Medical Diagnostic for Childhood Pneumonia in India: Sara Dolcetti, G
Sara Dolcetti (G, Master of Science & Master of Business Administration) is in India, accelerating the development of a low-cost mobile phone-based thermal imaging device to screen for pneumonia, the leading cause of death in children less than 5 years of age. She was awarded this fellowship in 2014.
Sara’s work involves determining the clinical and operational environment for children presenting with symptoms of pneumonia. Her goal is to help build a simple tool for healthcare workers in the developing world to use and evaluate its effectiveness. She is partnering with physicians at the Lata Medical Research Foundation in India for their clinical and operational expertise in local public and private healthcare facilities.
Thermal Imaging Diagnostic for Childhood Pneumonia in Resource-Poor Settings
The problem: Pneumonia (PNA) is the primary cause of death in children less than 5 years of age and accounts for 18% of total deaths worldwide in this age group. Approximately 25% of these deaths occur in India, where many regions suffer from a lack of healthcare workers and cost-prohibitive diagnostic equipment. Because early stage pneumonia is difficult to diagnose, due to a variety of pathogenic causes, it is often treated too late or as if it were Malaria. To postpone treatment and to use malaria medication likely exacerbates the condition, increasing the risk of death and the resistance to medication.
Our hypothesis: Diagnosing pneumonia at an earlier stage could help reduce false positives, false negatives, mortality rates and system costs.
The device: Massachusetts Institute of Technology (MIT) and The Consortium for Affordable Medical Technologies (CAMTech), headquartered at MGH, is developing a thermal imaging device capable of being fixed to the cell phone of a healthcare provider. Thermal imaging offers a novel, cost-effective approach to PNA screening. Using CAMTech’s cell phone ‘app,’ providers can quickly generate a thermal image which, if asymmetrical, can indicate the presence of pneumonia (Figure 1).
Figure 1: Thermal imaging as a diagnostic device (Source: CAMTech Proposal)
Our team: Our team is comprised of myself (a joint Master of Science and Master of Business Student at MIT), MIT and Harvard professors, an MIT Technology and Policy student, a Harvard Medical student and an MIT Engineering Systems Division Masters student. Our affiliates and partners are: Physicians from Massachusetts General Hospital (MGH), The Consortium for Affordable Medical Technologies (CAMTech) and the Lata Medical Research Foundation in Nagpur, India
From Delhi to Nagpur and monsoons in-between
Something feels amiss.
As we make our way through security checkpoints, I look around and immediately see what it is. At noon on this Tuesday in July, the Delhi airport is unlike the Delhi I’ve experienced thus far: it’s almost barren!
Stepping onto the plane, I find it difficult to bid ‘Alavidā’ to New Delhi – with its kind people, delicious food and fascinating history.
I look forward, however, to saying ‘Namastē’ to Nagpur. There, my colleague and I will meet our sponsor and her team at the Lata Medical Research Foundation and begin our field work. I have learned a great deal about the Indian healthcare system and cultural norms from them thus far and am keen to imbibe the environment once there.
Tomorrow, we meet with the Lata team in India to discuss our research plan in person and to gather any final input and advice. Our first priority is to ensure that we understand the system which cares for children presenting with symptoms of pneumonia and the children (and their families) themselves. If we don’t do this, we risk applying a ‘solution’ to an insignificant (or even worse, to the wrong) problem.
The challenge will be to do this within the less-than three week timeframe, with translators, in monsoon season and still get the data we need in order to continue our research when we return home. Additionally, while we have extensively researched prior to arriving, I am mindful that we’ve likely formed a series of assumptions through that research which we will need to identify and then challenge.
Working closely and aiming for quick iterations with the expert medical team here in India will be critical to getting to the key issues efficiently and effectively.
The monsoon rains embrace our plane as we arrive in Nagpur.
We’re ready to begin!
Auxiliary Nurse Midwife using her smartphone during a vaccination session in the village Hatodi
Hub and Spoke
And begin we did! The LATA team immediately immersed us in the healthcare system and local Nagpurian culture. In the span of a few hours we got an in-depth review of the healthcare system, vetted our plan by the team and Dr. Patel and started to work through their databases.
The Indian Healthcare System follows a hub and spoke model: ASHA workers –> Sub Centers –> Primary Health Centers –> Rural / Sub-district Hospitals –> General Hospitals –> Tertiary Medical Centers (e.g. Medical Colleges). Our plan is to sample from each center and level of care in both the private and public system.
After a full day of prepping for our field analyses, Sanjeev and Ambar took us out for dinner in a traditional restaurant – typical of the Maharashtra state. Delicious? Yes. Spicy? Yes.
Cost of dinner? 350 INR (~$6) Litres of milk consumed to douse the spiciness? Priceless.
Primary Health Center (PHC) and Residences of medical team (adjacent to the PHC)
Corinne and I with Ranaya, Medical Officer at a Primary Health Center in the Nagpur Cluster
At the heart of it all: Starting with the patient
Today we began our field visits.