Kickoff Meeting - 9/27/2011

Tonight we had our first official meeting for the new semester. Jack, Mike, Oliver, and Bilal joined us for the first time. Members present: Steve, Dan, and Elliot.

Here's an outline of the meeting:

I. Introduction: Gave prospective members an overview of the project and where we're headed during a Q&A session.

II. Short-term goals for this semester

• Redesign lamp head: new LEDs, focusing, etc. Jack's Engin 100 group might take on the project
• More stable base
• Circuitry
• Find LEDs with narrower beam angle: Mike knows where to get them
• Portability & Modular design
• Recruit faculty advisor specifically for the Life Lamp Team
• Modify previous grant proposals: We should look into working with Centricycle Team for some insight since they have some experience

III. Trip Opportunities

• World Medical Relief (WMR): Those that are interested may travel abroad with WMR with the surgical lamp. It will most likely be Philippines, but we need to contact WMR for more info.
• Nicaragua: Next Summer - We could collaborate again with the Maternal Health Team.

IV. Meeting time: Our regular meeting time will be Tuesdays at 7 PM @ LBME for this semester.

V. Next week: We will start working on a new prototype.

Elliot

2011 Nicaragua Trip Update

This is what the lamp looked like right before the trip.

 Here's a brief summary of the trip to Nicaragua (Summer 2011).

1. District Hospital of Esteli, Nicaragua: We assembled the lamp in front of the technicians and officials of the hospital. Once the lamp was put together, we demonstrated its use and various features. In general, the lamp was well-received and people were highly interested. They even took pictures of the lamp!

• Is there a need for improved surgical lamps? Yes. More efficient lamps are needed (v.s. conventional incandescent lamps).
• Is need constant or sporadic? The lamp we have here works well sometimes, but is intermittent. Bulbs don’t last long (200-300 hrs) from the overhead source. We tried to extend life by adding protection/insulation. We have electrical energy but quality of the lamp is a problem. Power also gets interrupted, and we tried to fix fluctuations from power surges. For example, this morning, we lost power for three hours (happens about once a month), but we do have two back-up electrical generators (can support everything but X-ray) that can each supply 72 hours worth of power. 
• Hospital does not have any type of mobile solar systems, but that could be potentially helpful in different areas. 
• Hospital's top priorities for a surgical light source: white light, cool, low energy.
• They really liked the ~12 in. diameter spot and how we worked on shadow control.
• Ideal/desired battery life is ~12 hrs.
  
• They liked how we used PVC to narrow beam angle.
• They suggested the wooden base made of something else. Keep it light, but some weight would be good for balance and stability.
• They suggested lamp head open like an umbrella mechanism to adjust focus...however, the current setup is good enough for minor surgeries.
• Make it consistent with different assembly tools (for instance, be able to assemble the lamp with 2-3 different tools).
• Most complicated issue for the hospital is to buy and attach LEDs, otherwise the lamp can be built there.

 

2. Sacuanjoche Clinic in Matagalpa, Nicaragua: We visited a small private clinic that visits isolated rural villages routinely to provide health services. We also traveled to one of the villages, Santa Ana, with the clinic. During the visit, we experienced a power outtage that delayed medical exams. See where the lamp comes in? Here are some of the feedbacks:

• Change wood base...perhaps to a tripod base.
• Be able to focus the light.
• Adjustable (extendable) arm.
• All parts are readily available in Nicaragua says Dr. Armando (head of the clinic).
• Increased portability: this was the clinic's particular interest since they frequently visit rural villages with their medical equipments.

Elliot

3/29 Lamp Update

Today's meeting was just a planning meeting. Next week we will begin work on the second lamp head.

Assignments for the week:
Steve: buy metal strips, a switch, and sticky squares
Elliot: buy cell phone batteries
Melissa: pick out LEDs
Liz: Talk to BlueLab about the generator (probably by emailing the officers)
Dan: Talk to CGH about people to interview about the lamp, talk to Aileen (aileenhs@umich.edu) about getting into contact with Frank Andersen and other MDs.

Here's a tentative schedule for the next two months:
4/5: Start working on lamp head #2, wire up the cell phone batteries
4/12: Finish lamp head #2
4/19: Finals, probably no meeting
4/26: Make contact with UM surgeons to give us feedback on the lamp, work on getting the lamp to run off wall power
5/3: Finish getting the lamp to run off wall power
5/10: Internal testing
5/17: External testing with UM surgeons
5/24: Make modifications as recommended by the surgeons
Early June: send lamp to Nicaragua

Here's two links to the surgical lamp that won the Australian design award:
http://www.abc.net.au/tv/newinventors/txt/s3158339.htm
http://student.designawards.com.au/application_detail.jsp?status=3&applicationID=9657


Because I forgot to send them out last week, here are the interview questions:
1. Have you seen a need for improved surgical lighting?
2. Is the need sporadic or constant? What is the cause of the need? If sporatic, how long and how often?
3. Where does surgical lighting rank in the list of priorities?
4. How much do you think clinics/hospitals would be willing to spend on a grid-independent surgical lamp?
5. Have you witnessed a surgery that had to be stopped due to inadequate surgical lighting? What was the result?
6. What manufacturing capabilities are available?
7. What batteries are locally available? LEDs? Used bike parks? Cost?
8. How often does the power go out for? For how long?
9. What are the most common procedures requiring surgical lamps? Where are they performed?
10. Do you see the lamp being used for anything other than surgery?
11. What is currently being used for surgical lighting? What about during blackouts? How well does this work?
12. Do you think a grid-independent surgical lamp would be a cost-effective way to improve the quality of care?
13. How important is portability for surgical lighting?
14. Are you interested in helped us to design/implement a surgical lamp?
15. What other equipment/supplies are needed for surgical lamps to be useful? Anesthesia? Disposables?
16. Do you have any questions or comments? Are there any questions that you think we should have asked that we didn’t?

Some Lit Search Findings

I worked on a lit search regarding the availability and quality of surgical lighting, and while I didn't find any studies explicitly reporting the information we were looking for, I did find some interesting papers. I'm including the name and some of the important information from them; they're all available from google scholar or through the university.

Quantifying Surgical and Anesthetic Availability at Primary Health Facilities in Mongolia
David A. Spiegel • Shelly Choo • Meena Cherian •Sergelen Orgoi • Beat Kehrer • Raymond R. Price •Salik Govind

Not much info, but in the table towards end 11% reported to have access to lighting, eg flashlight, surgical, etc

A protocol for safe anasthesia for cleft lip and palate surgery in developing countries
S. C. Hodges, A. M. Hodges

"The majority of hospitals in Uganda are severely underfunded and understaffed. Reliable electricity is unusual. In some centres there is no running water and the majority of hospitals have no oxygen. Many of the operating theatres are small and cramped with poor lighting and no recovery room"

Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care
T. Peter Kingham, MD; Thaim B. Kamara, MD; Meena N. Cherian, MD; Richard A. Gosselin, MD; Meghan Simkins, BA; Chris Meissner, BA; Lynda Foray-Rahall, MD; Kisito S. Daoh, MD; Soccoh A. Kabia, MD; Adam L. Kushner, MD, MPH

-info on availibility and periodicity of electricity

-"Even when electricity was available, lighting was
a problem, given there were approximately 6 individual lightbulbs that worked in all of the dome lights throughout Sierra Leone. Most operating rooms subsisted with a portable light or sunlight."

-hospitals in the capital have been receiving electrical power at an increasingly steady rate

-"The 5 other hospitals surveyed depended on generator power, but owing to the scarcity and cost of fuel, patients’ families were sometimes required to provide the necessary fuel to power generators during surgical procedures."

-"In addition, basic infrastructure, such as lighting in the operating room, is an example of a small investment that can have an enormous effect. The lightbulbs required in Sierra Leone, for example, were found to cost less than US $0.50 at a factory in China."

Lamp Head/Thesis Review

Hey guys,

Below is a picture of our next-prototype lamp head, in case you didn't get a chance to see it:

Also, I looked over Abigail's thesis for background information and this is what I found:

She visited 3 regional hospitals and ten health clinics in Ghana/Uganda, and from these trips claims that "due to the unreliability of electrical energy there have been cases of deaths in surgery and delivery wards.” She then shares several anecdotes concerning complications caused by surgical lighting failure during power outages, but has no numbers or data to show how often this is actually happening.

She also claims that the electrification rate (percent of population that has electricity) in Uganda is 10%, and states that this is similar to most low HDI countries, where electrification rates range from 2-50%, with reliability at or below 50%.

This graph below was also contained in her thesis. I am unsure of its source, but it shows how often power outages occur in Uganda, and could definitely be helpful when we are looking for more quantitative data to prove our cause.

-Melissa

NCIIA Grant Application

Here's the last NCIIA grant application we sent in, just in case you ever want to use it as a reference.

http://www-personal.umich.edu/~stvdwtt/NCIIA_Grant_Application.pdf

http://www-personal.umich.edu/~stvdwtt/marketing_schematic.pdf

Lamp Update 3/15

Hey guys,
First Jack and Melissa gave some quick updates on research they've found relating to surgical lighting in developing countries. This info should be up on the blog soon. Next, we a look at the light the lamp head puts out. From a completely unprofessional viewpoint it seems to be bright enough and was able to (dimly) light up an entire LBME classroom. Next, Elliot and Mike went to the Wilson Center to attach the lamp head to the lamp frame with a pair of L-brackets. The process ended up being more difficult than anticipated, so we'll finish that up next week. Liz, Melissa, and I made a list of new survey questions (included at the bottom of this email) which have been sent to the survey team. Next, we talked about the poster and changed the categories to Background, Lamp Design, Implementation, and Future Work.

Registration for the global health symposium is due on Monday, March 21st, don't forget to register if you plan on going.

Tasks for the Week:
Steve: Find out when M-HEAL is going to WMR next, write the Future Work part of the poster
Melissa: Post lamp need info, write the Implementation part of the poster, talk to Mike Lee about when Wilson Center trainings will be
Liz: Write Lamp Design part of the poster
Jack: Post lamp need info, write the Background part of the poster
Elliot: Compile the poster over the weekend
Pat: Write the abstract for the poster
Mike: Begin work on a CAD drawing of the lamp

Please send your portion of the poster to Elliot by 7pm on Friday. Elliot, send the compiled poster to the group by Sunday at 7pm for feedback.

Let me know if you have any comments or questions or if I forgot to include something.

Best,
Steve

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Survey Questions:
1). Describe what you use for surgical lighting. What procedures do you use it for?
2). In these case of a power outage, what surgical lighting do you use?
3). What have been the complications due to inadequate surgical lighting (including doe to power outages)? How frequent are these complications?
4). How much would you be willing to spend on a surgical lamp that continues to work during power outages? $___________
5). How high of a priority is surgical lighting that continues to work during power outages in terms of equipment needs?
__ Top 3
__ Top 5
__ Top 10
__ Higher than 10th