Portable NonPowered Safe Instrument Box

Worldwide, five billion people lack access to safe and affordable surgery. An estimated 93 percent of people in Sub Saharan Africa cannot obtain basic surgical care. Even if surgery is available, its safety remained a big concern. In Africa, up to  Twenty percent of women who have caesarean section end up with infections and this is worse in conflict setting. 

The autoclave is the most popular sterilization mechanism in low resource setting. Majority of the low resourced setting lack autoclave and resort to boiling of instrument which does not make instruments safe for surgery. Our solution addresses this challenges. 

Our Solution utilizes novel nitrogen dioxide (NO₂) technology to sterilize instruments at room temperature and without external power or water. Our solution is designed to work in any environment including conflict setting where basic surgery is required and is expected to increases the safety of surgery and reduces mortality.

Providing basic surgery and promoting safety among the patients and providers is biggest challenge resulting from the risk of using unsterilized instruments and medical supplies.

 Frequent attacks, destructions of existing infrastructures and inadequate instrument and medical supplies are some of the reasons for high infections estimated at Forty percent in South Sudan. Instead providers use autoclaving and boiling method to make surgical equipments safe. 

Ninety percent of the health facilities lack appropriate sterilization units. In South Sudan, caesarean section and gunshot wound management are the main common operative procedures that requires safe surgical intervention every time. 

The internal conflict has resulted into the complication of management of injuries, difficult access coupled with limited access to skilled personnel and lack of appropriate infection control measures is contributing to high mortality. 

More than 40 percent of women who had caesarean section end up with a wound infection. Providing safe surgery is challenging. The ability to sterilize instrument remain scarce and difficult. Non sterilized health materials increases infection rate by 25%. 

Existing solutions to sterilization use expensive solutions of boiling of instrument and autoclaving. Current instrument sterilizers require electricity which is not available in most regions and is costly and frequently break down.   

Our solution is Portable Non Powered Safe Instrument Box. The Portable Non Powered Safe Instrument Box increases the ability for an instrument to be ready at all times for basic surgery. 

Our solutions offer excellent protection against infections that can easily be deployed as it requires either no access, or unreliable access, to electricity and clean water which fits in South Sudan settings. 

The Portable Non Power Safe Instrument Box  is cost effective, portable, easily and rapidly deployable with high impact.The Portable Non Powered Safe Instrument Box has been optimized and tested for use in rural health clinics and temporary medical response units that have either no access, or unreliable access, to electricity and clean water which is typical situation found in hard to reach and conflict affected zones.

 The Solution  uses nitrogen dioxide technology, simplified, rugged form that is appropriate and relevant to vulnerable and hard to reach populations due to its lack of reliance on electricity or other infrastructure to support basic surgery. 

In South Sudan, the alternative solutions to surgical sterilizations is far-fetched boiling and steam sterilization that does not make instruments readily available for basic surgical interventions contributing to high infections and mortality rates. 

The Portable Non Powered Safe Instrument Box is targeting communities in conflict-affected areas of South Sudan where infections arising from post- Operative procedure is the highest. Based on the prevailing conditions and settings, our solution will target the following populations:

2) Childbirth: Our main target, the pregnant mothers undergoing child birth require sterilized instrument and materials to reduce puerperal sepsis. The availability of sterilized instruments and materials hasten recovery among the caesarean section mothers.

2)Health Workers: The health workers require the Portable Non Powered Safe Instrument Box for making instruments and materials safe easily and cheaply without much power requirements

3) Health facilities: The availability of Portable Non Powered Safe Instrument Box enhances health services delivery particularly surgical interventions that has been a challenge in most of the health facilities in South Sudan.

4) Wound Management patients: Although this is not our primary beneficiaries, the gunshot wound management includes even pregnant women caught at cross fire requires sterile instrument and materials. The increasing number of wound resulting from gunshot reduces infections and complications.

The provision of medical sterilization using the existing autoclaving and boiling is costly. 

In South Sudan,where autoclave exists, there is no or erratic electricity across the country rendering it non-effective. Our Solution  address this problem.

 Our  Solution  is cost effective, portable, easily and rapidly deployable with high impact. 

The  Solution is optimized for rural health clinics and temporary medical response units that have either no access, or unreliable access, to electricity and clean water which is typical situation found in hard to reach and conflict affected zones.

The innovativeness of a solution is based on its ability to make instrument safe and free from infections rapidly and  at low cost. Portable Non Powered Safe Instrument Box is the only medical sterilization infrastructure that leverage this technology. The solution has enabling ability to make instrument safe and easily deployable anywhere increasing access to safe basic surgery and reducing cost.

Traditionally, the autoclave and boiling  is the most popular sterilization mechanism. The original form, a high-pressure steam digester was invented in 1679, but people soon realized anything exposed to high-pressure saturated steam could be sterilized. About 20 years ago, Bernstein started a company called Noxilizer as a new way to sterilize medical instruments. It uses nitrogen dioxide, which is basically smog, as a sterilant. 

Our solution  is  innovation  leveraged from Eniware which  is cheap and efficient. Due to lack of affordable sterilization products, every day we don’t have the product available, somebody dies. Says Bernstein. The solution, doesn’t need electricity or water to work.The sterilizer comes with a disposable ampoule that generates nitrogen dioxide gas, and a disposable scrubber that absorbs the gas after sterilization is complete.

 Instruments are placed inside the sterilizer, along with chemical indicators that confirm the sterilant gas is released. Instruments can then be kept in the case until used. It works well in rural areas and hospitals without electricity or clean water around the world. In South Sudan where maternal mortality is highest in the world, the solution would make massive difference

The core Technology of the solution is the innovation that quickly soaks and sterilizes the instrument without electricity and water. It does so without requiring any external power. The Portable Non-Powered Safe Instrument Box uses novel nitrogen dioxide (NO₂) technology to sterilize instruments at room temperature and without external power or water. Nitrogen dioxide is a reddish-brown gas that is generated through a chemical reaction when the Steril Nox Ampoule is placed and engaged in the Portable Non-Powered Safe Instrument Box. 

While it is commonly found as a byproduct of factories, cars, and power plants, NO₂ gas has also been proven to be an effective and safe chemical sterilant. Nitrogen dioxide has been shown to be effective against a wide range of microorganisms, including bacteria, viruses, and spores, and it works as a sterilant by degrading the microorganism’s DNA through single-strand breaks. NO₂ gas is a small molecule with a low boiling point, making it especially good at diffusing into complex devices and filling spaces. 

While NO₂ can be toxic at very high concentrations, it is dramatically safer than similar sterilant gases such as hydrogen peroxide, ethylene oxide, or chlorine dioxide and requires a smaller concentration to be effective. Unlike autoclaves, which require large amounts of electricity and distilled water, NO₂ sterilization within the Portable Non-Powered Safe Instrument Box does not require external power or water, and because it works at ambient temperature and pressure, it is uniquely suited for low-resource settings.

Surgical sterilization in form of high pressure steam digester was invented in 1679 and has been the main stay for making medical equipment and materials safe for surgical interventions. It is the heat that is effective in making the instrument safe for use in basic surgery by the medical staff. Conflict and hard to reach population requires rapid health care interventions for patients who requires basic surgery where highly resourced health care services and surgery is unavailable. Local medical sterilization remains impossible, and had to rely on medical imported supplies, or use of boiling or chemical dipping. Local health communities need sterilization options which are affordable, accessible, efficacious and easy to use. Providing safe instrument and materials in the low resourced and conflict setting is becoming a challenging situation.

 Use of existing sterilization methods that requires electricity and water and other features is not cost effective. Utilizing Portable Non-Powered Safe Instrument Box will change the landscape of rampant infections and deaths and saves many lives within the zone resulting from infection due to lack of proper and good sterilization. The solution further helps to increase safety of ambulatory as well as complex procedures in conflict and hard to reach locations. 

Ultimately, with effective enough economy of scale and widespread enough acceptance, portable sterilizer will reach anywhere safe surgery is needed. The Portable Non Powered Safe Instrument Box utilizes technology of freeing instrument and medical materials from infections from proven sterilizing devices that fits the low resources and conflict settings.

What is your theory of change?

Our Theory of Change (TOC) for Portable Non-Powered Instrument Box is based on the planned output, outcome and the impact as discussed: As discussed earlier, our target for the solution are the Pregnant mother/women, health workers, patient with gunshot wound and health facilities. Our Theory of Change will focus on the addressing the requirements and the needs outcome and impact of the beneficiaries as follows:

Activities

1) Pregnant Mothers and Newborns: The solution has the capacity to increase surgical and obstetric material and instruments that reduces infections for both the mother and the thus hastening the recovery and healing.

2) Health workers: The solution working to provide safe and sterile medical equipment and materials ready to use by the health workers. Furthermore, the health workers have the capacity to operate and sterilize the required medical/surgical instrument

3) Health facilities and Hospitals: The solution provides un disrupted supply of safe and sterilized equipments and materials that continuously is available for basic surgery without the need of electricity

4) Gunshot surgical Patients and other patients: The solution provides adequate safe adequate surgical for the common surgical gunshot wounds and other related surgical interventions. The safe and sterilize equipment and materials provides pathway for recovery and healing

Short term Outcome

1) Pregnant mothers: the mothers and their newborn have reduced unwanted post-operative infections such as puerperal and neonatal sepsis

2) Health Workers: The solution availability at the health facilities enable health workers carry out basic surgery to take place even in most difficult situation.

3) Health facilities and hospitals: The cost of using old generation autoclave, boiling related to basic surgery at the health facilities is reduced through the use of the solution.

Long term output: 

Generally, the long term of the solution for the health workers, pregnant mothers and newborn, gun shot and surgical patients and health facilities will be reduced surgical morbidity and mortality, reduced cost.

We are working with mothers and newborn in hard to reach location of South Sudan where birthing accounts for the 75 percent  of the health facility or hospital activities. Our targets are the population in the rural and conflict setting of South Sudan. Currently we planned to work with 10 Health care facilities network in the region. 

In Consultation with the Ministry of Health Republic of South Sudan, the region, has about 35,000 women who give births yearly and estimated 5-15% requires cesarean section.

 In 5 years we will impact on 3 million mothers and newborn through our network of 1,000 health care facilities network.Our solution is expected to impact by reducing post-operative infections, disability and mortality. Safe delivery and surgery through our Portable Non Powered Instrument Box is the mainstay for the impact.

In sub Saharan Africa, over Ninety Three  Percent of the population cannot obtain safe basic surgery. Over 5 billion people in the world lacked access to safe basic surgery. Providing accessible safe basic Surgery in locations will have ultimate impact on the lives of the mothers and other people requiring surgical interventions. 

Our planned approach is to ensure majority of the population have access to our quick deployable solution. Within the next five years of our optimal distribution, we intended to reach 3 million people through the network of over 1,000 health facilities. We expect to improve life of the population through provision of accessible quality and rapid sterilization units for basic surgical interventions.

To distribute and sustain the novel solution, we planned to work with our existing network in South Sudan and other locations. The effective deployment of the solution will require well trained and competent health workers. We will adapt and develop the training materials to build the capacity and skills of the health workers and technologist. Health workers will receive training and sensitization on application and benefits of using the solutions.

 We will also deliver training using audio and visual as well WeChat communication to support the Technologist and the health workers to enhance their knowledge and skills for better management. We shall conduct focus interview and review data from health facilities to determine the impact of deploying the solution on pre-operative infections.

In majority of cases, deploying new technology to an environment for the first time is challenging. Our solution is going to be placed among health care workers with little knowledge and emerging from conflict setting. We anticipated to have the following barriers:

1) Raising adequate funding to expand or deploy the Portable Non-Powered Safe Instrument Box to the various health facilities especially given that we are taking risks to deploy novel solution to low income and conflict setting. Most donor tend to avoid giving their funds to such innovation with believe that it will be destroyed with no benefit.

2) We are also anticipating the challenge of sourcing enough Portable Non-Powered Safe Instrument Box from our manufacture Eniware. The solution is not locally available in South Sudan and even sub Saharan and it requires setting up prior smart partnership with the Eniware and their agencies in East African region.

3) Lack of medical equipment technologist, Lack of commitment for funding from Ministry of Health (MOH) and other humanitarian actors to take up the solutions to scale and expand it to all regions.

4) COVID-19 pandemic: The lock down and restrictions of movement could affect the deployment of solution quickly and this probably could interfere with the actual deployment and the expected impact.

To mitigate some of the barriers related to the deployment of our solution, we aim to work toward creating smart partnership with both national and international actors. We aim to address the challenges/barriers as follows:

1) Fundraising: We have started to look at some smart partnership to help generate earlier revenues sponsored deployments, strategic investments, integration and medical consulting services. Also, as we begin to collect data generate evidence from our field deployment and demonstrate the potential impact of our innovation, we should be able to have more advanced discussions with investors.

2) Procurement of the Portable Non Powered Instrument Box challenges will be addressed by working with the Eniware representative in East Africa and we are exploring partnership in near future.

3) Lack of support from the Government: For  a lack of support from the Government, we are addressing this through engaging the Ministry of Health and other private health care to support our health care solution for basic surgery.

4) Lack of technologist: For lack of health care technologist, we will network with the available technologist within the region to provide the initial training. We shall continuously provide audio and visual and WeChat communication to support the field health care workers in rolling out the solution.

5) COVID-19 Pandemic: We will address the COVID-19 pandemic on deploying our solution including our health care operation by having team both at the field and team working with the Eniware manufacturers.     

N/A

We have 5 prople wokring on Solution 

1 Full time

2 Volunteer 

2- Part time 

Portable Non Powered Instrument Box team is comprised of competent multi-disciplinary team of Medical Equipment Technologist, Public Health Specialist, Medical and Clinicians and Supply Chain Specialist. The team came to existence after fronting a vision of Communities where everyone has access to quality of health care services resulting in positive access and sustainable health status. 

The team has cumulative work experience of 50 years. The team are :

1) Amadra Stephen, Executive Director Founder, ICT and Public Health Graduate. Stephen conceives the idea of leveraging the solution within the conflict setting 

2) Dr. Simon Okony Mori, (MPH) Medical Specialist in Maternal and Newborn and Researcher 

3) George Vunni Blue (PhD): Physicist and technology specialist, 30 years of experience in Military innovation: Consultant 

4) Guma Abraham, (MPH):  Social impact Coordinator 

5) Dr. Iddi Franklin(M.Sc.) Medical Specialist. 

The team worked with MOH during the pilot of ORS equipped in Zinc in health facilities in conflict setting. It is from this working together when the team noticed lacked of safe medical instrument sterilization in the various health facilities. 

The team realized that the challenges of making medical instrument safe for basic surgery during emergency health responses and intervention. The challenge of getting instrument safe   for surgery and caesarean section was notable. Use of traditional ways of making instrument safe through boiling and autoclaving was obsolete during this emergency situation.

We are currently working with the following partners:

1) Eniware Manufacturer: We will work with the private sector Eniware and their representatives in East Africa to make the deployment available within the conflict zones and their commitments to distribute the solutions even after the pilot phase.

2) Health Organization: We work with international and national health organization within South Sudan and Uganda. The health organization running humanitarian services face challenges of making equipment and materials safe  for surgery in South Sudan. We carried interviews and Focus Group Discussion (FGD) on the changes of instruments sterilization and received feedback for the urgent need for the provision Portable Non-Powered Instrument Box.

3)Training institutions: To scale our proposed Portable Non Powered Safe Instrument Box, we plan to partner with Eniware and the Essential Surgery Company committed to improving public health by increasing access to safe essential surgery through public-private partnerships and medical post graduate College to offer training to health workers and surgeon and medical equipment experts with low cost for the underserved, more difficult to reach conflict setting. This plan will align with our long-term goal of impacting on reducing mortality in South Sudan

4) Health facilities and Hospitals: Our hospital Juba Teaching hospital, Wau Teaching Hospital and other health facilities in Central Equatoria and Eastern Equatoria. We have worked with this hospital on innovative approaches such as helping Babies Breathe and PostPartum Hemorrhage 

Our Portable Non Powered Safe Instrument Box business model is designed on human centered focusing on leveraging and distributing low cost alternatives to the existing costly surgical sterilization products and that customers (Pregnant mothers, Health facilities and Government) get back more value than the capital that is going to be spend.

 Our intended product is build using top notch technology to address the surgical sterilization issues in the low resources and particularly conflict setting. Our initial distribution will focus on the public health care network which is responsible for taking care of the vulnerable population low resource and conflict setting funded mainly by the poor government allocation. Certain public health care network raises funding through Non-Governmental modality to purchase medical and surgical equipments. Our model will focus on leveraging the existing medical and surgical funding model in the first one year and then work with the private sector on the possibility of generating revenue from the sales of the Potable Non Powered Safe Instrument Box through cost sharing. 

Over 6 years’ time, the government and our team will be able to cover the expenditures through direct or indirect saving. However, there is need to have profitable business model for our solution to continue being distributed to the customers as we work on delivering our ambitious vision of promoting safe Surgery. Together with the government, we will build an economically sustainable venture.

When we plan to distribute Potable Non Powered Safe Instrument Box, it was clear in our mission and vision that we want to work towards helping the vulnerable population in South Sudan through delivering sustainable and powerful impact by bringing low cost technology for people. Becoming financially sustainable in long term is critical to be able to continue to innovate as rigorously to achieve our vision. As such, we are working on the following path:

1) Grants and competitions: We will be seeking out grants from government and Non-Governmental Organizations within Africa and Globally. We will be participating in any competitions that address Maternal and Newborn issues in low resources setting. We aim to be winner of the MIT Solve challenge competitions so that we can start working on our solution by the end of the year.

 2) Investors: We will be looking out for impact investors.  At the same time, to scale the solution rapidly we realize how important traditional venture capital is. As we understand their expectations, we are leveraging and building a solution that not only creates impact but is lucrative for investors to invest in Sub Saharan Africa.

We need not only their capital support but also growth and network support system to push for rapid scaling and establish operations within the government system

Potable Non Powered Safe Instrument Box is working on solution that solve one of the most challenging problems that affect the lives of more  than 10 million people in South Sudan and 5 billion globally. As we create optimal distribution system for the Potable Non Powered Safe Instrument Box to deliver high impact solution for billions of people worldwide, we are working with stakeholders and supporters at all levels to build a strong support system. MIT solve will help us to begin out our optimal  distribution system. Additionally, our team  is  interested in joining a high-performing network of social-impact enterprises that have learned important lessons in  bringing new technology to low-resource setting  and developing training  materials to accompany new innovation. We are aware that MIT solve support developing health care solutions that address main challenges in the low resources setting such as South Sudan.

We are planning on expanding our operation to cover the whole region of South Sudan as well part of Uganda subjected to raising adequate funding, to carry on with our optimal distribution system. This mean , we need to have trusting partner with vast experience in bringing enough resources. This is the most significant aspect that will help us to ensure sustainability  of the Portable Non Powered Safe Instrument Box during the scale.

This year, we need to raise significant funding to scale our deployment of our Portable Non-Powered Safe Instrument Box. We hope to leverage the SOLVE ecosystem to find funders and investors aligned with our impact goals. We also need connections to governments, manufacturers and donors who work with other small innovators in deploying portable Non powered Instruments Box at large scale.

Through this MIT Solve, we anticipated to gain visibility on safe surgery sterilization globally as we could provide network for the deployment of the solutions. We would also like to work with international and national NGOs that facilitate deployment of Portable Non Powered Instrument Box or focus on providing health care network programs in hard to reach and conflict settings.

In our thinking, we would like to help and benefit from any partnerships from organizations that procure technology for humanitarian relief as part of government or United Nation procurement. We also hope to partner with other SOLVE teams to establish synergies and collaborations to amplify all our efforts to deliver better services to vulnerable communities.

The Women prize will allow us to deploy our Portable Non powered  Safe Instruments Box and achieve our impact by launching in in late 2020. The Women prize  will specifically be used for:

 1) procurement of Portable Non Powered  Safe Instruments Box 

2) deployment of the Portable Non Powered  Safe Instruments Box 

3) Training of the health care unit workers and managers on the use and maintenance of the Portable Non Powered  Safe Instruments Box.

4) Payment of the innovation team salaries, travel to site, shipping, materials and field support.

The Health Workforce  Innovation Prize will allow us to deploy our Portable Non Powered safe Instruments Box and achieve our impact by launching in in late 2020. The Health Workforce Innovation Price will specifically be used for 1) procurement of Portable Non powered Instruments Box 2) deployment of the Portable Non powered Instruments Box 3) Training of the health care unit workers and managers 4) Payment of the innovation team salaries, travel to site, shipping, materials and field support.