intestinal diseases in children in villages with UV Waterworks systems, with a concomitant dramatic reduction in infant deaths from diarrheal diseases.

The UV Waterworks design has been licensed for commercialization by WaterHealth International (WHI), a California-based company. With Gadgil’s technical support, WHI has expanded the product line to home, community, and commercial-scale devices, as well as an easily portable unit suitable for emergency relief operations. Filtration has been incorporated into the larger-scale devices. The low power usage of these devices allows a variety of power options, including solar and wind power. The community water systems can produce around 2.6 gallons (10 liters) of water per day for up to 4000 people, at a cost of only four cents per ton (about 240 gallons). UV Waterworks units are currently serving over 200,000 people, mostly in the Phillipines and Mexico, but increasingly in Africa, India, and elsewhere. UV Waterworks has been particularly successful in helping to establish small, sustainable businesses selling drinking water. Dozens of these stores have been set up in Manila and Acapulco, providing jobs and safe, economical, water supplies in neighborhoods underserved by municipal water systems.

More information on UV Waterworks can be found at: http://www.waterhealth.com. For information on some of Dr. Gadgil’s other projects, addressing issues such as improving the energy efficiency of household appliances and dealing with air pollution, see: eetd.lbl.gov/staff/GadgilAJ.html.  

 

Joint IFSS Team, SingaporeTechnologies Electronics, Ltd.,

Defense Science and Technology Agency, Chartered Electro-Optic, Singapore

For several months in 2003, a mysterious disease dominated the news and caused massive economic disruption in Pacific Rim countries. Nearly 800 people eventually died from “SARS” (Severe Acute Respiratory Syndrome) before the epidemic was brought under control. While this toll pales in comparison to that of AIDS, malaria, tuberculosis, and other ongoing scourges, SARS had disproportionately large social and economic impacts. SARS was apparently highly infectious, acted (and sometimes killed) quickly, elicited vague clinical symptoms (fever and respiratory difficulties), and responded poorly if at all to available drugs—all of which engendered widespread fear and confusion. A public health nightmare emerged.

The greatest impact of SARS was in Asia, where the SARS virus originated, and where confirmed infections were concentrated. Until the virus was identified and reliable diagnostic methods developed, health authorities had few options for quelling the epidemic. Singapore, a major Asian business and transportation hub and one of the most densely populated countries in the world, was near the center of the SARS storm. Because fever was the most obvious (albeit non-specific) symptom of SARS infection, Singaporean authorities instituted fever-screening checkpoints in transportation nodes in hopes of limiting the spread of the disease. Feverish individuals were subjected to additional medical examination, and placed under quarantine if SARS was suspected.

As might be expected, funneling all airline and border traffic through checkpoints staffed by thermometer-wielding medical personnel in protective gear put a damper on the flow of people and commerce, the economic lifeblood of Singapore. Critical medical personnel were also tied up by screening, hampering other programs. In response, the Ministry of Health urged the Singapore Defense Science and Technology Agency to develop a device for mass temperature screening. Within weeks, a team of scientists and engineers developed a prototype non-intrusive infrared imaging system that was quickly tested, modified, and calibrated. Within two months, the first batch of “infrared fever screening systems” (IFSS) had been built and deployed at airport, seaport, and land checkpoints throughout Singapore. Today, more than 170 IFSS units are in place in several countries and more than 20 cities across Asia.

The IFSS uses a sensitive thermal imaging camera (originally borrowed from the military) to capture an infrared image of a person’s exposed skin, usually the face and neck region. The thermal data is continuously fed to software that generates color-coded video images on a monitor. Individuals whose facial temperature shows up as significantly above normal are flagged by the operator to step aside for further examination, with minimal disruption to traffic flow at checkpoints. To maximize instrument sensitivity and minimize false positives, a high degree of thermal accuracy is obviously required. A controlled temperature reference is kept within constant view of the camera, allowing the system to self-calibrate and achieve a reported accuracy of + 0.3oC under optimal operating conditions.

Did IFSS contribute to stemming the spread of SARS in Singapore and other countries? That question is difficult to answer with certainty, as limited data are available, and IFSS was part of a multi-pronged public health response in a dynamic environment. IFSS accomplished its immediate goal of mass screening for fever, reducing impediments to travel and commerce, and helping to restore public confidence. Further research is necessary to determine whether mass temperature screening using IFSS could be an effective component of the public health response, should SARS or similar diseases characterized by high fever re-emerge in epidemic proportions. Regardless, the remarkably rapid development of IFSS in response to the SARS crisis is testimony to creativity and hard work of the Singapore Technologies team.

  For more information on IFSS, see: http://www.ifss.com.sg.

 

Integrated Medical Systems, Signal Hill, California, U.S.

Traumatic injuries are one of the major global causes of human death and disability. Sources of life-threatening, traumatic injuries include motor vehicle crashes, industrial accidents, and violent events such as suicide attempts, assaults, and military conflict. Not surprisingly, quick delivery to a good hospital emergency room after a traumatic injury reduces the chance of death or permanent disability dramatically. That luxury is not available in many under-developed or less populated parts of the world, or in war-torn regions lacking functional medical institutions. In certain situations, the deployment of mobile trauma care units that can reach into such locations is a viable solution to the problem. To support such missions, Integrated Medical Systems (IMS) has packaged advanced technology into a portable intensive care unit and surgical platform called LSTAT (Life Support for Trauma and Transport).

The LSTAT platform is roughly the length and width of a stretcher. Though it is only about five inches (12 cm) thick, it manages to integrate a ventilator (with onboard oxygen supply), defibrillator, blood chemistry analyzer, suction, infusion pumps, vital signs monitor, rechargeable power supply, data storage card, and a wireless-enabled, networkable communication unit. These capabilities allow LSTAT to be used as a field surgical platform if necessary, or as an evacuation platform allowing continuous monitoring and treatment of critically injured patients. The U.S. Food and Drug Administration (FDA) has formally approved LSTAT for trauma care and transport use. 

IMS, the developer of LSTAT, was spun off from Northrop Grumman, a major defense contractor, to commercialize biomedical technologies. The initial development of LSTAT was funded by the U.S. Army and the Defense Advanced Research Projects Agency. Over the past few years, Army medical units have used LSTAT in operations in Kosovo, Afghanistan, and Iraq, and the other branches of the U.S. military are now also using LSTAT. Army medical units also have taken LSTAT off the battlefield for humanitarian missions, including treating land mine victims in Cambodia. LSTAT is increasingly found at motor sports events, where it has transported injured drivers, motorcyclists, and spectators. IMS envisions expanding civilian use of LSTAT by mobile medical units, facilities in rural and wilderness areas, and disaster relief missions.

For more information on LSTAT and IMS, see: http://www.lstat.com.

 

SATELLIFE, Waterloo, Massachusetts, U.S.

The Internet has revolutionized global information access over the last decade. There is little doubt that universal access to health-related information would lead to improvements in global healthcare, but Internet access is still limited in most of the world’s poorest regions, the places most affected by disease, malnutrition, and limited education and healthcare services. In response to these limitations, SATELLIFE, a non-profit organization based in Watertown, Massachusetts, is showing how low-cost, hand-held computers can bring the benefits of Internet access to physicians and healthcare workers in developing nations, and ultimately to the populations they serve. 

SATELLIFE was founded in 1990 by Dr. Bernard Lown, a physician and social activist. Lown co-founded International Physicians for the Prevention of Nuclear War, winner of the Nobel Peace Prize in 1985. SATELLIFE, which pre-dated the Internet revolution, was originally created to promote the use of satellite communications for the exchange of information among health professionals around the world. Today, SATELLIFE operates a global electronic communications network called HealthNet, connecting over 10,000 health professionals in 120 countries. HealthNet provides online content, including “E-Drug” sites in several  languages with information on essential drugs for many important diseases. HealthNet has a major presence in Africa, with locally-maintained branches in Uganda, Zimbabwe, Ethiopia, Eritrea, and Kenya that provide locally-relevant content and ICT training, and that connect health professionals in each country. 

SATELLIFE sponsors a number of projects in Africa and elsewhere employing Personal Digital Assistants (PDAs) for a variety of healthcare-related applications. In Ghana, for example, community volunteers were trained to use PDAs to collect data during a childhood measles vaccination campaign run by the Red Cross. This partnership with the Red Cross was subsequently expanded to measles vaccination campaigns in other countries. In Uganda, PDAs are used in blood donor screening and data entry to improve the safety and efficiency of the blood bank system, which faces enormous challenges from HIV, malaria, and other infectious agents in the population. In Kenya and Uganda, medical students have been provided with and trained on PDAs loaded with medical references and educational materials. These projects are helping to prove that in resource-poor environments lacking highly developed telecommunications networks, low cost computing devices such as PDAs can be productively integrated into programs to improve human health.

For more information on SATELLIFE and their many programs, go to www.satellife.org.

 

Conclusion

The  Affymetrix Tech Awards Health Laureates have used technology creatively to address important global health problems, for which we salute them. Admittedly, none of these projects provide complete solutions, but in truth it is difficult for any single technological innovation to quickly and completely solve health problems of global proportions, although cheap and broadly effective vaccines for AIDS, malaria, and tuberculosis could be exceptions to this generalization. As long as much of the world’s population suffers from poverty, inadequate education, and the effects of violence and political instability or oppression, billions of people will suffer unnecessarily or die prematurely. But even if technology alone can’t solve all these problems, these Laureates are to be commended for taking advantage of opportunities where technology can make a difference.

Implementation of technological solutions takes time, effort, and money. UV Waterworks units could save many more lives if they were installed in more villages in Africa, Asia, and Central and South America, but scaling up production, marketing, and distribution of these devices requires investment. LSTAT units can potentially save the lives of more trauma victims if civilian use is expanded. HLS software could allow more aid organizations to provide faster and more effective disaster relief, if it were adopted more widely. PDAs and low cost computers could be used more to enhance healthcare delivery and education in developing nations, if they were made widely available with appropriate software and content, at an affordable price.

Finally, we know that there are many people and organizations applying technology in new and exciting ways to improve human health. Ultimately, by recognizing and honoring such pioneers, we not only celebrate technological innovation, we also stimulate future efforts to make the world a better place.

 

The Panel

 

Craig Stephens, Chair, Associate Professor of Biology, Director,

Biotechnology Program, Santa Clara University

 

Marie Barry, Former Director, Global

Partnerships, ALZA Corporation

 

Steve Eglash, Senior Associate,

Worldview Technology

 

Jonathan Showstack, Adjunct Professor

of Medicine and Health Policy Institute

for Health Policy Studies, School of

Medicine, University of California,

San Francisco

 

Russel M. Sampson, Vice President,

Research and Development,

Cytyc Surgical Products

 

Peter Sullivan, M.D., Vice Chairman,

Emergency Medicine, California Pacific Medical Center

About the author

craig stephens article

Craig Stephens

Craig Stephens is Associate Professor in the Department of Biology and Director of the undergraduate Biotechnology Program at SCU. Professor Stephens received a B.S. degree from Roanoke College in 1985 and a Ph.D. from the University of Virginia in 1991, after which he was a postdoctoral research fellow at Stanford University (1992-1996). His research focuses on how genes and enzymes function in microorganisms, for which he has been awarded grants from the National Science Foundation, the National Institutes of Health, and Smith-Kline Beecham. He teaches courses on biotechnology, microbiology, and molecular biology.

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