There was a deathly sound in the ward, of lungs struggling, and wheezing. Most of the patients were children, with a variety of winter respiratory diseases, including but not limited to Pneumonia. Around each bed, loved ones stood guard. Fathers and sons, mothers and daughters. They looked on as their own fought for their lives. And to make things even more difficult, some of these loved ones, were bent over a machine, pumping precious air into the lungs of their children.
Dr. Mujeeb ur Rahman was one of them.
“My nephew had been brought in from Sahiwal, and as his condition went from bad to worse, there was no ventilator available for him. What we were given instead was an ambu bag which is generally used as a stop gap arrangement to save a patient’s life. Me and three other people took turns on this bag to make sure the child got his body’s requirement of air.”
The lack and state of ventilators in public hospitals across the province is nothing new. According to a leading newspaper, a report recently filed by the Provincial government in the Supreme Court alleges that out of the 885 ventilators available across the province, at least 122 are dysfunctional. That is nearly 14%. The same report claims that while many faults have been repaired locally, major defects cannot be resolved in the short term due to the unavailability of certain high tech parts which have to be imported from manufacturers and/or agents abroad. Numerous deaths have also been attributed to these damaged ventilators. Just last December, at least ten children died in a leading public hospital in Lahore due to dysfunctional machines.
With the number of working ventilators low, it is a challenge for most people to get access to the life saving machine. Especially in public hospitals. And that’s where the ambu bags come in.
Even for a person with no medical background, it is easy to see that this manual ventilation method is a recipe for disaster. The human heart is a perfect engine. It regulates the pace and pressure of air into the lungs. But when the heart is unable to pump enough air into the lungs, intervention is necessary, and that’s where the ventilators come in. Most private hospitals have a much better ventilator to bed ratio as compared to public hospitals, but since they are business oriented, these private hospitals charge exorbitant rates for the use of the machines. Rates that most of Pakistan cannot afford.
And so, Dr. Rahman’s young nephew fought for his life, for three days and three nights, in a public hospital, breathing through an ambu bag. And soon faded away.
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An electrical engineer from the University of Engineering and Technology (UET), Lahore, Dr. Rahman had recently returned from the United States after completing his Masters and PhD from The California Institute of Technology (Caltech), one of the world’s leading institutions in the field of science and technology. Now, he felt helpless.
“As an engineer, I couldn’t reconcile myself with the state of affairs in the ward, that too in the 21st century,” says Dr. Rahman, who is now an Assistant Professor of Electrical Engineering at Lahore’s Information Technology University (ITU). “I now had a choice to make: either I could sit and fume, or I could use my engineering acumen and look for a solution.”
The good doctor chose the latter.
The idea was not to reinvent the wheel, but to create a product that could at the very least, take out the human errors involved in using an ambu bag as a ventilator. So the decision was made to automate the ambu bag. “It’s much easier to accept something familiar,” Dr Rahman says, “if we’d gone out and built something completely different, there would be challenges in getting it accepted.”
With another mechanical engineer colleague, the process of invention began, and as with most such efforts, it all started on paper, with some preliminary sketches. From there, they moved towards mechanical designs, and soon enough, the design was ready. At this point, Dr. Rahman felt that a full time resource was needed, and that’s how Saad Pasha came on-board, as a research associate provided by ITU.
Together the two have put together what is version 0.1 of the low cost ambu bag ventilator system. “Clearly there is a lot of optimisation that can happen, in the weight, size and form of the device,” says Dr. Rahman. “And as with all things medical, this needs to now go into a testing phase after which it can be rolled out.”
At the heart of the invention is a motor, that regulates the flow rate and the tidal volume of the ambu bag. Both these two parameters can be monitored via sensors connected at both ends, the motor and the ambu bag. These sensors not only help in ensuring that the correct parameters are being delivered, but also come in handy when and/if the device develops a fault. A standard 12 volt battery powers the device. “At the end, we want this to be a handheld device,” says Dr. Rahman. All the money needed to build the prototype came from ITU’s research fund, which is made exclusively for such projects.
There are at least two major challenges ahead. The crucial step is testing. For the device to be accepted, it needs to go through a rigorous process where it is first tested and monitored on animals, and then human testing may begin. Then if it meets certain regulatory standards, it can be allowed for mass scale production. However, in in-house testing, the device has performed remarkably well: where human input has been terribly scattered, the device has been exactly on point.
The other challenge is scalability. This prototype is handmade. Most of the components are locally sourced, from areas like Hall Road and Brandreth Road, which are more renowned for their audio and spare parts shops than components for lifesaving equipment. If the ventilator is to be mass produced, it will need to be an assembly line production.
As a start, Dr. Rahman believes that his team can hand make up to ten ventilators, which can be installed at a single hospital. There, both the doctors and his team can work together to monitor the devices for effectiveness, precision and faults.
“One problem with us engineers is that we build something and then put it away on the shelf to gather dust,” admits Dr. Rahman. “I don’t intend on letting this happen to the ventilator.”