Teaching and Learning Self-Sustainability in Global Health

A wise proverb reads, “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.” Although this advice is applicable in multiple situations, the importance of self-sustainability is particularly important in global health. 

Many medical experts have focused on improving access and clinical outcomes. Specifically, with the expansion of technology in many developing areas, biomedical innovation is becoming a conduit to improve medical access and clinical outcomes. Among many recent examples, Butterfly iQ, a handheld ultrasound device, has achieved a mobile design to potentially expand ultrasound technology accessibility to the over four billion people globally who lack access to medical imaging. 

The process of medical device development is a growing area of popularity among medical professionals. Consistent exposure to the front lines of medicine gives medical experts a prime opportunity to identify important clinical problems and shortcomings. Generally, medical professionals are known to be efficient problem solvers. Creating sustainable solutions becomes increasingly natural over a lifetime of training and medical practice.

Biomedical innovation and medical device development is complex and challenging because it represents a unique intellectual challenge that differs from patient care. During the last six years, I have had the opportunity to establish multiple teams of creative clinicians, engineers, and medical students to generate innovative solutions. My most recent involvement in global health innovation provided a valuable teaching and learning experience. 

In 2016, through the University of Utah Center for Medical Innovation, we created a development team of two physicians, one bioengineering faculty member, one medical student, and one engineering student. Our objectives were to identify a global health problem and work toward developing an effective and affordable solution. 

As a team, we pooled our collective medical experiences to identify several important medical needs that were not being addressed. After identifying, researching, and verifying the medical problem, we began the medical device development process. Due to the extensive collective global health experience possessed by the team, we decided to focus on global health-specific issues. As a result, we created a potential solution for anemia diagnosis in developing areas that generally lack resources for disease identification, despite having the resources to treat anemia. 

We began the process by learning more about our potential users with the goal of creating accurate marketing and user requirements. We were interested in clinical utility, user capabilities, physical requirements, cultural acceptability, compatibility with the environment of intended use, safety requirements, performance need, shelf-life needs, sterilization/sterility, and affordability—to name a few. Throughout the entire process, our team worked with many of the key users in developing countries. From these interactions, we then generated the initial marketing requirements to better understand the potential users’ needs. From these requirements, we developed design specifications. Accurate specifications then led to the creation of multiple different designs. We were confident in our initial prototype design.

To gather preliminary data on our design, we took the prototype to rural India for an on-site observational visit. We were well-received by our new friends and mentors, and for some, we were the first Americans they had ever seen. We met with local medical providers to discuss a plan for exposing our prototype to potential users in a variety of real situations. We spent the following weeks meeting and working with people in the area while also learning priceless lessons about life, global health and innovation. The lessons we learned were truly priceless. 

During the on-site visit, we worked closely with local community health workers to navigate the rural villages and patient population. Together, we used our prototype to non-invasively test for anemia. We learned volumes by watching patients use the device in ways we could not have anticipated. For example, it was immediately apparent that our device was too large; we needed it to fit in the palm of one hand. Additionally, our design needed to be lighter, with larger buttons. The screen needed to be more vibrant to allow for better visibility in a bright outdoor setting. The protective casing for storage also needed to be smaller, and waterproof. As patients gained experience using the medical device prototype, they provided pivotal recommendations for improvement of the prototype’s design. Despite our best initial efforts to understand our users, many of our original prototype’s design specifications would not have realistically worked in developing areas. It was slightly cumbersome and presented potential ergonomic difficulties for the user. Overall, our original design was not ideal for the realities of the harsh environment.

The local people in the surrounding rural villages continued teaching us by example and humble instruction. As our prototype design changed, it became simpler and more effective. As it changed, we changed. It became clear that without experience and wisdom, we could not gain quality, accurate information. Learning from all stakeholders, specifically users and patients, is critical to innovation. Our team would not have learned this lesson if we had not entered the classroom — i.e., the developing areas themselves. 

As we discussed this experience as a team, we began reflecting as a group on the countless global health experiences we had had. Many of these experiences ultimately improved our clinical skills and knowledge. Many of the patients and providers with whom we worked with in developing areas trained us to think differently and more effectively. We developed better clinical decision processes and perspectives. Regardless of our level of training, we returned as true students of medicine. Our team returned full of new ideas and experiences, which ultimately benefited our patients.

Experiences in developing areas can have a significant impact, both clinically and innovatively, on the future. Individually, global health experiences changed my clinical knowledge and perspective. Collectively, I am certain that developing areas have the individuals, populations, challenges, and lessons necessary to develop and advance the future of medicine and innovation. Knowledge, coupled with experience, is wisdom, which is vital for the advancement and improvement of medicine and innovation. When we approach global health as a collaborative task, we, too, can figuratively “[learn] to fish” and encourage self-sustainable solutions. I am humbled and grateful to be a lifelong student of our colleagues and friends in developing areas.

Tyson Schwab, MD, MS is a clinician at Intermountain Healthcare. He practices at Utah Valley Hospital as part of the Utah Valley Family Medicine Residency program. His medical interests includes primary care, innovation, technology, health policy, and improving medical quality. Dr. Schwab is a 2019-2020 Doximity Fellow.

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