Portable Ultrasound for Dengue Fever Complications

What makes your solution innovative and sustainable?

There is currently no global protocol for the use of POCUS to screen for plasma leakage associated with dengue. In a region where severe dengue is common, improved triage and faster diagnosis of dengue in outpatients will alleviate the burden on the healthcare system. This knowledge has global potential to be adapted to other tropical diseases affecting 50% of the world’s population. We will also using We Care Solar's solar-powered, portable suitcases in remote areas. With half-a-million people without access to electricity in Peru, the potential for broader impacts is significant. 

By demonstrating that effective ultrasound services have been miniaturized and are able to be brought to remote patients as an effective diagnostic tool- we hope to further the understanding of the medical community around the lower environmental impact of hand-held medical diagnostics compared to traditional large physical footprint cart-based ultrasound equipment. 

We have previously demonstrated that POCUS in limited resource settings can reduce the burden on healthcare systems and enhance the diagnostic capacity of local healthcare providers, while contributing to broader development impacts, such as gender-equality.

Building on our past success, we intend to establish the efficacy, appropriateness, cost effectiveness and potential to scale POCUS in remote regions severely affected by climate change. We will use M&E to measure health outcomes (successful diagnosis, referrals, mortality) and identify limitations (HCP stability, engagement). We will prove scalability through a train-the-trainer model, along with remote quality assurance monitoring.

This model is designed with minimum foreign intervention and minimum impact on the environment. Our local clinicians will lead the program on the ground, with remote support provided by our experience team. To ensure sustainability beyond proof-of-concept, we will leave all technology for continued use by our beneficiaries. The developer of the POCUS devices has agreed to provide on-going access to their cloud-based platform free of charge, creating a continuous feedback loop with other practitioners globally.

During a site visit to the region in 2022, we established partnerships with indigenous community leaders with whom we are currently working with on related research with the Lancet Countdown on Health and Climate Change. We have also confirmed the participation of three district hospitals, where there is significant clinical knowledge of tropical diseases, although a lack of supporting technology.

With 50% of the world’s population currently vulnerable to dengue (and rising due to climate change), our innovation has global relevance and will result in new guidelines for the use of POCUS to detect abnormal collections of fluid caused by tropical viral syndromes (including ebola). We expect our innovation to inform future health policy. 

What are your impact goals for the next year and the next five years, and how will you achieve them?

Next Year Impact Goals:

1. Train and empower 50 healthcare providers in Loreto, Peru, in the use of portable ultrasounds for early detection and accurate stratification of dengue patients.
2. Conduct ultrasounds on 500 suspected dengue cases, leading to improved diagnosis and timely intervention.
3. Collaborate with local health authorities to develop and implement new protocols for dengue management using portable ultrasounds in limited-resource settings.
4. Establish partnerships with local organizations and community leaders to enhance community engagement and awareness about dengue prevention and management.

How We Will Achieve Them:

• Develop a comprehensive training program: We will design and implement a structured training program to educate healthcare providers in Loreto on the use of portable ultrasounds. The program will include theoretical and practical components, ensuring that providers gain the necessary knowledge and skills to effectively use the technology.
• Procure and distribute portable ultrasound devices: We will secure funding and establish partnerships to procure portable ultrasound devices. These devices will be distributed to healthcare facilities in Loreto, ensuring their availability for early detection and stratification of dengue patients.
• Conduct blended remote-in person training workshops and mentorship through a POCUS community of practice: We will organize workshops and provide ongoing mentorship to healthcare providers to support their learning and application of portable ultrasound technology. This will include hands-on practice, case discussions, and continuous feedback to enhance their proficiency and confidence in using the devices.
• Establish collaborations with local health authorities: We will collaborate closely with regional health directorates and other relevant stakeholders to develop and implement new protocols for dengue management. This will involve aligning our approach with existing guidelines, conducting research to gather evidence, and incorporating local expertise and perspectives.
• Community engagement and awareness campaigns: We will actively engage with local communities through awareness campaigns, educational sessions, and partnerships with community leaders. By raising awareness about dengue prevention, symptoms, and the benefits of early detection, we aim to empower individuals to take proactive measures and seek timely healthcare when needed.

Next Five Years Impact Goals:

1. Train and empower 100 healthcare providers in other regions vulnerable to dengue and other tropical illnesses (inlcuding Ebola) ensuring widespread adoption and sustainability of portable ultrasound use for dengue management. We will also train technicians in remote areas to use POCUS and submit scans to the regional hospital for verification.
2. Advocate for the integration of portable ultrasound guidelines and protocols into national healthcare policies and guidelines globally.
3. Share our knowledge, experiences, and best practices with other countries facing similar challenges, catalyzing the adoption of portable ultrasound technology for disease management in resource-limited settings.
4. Expand our community practice and knowledge sharing between different regions, enhancing south-south cooperation.

How are you measuring your progress toward your impact goals?

Objectives

Proof of concept will be demonstrated by:

A. Healthcare providers in Loreto, Peru are able to effectively identify clinically evident plasma leakage using POCUS among patients with suspected dengue infection.

1) 20 Healthcare workers trained in at least three locations (Iquitos and Pebas).

2) 85% accuracy achieved in reading scans.

3) 500 suspected dengue patients screened and analyzed.

B. Demonstrate that POCUS can detect plasma leakage in ambulatory patients with dengue fever, enabling the identification of outpatients who are at risk of developing dengue disease complications.

1) New global protocols to screen for plasma leakage associated with dengue developed

C. Improved awareness among the community of increased instances of dengue in the Loreto region, Peru and prevention techniques.

1) 300 community members with improved understanding of dengue, how it is transmitted and how it can be prevented.

2) 10 health technicians in remote parts of Loreto able to locate fluid leak through POCUS.

D. Improved awareness of policy-makers in Loreto to respond to increased instances of dengue, including revised treatment plans for suspected cases

1)  Policy-makers report new knowledge of dengue and understand gaps to treatment in remote regions

E. Increased south-by-south cooperation

1) Knowledge sharing network established between Peru and Colombia cohorts (and other countries)

Describe in simple terms how and why you expect your solution to have an impact on the problem.

Our innovation aims to address the impact of dengue fever exacerbated by climate change in Peru's Loreto region through the implementation of point-of-care ultrasound (POCUS) technology. By training healthcare providers to use portable ultrasounds, we will improve the detection and stratification of patients with suspected dengue, enabling more accurate triage and timely interventions. This innovative approach will enhance the healthcare system's capacity to manage dengue outbreaks in resource-limited settings and contribute to the development of new protocols for the use of POCUS in tropical viral syndromes.

Throughout the training, we will test 500 patients with suspected dengue in 2 hospital sites in Loreto, Peru, using a blended-remote training methodology we have successfully tested in Yemen and Uganda. The suspected cases identified through POCUS will be confirmed with blood tests.

In parallel, the team will set up a knowledge sharing network between the participating hospitals and launch a comprehensive awareness program in the Loreto region of Peru to build awareness of increased cases of dengue associated with climate change and promote prevention. We will work with community stakeholders (local authorities, indigenous leaders and healthcare workers) to determine a treatment plan for suspected cases and identify gaps in the system.

Broader expected outcomes include new protocols for use of POCUS in limited-resource settings and improved knowledge of plasma leakage in dengue disease.

If your solution is tech-based, describe the core technology that powers your solution.

The core technology that powers our solution is portable ultrasound devices. Portable ultrasounds are compact, handheld devices that use sound waves to create real-time images of internal body structures. They are equipped with transducers that emit sound waves and receive the echoes produced by the interactions of the sound waves with the body tissues. These echoes are then processed and transformed into visual images, allowing healthcare providers to visualize organs, blood vessels, and abnormalities.

The technology behind portable ultrasounds is based on the principles of medical ultrasound imaging, which have been widely used in healthcare for diagnostic purposes. However, traditional ultrasound machines are large, stationary systems that require a dedicated space and trained operators. Portable ultrasounds, on the other hand, are designed to be lightweight, compact, and easy to transport. They are battery-operated and can be used at the point of care, making them particularly suitable for use in resource-limited and remote settings.

Portable ultrasounds rely on advanced hardware and software components to generate high-quality images. The transducer, a key component, emits sound waves and receives the echoes, which are then converted into electrical signals. These signals are processed by the device's electronics and transformed into real-time images that are displayed on the device's screen. The software algorithms used in portable ultrasounds enhance image quality, optimize settings for different applications, and enable various imaging modes, such as 2D imaging, Doppler imaging, and color flow imaging.

The core technology of portable ultrasounds enables healthcare providers to visualize internal structures, identify abnormalities, and make clinical decisions. In the context of our solution, portable ultrasounds are used by trained healthcare providers to detect and stratify dengue patients by identifying abnormal fluid collections caused by plasma leakage. This enables early intervention, appropriate management, and improved outcomes for dengue fever patients.

The technology behind portable ultrasounds has evolved over the years, leading to smaller and more powerful devices with improved image quality and user-friendly interfaces. They are now more affordable, making them accessible in resource-limited settings. The advancements in portable ultrasound technology have expanded the possibilities for point-of-care diagnostics and improved healthcare delivery, particularly in remote and underserved areas.

Overall, portable ultrasound technology forms the core of our solution, empowering healthcare providers to detect and stratify dengue patients accurately. Its portability, affordability, and ease of use make it a transformative tool in addressing the challenges of dengue fever management in limited-resource settings, ultimately improving patient outcomes and healthcare access.

Which of the following categories best describes your solution?

A new application of an existing technology

Please select the technologies currently used in your solution:

• Big Data
• Imaging and Sensor Technology
• Internet of Things
• Software and Mobile Applications

If your solution has a website, app, or social media handle, provide the link(s) here:

https://www.butterflynetwork.com/

In which countries do you currently operate?

Peru, Colombia, Jamaica, Yemen, Uganda, Rwanda, Kenya

In which countries will you be operating within the next year?

Peru, Colombia, Jamaica, Yemen, Uganda, Rwanda, Kenya

What type of organization is your solution team?

Nonprofit

How many people work on your solution team?

15 volunteers
3 part time staff

How long have you been working on your solution?

5 years 

What is your approach to incorporating diversity, equity, and inclusivity into your work?

At the core of our work is a deep commitment to diversity, equity, and inclusivity. We believe that embracing and integrating diverse perspectives and experiences is essential for developing effective solutions that address the needs of all individuals and communities we serve.

Diversity in Leadership Team: Our leadership team is intentionally diverse, comprising individuals from different backgrounds, cultures, and identities. We recognize the value of diverse representation in decision-making processes, problem-solving, and innovation. Our team members bring a wide range of expertise and perspectives, ensuring a holistic approach to our solution development.

Goals for Diversity, Equity, and Inclusion: Our team's goals center around fostering a diverse, equitable, and inclusive environment within our organization. We are committed to:

1. Diverse Representation: We aim to continuously increase the diversity within our team, fostering an inclusive environment that reflects the social, cultural, and identity-based attributes of the communities we serve. We actively seek to recruit and engage individuals from underrepresented groups to bring their unique perspectives and insights to our work.

2. Equity and Fairness: We strive to create an equitable and fair environment where all team members have access to opportunities, resources, and advancement. We address unique and systemic barriers that have historically hindered the full participation of marginalized groups. We actively work to promote fairness, eliminate biases, and ensure equal access to leadership roles and decision-making processes.

3. Inclusive Practices: We are committed to creating an inclusive culture where all team members feel welcomed, respected, supported, and valued. We foster an environment that encourages open dialogue, collaboration, and the sharing of diverse perspectives. We actively seek input from team members at all levels and ensure that their contributions are acknowledged and appreciated.

Actions Taken: To achieve our diversity, equity, and inclusion goals, we have taken the following actions:

1. Recruitment and Outreach: We have implemented inclusive recruitment practices to attract a diverse pool of candidates. We proactively seek talent from underrepresented groups through targeted outreach, partnerships with diversity-focused organizations, and by fostering connections with communities that have been historically marginalized.

2. Training and Awareness: We regularly conduct diversity and inclusion training sessions within our team to raise awareness, deepen understanding, and foster a culture of inclusion. These sessions provide an opportunity for team members to learn, engage in meaningful discussions, and challenge biases and stereotypes.

3. Collaborative Partnerships: We actively seek partnerships and collaborations with organizations and individuals who prioritize diversity, equity, and inclusion. By collaborating with like-minded entities, we aim to amplify our impact, exchange knowledge, and contribute to a broader movement towards a more equitable and inclusive society.

4. Continuous Learning and Improvement: We are committed to ongoing learning and improvement in our approach to diversity, equity, and inclusion. We regularly evaluate our practices, solicit feedback from team members, and explore new strategies and initiatives to enhance our inclusivity efforts.

Through our approach to diversity, equity, and inclusion, we aim to create a supportive and empowering work environment that embraces the strengths and perspectives of all team members. We believe that by fostering diversity and inclusion, we can better understand and address the needs of the communities we serve, leading to more impactful and sustainable solutions.

What is your business model?

Our business model focuses on providing value to the populations we serve in terms of impact and sustainability. We have identified key customers and beneficiaries and developed products and services to address their needs.

Key Customers:

1. Healthcare Providers: Our primary customers are healthcare providers in Peru's Loreto region. They benefit from our training programs and access to portable ultrasound devices, enabling them to improve dengue fever management through early detection and accurate stratification of patients.

2. Dengue Patients: The ultimate beneficiaries of our solution are dengue patients. Through early detection and appropriate management facilitated by portable ultrasounds, we provide improved health outcomes, reduced complications, and increased chances of recovery.

Products and Services:

1. Training Programs: We offer comprehensive training programs to healthcare providers, equipping them with the knowledge and skills to use portable ultrasounds effectively. These programs include theoretical and practical components, enabling providers to confidently use the technology for dengue fever management.

2. Portable Ultrasound Devices: We procure and distribute portable ultrasound devices to healthcare facilities. These devices are specifically designed for point-of-care use, allowing healthcare providers to conduct ultrasounds on suspected dengue patients and make informed decisions for timely intervention and appropriate patient stratification.

Value Proposition:

1. Improved Diagnostic Accuracy: Our solution provides healthcare providers with a powerful diagnostic tool that enhances their ability to detect and stratify dengue patients accurately. This leads to improved clinical decision-making, optimized resource allocation, and better patient outcomes.

2. Enhanced Healthcare Access: By equipping healthcare providers with portable ultrasounds, we bridge the gap in healthcare access for remote and resource-limited areas. Patients in these regions can receive timely and quality care, reducing the burden of traveling long distances to access healthcare facilities.

3. Sustainable Impact: Our business model prioritizes sustainability by exploring avenues for revenue generation and partnerships. This ensures the long-term viability and scalability of our solution, enabling us to continue making a meaningful impact on dengue fever management.

Revenue Generation:

Partnerships and Grants: We seek partnerships and apply for grants from philanthropic organizations, government agencies, and other funding sources that align with our mission. These partnerships and grants provide financial support for the procurement of portable ultrasound devices, research activities, and capacity building.

Our revenue model is primarily based on grant funding and partnerships with healthcare technology manufacturers, including MedGlobal and Butterfly Network, who provide us with discounted POCUS devices. We also plan to explore opportunities for fee-for-service models, where we would charge for our training program or for diagnostic services provided with our POCUS devices.

Do you primarily provide products or services directly to individuals, to other organizations, or to the government?

What is your plan for becoming financially sustainable?

Our plan for becoming financially sustainable involves a combination of revenue streams to fund our work and cover our expected expenses:

1. Grants and Donations: This idea has global relevance and we are confidence it will be of interest to philanthropic organizations, government agencies, and foundations that align with our mission. These grants will provide initial funding to support our activities, including training programs, procurement of portable ultrasound devices, research, and community engagement efforts.

2. Service Contracts: We will explore opportunities both for the program team and our trainee network to enter into service contracts with governments and healthcare institutions. These contracts may involve providing training programs, consultancy services, and technical support in implementing portable ultrasound technology for dengue fever management. The fees generated from these contracts will contribute to our financial sustainability.

3. Partnerships and Collaborations: We will seek strategic partnerships with organizations and companies that share our vision and can provide financial support. These partnerships may involve joint initiatives, research collaborations, and co-development of innovative solutions. Such partnerships can bring in funding and resources, supporting our long-term financial sustainability.

4. Social Impact Investment: In the future, we may consider raising investment capital from impact investors who align with our mission and values. This investment can provide the necessary resources for scaling our operations, expanding our reach, and achieving greater impact. We will ensure that any potential investment aligns with our commitment to social impact and sustainable growth.

Share some examples of how your plan to achieve financial sustainability has been successful so far.

We are negotiating funding of a similar scale for the same idea, however, until confirmed, we cannot share further information.