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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, maskCompressor not a medical device, simply

supplies airCup 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 clinics

oOnly 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 partsTreat and take data in health departments and

villagesTrain people in health departments and villages on

how to build and useDistribute manuals on operation and creation of

deviceDonate a nebulizer to each villageGain local feedback

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In-Country Implementation: Week 1Day 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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In-Country Implementation: Week 1

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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In-Country Implementation: Week 1

Day Date Tasks Completed

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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In-Country Implementation: Week 1Day Date Tasks Completed

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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In-Country Implementation: Week 2

Day Date Tasks Completed

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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In-Country Implementation: Week 2Day Date Tasks Completed

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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In-Country Implementation: Week 2Day Date Tasks Completed

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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In-Country Implementation: Week 2

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In-Country Implementation: Week 2Day Date Tasks Completed

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 dependabilityQuality of Honduran materials and healthcareGiven “North American Prices” – Prices also

variedQuantity and age of patientsLanguage Barrier – Quality of our instruction

may have variedCreation of the manuals – Far walk to print

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Evaluation/FeedbackCheap; most who need cannot afford

electric nebulizer (L1,800), ours cost L343Generally preferred reservoir designGeneral 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 Sporti ng GoodsSize 5 Soccer Ball 1 24.99$ 24.99$ -$ 3/25/2014 Dick's Sporti ng GoodsSize 5 Soccer Ball 2 15.99$ 31.98$ -$ 3/25/2014 Dick's Sporti ng 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,

DollarsPayment, 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-14Copy Centro Douglas copying $ 5.85 L. 120.00

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

10-May-14Copy Centro Douglas copying $ 4.88 L. 100.00

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-14Copy Centro Douglas copying $ 6.10 L. 125.00

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

10-May-14Copy Centro Douglas copying $ 3.02 L. 62.00

Total Cost 298.64$ L. 6,122.10

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Total R&D CostMostly from purchasing balls and prototyping

materialsLarge 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 measurements

Qualitative 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 pointsHonduran Nurse at the private clinic collected 2 control

data points and 4 more data points using our nebulizerThe power of the test will be low, will hopefully increase as

our contacts continue to take dataAlpha 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 0.413We 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 ResultsTreatment had qualitative successStopped bronchospasms in one patientPatients reported less or no difficulty breathing

post-treatmentSome 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 constructingTrained variety of individualsTargeted 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 departmentsDr. Giron will make and distribute nebulizers

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Entrepreneurial Opportunities

Demand existsProduct: Nebulizer kit and manualEnd user: Asthma patientsCostumer: Philanthropic or Social Enterprise

Non-profits such as NGOsSocial entrepreneur

Dr. GirónRoger HenriquezCarlos Ferrera

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ConclusionsThis was a reasonably successful pilot studyThere is a need for this project in the developing

worldWell-perceived and culturally acceptable deviceFuture studies should collect more dataFailed to reject the null hypothesis that this

method is as effective as the medical nebulizer.

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AcknowledgementsRoger Dzwonczyk Mariantonieta GutierrezAngie Overholt and the entire WGM teamAnna K YoungKathy StoneDuane HartNationwide Children’s Hospital

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Questions?