Archive for the 'aid' Category

Mass Customization in Prosthetic Care

We’ve been up to a lot here at The BETH Project. Thanks in part to the support of the IDEAS Global Challenge and MIT Public Service Center, we’ve been busy prototyping, testing and talking to patients and prosthetists.

The BETH Project team first  came together at a MIT H@cking Medicine conference in early 2012, gathering around Asa’s proposal to leverage desktop 3D printing technology to respond to the need of low cost prosthesis in developing countries. Early on we identified that the challenges in providing prosthetic could not be simply solved by reducing existing device cost to increase availability. We began to investigate how the system of care was limiting affordable healthcare and mobility solutions for the global population.

A central problem to addressing the developing world was the lack of trained prosthetists, which essentially creates a bottleneck to meeting the demand for prosthetic care. Even today’s most advanced sockets are made using a half-century old iterative artisanal process that can take weeks and requires expensive specialized machinery.  The limited labor force in combination with the overhead costs results in care facility consolidation making it even more challenging for patient with limited mobility to access the care they need. The World Health Organization estimates there is a shortage of 40,000 prosthetists in the world today and at the current rate it will take 50 years to train another 17,000. This insight led us to design our solution from the ground up instead of trying to attach our ideas onto the existing fabrication and care paradigm.

As with many personal medical devices, understanding the challenges requires getting up close and personal with the problem. Unless you are close to a loved one who wears a prosthesis or you work in the industry, you would not be aware of the daily routines and maintenance that comes with using an artificial limb. After speaking with amputees who have worn prostheses from anywhere from a few months to sixty years, the one concern that came up over and over again was comfort. The difference between comfortable and uncomfortable is quite subtle and a common means to adjust for greater comfort is to grind the hard socket as shown in the image below.



The socket is the core component to a comfortable fitting prosthesis because forms a crucial interface between an amputee’s residual limb and his or her prosthesis. Structurally sockets are unique in that they are required to carry heavy loads and function as an  extension of our skeletal structure, but at the same time provide a comfortable interface where contact is made with an amputee’s soft muscle and skin tissue. Our goal of providing a comfortable fit with a simple fitting process led us to explore socket material alternatives. Conventionally, this is the rigid composite receptacle that is attached to the top of lower-limb prostheses. Unlike the rest of the prosthetic limb, which is generally a standardization part, the socket must be custom fabricated for each individual then painstakingly fitted, adjusted and replaced over time. Ill-fitting sockets are common because of the natural volume changes in our bodies which leads to and uncomfortable fit and if not adjusted, sores that can lead to infections that ultimately compromise amputee health and mobility.


The BETH Project is focused on addressing these challenges with an adjustable socket design that provides the ability to accommodate natural volume changes and reduce pressure on sensitive areas to promote faster healing of sores while extending the usability of a prosthetic limb. Our chosen material provides the opportunity to tap the benefits of mass manufacturing rather than local fabrication, thus lowering costs for all care providers and creating a consistent quality standard for sockets. In places where trained personal and facilities are a premium we hope to relieve care providers from the complexities of socket fabrication, and in some cases providing the opportunity for physical therapists who have transferable skills to fit and provide rehabilitative care to amputees.

The fortress and the free agent

Non-profit tech experts Beth Kanter and Alison Fine have a great article in the June 13 edition of the online Chronicle of Philanthropy. In it, they profile a 29-year old Canadian who has spent the last couple of year traveling the world, doing good deeds, documenting his experiences, and sharing them online – inspiring millions to follow along and contribute to his work. Pretty cool stuff. Reminds me a little of the work of Gabriel Stauring, inspiring founder of stopgenocidenow.org.

In the article, they make a provocative claim: “Free agents do it when and how they please, making them distinct from and more powerful than traditional volunteers.”  ”He is inspiring other people to talk about the issue of global poverty and take action “’in a way that is different from the big nonprofit organizations,’” he says.

But he’s having a hard time earning credibility with the big guys – the more conventional aid organizations. Alison and Beth explain:

““The problem isn’t social media, the problem is that you are the fortress. Social media is not my problem: I have over a quarter million followers on Twitter, 10,800 subscribers on YouTube, and 2.1 million views. Yet despite that, I have a hard time having you guys take me seriously. I get dismissed as ‘just a guy on YouTube.’”

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Some of Voices of Public Service at MIT

Voices of Service at MIT

Meet some of the students and learn about the ways they are putting their talent, skills, and passion to work around the world. Click here for the scoop…

eHealth, telemedicine, capacity building, and learning

Love this video of the incredibly articulate Chris Moses ’10, who was awarded a Davis Projects for Peace Fellowship and participated in the Public Service Fellowship and Grants program. Here, he discusses Sana (formerly MocaMobile). Sana earned a development grant from the MIT IDEAS Competition, and went on to win the mHealth Alliance Award and Vodafone Wireless Innovation Prize. The $150,000 in awards will enable the group, of which Chris is an integral part, to improve their telemedicine-based health care delivery system for rural underserved populations.


Chris Moses on MIT TechTV

US Aid Professionals to American Volunteers: Stay Home

William Easterly is a well-respected economist, author, and aid critic at New York University. One of his books that influenced me quite a bit is “The Elusive Quest for Growth: An Economists Adventures and Misadventures in the Tropics.” In it, he lays out a passionate, cogent case that U.S. foreign aid has not delivered the economic and social benefits donors should expect. You can keep up with his writing at his blog, Aid Watch. Much of it is a consistent stream of criticism around ways aid is portrayed in the media, with timely quarrels with the numbers and policy recommendations.

An interesting side effect of this work has been a rising call for American voluntary aid workers to stay home. In fact, you might even say that the work of journalists like Nicholas Kristoff to popularize awareness of conditions in struggling regions has been met with frustration at Americans’ corresponding desire to do something.

This do something spirit, perhaps amplified in our age of Internet-enabled media and visibility, has even been given a new name, voluntourism.

The frustration with Americans pitching in generally, and voluntourism specifically, is exemplified by the blog Tales from the Hood - at the center of a group of bloggers with titles like Blood and Milk, Good Intentions Are Not Enough, and Wronging Rights – that regularly launches salvos across the bows of DIY do gooders and “amateur” aid workers. Its not clear how they themselves cut their teeth in aid, for whom they practice, and the lasting results that they have produced.

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Can Information Improve Aid Effectiveness?

In 2009 Oxfam America published a brief on “smart development,” in which the authors advocate for increased transparency and predictability in US overseas assistance (ODA). In defining the challenge and the opportunity, Oxfam America identifies three reforms central to their strategy: provide increased access to information to recipient countries; build capacity and help countries lead their own development; and finally let countries lead by opening control.

In making the case for reform 1 (increasing access to information), Oxfam America gives three examples of the information entanglements that arise from massive aid programs that lack effective information sharing regimes:

For years, Afghans have heard about billions of dollars being promised by foreign  donors, yet they have no way to find out where that money is going. Even their  government does not know how one-third of all aid (some $5 billion) has been  spent since 2001.13 In Uganda, a mapping exercise in 2005 found twice as much  aid being spent than what the government was told.14 In Sierra Leone, the government knows little of the 265 different aid projects that donors are funding.15 And
in Malawi, there was a $119 million difference in what donors reported they were  providing to the government of Malawi and what donors reported to the OECD.16

“How” the authors ask, “can recipient governments use donor aid to plan in such circumstances?”

In reading the report, which is a sleek 40 pages, I realize there is a tremendous innovation opportunity here – which is to develop better tools, standards, and administrative reforms that will lead to the kind of information coherence across ODA actors necessary for effective development planning. In a sense, a GPRA for aid that harnesses the open data reforms of the last decade and the flexibility of information sharing tools available on the web.

A problem with enough technical challenges to be of interest to MIT management and programming talent?