Tech4MH: Five Typical Misfits of Technology in the Developing World

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By: Elizabeth Johansen, Director of Product Development, Design that Matters

Well-designed medical technology has tremendous potential to reduce maternal and neonatal mortality in developing countries. However, according to an influential Duke University study, 98% of donated medical equipment breaks within five years largely because it is designed to function in developed country settings, with regular and adequate supplies of electricity and maintenance. As a result, the social sector is currently flooded with inappropriate technologies for developing countries that do not provide many benefits and are not trusted or adopted by users.

Design that Matters (DtM) finds the best applications for design and technology to create massive impact serving the poor in the developing world. Through our design process, we have found that most existing technologies do not make a big impact because of five typical misfits; they are too expensive to own and operate, hard to use correctly, hard to maintain, context incompatible, and untrustworthy. DtM’s Firefly newborn phototherapy is an illuminating example of how trust – a factor that is often overlooked in technology adoption – plays a major role in lifesaving medical care.

During the Firefly newborn phototherapy design process, DtM found moms and babies were being kept apart during jaundice treatment; hospitals did not have any equipment they trusted to put in the room with mom. Maternal bonding and lifesaving breastfeeding were compromised as hospitals struggled to match newborns with moms for breastfeeding. Often babies were fed bottles of breast milk or formula, sometimes sharing the same bottle with many other infants in the ICU while mothers sat worried in another part of the hospital.

As we interviewed doctors, nurses, and mothers, we found the common overhead phototherapy devices were not trusted in the mother’s room. Locally made versions with bare sheet metal housings were too rough looking to engender trust. Imported overhead phototherapy was too complicated and precious to be trusted near mom. Out of 35 hospitals we visited, only Da Nang Hospital for Women and Children had a substantial, ongoing program to provide phototherapy in the mother’s room. During our visit, Dr. Truong Thi Nhu Huyen commented, Using overhead phototherapy in mom’s room is not ideal since the height is often set incorrectly.” In most hospitals, medical professionals worried that mothers would impede phototherapy by laying a blanket over the child, changing the device settings, or breaking the device entirely.

In response, Design that Matters created a device with high-intensity, top and bottom lighting. Even if a blanket is placed over the newborn, they still receive effective phototherapy from beneath. The light height cannot be altered, leading to physicians feeling more comfortable that newborns will receive the optimum intensity of therapy at all times, even when the device is left unsupervised with the mother. The unit is also smaller and very durable with a high-tech, trustable aesthetic, enabling it to fit in the mom’s room without worrying medical professionals or mothers.

So far, Firefly phototherapy has been successful in fostering trust through design. After witnessing the introduction of the device into Da Nang Hospital, Dr. Huyen commented, ”We have been using phototherapy in mom’s room for 5 years. In the past we have had to treat the infant next to mom’s bed, this is better with Firefly because we can treat them in mom’s bed.”

 Over the next several years, DtM will continue to work with our partners East Meets West Foundation and Medical Technology and Transfer Services (MTTS) to study the adoption of Firefly as it serves at least 100,000 jaundiced newborns and their mothers in Southeast Asia and beyond.

Tech4MH is an ongoing guest blog series curated by MHTF Research Assistant Yogeeta Manglani. If you would like to submit a guest blog post for possible inclusion the series, please email Yogeeta at