Make it locally.
Ultrasound is an important tool for obstetric and trauma care in resource-limited settings, with many studies demonstrating that it significantly impacts diagnosis and management. Despite this evidence, ultrasound use by local providers remains limited due lack of access to consumable supplies such as commercial ultrasound gel.
Drivers to the limits are the cost of the gel and its availability in local markets. For example, a 0.25-liter bottle purchased in bulk costs $5 to $15 in Ethiopia and Democratic Republic of Congo (DRC). This does not bode well given Ethiopia’s annual healthcare spending is $18 per capita while DRC’s is only $3.
Any savings on consumable products would have a significant impact on public health.
We designed a low cost ultrasound gel made from cassava root, a local starch purchasable in the local markets for very little cost.
Our multidisciplinary team worked with local clinicians following the format outlined in the IDEO Design Kit: Human-Centered Design Toolkit on how to create products for people who live under $1 a day. Research began by defining the challenge: How do we create locally available alternative ultrasound gel for a low-resourced environment?
The “end users” were identified as clinicians who use ultrasound in Democratic Republic of the Congo (DRC), Mali, Ethiopia, and Rwanda. An expert group was queried for possible alternatives. Among the responses was cornstarch, which, while a reasonable solution, was either not available or too expensive. We then sought deeper knowledge of locally sourced materials from local experts and market vendors to develop a similar product. Suggested solutions were collected and used to create ultrasound gel accounting for cost, image quality, and manufacturing capability.
Initial prototypes used cassava root flour from the Great Lakes Region (DRC, Rwanda, Uganda, Tanzania) and West Africa, and bula from Ethiopia. Prototypes were tested in the field and the final product selected was cassava and bula at a 32 part water, 8 part flour and 4 part salt, heated, mixed, then cooled.
Global Health Emergency Medicine’s Innovations committee has recently published a map of the African continent with validated recipes for the manufacture of ultrasound gel out of materials available in their local markets.
The Gynecology and Radiology Department of Albert Einstein School of Medicine continues to conduct research and in-field testing to include a more intensive review of image quality, considerations of potential bacterial load and effects on bacterial load of in-field processing options (such as boiling time and ingredients), and potential for allergic reaction or skin irritation.