Duke BME Magazine Fall 2017

DukeBME
Duke Biomedical Engineering Magazine

Serving a Global Community
The Worldwide Impact of Duke BME

UNIQUE
TOOLS FOR
WOMEN’S
GLOBAL
HEALTH | 6

DUKE BME
ACROSS
CONTINENTS
| 14

FIVE DAYS OF
FIELDWORK
IN LIBERIA | 22

Fall 2017 Issue Number 1

Biomedical Engineering for Global Health

Dear Colleagues and Friends,
I’m thrilled to provide you with the first issue of our new thematic
magazines, intended to highlight the various strengths of Duke Biomedical
Engineering.
We believe that the goal of engineering is to provide service to a global
society, and our efforts to meet this goal are evident in the projects we
pursue, from the development of novel, non-invasive screening and
diagnostic tools to the creation of international educational BME programs.
In this issue, we chose to highlight the global reach of the department
through stories that illustrate the human and scientific impact of our work
in global health. We hope that you find these stories interesting, instructive
and inspiring.
Ashutosh Chilkoti, PhD
Chair, Duke Biomedical Engineering

DukeBME

Duke Biomedical Engineering Magazine

Fall 2017 Issue Number 1 The Pratt Pouch—created by the
Duke undergraduates and faculty—
is preventing mother-to-child HIV
transmissions on a global scale.

2 Letter from the Chair

The role of biomedical engineering in global health

4 Duke BME Research Around the Globe

6 Engineering a New Narrative
Duke biomedical engineers are creating unique tools geared towards

women’s health to address global health inequality

14 Collaboration Across Continents

BME professors challenge students to design solutions with global
communities in mind

22 Five Days of Fieldwork

Biomedical engineers travel to Liberia to try out a novel diagnostic test
for malnutrition

30 Duke BME by the Numbers

Duke BME Magazine is published twice yearly by Duke Biomedical Engineering,
Room 1427, Fitzpatrick Center (FCIEMAS), 101 Science Drive, Campus Box 90281,
Durham, NC 27708-0281
Phone: 919-660-5131
bme.duke.edu

Editorial Director: Ashutosh Chilkoti
Editor: Michaela Kane, Duke BME Communications
Designed by Pam Chastain Design
Photos by Duke University Photography on pages 6, 10, 14, 17
Copyright 2017 Duke University

Global Impact

By organizing education and training programs,
pursuing novel research opportunities, and
supporting student-led projects in more than 20
countries around the world, biomedical engineers
at Duke University are making an impact on a
global scale. Explore these wide-ranging projects
online at Duke Biomedical Engineering and
the Duke Global Health Institute:
http://globalhealth.duke.edu/work

4 Duke BME Fall 2017

5

GLOBAL HEALTH

Engineering a New Narrative

6 Duke BME Fall 2017 BME’s Nimmi Ramanujam shows the Pocket Colposcope, a
low-cost device that helps screen for and diagnose cervical
cancer, to Duke University President Vincent Price.

Duke biomedical engineers are creating unique
tools geared toward women’s health to address global
health inequality

In the bustling neighborhoods in Lima, Peru, it’s “Cervical cancer is a disease of excess mortality.
common to see bright pink trailers parked by the This is the one cancer that can be prevented
side of the road. Although these vehicles stand out through well-established interventions, and if
because of their vibrant hues, the white inscription these interventions were available to all women I
on their sides also draws a passerby’s attention: believe the cervical cancer mortality rate would be
Todas las mujeres merecer tiempo para cuidarse. zero,” says Ramanujam. “The Pocket Colposcope
is our first step towards bringing complex services
All women deserve time to take traditionally offered at hard-to-reach referral
care of themselves. settings to primary care.”

These cheery trailers are mobile clinics sponsored Traditional colposcopes are bulky magnifying
by Peru’s La Liga Contra el Cancer, or The League devices with cameras that allow doctors to examine
Against Cancer, which uses them to help screen a woman’s vagina and cervix for signs of cancer if
women for diseases like cervical cancer and breast a Pap smear shows an abnormal result. During a
cancer. The healthcare workers who run the clinics gynecological exam, doctors first use a speculum to
park the trailers in one location for a week before spread the vaginal walls. A colposcope is then used
moving to another district in the sprawling city. to visually check for abnormalities.

Although the trailers’ mobility offers greater Shaped like a tampon and packing the performance
healthcare access to women around Lima, the of a high-end clinical colposcope, the Pocket
clinics are limited in the services that they can Colposcope re-imagines the way a gynecological
provide. If screening flags a potential problem,
“More than half of the women are lost to follow-up
because it is difficult for them to get to a hospital,”
say Dr. Gino Venegas, former director of La Liga
Contra el Cancer.

Nimmi Ramanujam, the Robert W. Carr Jr.
Professor of Biomedical Engineering at Duke
University and director of Duke’s Global Women’s
Health Technologies Center, a joint center between
the Pratt School of Engineering and the Duke
Global Health Institute, has devoted herself to fixing
this problem. With a network of collaborators, from
local caregivers to Duke faculty and students, she’s
creating low-cost medical tools designed for women
in settings with limited resources.

The poster child for Ramanujam’s research is
the Pocket Colposcope, a compact tool being
developed to enable healthcare workers to both
screen for and diagnose cervical cancer without
expensive imaging equipment.

Students visited mobile clinics outside of 7
Peru, where women receive Pap smears
and other health services.

GLOBAL HEALTH

“Ultimately, exam is performed compared to both traditional Chris Lam, a PhD student in BME, shows how to
we’d like to and other redesigned, low-cost colposcopes on operate the Pocket Colposcope.
increase our the market. Rather than visualizing the cervix from
pipeline of the outside, the tool is slender enough to be used A group of students from the Bass Connections:
researchers inside the speculum. Due to the camera’s proximity Pocket Colposcope team visit the Ministerio de
and students to the cervix, the Pocket Colposcope works Salud (The Ministry of Health) in Lima, Peru during
who can effectively with consumer-grade LEDs and a five- their research trip over spring break.
design megapixel camera in lieu of high-end components,
technologies making it both cheaper and lighter than traditional Mercy Asiedu and Júlia Agudogo show the
that improve colposcopes. Working with Robert Miros at 3rd speculum-free model of the Pocket Colposcope.
women’s Stone Design to finalize the design, the team has The device can be attached to a smartphone to help
lives.” the cost down to about $500 and weight under half healthcare workers screen for cervical cancer.
a pound, making it ideal for use in mobile screening
vans.

So far, Ramanujam, Dr. John Schmitt, a professor of
obstetrics and gynecology in the Duke University
School of Medicine, and their collaborators have
implemented the Pocket Colposcope with over
500 women in seven sites on four continents.
Ramanujam and her team are working with Duke
electrical and computer engineering professor
Guillermo Sapiro to develop smart algorithms that
bring clinical expertise in image interpretation
to the community level. And, in another effort to
ensure women receive effective treatment in the
community setting, she is collaborating with Duke
BME’s David Katz to develop a novel liquid scalpel
as a low-cost therapeutic that promises to be as
effective yet significantly more accessible than
standard-of-care ablative techniques for treating
lesions in low-resource settings (see page 12).

As Ramanujam and her team devise a model to
commercialize the Pocket Colposcope, they are
enlisting help from students from interdisciplinary
backgrounds through Duke’s collaborative Bass
Connections program. In March 2017, students
working on the Pocket Colposcope Bass
Connections team traveled with team leaders to
Lima to speak with doctors, midwives in mobile
clinics and biomedical engineers to discuss how the
tool should be implemented into Peru’s healthcare
system.

The WHO estimates that more than 85 percent of
the deaths from cervical cancer occur in low- and
middle-income countries. That does not mean,
however, that it’s absent from the United States.
Each year more than 12,000 American women are
diagnosed with the disease—and more than 4,000
die from it.

8 Duke BME Fall 2017

“When we discuss global health, DukeEngage in Orange County
my concern is that we focus on
countries outside the US, even Building a Pipeline
though we still have issues with
cancer mortality in medically Through the DukeEngage outreach program in Orange
underserved communities here at County, California, student mentors from Duke University
home,” says Ramanujam. “We need teach engineering and problem-solving skills to middle-
to find ways to fix that. We need school girls in collaboration with Girls Inc., a local non-profit.
to invest in low-cost, high-quality Nimmi Ramanujam has also launched similar collaborative
interventions that not only empower projects in Kenya, Guatemala and India, where Duke
primary caregivers, but also improve mentors teach students in energy poor communities how to
a woman’s experience during her build renewable energy flashlights to improve the efficiency
gynecological exam.” of their daily activities.

Toward that end, Ramanujam’s Ramanujam’s program
team has more recently developed
a tampon-like introducer called the Calla for the in Kolkata, India follows
Pocket Colposcope that can make the entire exam
speculum-free, particularly for women who have this model, but with one
never had a gynecological exam or are afraid of
the speculum. A slimmer version of the Pocket crucial difference­—many
Colposcope can be positioned through the Calla,
which is then inserted either by a care provider of the students in the
or the woman herself into the vagina to provide
reliable views of the cervix. program are also young

Ramanujam is using the Calla in an advocacy mothers. To Ramanujam,
project to raise women’s awareness of their
reproductive anatomy and cervical cancer through this program embodies
a collaboration with Duke Center for Documentary
Studies director Wesley Hogan, Franklin Humanities the purpose of the
Institute director Deborah Jenson and School of
Medicine faculty Megan Huchko and Gita Suneja. Global Women’s Health
The idea is for a woman to be able to explore her
anatomy in the comfort of her home in order to Technologies Center, which
understand both what her cervix looks like and the
importance of cervical health and cervical cancer aims to educate women
prevention.
about the intersection
Beyond developing new technologies, Ramanujam
is focusing on what she can do as a biomedical Duke students work with mothers of ‘light,’ technology and
engineer and educator to encourage women to who are participating in the health by providing the
be the next generation of technology leaders for
women’s health. “Ultimately, we’d like to increase DukeEngage: Kolkata program, students with a novel way
our pipeline of researchers and students who can which culminated in a project to engage in engineering.
design technologies that improve women’s lives,” to engineer flashlights out of “Engineering can be
says Ramanujam. “We’re encouraging our students recycled materials. as pervasive as music,
to actively engage with young women to show them
how engineering can impact women’s health.”

and these projects are ways for women and girls to express

themselves in a new way,” says Ramanujam.

9

GLOBAL HEALTH

HIV Prevention with Globally, there is a need for multiple options for
Women’s Needs in Mind HIV/AIDS prevention, and success will not be a
one-size-fits all result. Katz’s work has a large
Empowering women is critical to any attempt focus upon topically acting anti-HIV drugs, called
to improve healthcare on a global scale, agrees microbicides, and emphasizing those that women
Ramanujam’s colleague, David Katz, the Nello L. can apply very soon before sex—“on-demand”
Teer, Jr. Professor of Biomedical Engineering and products. Microbicide products could take several
Professor of Obstetrics and Gynecology at Duke. In forms, including gels, dissolving tablets, films and
fact, as Katz often says, “Women’s health is global intravaginal rings, as well as injections and implants,
health.” to provide women the choice of a method that
works best for them.
“A woman’s own personal and reproductive health
often affects the health of her children and of her When a woman has unprotected sex with a man
partner,” he notes. “Women across the globe are who is HIV-positive, the virus in his semen comes
disproportionately affected by the challenges of into contact with the mucosal surface in her
sexually transmitted diseases and limited access to reproductive tract. From there, the virus migrates
screening, and the ramifications from these issues below the top epithelial layer of cells in her vagina,
can extend to the entire family.” where it can infect its target cells.

“Women’s Since starting at the university in 1994, Katz has Microbicide products could create both a chemical
health is applied biomedical engineering to the science of and physical barrier between the virus and mucosal
global reproductive biology and medicine—focusing on surface, making it difficult—if not impossible—for
health. A diagnostics and treatments that empower women infectious virus to pass through and reach the
woman’s own to protect themselves against sexually transmitted infectable cells. Creating such products is, in part,
personal and infections such as HIV, the virus that causes AIDS, an engineering design problem, says Katz. And
reproductive as well as on contraception. Prior to his arrival at part of the design process is behavioral as well as
health often Duke, Katz had become an authority on advancing biological.
affects the methods of contraception and understanding,
health of diagnosing and treating fertility and infertility.
her children
and of her Today, more than 36 million people around the
partner.” world are living with HIV/AIDS. Most of them live
in low- and middle-income countries, and most of
them are young women: according to the United
Nations, females make up 60 percent of the HIV
cases in people between the ages of 15 and 24.

In the HIV/AIDS research and development
community, there is emphasis upon prevention
(termed pre-exposure prophylaxis —“PrEP”) as well
as cure. Condoms are effective if they are used, but
their use is not widespread typically not controlled
by the woman. Vaccine development continues, but
an effective one is not on the near-term horizon.

There is currently a pill containing anti-HIV drugs
which, if taken diligently, can reduce the likelihood
of HIV infection. This is a major advance, but missed
pills reduce effectiveness more for women than
men, and there are other drawbacks, including
digestive issues and pain.

David Katz

10 Duke BME Fall 2017

“A big question is understanding what Robert Morhard, Jenna Mueller, and Corrine
women prefer to put in their bodies for Nief of Nimmi Ramanujam’s lab are working
protection,” says Katz. “For example, to develop an enhanced ethanol ablation
some women prefer condoms because strategy to treat cancerous tumors.
they provide on-demand pregnancy
protection, but others prefer to get a From Bench to Publication
shot of a progestin that offers long- In August, Robert Morhard and his lab
lasting protection. Different people mates celebrated the first publication
want different things, and we’re trying to from their project, which appeared
accommodate that.” online in Nature: Scientific Reports.
In this study, the researchers combined
Originally trained as a mechanical ethanol with the ethyl cellulose to address
engineer, Katz draws on his expertise the limitations of ethanol-based tumor
in fluid mechanics to study how ablation. Their results showed that
microbicides migrate once they are the ethyl cellulose-ethanol injections
in the body. Through mathematical caused a complete regression of 100%
modeling and in vitro and in-vivo of tumors in their experimental models.
experimental studies, Katz and his These results effectively illustrated
students examine how microbicides distribute after a proof-of-concept for the treatment
women place them in their vagina, how the anti- method, allowing the researchers to
viral compounds react to vaginal fluids and semen, move forward as they consider new ways
and how well they stay in place during sex to ensure to optimize this technology for use as a
constant protection. potential alternative to surgical treatment
in developing countries.
Some of this work involves developing and applying
new imaging instruments, in collaboration with 11
Adam Wax, a BME professor at Duke. Those
instruments are being used both on the bench in
laboratory studies and in clinical imaging studies in
women. They measure details of the distributions
of products such as gels, the molecules which
are delivered, and structural details of the tissue
into which the molecules migrate. Wax’s expertise
in conceiving, creating and applying new optical
imaging devices is combined with Katz’s expertise
in mechanical design to tailor the instruments to
particular demands of the imaging, for example
detailed in vivo imaging within the reproductive
tract in women.

“Microbicides are tricky. Not only do we need to
understand the pharmaceutical side of these
compounds, we also need to understand how they
interact with the physiology of women and the
behavioral science associated with the willingness
to use them,” says Katz. “For example, behavioral
studies have shown women are less willing to use a
microbicide if it’s really messy and difficult to apply.”

To study these microbicides, Katz is collaborating
with Michael Lynch, an associate professor in
BME. The team has recently focused their attention
on Griffithsin, a protein isolated from a type of red

GLOBAL HEALTH

algae. Lynch began working on the compound in
his biochemical design course (BME 490), where
students learned how to refine and efficiently
synthesize the protein with E. coli bacteria.

Previous studies have shown that Griffithsin can David Katz discusses results with Rob Morhard
efficiently bind to key surface proteins on HIV, and lab member Nancy Zhang.
preventing the virus from attaching to and infecting
cells. Griffithsin is also a ‘sticky’ molecule, as it can
bind to the sugar-coated envelopes of viruses and
onto the surface of the reproductive tract with
relative ease, with Katz comparing it to ‘molecular
flypaper’.

“I like Griffithsin because it is intended for the Katz is determined to develop an effective vaginal
on-demand user,” says Katz. “The current topical microbicide given the end goal—allowing women to
products and microbicides that people use typically gain better control of how they protect themselves
have a bit of a time lag between when you apply against disease.
them and when they become effective. But with
Griffithsin, you don’t have that problem. The virus “Many problems in medicine require engineering to
just collides with the molecule in the vagina, and it solve them, as we in BME know,” he says. “Women’s
gets to the virus and neutralizes it before the virus reproductive health is certainly one of them.”
can get into the tissue.”
Combining Expertise
Currently, Lynch is working with students to refine to Fight Cancer
Griffithsin to make it more functional for a global
health setting, including increasing its shelf-life as Nimmi Ramanujam’s and David Katz’s labs may be
a topical treatment and engineering variants of the separated by a quarter-mile of dense Duke forest,
molecule to be temperature-resistant. While HIV but their mutual goal of improving women’s lives
is the current target, Lynch and his team are also has brought them together for a new project—one
exploring how to expand the molecule’s use to that combines their expertise—to help treat cervical
potentially protect against other viruses, including cancer.
the Herpes simplex virus and human papilloma
virus—the virus that causes cervical cancer. “Nimmi and I joke about why it took us so long to
work together when we both are committed to
Although more work needs to be done before applying engineering to improve women’s health,”
Griffithsin becomes a viable prophylactic against HIV, says Katz. “With this project, we’re able to use my

Griffithsin (GRFT) protection
against HIV infection: “This is a
very intriguing molecule because of
its stickiness,” says David Katz. “If
the virus can somehow escape the
microbicide in the vaginal canal, it
still needs to migrate through the
tissue to infect cells. But if you have
lots of Griffithsin molecules that are
also stuck to the tissue, it acts as an
effective backup because it’s another
opportunity to grab the virus.”

12 Duke BME Fall 2017

work with fluid mechanics, biomechanics and “After doing a few experiments I was cleaning out
mechanical design to extend the line of work she’s the containers and I noticed that when I added
pioneered with the Pocket Colposcope, to help treat water a white gel formed,” he says. “We hadn’t
cervical cancer once it’s diagnosed.” realized until that point that since ethyl cellulose
was not water-soluble that it formed a white gel
The idea for the project came about after Rob when it was mixed with water.”
Morhard, a PhD student in Ramanujam’s lab, took
Katz’s biofluid mechanics course in 2016. Morhard This accidental discovery proved to be an
was interested in a problem pertaining to cervical advantageous development for the treatment.
cancer—specifically how to create a therapeutic
that will treat the tumors on the surface of the “Our main issue with this treatment is ensuring that
cervix. the injected ethanol stays localized around the
injection site and that it stays in the tumor for a
“This is the wonderful thing about academia, where long time to increase efficacy,” says Morhard. “The
you just have these conversations about ideas longer the ethanol concentration within the tumor
you’re interested in, and the next thing you know is elevated, the more likely the tumor cells are to die.
you’re working together,” says Katz. The fact that this ethyl cellulose-ethanol solution is
consistently effective in the treatment of tumors is
Katz, Ramanujam, Morhard and other students in likely due primarily to this gel formation.”
Ramanujam’s lab got to work studying how they
could remove the cancerous tumors from the cervix Along with these positive developments, the team
using an ethanol-based formulation. While previous
studies have shown that ethanol can kill tumor is optimistic about how this new approach could
cells, the researchers also needed a way to keep
the liquid in place: “It needs to be localized on the be deployed in resource-limited settings worldwide.
tumor so it can do its job,” says Katz, “and to avoid
damaging healthy tissue nearby.” The method could cost less than one dollar per

The team decided to use ethyl cellulose, which treatment, and could be implemented without “This is the
dissolves in ethanol and increases the liquid’s electricity, specialized equipment or hard-to- wonderful
viscosity, making it thicker and more effective at supply consumables. Thus, it would be useful in a
ablating the tumors. But one day, as Morhard was
cleaning out the storage containers for the liquid, multitude of healthcare settings—including mobile thing about
he made a strange discovery. clinics that use the Pocket Colposcopes to help academia,
identify women at risk of cervical cancer. where
you just
Although the research still has a long road to reach have these
the clinic, the team has established a proof-of-
concept and recently published their first findings conversations
in Scientific Reports, a Nature research journal. They

next plan to conduct safety trials in other scientific about ideas

models, while they refine details of the injection you’re
process and then design an injection device interested in,
suitable for the same global settings in which the and the next
Pocket Colposcope is applied.

For Ramanujam, these collaborative projects thing you
help to cement her belief in the work biomedical know you’re
engineers are conducting at Duke—and far beyond
working

campus. together.”

The purple dye shows an example of “I think Duke is special because we recognize that
the ethanol gel that would potentially engineering is part of a larger narrative in making
be used to treat cancerous tumors. the world a more equal place regarding healthcare
for women and girls,” says Ramanujam. “The culture
here is one of service, and the researchers and
students embody that desire to use our work to
help others.”

13

GLOBAL HEALTH

Collaborating
Across Continents

14 Duke BME Fall 2017

Duke BME professors challenge students to design
solutions with global communities in mind

In hospitals with plenty of resources, infants in the
neonatal ward are connected to separate oxygen
tanks where the gas flow is carefully regulated,
ensuring that they receive proper oxygen therapy
for any breathing problems they may have.

But this was not true at the ward in Mulago
Hospital in Kampala, Uganda where newborns
with breathing problems are given oxygen by a
haphazard daisy chain of tubes all connected to a
central oxygen canister. The only way to control
the flow of oxygen is by opening and closing the
valve on the top of the tank, that may or may not
include a flowmeter. In this arrangement, the
newborn closest to the regulator got too much
oxygen, while the child farthest away barely
gets any.

In a classroom in the back corner of Hudson Hall,
four biomedical engineering students flashed
through an in-class presentation showing their
plans to create a simple system to produce a
controlled “split” of oxygen from a single line to
multiple infants in the neonatal ward.

A student in the class raised her hand. “How do
you ensure that this will allow newborns to get the
needed amount of oxygen?”

Combating HIV with the Pratt Pouch

The Pratt Pouch was developed in 2008 by Duke students and faculty as
an easy and effective measure to prevent mother-to-child HIV transmission.
Named after Duke’s Pratt School of Engineering, the ketchup-packet like
pouch contains antiretroviral drugs that mothers can squeeze into their
newborns’ mouths after birth. This tool was named one of the Top 10 Most
Innovative Health Technologies by the World Health Organization, and it is
currently being used in Ecuador, Zambia and Tanzania. Now, BME’s Robert
Malkin plans to bring the tool to Uganda and expand its use in Ecuador with
the ultimate goal of reaching 80 percent of babies born to HIV-positive
mothers. Read more on Page 20.

15

GLOBAL HEALTH The group flipped back to images of their project,
showing a panel with separate plastic regulators
Above, from left to right: Bridget Namugga, Success to control each patient’s oxygen supply, each of
Kamuhanda, Meredith Lee, Peter Walusimbi, Stacie which was connected in parallel to the central
Arechavala, and Christine Nalwoga developed tank. This allowed the same gas pressure to be
the oxygen flow-meter during the Duke-Makerere applied to each regulator of the panel from a single
program. Team members Martin Mbowa and oxygen tank. The design was also easy to create
Sanjuana Martinez-Ceniceros are not pictured. and replicate, they said, and it wouldn’t require
the hospital to order expensive parts when things
Ugandan students work on the oxygen regulator broke down.
prototype in Makerere.
“This doesn’t solve all the problems that they
16 Duke BME Fall 2017 encounter in the ward,” said Meredith Lee, a BME
master’s student and one of the presenters, “but it’s
starting to address a big one.”

Engineering a New Perspective

Creating workable solutions to real-world problems
is a key part of the novel Duke-Makerere University
BME Partnership, a collaborative program between
Duke University’s Department of Biomedical
Engineering and the new BME program at Makerere
University in Kampala, Uganda. Spearheaded by
William (Monty) Reichert, the Theo Pilkington
Professor of Biomedical Engineering, the
partnership was created to encourage biomedical
engineering students to approach engineering
problems with cost-efficient and practical solutions
that can be created in resource-limited settings.

Reichert developed the program after spending
the 2014–2015 academic year as a Fulbright Scholar
at the university in Uganda. During his time at
Makerere, he worked as a professor in its newly
created BME program, teaching engineering classes
in biomaterials, tissue engineering, drug delivery,
BME design and even environmental engineering
while also spearheading a major revision of their
BME curriculum.

At Makerere, Reichert noticed that while the
engineering students in Uganda were just as driven
to solve problems as their Duke counterparts, they
were limited by the technology at their disposal.
They could develop a theoretical knowledge of
biomedical engineering, but were hard-pressed
to gain practical experience without sophisticated
tools or labs.

Other issues persisted as well. “One of the main
challenges we face—and continue to have—is
a shortage of staff to support the training of

students,” says Dr. Robert Ssekitoleko, acting In response, Reichert devised a proposal to create “Everyone’s
head of Makerere’s BME Program. “That is being a unique partnership between the schools. This experience
handled in part by the volunteering team that has collaboration would allow Duke students to work in healthcare
been retained as teaching assistants, but these with their Makerere counterparts to create much- is drastically
trainers cannot be officially recognized because the needed, practical medical tools, and Chilkoti
minimum qualification for recruitment at Makerere enthusiastically offered his support. different
is a master’s degree.” depending
“Western engineering doesn’t always apply to on where they
In 2014, Reichert returned to Duke for the problems that people face in places where are, and as
Christmas break and met with BME chair, Ashutosh resources are limited,” says Reichert. “Everyone’s engineers
Chilkoti. Chilkoti encouraged Reichert to think of experience in healthcare is drastically different at a research-
creative ways to build upon his stay in Uganda. depending on where they are, and as engineers at intensive BME
a research-intensive BME department we have the department
“Given the connections Monty had made at ability to address that.” we have the
Makerere University, I thought this provided a
unique opportunity for Monty and our department Reichert worked with Ssekitoleko to create the ability to
to do something meaningful in Uganda,” Duke-Makerere partnership in 2014. Together, address that.”
Chilkoti says. they aimed to create a program that would give

The first two MUK students participating in the graduate program, Kenneth Rubango (right)
and Henry Kiwumulo (left), set an impressive precedent for their peers to follow.

The First Students

Sidebar, first sentence: Kenneth Rubango and Henry Kiwumulo arrived at the Pratt School
of Engineering in the fall of 2016 to pursue their master’s degrees as the first pair of Duke-
Makerere Scholars, with the goal of bringing new skills back to Makerere University to advance
its BME program. During his time at Duke, Kiwumulo aimed to understand how he could design
a biomedical engineering lab that could efficiently operate in a resource-limited setting. This
work culminated in his thesis, where he discussed how to implement practical changes and use
affordable and efficient tools to improve biomedical engineering in Uganda. Rubango, who was
in the first BME class to graduate from Makerere in 2011, aims to create a “high social impact
through medicine,” with a long-term goal to set up a venture capital firm in Uganda to support
the creation of innovative medical tools.

17

GLOBAL HEALTH

“We worked Makerere students practical experience, and peers face-to-face and conduct research in the
through provide Duke students with a unique perspective Mulago hospital to improve their designs.
different time on how they can efficiently design tools and
zones, gained technologies that are made with resource-limited “I learned how to work on a global team,” says
insights into settings in mind. They also arranged for the first Jawad Hoballah, a master’s student in BME who
our Ugandan of six Ugandan engineers, Kenneth Rubango participated in the Spring 2017 Duke-Makerere
teammates’ and Henry Kiwumolo, to come to Duke on full program. “We worked through different time zones,
interests and scholarships to work towards master’s degrees at gained insights into our Ugandan teammates’
culture, and Duke’s BME department, preparing them to return interests and culture, and together we built a
together we to Makerere as instructors in BME. device that can have a meaningful impact on local
built a device communities in Uganda.”
that can have “There is no shortage of problems in resource-
a meaningful limited settings that need engineering solutions, With his family spread across the globe, Hoballah
impact and they don’t always need particularly has had numerous opportunities to see the
on local sophisticated ones,” says Reichert. “If you’re looking differences in access to healthcare across the world.
communities to see how your work is relevant on a human scale, For this reason, he says that Reichert’s course was a
in Uganda.” then there is great value in understanding and key reason why he decided to attend Duke.
devising solutions to these challenges.”
“If you’re going to succeed as an engineer, you need
During the school year, students in Reichert’s to take a different approach to solving problems
class at Duke pair up with groups of students around the world,” says Hoballah. “An issue we face
at Makerere to design tools that can be used to in America is not necessarily an issue they face in
solve common problems at hospitals in Uganda. Uganda, and we can’t just apply a bandage to the
To collaborate, the students communicate via situation and say it’s fixed.”
messaging apps and email, where they continually
refine and discuss their designs and work to ensure Students visit Makerere during
that their tools are cost-effective and practical. their spring break trip.

But the students aren’t limited to online
communication; each semester the teams from
Duke travel to Kampala to meet with their Makerere

Students from the BME programs at both
Duke and Makerere University

18 Duke BME Fall 2017

A prototype of the student-designed crib to A student demonstrates the backpack
treat infants with jaundice. To use the device, Kenneth Rubango and his team designed to
infants are placed on the bottom platform, help with vaccine transport.
and the LED lights provide blue light from
above and below.

During his time in the program, Hoballah’s team Inset: The containers inside the vaccine
helped create a project that addressed neonatal transport backpack allow workers to
jaundice, a common condition that occurs when the efficiently see the content of the vials without
baby’s liver can’t adequately remove a substance exposing the vaccines to warm air.
called bilirubin from the body. The standard
treatment includes light therapy, in which the problem that plagues hospitals and clinics in
baby is placed under specialized blue lighting that Uganda’s hot climate: vaccine transport. Their
can help break down the bilirubin molecules. But design features a carrier that is similar to a thermal
many hospitals in Uganda don’t have access to this lunch box, outfitted with a temperature sensor
treatment, or even incubators to house the children and stacked trays for easy vaccine access. While
during the therapy. the entire design is novel, the engineers took extra
care when designing the trays, as they wanted to
After visiting Mulago hospital, the students came up make it easier for healthcare workers to identify
with a new design for a “jaundice crib.” the vaccines without taking them out of the carrier
and exposing them to warm air, thereby saving their
This design used a box threaded with blue LED contents.
lights. To use the device, the baby is laid down on
the bottom portion, and treated with light from “This isn’t an issue that we’d have in the US, but in
both above and below. Because the LED lighting is Uganda vaccines are often transported by bicycle,”
also removable, when a strand breaks biomedical says Rubango, who was one of the first students to
engineers can easily fix and replace it at low cost. graduate from the BME program in Makerere. “So
spoilage is a big problem, and a simple change like
A third project, developed with Duke-Makerere this can make a big difference.”
Scholar Rubango, devised a solution to another

Supporting Big Ideas

While Duke-Makerere Partnership leaders would like to expand the Denali Dahl
program to help translate student projects into commercial products,
Denali Dahl, a master of science in global health student, is already
working to bring her project from the bench to the market. Dahl took
Monty Reichert’s course in the Spring of 2017, where she teamed up
with Makerere students Brian Matovu and Zoe Sekyonda to create an
at-home diagnostic test that would screen for preeclampsia in pregnant
women. The team submitted design to the Big Ideas Competition,
winning $13,000 in funding to continue to develop the project.

19

GLOBAL HEALTH

Donations Hurt designed for the developed world, not places where
power shortages and other limitations are common.
For Robert Malkin, understanding the context
surrounding a problem is key. Malkin, a professor of Essentially, he says, “If you have donated medical
the practice in BME, is the founder of Engineering equipment to a developing world hospital, you
World Health (EWH), a non-profit organization that have probably hurt the people you were intending
engages students from Duke and around the US to to help. It’s like donating your car to a community
improve healthcare in low-income countries across without gas.”
the globe. Originally, the organization’s goal was to
take decommissioned hospital equipment and fix Malkin shifted his goal when he came to this
it so it could be used in hospitals where resources realization. Now, students who participate in
where scarce. the program are challenged to create low-cost,
sustainable solutions to circumvent the issues that
Malkin says this goal changed after a trip to arise in hospitals where resources are scarce.
Nicaragua, where he found that hardly any of the
equipment that had been donated was being used. One of Malkin’s favorite success stories involves
Instead, the hospital had to rent out a building engineers who recognized that hospital workers
to store the sea of medical equipment that had had a hard time accessing replacement lightbulbs
been donated from EWH and other organizations. for the specialized surgical lights in operating
According to Malkin, the equipment was either rooms. Instead, workers were using regular
already broken when it was donated, or it had lightbulbs, which would quickly overheat and even
broken at the hospital where the staff didn’t have catch fire.
the resources to fix it.
Instead, students devised a method to rewire the
“In our efforts to help, we sent this hospital surgical lights so the bulbs from the backup lights
backwards,” he says. in a truck could be used as an alternative. Their
approach not only increased the longevity of the
According to the Director General of the World surgical lights, but it made replacement bulbs
Health Organization only 10 to 20 percent of immediately accessible and affordable.
donated, critical equipment is ever used, and most
of it requires materials and parts that constantly Devising Lasting Solutions
need to be updated. On top of that, most of the
medical devices that have been donated were Malkin uses his design course—Design for the
Developing World—to challenge students to think
outside the box for their designs, while still being
realistic about cost and utility. Although the course
is independent of the activities of EWH, the projects
that students work on are based on previous
research from students who visited hospitals
through the EWH program.

Students in this course will typically create five to
10 new products a year, which are then used in
hospitals in resource-limited settings. One of the
more enduring projects created through Design for
the Developing World is the Pratt Pouch, a ketchup-
like packet that contains antiretroviral medications
to prevent mother-to-child transmission of HIV
during childbirth.

Volunteers through Engineering World Health “The problems that you solve through EWH and
in Granada, Nicaragua in Summer 2015 through Design for the Developing World extend
beyond technical limitations,” says Meggie Lund,
a recent BME graduate who took Malkin’s design

20 Duke BME Fall 2017

Meggie Lund, a recent BME graduate, fixes globe. Instead, Lund and her team worked on “If you really
a scale during the EWH Summer program in an alternative—a specialized belt that loops want to
Nicaragua. around a person’s chest and utilizes impedance help the
plethysmography to diagnose pneumonia, even
going so far as to distinguish between bacterial developing
and viral strains. Given the impedance disparity world, you
between fluid and air in the lungs, a series of
resistance measurements across the chest could need to
be plugged into an algorithm to “reconstruct” an be in the
image of the lungs and make a diagnosis. The developing
project has continued with different teams
across multiple semesters, Lund and her team world.
are optimistic about the tool becoming a viable These
alternative for doctors. programs

“We try to make sure that we’re designing equipment give
so that the spare parts are locally available,” says students an
Malkin. “But we can also benefit the local economy opportunity
if we can develop these products to be locally
manufactured.” to do just
that.”
Engineering World Health has grown to be an
established presence at Duke since Malkin created
the program in 2001, and the lessons it imparts to
its students are similar to those gained from the
new Duke-Makerere partnership.

And these programs continue to grow.

Raina Kishan and Zoe Roecker fixing a Since its inception, EWH has expanded to include
microscope while working in the San Jose more than 40 chapters at universities across the
Hospital in Diriamba, Nicaragua. US, and it supports training programs in various
countries in Asia, Africa and Latin America. As
course after conducting work with EWH in the the Duke-Makerere BME Partnership enters the
summer of 2015. “Working as a technician in a second year of the five-year agreement, Reichert
Nicaraguan hospital offered a firsthand glimpse is similarly looking at ways to continue to
into equipment needs and common failure points expand the reach of the program. One idea he’s
of existing technology, which we translated into mulling over involves working with students to
more effective, sustainable solutions in Dr. Malkin’s commercialize their products once the course is
design class.” over so their work can also be used outside Uganda.

In Design for the Developing World, Lund was As global-health education expands in Duke
on a team that developed parts of a device to BME, Reichert and Malkin are hopeful that the
diagnose pneumonia. In the US, doctors diagnose students who participate are broadening not
pneumonia via an X-ray, but X-ray machines only their technical, cultural, problem-solving and
aren’t always available in hospitals around the entrepreneurial skills, but also their understanding
about how they can use engineering to help others
around the globe.

“If you really want to help the developing world, you
need to be in the developing world,” says Malkin.
“These programs give students an opportunity to do
just that.”

21

GLOBAL HEALTH

Five Days of Fieldwork

22 Duke BME Fall 2017 Daniel Joh prepares serum samples during the field
test at the Redemption Clinic in Monrovia, Liberia.

Testing a diagnostic tool in Liberia

The generator that powers the Redemption Clinic device that would rapidly test for biomarkers of
doesn’t click on until 10:30 in the morning, but this malnutrition.
delay doesn’t slow the crowd of patients who fill the
healthcare center before 8 am. In one corner of the “You guys ready to get set up?” asked Trenton
clinic, patients wait on rows of wooden benches as Dailey-Chwalibóg, a research project manager from
healthcare workers sort through medical files, the the French non-governmental organization Action
walls surrounding them adorned with murals that Against Hunger/Action Contre la Faim (ACF). For two
illustrate basic health instructions: wear a condom years, organization has partnered with Liberian
to prevent HIV, wash your hands to prevent the health authorities and Duke University Medical
spread of germs, sleep with a mosquito net to Center to investigate the clinical significance of
prevent malaria and yellow fever. the current diagnostic criteria of malnutrition in
hospitals like Redemption. Through his role at
The clinic is adjacent to the larger Redemption ACF, Dailey-Chwalibóg had helped the Duke team
Hospital in the densely populated community of coordinate their field test, and was now acting as
New Kru Town, a neighborhood on the outskirts their unofficial guide to Monrovia.
of Monrovia, Liberia’s capital city. Men and women
of all ages come in to seek free medical care for Joh grabbed his gear. “Let’s get started!”
a variety of issues, but one corner of the clinic is
dedicated to a very specific purpose—screening
children for signs of malnutrition.

Staff from the Ministry of Health work their way
through the growing queue of mothers and
children, measuring the children’s weight, height
and arm circumference before recording the
measurements onto small squares of paper. The
children vary in age, with the youngest in the crowd
appearing to be no more than three months old.
Some children seem content to calmly watch the
process, while others cry when they’re taken out of
their mother’s arms, contributing to the orchestra
of noise that echoes through the clinic’s hallways.

This was the scene that greeted Daniel Joh and
Angus Hucknall when they arrived at Redemption
on an early August morning. Joh, a MD-PhD student
at Duke University, and Hucknall, a senior research
scientist at the university, had traveled from the
U.S. two days earlier, making the journey across
the Atlantic to complete the next stage of their
research—conducting a field test for a diagnostic

Trenton Dailey-Chwalibóg and Issa Kemokai 23
enter the Redemption Clinic. The walls are
painted with murals that show health instructions.

GLOBAL HEALTH

tests to determine if we can take them into our
outpatient program. But what’s interesting is that
these two measurement criteria don’t always
identify the same populations of children as being
severely acutely malnourished.”

Based on these measurements, Dailey-
Chwalibóg and his colleagues sort children into
three categories: children who are considered
malnourished based solely on their MUAC score;
children who are considered malnourished just
based on their z-score; and children who have
both a MUAC of less than 11.5 centimeters and a
low z-score.

“We A mother and her child from the out-patient Focusing on both criteria poses a challenge, as
recognized OptiDiag project at the Redemption Clinic it’s difficult to provide completely consistent
that 35 in Liberia. measurements in the clinics, especially when a
percent of child is protesting and moving around during the
the deaths New Targets and New Tools measurement process. Even if a child remains still,
of children there is no way to ensure that clinicians around the
around Today, more than 25 percent of children under age world have access to the same tools and training
the world five are malnourished. According to the United that would allow for consistent measurements.
are either Nations Children’s Fund, more than 16 million
caused by or of these children suffer from the most extreme “Being able to use a rapid diagnostic test for
exacerbated form of the condition, severe acute malnutrition malnutrition would relieve the staff of a huge
by (SAM). Children with SAM have very low weights burden,” says Issa Kemokai, a research program
malnutrition.” relative to their heights or a very small upper arm manager with ACF based in Liberia. “It would mean
circumference. SAM is a major cause of death that we could help children regardless of the
in children under five, as its victims are more measurement criteria, and it would help us make
likely to contract diarrhea, pneumonia and other our rehabilitation efforts more accurate.”
communicable diseases that their immune systems
can’t fight off. But to make an efficient diagnostic test, researchers
would need a single, easy-to-measure biological
But despite the severity and extent of the problem, target. The problem was that no clear target for
there is currently no simple test to diagnose malnutrition had been identified.
malnutrition.
That changed after Dr. Michael Freemark, the
“The World Health Organization recommends that division chief of pediatric endocrinology at the
we use two different criteria to diagnose severe Duke University School of Medicine, conducted a
acute malnutrition, with the first being the weight- field test in Uganda in 2014 to examine metabolic
for-height z-score, which is like a measurement changes in children who were undergoing
for body mass index,” explains Dailey-Chwalibóg. treatment for malnutrition.
“But we also measure their middle upper arm
circumference, called MUAC. If children have a “We recognized that 35 percent of the deaths of
MUAC of less than 115 millimeters, that tells us that children around the world are either caused by
they are considered severely acutely malnourished or exacerbated by malnutrition,” says Freemark.
and need rehabilitation, so we conduct more “We analyzed comprehensively the hormonal and
metabolic changes that occurred before and during
recovery—no one had really ever done that before.
The factor that stood out as the most powerful
determinant of the risk of death was a low level of a
hormone called leptin.”

24 Duke BME Fall 2017

Leptin, a marker of energy storage, is produced by test using a unique non-stick coating that acted
white adipose tissue. Malnourished children have like Teflon for molecules and cells found in blood. “I
a low amount of this fatty tissue, making it more told Tosh what I was looking for and asked for his
difficult for them to maintain the energy needed advice, and he suggested using this new tool that
to keep their bodies properly functioning under he’d helped create,” says Freemark. “We ended up
severe stress. According to Freemark, this hormone writing a grant with ACF and together we created
also helps stimulate various components of the a portable diagnostic device to measure various
immune system, so patients who have lower levels proteins including leptin.”
of leptin can also develop an immune deficiency,
making them more susceptible to infections. Now, three years after the initial collaboration,
they were going to see how the test performed in
Freemark presented his findings at the 2014 the field.
International Atomic Energy Agency Conference,
where he met with several researchers who
expressed interest in studying leptin, including
Dr. Benjamin Guesdon, a staff scientist for ACF.
Together, they discussed forming a collaboration to
use leptin as a biomarker for a diagnostic test.

“Drawing blood from a patient and shipping it back
for testing at Duke wasn’t really feasible,” says
Freemark. “We needed a test that could work in
settings around the world where malnutrition is a
significant problem, and a colleague suggested I
meet with Ashutosh Chilkoti, the chair of Duke’s
biomedical engineering department, to see if he
had any ideas about a point-of-care diagnostic test.”

At the time, Chilkoti was working with Hucknall, Joh
and other students in his lab to develop a diagnostic

Adam Wax

Developing Diagnostic Tools for Cancer, Eye Diseases

BME’s Adam Wax is developing diagnostic devices that can be used to detect and
diagnose cancers without the need for a biopsy. These diagnostic tools use low-coherence
interferometry and light scattering to detect the size of cell nuclei beneath the tissue
surface, which serve as powerful indicators of pre-cancerous conditions. Currently, Wax and
his collaborators are creating spectrometers that are made with 3D printed parts to detect
cancers in the esophagus, with the goal of using the devices to diagnose cervical cancer.

Wax has also developed a low-cost approach for optical coherence tomography (OCT), a
widely-used technology for early detection and diagnosis of eye-related issues, including
macular degeneration and glaucoma. OCT is a non-invasive imaging test that uses light
waves to take images of a patient’s retina for screening purposes, but the devices that
operate the technology are expensive, and they aren’t typically used outside of large eye
centers. By developing a less-expensive, portable device for retinal imaging, Wax and Dr.
Nick Ulrich, his collaborator from UNC, are paving the way for more healthcare providers to
use OCT imaging for screening and diagnosis around the globe.

25

GLOBAL HEALTH

Trials and Triumphs Joh, Dailey-Chwalibóg and Jay Gupta perform
preliminary verification tests using the D4 assay at
Joh and Hucknall were led down a dark hallway the ACF Liberia base.
to a room in the back of the clinic, where posters
from ACF illustrating symptoms of malnutrition The D4 assay is coated with a novel polymer that prevents
were nailed to the wall. A large wooden desk was in non-target proteins from sticking to the surface.
the middle of the room, facing away from a barred
window that peered back into the clinic. and dry it in a centrifuge before viewing the reading
with a smartphone camera attachment.
“You guys can set up your stuff here. I’ll be back to “This can achieve comparable sensitivity to the
bring you more samples as our patients come in,” ELISA assay within 15 to 30 minutes,” explains Joh.
Trenton said, leaving the room to help the staff with “If we think we need even greater sensitivity then we
measurements. just let the sample incubate longer.”
Initially, the team had packed 250 samples of the
Joh nodded and began unloading his pack, pulling test, but during verification testing at ACF base,
out two small blue boxes that contained their they realized something was wrong.
diagnostic test—the D4 assay. “When we read the slides with the smartphone
detector, you should be able to see quantum dots,
In resource-limited settings, clinicians typically and those will tell you how much leptin is present in
rely on rapid diagnostic tests, called lateral flow the sample,” says Jay Gupta, a sophomore studying
tests, which can provide a diagnosis in five minutes biomedical engineering at Duke and the third
and are highly portable. But the trade-off is a member of the Chilkoti lab in Liberia for the field
diminished sensitivity. Highly sensitive tests, like test. “But when we tested the slides we found that
the ELISA platform, can give researchers a highly
accurate analysis of a sample, but they aren’t
portable or rapid.

Duke’s D4 assay was designed to combine the
sensitivity of an ELISA platform with the portability
and speed of a lateral flow assay.

The D4 assay uses a matched pair of antibodies
to detect and capture leptin in a biological sample.
The array contains two types of antibodies—
immobilized capture antibodies and soluble
detection antibodies—which are tagged with a
fluorescent marker to allow the researchers to
identify how much leptin is present. When a drop
of blood is placed on the slide, the detection
antibodies dissolve, separate from the array and
bind to the leptin in the blood. These fluorescing
antibody-leptin pairs then attach to the capture
antibodies that are still on the slide.

Unlike other diagnostic tests, D4 assay’s antibody
array is printed on a novel polymer brush coating
that works like Teflon to prevent non-target
proteins from attaching to the surface of the slide.
By preventing unwanted proteins from binding to
the assay, the polymer brush makes it easier to
detect low levels of target proteins by getting rid of
the ‘background noise’ on the chip. Before reading
the assay, users wash the chip in a buffer solution

26 Duke BME Fall 2017

most of the tests we packed remained blank, where
control dots didn’t even show a reaction.”

The malfunction may have been caused by the
drastic flux in temperatures during the assays’
journey from the USA to the cold cargo hold to
Liberia, or by the difference in humidity between
Liberia and the laboratory environment at Duke—
but it was clear something had interfered with the
activity of the biological reagents on the slides.

After testing more samples from the remaining
boxes, the team found that two boxes of assays
still worked, though the results were faint. To get a
more sensitive reading, they decided to try testing
the assays with serum rather than whole blood
to get a more concentrated sample. They also let
the assay sit for an hour instead of 15 minutes
to achieve greater sensitivity. By making these
changes, the team could still test the D4 assay in
the field.

Issa Kemokai examines the assay using a
portable microscope.

Tuan Vo-Dinh “We anticipated that there would be problems “This
during these field tests,” says Chilkoti. “This iteration iteration of
Diagnosing Dengue and Malaria of design-build-test-modify and test again is design-build-
inherent in all tech development, and it’s even more test-modify
Tuan Vo-Dinh, the Goodson Professor of critical when the technology is made for demanding and test again
Biomedical Engineering at Duke, is currently environments where point-of-care tests are used.” is inherent
at work on multiple diagnostic assays for in all tech
point-of-care settings. The first is a novel Dailey-Chwalibóg returned with a blood sample development,
lab-on-a-chip that can detect the nucleic acid from a child who has been recruited into ACF’s and it’s even
sequence of the dengue virus using a method OptiDiag project, a study designed to describe and more critical
known as surface-enhanced Raman scattering compare the vulnerability of SAM patients based on
(SERS). Vo-Dinh is also developing a test that their diagnostic category (MUAC, z-score or both). when the
can use the SERS method to detect malaria, technology
a disease that affects more than 200 million “Once a child is identified as being a candidate is made for
people around the globe. for OptiDiag, ACF workers will help the mother or demanding
caretaker fill out a questionnaire about her child’s environments
health history and eating habits, and they’ll collect where point-
hair, urine and blood samples that we use in of-care tests
diagnostic tests to identify biomarkers, like leptin,”
explains Dailey-Chwalibóg. “These kids then receive are used.”
a weekly nutritional supplement with the nutrients
they need for recovery, and return to the clinic
weekly for a medical follow-up until they recover.”

Joh snapped on the gloves and took the sample.
After separating the serum from the blood, he
applied it onto one of the D4 slides, setting a timer

27

GLOBAL HEALTH

“No amount for an hour. Children peered into the room from the “We’ll be able to bring these samples back to Duke
of testing barred window behind him, watching with curiosity and process them normally, as well as on the D4
at Duke as he worked. chips as originally intended,” Gupta explained. “In
would have doing so, we’ll be able to generate essential data
brought these After an hour passed, Joh rinsed off the slide in the which we can use to answer questions about how
issues to the buffer solution before handing it to Hucknall, who the D4 performs and how sampling methods like
forefront, plugged the slide into the phone attachment and the Mitra perform in settings we haven’t tested yet.”
which is why turned on the camera. Although the quantum dots
the trip to were faint, they were visible. After a morning of collecting samples from children
Liberia was at the Slipway Clinic across the Mesurado River,
so useful, “I think we’ll get a better reading using the tabletop Gupta joined Hucknall and Joh at the Redemption
despite the scanner,” Joh said as he examined the photo. They Clinic, where he helped run more D4 assay tests.
setbacks the planned to send the completed assays back to They worked efficiently in a small ACF storeroom,
team faced.” Duke where they could read them with the stronger holding vials up to the light to pipette the serum
scanner to get more accurate results. and placing the micro-samplers into their bags for
shipment.
Once they finished the first slide, Joh and Hucknall
cleaned up and prepared to run a second test while Farewell
they waited for the next sample.
Over the next three days, the team continued their
In addition to testing the D4 assay in Liberia, the work in this manner, with Hucknall and Joh traveling
team had also decided to collect samples to ship to Redemption to test the assays in the clinic while
back to Duke so they could test them on freshly Gupta gathered samples at Slipway. The novel
printed D4 assays and potentially determine what tests might not have worked as the team intended,
went wrong with their slides. but they did have a better understanding of the
parameters where these diagnostic tests were
Traditionally, biological samples collected in the needed.
field are transported by a cold chain process,
which requires researchers to keep them frozen or “Even the initial issue with the antibodies on the
refrigerated to prevent protein degradation. That assay taught us a lot,” Joh said on the last day in
wouldn’t work in this case, so the team opted to use
a Mitra micro-sampler, a unique tool shaped like a Jay Gupta watches as Trenton Dailey-Chwalibóg
Q-Tip that allows researchers to collect and ship prepares a sample for the D4 assays.
biological samples at room temperature. A polymer
in the micro-sampler preserves the sample and
easily allows it to be reconstituted in the lab.

Daniel Joh and Angus Hucknall set up their
supplies and wait for samples in a closed-off
room at the Redemption Clinic.

28 Duke BME Fall 2017

Liberia. “The test won’t be useful to anyone if we Gupta shows Kemokai how the micro-samplers
can’t safely ship it, so it’s good for us to know and are stored so they can be transported without
address.” a cold-chain.

For Chilkoti, the field test provided the team with an goodbyes there was already a discussion about how
important opportunity to test their technology for to improve the assay’s design for the next trip.
any weak links or critical issues.
“We’re bringing samples back to Duke and we’ll
“Now that we’ve had a chance to identify problems, conduct a lot of experiments to see what went
this test gives us the confidence and critical wrong with the sensitivity on the slides, but this trip
information we need to make crucial modifications showed us how this tool could be implemented in
to the technology that we are hopeful will lead to resource-limited settings,” said Joh.
success in the next round of field testing,” says
Chilkoti. “No amount of testing at Duke would have With their work complete and their bags packed,
brought these issues to the forefront, which is Gupta, Hucknall and Joh said goodbye to Dailey-
why the trip to Liberia was so useful, despite the Chwalibóg and Kemokai back at ACF Liberia base.
setbacks the team faced.” “I’m sure we’ll see everyone soon,” Dailey-Chwalibóg
said before everyone piled into the car that would
The team left nearly 30 micro-samplers with take them back to the airport. “It’s great to see the
Dailey-Chwalibóg and the ACF team to collect progress on this.”
more samples over the coming weeks, with plans
to ship them back to Duke when Dailey-Chwalibóg “Definitely,” said Joh. “But there is always more
returned to Paris. As everyone said their final to do.”

OptiDiag is supported by the Humanitarian Innovation Fund, a program managed by ELRHA (Enhancing
Learning and Research for Humanitarian Assistance), ECHO (European Union Civil Protection and
Humanitarian Aid) and the Fondation ACF pour la Recherche et l’Innovation. The views expressed herein
should not be taken, in any way, to reflect the official opinion of these donors and they are not responsible for
any use that may be made of the information it contains.

29

GLOBAL HEALTH

Duke BME Stats

Rankings 1TO0P
faculty scholarly productivity
#3 Numberin world in ShanghaiRankings’s global ranking of biomedical ranking among U.S.
engineering programs (Academic Ranking of World Universities) biomedical engineering
programs (Academic Analytics)
in the United States
for undergraduate

Four BME major in U.S. News
& World Report Best
Colleges rankings

#3 in the country for highest median
starting salary for biomedical
engineers—$70,000 (Medical
Product Manufacturing News)

Research: By the Numbers 2
$30
million 38 Tenured or tenure-track faculty—including: NIH pre-doctoral
in new research awards SPIE and OSA training grants:
in fiscal year 2017 7 BMES fellows Medical Imaging
15 (Nightingale, PI) and
companies fellows 4 Society for Biomolecular and
launched by Duke Biomaterials Tissue Engineering
21 4 Clemson (Gersbach, PI)
22 Award winners
AIMBE (since 2010)
fellows
members
of the National
Academy
of Engineering

BME faculty—2 members of the National
acquired in Academy of Inventors
the past three

years (Sentilus,

Bioptigen)

30 Duke BME Fall 2017

Affiliated Centers and Institutes Pioneering
from
C enter for Biomolecular and Tissue Engineering (CBTE)
C enter for Entrepreneurship and Research the Start
Commercialization (CERC)
C enter for Global Women’s Health Technologies Duke
D uke Cancer Institute (DCI) Biomedical
D uke Center for Genomic and Computational Biology Engineering
Duke Global Health Institute (DGHI) was one of
Duke Institute for Brain Sciences (DIBS) the first BME
Duke MEDx departments
Fitzpatrick Institute for Photonics (FIP)
Research Triangle Materials Research Science and in the
Engineering Center (RT-MRSEC) United States

Fall 2017 Enrollment (est. 1971),
and
263
consistently
undergraduate ranks among
students the top such

178 education
and research
PhD students programs in

the world.

MS students

52
41 MEng students

31

NonProfit Org
U.S. Postage Paid
Durham, N.C.
Permit No. 60

Duke University
Department of Biomedical Engineering
Room 1427, Fitzpatrick Center (FCIEMAS)
101 Science Drive
Campus Box 90281
Durham, NC 27708-0281

“We believe the goal of engineering is to provide
service to a global society.” | 6

The interior of the Fitzpatrick Center for Interdisciplinary
Engineering, Medicine and Applied Sciences, home to
Duke BME