MAKING EXAMINATIONS SAFE AND ACCESSIBLE

Contact Information: mheal-projectmesa@umich.edu


Abstract

80% of cervical cancer deaths occur in rural, developing regions, accounting for 190,000 deaths each year [1]. Since transportation to rural areas is limited, health workers bring minimal equipment to mobile exams. As a result, gynecological exams are conducted on non-ideal surfaces, limiting exam safety and effectiveness. To ease the facilitation of gynecological examinations for clinicians and patients, we have designed a portable gynecological examination table. The table is constructed from hollow aluminum square stock, aluminium sheet metal, and PVC piping, materials which are lightweight and readily available in the communities we serve. Our design is mechanically sound, supporting more than 150 kg and withstanding dramatic weight shifts. The table can be folded and easily carried like a backpack. It is easy to sanitize, with a non-corrosive and non-absorbent material. It is water-resistant, heat-resistant, and crash-resistant. Two of our past designs are currently being used clinically in Nicaragua, and we are continuously gathering data regarding table examinations. We are currently designing our fifth prototype, along with a holistic gynecological examination kit. By enabling mobile doctors to better serve rural areas with our table, we can alleviate some of the crippling impact that cervical cancer has on Nicaraguan villages.


[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071564/


Gynecological Health in the Developing World

Despite being highly preventable with regular screening tests to identify pre-cancerous conditions [1], cervical cancer is the leading cause of death from cancer among women in developing countries, where it causes almost 200,000 deaths each year [2]. Additionally, adolescent pregnancies are common in the developing world, but these types of pregnancies present significant health risks; the risk of maternal death is four times higher among adolescents younger than 16 years than among women in their twenties [3].

Nicaragua has the highest mortality from cervical cancer [4] and highest teenage pregnancy rate [5] in Latin America. Regular gynecological examinations are necessary to screen for pre-cancerous conditions as well as to monitor pregnancies, especially in adolescents at high-risk for complications [6]. However, gynecological exams are difficult to conduct in rural mobile clinics within Nicaragua because of a lack of portable and affordable equipment. Clinicians travel upwards of six hours to reach rural communities and are only able to bring supplies they can physically carry. As a result, many exams are conducted on household beds or tables in poor lighting conditions, not only making the exams unsterile and uncomfortable for both the staff and patient, but also limiting the success and efficiency of identifying health-risks.

Mission Statement

Develop a method that enables local clinicians to conduct more effective and frequent women’s examinations in mobile health settings.

Team History

M-HEAL’s Project MESA began with a needs assessment trip to Nicaragua in August 2010. By visiting several clinics focused on maternal health and education, the students found that limited transportation to clinics and a lack of portable equipment are two challenges rural women face in receiving gynecological examinations. Following their trip, the team designed an alpha prototype of a portable gynecological exam table that folds into a large backpack. Our team has since developed four iterations of a portable gynecological examination table that can be worn as a backpack for easy transportation to rural communities. Our main design criteria are that the table is safe to use and affordable, enables appropriate and comfortable patient positioning, and can be easily transported long distances. The design utilizes materials locally-available in rural communities in Nicaragua, namely aluminum stock and sheet metal, and is built using low-cost manufacturing techniques to enable simple repairs.

Current Work

Our team is currently working on building our Epsilon prototype based on the feedback we received during our trip to Nicaragua in May 2016. This prototype will combine our previous two designs, using the features of each prototype that were well-received by our partners in Nicaragua. We are also working on designing other equipment necessary for mobile gynecological exams, including collapsible curtains, an adjustable stool for clinicians, and a flat exam table for pregnant patients. Our goal is to create a holistic examination kit, including our mobile table, to make gynecological exams safer and more comfortable for women in Nicaragua. Additionally, our business committee is working on refining our business model to feasibly scale our project to serve more communities, both within and outside of Nicaragua. We hope our work with diverse medical stakeholders in Nicaragua, ranging from large regional hospitals to small, private clinics, will enable us to develop an innovative, sustainable design that can be successfully implemented and used by global communities.

Collaborations & Acknowledgements

Advisors & Mentors

  • Michael Deininger, PhD Pre-Candidate in Design Science | Technical Advisor

  • Dr. Frank Anderson, OBGYN | Clinical Advisor

  • Dr. Kathleen Sienko, ME and BME Professor | M-HEAL Advisor

  • Dr. Aileen Huang-Saad, BME Professor | M-HEAL Advisor

  • Dr. Clive D’Souza, IOE Ergonomics Professor

  • Dr. John Marshall, Director of MDes Integrative Design Program

  • MDes 2015 Cohort: Manasi Agarwal, Aditi Bidkar, Kuan-Ting Ho, Ji Youn Shin, Elizabeth Vander Veen, Kai Yu

Nicaraguan Partners

  • Casa Materna, Mary Ann Jackman | Matagalpa

  • Estelí Regional Hospital | Estelí

  • Foundation for International Medical Relief of Children (FIMRC) | Limón

  • Sacuanjoche Women’s Group | Matagalpa

  • Santa Lastenia Health Clinic | Matagalpa

  • Ministry of Health Public Health Post | Las Salinas

  • The Lily Project | Matagalpa

 

Sources

  1. Cervical Cancer (2015). Centers for Disease Control and Prevention. http://www.cdc.gov/cancer/dcpc/resources/features/cervicalcancer/.

  2. Sherris, J., Herdman, C., & Elias, C. (2001). Cervical cancer in the developing world. Western Journal of Medicine, 175(4), 231–233. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071564/.

  3. Adolescent pregnancy. World Health Organization: Maternal health.

  4. Creel, L. (2000). Cervical cancer is major health problem in Latin America. Population Reference Bureau. 

  5. Nascimento, M.G. (2015). Nicaragua has the region’s highest teen pregnancy rate. Many moms are OK with it. Global Post. http://www.globalpost.com/article/6554041/2015/05/19/nicaragua-teen-pregnancy

  6. Pelvic exam for women. WebMD. http://www.webmd.com/women/guide/pelvic-examination.

 

Project Leads

 

Jen Spiegel | jlspieg@umich.edu

Maya Ben-Efraim | bemaya@umich.edu

Team Roster