Nebulizer Project Matthew Lawrence Brockman Daniel Puthenpurayil George Nathan Joseph Hankins Marissa Kathleen McHugh 1

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Nebulizer ProjectMatthew Lawrence BrockmanDaniel Puthenpurayil George

Nathan Joseph HankinsMarissa Kathleen McHugh

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OutlineI. What’s a Nebulizer, Needs Assessment & Scope of Work - MatthewII. Our Design – MatthewIII. In-Country Implementation – NathanIV. In-Country Training – MarissaV. Issues Encountered – DanielVI. Evaluation/Feedback – NathanVII. Cost Analysis – DanielVIII. Testing and Results – MatthewIX. Sustainability and Ownership – MatthewX. Entrepreneurial – Nathan

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What’s a NebulizerCompressor, filter, tubing, cup, mask

Compressor not a medical device, simply supplies air

Cup aerosolizes water with medication

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Needs Assessment: Respiratory Problem

Causes

Environmental effectsDesert climateDrynessWindDusty air/Dust stormsAllergenic trees

Garbage and vegetation burned near homes

Indoor cooking firesCockroach infestations

Factors contributing to high prevalence of respiratory problems:

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Needs Assessment: Nebulizer Availability

Problems receiving nebulizer treatment:

Limited availability at local clinicsoOnly 1-2 nebulizersoWalking distanceoClosed on weekendsoOpen 7AM to Noono Frequent power outagesoDays designated for non-respiratory problems

High cost (about $100) compared to salary

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Scope of Work and Needs Assessment

Problem Statement: Deliver a simple, home-made nebulizer and an instruction manual

Costumer: o Resistants of Choluteca, Honduras who suffer from

respiratory problemso Larry and Angie Overholt

Needs Assessment: o Large portion of the population suffers from asthmao Environmental causeso Low availability of nebulizers

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Our Design

Filter filters to about 10 micrometers, car or motorcycle fuel filters will work similarly

Bike pump acts as compressor

This project uses actual nebulizer cup, mask, and tubing

Soccer ball filters out the duty cycle of the pump as a capacitive element

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In-Country Implementation

The team’s main goals were as follows:

Source local parts

Treat and take data in health departments and villages

Train people in health departments and villages on how to build and use

Distribute manuals on operation and creation of device

Donate a nebulizer to each village

Gain local feedback

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In-Country Implementation: Week 1

Day Date Tasks Completed

Monday

5/5/2014

- Sourced Parts Locally- Tested/Troubleshot Local

Parts - Worked on Manual

Tuesday 5/6/2014

- Worked on Manual - Reassessed Schedule and

Desired Statistical Method to be Used

- Tested/Troubleshot Local Parts

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Day Date

Wednesday 5/7/2014

Tasks Completed

- Finalized Manual/Made Copies- Introduced Both Methods, Treated, and Trained

Local Woman, Erma (donated nebulizer)- Introduced Both Methods and Trained

Nurses/Doctor at Choluteca Health Department

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In-Country Implementation: Week 1Day Date Tasks Completed

Thursday 5/8/2014

- Introduced Both Methods, Treated Patient, and Trained Nurses/Nursing

Students/Doctor at Namasigue Health Department (donated nebulizer, health

department had no electricity) - Purchased Additional Parts

- Introduced Both Methods, Treated Children, and Trained Women’s Guild of Siete de

Mayo (donated nebulizer)

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Friday 5/9/2014

- Introduced Method and Trained Nurses/Patients at Choluteca Health Department (donated

nebulizer)- Lined up Visits to Private Clinic, Hospital, and

Pharmacy- Prepared for Pharmacy Advertising

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Saturday 5/10/2014

- Provided free treatments, demonstrated the method, and handed out manuals outside

pharmacy (met teacher)- Worked on Poster design for Public Health

Departments

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Monday 5/12/2014

- Introduced Method, Treated Patients, and Trained Nurses/Doctor/Patients at

Dr. Girón’s Private Clinic (donated nebulizer, committed to getting more

data)- Printed and Laminated More Manuals

- Updated Treatment Forms

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Tuesday 5/13/2014

- Introduced Method and Trained Nurses/Doctor in Namasigue Health

Department (presented poster)- Treated Infant Successfully with Only Saline- Discussed Entrepreneurship Opportunities

- Introduced Method and Trained Women in Siete de Mayo

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Wednesday 5/14/2014

- Visited Choluteca Health Department (presented poster)

- Interviewed by Local News TV Station, TeleVida63

- Searched and Found Teacher of Cambridge Bilingual School we Met on the Street Saturday and Presented for

His Class (donated nebulizer)

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Thursday 5/15/2014

- Introduced Method and Trained Nurses/Patients/Doctors at the

Choluteca Hospital’s Nebulization Clinic, Emergency Room, and Pediatric

Ward (donated laminated manual)- Introduced Method and Trained Entire

Waiting Area of Hospital (ran out of manuals)

- Returned to Dr. Girón’s office and were able to record results of 2 patients

using an electrical nebulizer- Introduced Method, Treated, and

Trained 2 Women of La Bonanza (donated one nebulizer)

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The training process involved:Demonstration of assembly and

operationExplanation of evaluation formsReview and distribution of manualDistribution of posters

In-Country Training

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Constructed a user manual1. Instructions for assembly2. List of materials including pictures,

prices, and store names3. Directions for usage and sanitation4. Reservoir recommendations5. Troubleshooting

In-Country Training

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Distributed laminated, color copies to public health departments and Dr. Giron’s clinic, the women’s group in Siete de Mayo, and Mr. Carlos from Cambridge.

Distributed black/white copies to woman in Choluteca, woman in La Bonanza, public health departments, Dr. Giron’s clinic, and at Farma City.

In-Country Training

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All places visited followed the same basic pattern

Trained doctor(s) and nurses

Trained asthma and non-asthma patients and parents

In-Country Training

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Taught nurses how to use peak flow meters

Taught nurses how to complete the pre/post evaluation forms

In-Country Training

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Issues EncounteredTransportation dependability

Quality of Honduran materials and healthcare

Given “North American Prices” – Prices also varied

Quantity and age of patients

Language Barrier – Quality of our instruction may have varied

Creation of the manuals – Far walk to print

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Evaluation/FeedbackCheap; most who need cannot afford

electric nebulizer (L1,800), ours cost L343

Generally preferred reservoir design

General public eager to learn (passed out over 100 manuals)

“Our country needs this”

A few people were hesitant at first – required additional explanation

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Evaluation/FeedbackPeople were often excited by the design

and would tell others - Cambridge teacher had told students and staff members including the security guard

Doctor at Namasigue said it was a useful design because often patients are without electricity

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R&D Cost Pre-TripDate Source Material Purchased Quantity Individual Price Cost Shipping

2/12/2014 mil lersgarden.com In line Universal Gas Filters Fuel filter 1/4" 5/6 5 1.80$ 9.00$ 3.00$ 2/15/2014 justnebul izers .com Air Filters For Omron CompAir Nebulizer Systems 10 1.39$ 13.90$ 6.95$ 2/18/2014 Target Schwinn- Bike pump 1 17.29$ 17.29$ -$ 2/27/2014 Lowes Brass hose barb adaptor (1/8" ID x 1/4: MIP) 2 3.58$ 7.16$ -$ 2/27/2014 Lowes Brass hose barb adaptor (3/16" ID x 1/4: MIP) 2 3.88$ 7.76$ -$ 2/27/2014 Lowes Brass tee pipe (1/4" PIP) 1 7.47$ 7.47$ -$ 2/27/2014 Lowes Pressure gauge 1 9.98$ 9.98$ -$ 3/13/2014 Target Basketball 1 10.99$ 10.99$ -$ 3/20/2014 Walmart Bell-Bike pump 1 9.96$ 9.96$ -$ 3/20/2014 Target Basketball 1 10.99$ 10.99$ -$ 3/20/2014 Target Schwinn hand pump 1 24.59$ 24.59$ -$ 3/20/2014 Target Size 4 Soccer Ball 2 9.99$ 19.98$ -$ 3/25/2014 Dick's Sporting GoodsSize 5 Soccer Ball 1 24.99$ 24.99$ -$ 3/25/2014 Dick's Sporting GoodsSize 5 Soccer Ball 2 15.99$ 31.98$ -$ 3/25/2014 Dick's Sporting GoodsInflation Needles 4 2.49$ 9.96$ -$ 3/28/2014 Medicomp Nebulizer Filter 4mm M 50 3.23$ 161.56$ 13.44$

Subtotals 377.56$ 23.39$ Total Cost 400.95$

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R&D Cost During TripDate Supplier Item

Payment, Dollars

Payment, Lempira

8-May-14Comercial El Balon de Oro balls $ 36.59 L. 750.00

7-May-14 Super Torrillo pumps $ 44.44 L. 911.006-May-14 La Colonia balls $ 6.46 L. 132.457-May-14 Farmacias Kielsa parts $ 8.29 L. 170.008-May-14 Super Torrillo pumps and balls $ 21.85 L. 448.00

7-May-14Copy Centro Douglas copying $ 10.98 L. 225.00

7-May-14 Global Cyber copying $ 14.63 L. 300.00


8-May-14 Global Cyber copying $ 1.95 L. 40.00


10-May-14 Global Cyber copying $ 1.22 L. 25.008-May-14 Global Cyber copying $ 23.56 L. 483.00

14-May-14 Global Cyber copying $ 2.93 L. 60.0014-May-14 Global Cyber copying $ 9.76 L. 200.0012-May-14 Global Cyber copying $ 14.54 L. 298.0015-May-14 Global Cyber copying $ 1.22 L. 25.00


15-May-14Farmacia de los Pobres Masks $ 8.78 L. 180.00

15-May-14 Farmacia Familiar Masks $ 3.17 L. 65.005-May-14 Farmacias Kielsa masks $ 17.80 L. 365.00

5-May-14Comercial El Balon de Oro balls $ 6.10 L. 125.00

5-May-14 Auto Partes Dimer $ 0.98 L. 20.007-May-14 Motorepuestos filters $ 2.24 L. 46.005-May-14 Super Torrillo pump and needles $ 18.24 L. 374.009-May-14 DeTodo balls and pumps $ 23.06 L. 472.65


Total Cost 298.64$ L. 6,122.10

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Total R&D Cost

Mostly from purchasing balls and prototyping materials

Large purchase of the filters to donate

Pre-Trip 400.95$ During Trip 298.64$ Total 699.59$

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Per Nebulizer Cost – United StatesUsing a size 5 soccer ball and the cheapest of

the other materials, one nebulizer cost the team approximately $30.57

Without a reservoir, the nebulizer cost approximately $13.75

In line Universal Gas Filters Fuel filter 1/4" 5/6 1.80$ Bell-Bike pump 9.96$ Size 5 Soccer Ball 15.99$ Needle 0.83$ Nebulizer tubing, cup, and mask set 1.99$ Total Cost 30.57$

In line Universal Gas Filters Fuel filter 1/4" 5/6 1.80$ Bell-Bike pump 9.96$ Nebulizer tubing, cup, and mask set 1.99$ Total cost 13.75$

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Per Nebulizer Cost – Honduras

Cost with reservoir: $16.73

Cost without reservoir: $9.17

Hondurans can likely get these items for a lower price – One person commented they could get a soccer ball for L. 80.00

Motorcycle Fuel Filter L. 20.00 0.98$ Schwinn- Bike pump L. 125.00 6.10$ Size 5 Soccer Ball L. 150.00 7.32$ Needle L. 5.00 0.24$ Nebulizer tubing, cup, and mask set L. 43.00 2.10$ Total Cost L. 343.00 16.73$

Motorcycle Fuel Filter L. 20.00 0.98$ Schwinn- Bike pump L. 125.00 6.10$ Nebulizer tubing, cup, and mask set L. 43.00 2.10$ Total cost L. 188.00 9.17$

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In-Country Testing Regimen

Assess situation

Pre-treatment baseline measurementsQualitative testingQuantitative testing

Post-treatment evaluationQualitative analysisQuantitative analysis

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Pre and Post-Treatment Qualitative Testing

List observations related to breathing (Is patient coughing, wheezing, gasping for air, etc.)

Doctor/Nurse observations or comments

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Pre and Post-Treatment Quantitative Testing

Have patient blow into peak flow meter three times, take maximum

Ask patient to rate difficulty of breathing from uno to diez, uno being perfect lung function

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Post-Treatment Quantitative Analysis

Have patient blow into peak flow meter three times, take maximumApply Equation 1 to find percent increase

Ask patient to rate difficulty of breathing from uno to diez, uno being perfect lung functionReport difference

Equation 1

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Testing: ResultsTreated 14 patients while in country: yielded 8 numerical

data points

Honduran Nurse at the private clinic collected 2 control data points and 4 more data points using our nebulizer

The power of the test will be low, will hopefully increase as our contacts continue to take data

Alpha level of 0.05 (medically standard)

Null Hypothesis: The average percent increase in peak flow for the medical nebulizer is the same as the average increase in peak flow for the home made nebulizer.

Alternative Hypothesis: The average percent increase in peak flow for the medical nebulizer is greater than the average increase in peak flow for the home made nebulizer.

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Testing and Results

p-value was 0.413

We therefore fail to reject the null hypothesis that the two means are the same

Little data so far

Before AfterPercentIncrease

100 250 150%150 200 33%

92%Average

Medical Nebulizer

Before AfterPercentIncrease

125 160 28%100 220 120%

70 120 71%120 170 42%

50 80 60%110 150 36%190 245 29%

90 150 67%100 150 50%

60 150 150%100 200 100%

60 150 150%75%Average

Home-Made Nebulizer

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Observational Results

Treatment had qualitative success

Stopped bronchospasms in one patient

Patients reported less or no difficulty breathing post-treatment

Some children fell asleep while using the nebulizer

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Sustainability and Ownership

Made from locally available parts for low cost: sustainable supply of nebulizer

Ownership: instructions for constructing

Trained variety of individuals

Targeted individuals/groups who are most likely to continue using the device and teach others – parents

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Sustainability and Ownership

Cambridge teacher will continue to spread the idea

Posters and manuals at health departments

Dr. Giron will make and distribute nebulizers

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Entrepreneurial Opportunities

Demand exists

Product: Nebulizer kit and manual

End user: Asthma patients

Costumer: Philanthropic or Social EnterpriseNon-profits such as NGOsSocial entrepreneur

Dr. GirónRoger HenriquezCarlos Ferrera

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Conclusions

This was a reasonably successful pilot study

There is a need for this project in the developing world

Well-perceived and culturally acceptable device

Future studies should collect more data

Failed to reject the null hypothesis that this method is as effective as the medical nebulizer.

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AcknowledgementsRoger Dzwonczyk

Mariantonieta Gutierrez

Angie Overholt and the entire WGM team

Anna K Young

Kathy Stone

Duane Hart

Nationwide Children’s Hospital

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Questions?

Documents

Nebulizer Project Matthew Lawrence Brockman Daniel Puthenpurayil George Nathan Joseph Hankins Marissa Kathleen McHugh 1