Breathe: A Pathway to Care

by Thomas Lumpe (ETH Zurich), Leonie Korn (ETH Zurich) & Annie Hartley (EPFL), 5 May 2022
Leonie and a local doctor are discussing the design and the functionalities of the breathe ventilator (photo credit: Alex Shapiro)

In low-resource settings, small measures such as targeted training combined with simple, efficient technology, yield meaningful change and progress.

The first thing we saw on approaching Johannesburg’s O.R. Tambo International Airport, was a sprawl of informal settlements and shacks right next to luxurious neighbourhoods with manicured lawns and swimming pools. It was a telling glimpse of the contrasts that awaited us in the following days. Us, that’s Leonie Korn, Thomas Lumpe, researchers at the breathe ventilator project at ETH Zurich, and Annie Hartley, a South African medical doctor and researcher in AI4globalhealth at EPFL. After developing our low-cost ventilator breathe for months in the safe confines of our ETH labs, it was about time to test-drive it in the field. With Annie’s help as a collaborator and her extensive experience working in hospitals in low-resource settings, we had the opportunity to visit a rural hospital in the Mpumalanga province in South Africa to learn more about the context in which our device could be used and collect feedback from local doctors.

South Africa tops the global Gini-index charts, with its chasms between rich and poor being vaster than anywhere else in the world. This gap between the extremes of poverty and wealth also manifests itself in limited access to advanced medical care. While South Africans technically have universal healthcare coverage, it is often hindered by local resource scarcity such as non-functional medical equipment, a lack of training for doctors and nurses, and missing referral infrastructure.
Medical doctors practicing an emergency scenario with a patient dummy (photo credit: Thomas Lumpe)
To better understand the role of medical devices in these settings and how our ventilator could help bridge such shortfalls, we organised a locally certified training course in advanced airway management for twelve of the hospital’s core clinical staff. After some theory, everyone was eager to get started practicing their skills in hands-on simulations on airway management, intubation, and ventilation. After two days of intense training, the understanding grew that teamwork, communication, and continuous training are paramount to save patients’ lives in many critical situations. However, an in-course evaluation revealed that many doctors were intimidated by the complexity of ventilators, which ultimately limits their use. The simplicity of our breathe ventilator ended up contributing to this finding by revealing the simple mechanics of ventilation and making it tangibly analogous to manual “bagging” ventilation, with which all the doctors were already comfortable. This showed everyone the importance of simplicity when designing devices for challenging environments.
What impressed us most was that the effect of the training was already visible when we returned a few days later to the hospital: in the short time since, the doctors had asked for the broken ventilators to be repaired, they formed “resuscitation teams” to ensure efficient teamwork, and they successfully transferred multiple patients to nearby larger hospitals – something that seemed extremely challenging before. Finding their own way to incorporate the lessons from the course highlighted a simple yet significant insight: often what is needed are not individual solutions to single problems, but collaborative systems that are implemented and owned by the people who work with them.

About the authors

Photo credit: Thomas Lumpe
Thomas Lumpe leads the product development of the breathe ventilator, and is a Postdoc at the Engineering Design and Computing Laboratory at D-MAVT.
Photo credit: Leonie Korn
Leonie Korn leads the R&D of the breathe ventilator, and is a researcher at the Intelligent Control Systems group and the Product Development Group at D-MAVT.
Photo credit: Annie Hartley
Annie Hartley is the group leader of the Intelligent Global Health Research Group (iGH) at EPFL and a medical doctor with particular experience in resource-limited settings.