Contextualized adaptations
Diversion of existing tools for completely different purposes
Bogota bag
A Bogota bag is a simple, cheap but ingenious device that originated in Bogotá, Colombia. It is a sterile plastic bag used to provide temporary abdominal closure (laparostomy) in emergency laparotomy where closure of the abdomen is either impossible or unsafe owing to the risk of compartment syndrome, often after damage limitation surgery. In most hospitals a 3-litre glycine bladder irrigation bag is cut open and used to cover the laparostomy. It allows direct inspection of bowel in patients with ischaemia, facilitates relaparotomy, improves drainage of excess fluid from the abdomen and reduces tissue oedema. This facilitates eventual fascial closure.
References: Oppong FC. Innovation in income-poor environments. The British journal of surgery. 2015;102(2):e102-7.
Low-Cost Mesh in Groin Hernia Repair.
he most effective method for repair of a groin hernia involves the use of a synthetic mesh, but this type of mesh is unaffordable for many patients in low- and middle-income countries. Sterilized mosquito meshes can be used as an alternative. In a randomized controlled trial, rates of hernia recurrence and postoperative complications did not differ significantly between men undergoing hernia repair with low-cost mesh and those undergoing hernia repair with commercial mesh.
References: Lofgren J, Nordin P, Ibingira C, Matovu A, Galiwango E, Wladis A. A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair. N Engl J Med. 2016;374(2):146-53.
Coffee for postoperative ileus after surgery
Postoperative ileus is a common problem after abdominal surgery. Coffee consumption after colectomy was safe and was associated with a reduced time to first bowel action.
References: Muller SA, Rahbari NN, Schneider F, Warschkow R, Simon T, von Frankenberg M, et al. Randomized clinical trial on the effect of coffee on postoperative ileus following elective colectomy. The British journal of surgery. 2012;99(11):1530-8.
Vicks Vaporub for onychomycosis
Current medication treatments for onychomycosis have less than full cure-rate efficacy and have the potential for adverse side effects. Vicks VapoRub (The Proctor & Gamble Company, Cincinnati, OH) seemed to have a positive clinical effect in the treatment onychomycosis.
References: Derby R, Rohal P, Jackson C, Beutler A, Olsen C. Novel treatment of onychomycosis using over-the-counter mentholated ointment: a clinical case series. Journal of the American Board of Family Medicine : JABFM. 2011;24(1):69-74.
Using hardware drills as replacement for surgical drills
The UBC engineering team discovered that certain models of hardware drills (available from standard hardware stores) have the same torque and rotation speed as the surgical drill that is sold at 300 times the price. Designed for the durability demands of a construction site, a hardware drill is an ideal solution for surgical care in low-resource setting. However, hardware drills cannot be sterilized in a steam autoclave.The team of engineers came up with a solution to this obstacle: a two-part sterilizable drill cover. The cover envelops the drill in medical-grade cloth funnelling into a surgical-grade stainless steel ring. The second part, a stainless steel interface, creates a perfect enclosure and allows adjustment for the various surgical attachments required for the orthopaedic procedures. Ref: 1) Lam JMK, Buchan LL, Potter J, et al. Surgical device innovation for low-resource settings: an alternative for bone drilling. Can J Surg 2015. In Press. 2) O'Hara NN. Is safe surgery possible when resources are scarce? BMJ quality & safety. 2015;24(7):432-4.
Plastic bags for prevention of hypothermia in preterm and low birth weight infants
Placement of preterm/low birth weight infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low-cost, low-technology tool for resource-limited settings.
References: Leadford AE, Warren JB, Manasyan A, Chomba E, Salas AA, Schelonka R, et al. Plastic bags for prevention of hypothermia in preterm and low birth weight infants. Pediatrics. 2013;132(1):e128-34.
Solarclave: Surgical instrumentation sterilization using solar technology and found materials
With a bucket, a pressure cooker, and 140 pocket-sized mirrors, IIH researchers have invented a device that uses sunshine to sterilize surgical tools. Solarclave provides reliable surgical sterilization for rural clinics outside of the grid – enabling healthcare workers to provide basic, life-saving services for patients. It uses locally-available materials and manufacturing techniques that are already available in thousands of rural workshops across the world. Its thermodynamic efficiency allows for a small size that is easily transportable to remote clinics and is simple for one healthcare worker to set up. The technology is designed and built in collaboration with the Solar Women of Totogalpa, solar technology experts in Nicaragua.
Home-made spacers for bronchodilator therapy in children with acute asthma
A sealed 500 mL plastic bottle produced similar bronchodilation as a conventional spacer. An unsealed bottle gave intermediate improvement in lung function, and a polystyrene cup was least effective as a spacer for children with moderate to severe airways obstruction.
References: Zar HJ, Brown G, Donson H, Brathwaite N, Mann MD, Weinberg EG: Home-made spacers for bronchodilator therapy in childran with acute asthma: a randomised trial. Lancet. 1999, 354: 979-982. 10.1016/S0140-6736(98)12445-5.
Diagnosis of testicular cancer with a urine pregnancy test
Pregnancy tests work by detecting a hormone called Beta-HCG, produced by the cells of the placenta during pregnancy. Beta-HCG is also excreted by some kinds of tumors, including some, but not all testicular cancers.
Low-cost wheelchair cushion designed for developing countries
A low cost wheelchair cushion, called the Tuball is made from bicycle inner tubes and plastic balls. Its durability and pressure-relieving characteristics were comparable with the ROHOTM cushion and better than the foam cushions used in Brazil.
References: Guimaraes E, Mann WC. Evaluation of pressure and durability of a low-cost wheelchair cushion designed for developing countries. Int J Rehabil Res. 2003 Jun;26(2):141-3.
Paper clips as an alternate to raney clips during dental surgery
Textbooks have recommended the use of Raney clips for dental surgery but these are not available routinely in India and are expensive. Simple stationary paper clips, autoclaved and used for surgery can provide haemostasis but also aids in holding the flap during dissection.
References: Waknis PP, Prasad GS, Wadje S. A simple method to control bleeding by stationary paper clips as an alternate to raney clips during coronal incisions. J Maxillofac Oral Surg. 2013 Mar;12(1):117-9.
Low-cost sunscreen with natural ingredients
Home made and effective sunscreen created using local ingredients.
References: Miyar ME, Diven DG, Cosulich MT, Kidd LL, Braswell MA, Triplett TM, et al. Serving the underserved: creating a low-cost sunscreen with natural ingredients for humanitarian medical trips to the developing world. Br J Dermatol. 2014 Aug;171(2):415-7.
Urinary reagent strips for synovial fluids examination
In daily practice, the evaluation of synovial fluids by reagent strips could be of use to discriminate between inflammatory and non-inflammatory fluids.
References: Ravaud P, Hudry C, Giraudeau B, Weill B, Dougados M. Rapid diagnosis of inflammatory synovial fluid with reagent strips. Rheumatology (Oxford). 2002 Jul;41(7):815-8.
Urinary reagent strips for cerebrospinal fluids examination
Reagent strips can distinguish normal from infected crebrospinal fluids, and are of value in the diagnosis of meningitis.
References: Moosa AA, Quortum HA, Ibrahim MD. Rapid diagnosis of bacterial meningitis with reagent strips. Lancet. 1995 May 20;345(8960):1290-1.
