Portable Ultrasound for Dengue Fever Complications

Dengue fever, a rapidly spreading viral infection from mosquitoes that live in tropical and subtropical areas, is rising in Peru as a result of extreme weather events associated with climate change. While the majority of patients are minimally symptomatic, critical illness is possible with untreated hemorrhagic shock and death occurring in approximately 50% of untreated critical dengue patients.

Point-of-care ultrasound (POCUS) is an essential mobile health tool due to its portability, affordability and utility. Ultrasound can identify abnormal collections of fluid from plasma leakage that occurs during damage of the body’s vascular system by tropical viral syndromes, including dengue, hantavirus, and Ebola. Sonographic findings can rapidly stratify patients who will become critically ill. Especially in remote settings, this technology can be life saving. 

More than half a million people in Peru do not have access to electricity, one million households are not connected to the public water network, and more than 2.5 million households lack sewage facilities. The majority of these people live in Loreto, Peru’s Amazonian region, where we will deliver our innovation. Still recovering from the effects of the pandemic, which at one point Loreto was the region with the most cases globally, Peru has also faced a political crisis this year, with eruptions of violence across the country paralyzing essential services.

Our research over two years together with the Lancet Countdown links increased flooding as a result of climate change and the resurgence of mosquito-borne dengue in the past 10 years in Peru. Home primarily to indigenous communities sparsely distributed along the Amazon river, Loreto is suffering the effects of increased flooding, droughts and extreme temperatures, leaving its residents even more isolated and cut off from basic healthcare. 

Our solution is to train healthcare providers in Peru's Loreto region to use portable ultrasound devices for early detection and accurate stratification of dengue patients. Portable ultrasounds are handheld devices that use sound waves to create images of internal body structures. By performing ultrasounds on suspected dengue patients, healthcare providers can identify abnormal fluid collections caused by plasma leakage, a common complication of dengue fever. This allows them to quickly determine which patients require hospitalization and closer monitoring during the critical phase of the disease. The use of portable ultrasounds is affordable, portable, and well-suited for limited-resource settings like Loreto. By equipping healthcare providers with this technology and training them in its use, we aim to improve outcomes for dengue patients, develop new protocols for limited-resource settings, and contribute to the global understanding of using portable ultrasounds in healthcare.

Our solution serves the population of Peru's Loreto region, particularly those who are vulnerable to the health impacts of climate change and dengue fever. This includes indigenous communities living in villages along the Amazon River, where access to healthcare services is limited, and the elderly, pregnant women, and individuals with compromised immune systems face higher risks.

To understand the needs of the target population, we have conducted extensive research and engaged with local stakeholders, including healthcare providers, community leaders, and representatives from indigenous communities. We have collaborated with local health authorities, such as regional health directorates, to gather insights into the challenges faced in managing dengue fever in Loreto.

By training healthcare providers in portable ultrasound use, our solution directly addresses the needs of the target population in several ways:

1. Early Detection: Portable ultrasounds enable healthcare providers to detect dengue-related complications, such as abnormal fluid collections, at an early stage. This allows for timely intervention and appropriate management, reducing the risk of critical illness and death.

2. Accurate Stratification: The use of portable ultrasounds helps healthcare providers accurately stratify patients with suspected dengue. This ensures that those who require hospitalization and closer monitoring during the critical phase receive timely and appropriate care, while patients who can be managed as outpatients are identified, reducing the strain on healthcare facilities.

3. Improved Access to Care: By bringing portable ultrasounds to remote and hard-to-reach areas, our solution improves access to quality healthcare for indigenous communities and other marginalized groups in Loreto. This reduces the barriers related to distance, transportation, and limited healthcare infrastructure, enabling timely diagnosis and intervention.

4. Empowering Local Healthcare Providers: Through training programs, we empower local healthcare providers to effectively use portable ultrasounds. This not only enhances their diagnostic capabilities but also builds their capacity to address dengue fever and other healthcare challenges in limited-resource settings. This knowledge transfer and skill development contribute to long-term sustainability and local ownership of the solution.

Overall, our solution aims to directly impact the lives of the target population by improving health outcomes, reducing complications and mortality associated with dengue fever, and increasing access to timely and appropriate healthcare services. By addressing the specific needs and challenges faced by the community, we strive to create a solution that is contextually relevant, culturally sensitive, and sustainable in the long run.

The Team Lead and the team members have established strong relationships with the target communities in Peru's Loreto region. Several of our team members are from the Loreto region, and those who are not, are all fluent in Spanish. We have spent significant time on the ground, interacting with community members, healthcare providers, and local stakeholders. This proximity has allowed us to gain firsthand insights into the challenges faced by the communities and understand their unique perspectives.

Our team-member, Carlos Sandi, was previously the leader of the Peruvian indigenous group, FECONACOR, and is currently regional counselor in Loreto. We are also partnering with Comunidades Unidas (CU) Peru who have successfully trained community healthcare workers in the Loreto for more than a decade and established connections with other local communities, NGOs, regional hospitals and the district government that will ease program implementation. Bridge to Health has an MoU with the Cayetano University of Peru where we are collaborating on research into health vulnerabilities caused by climate change. 

To ensure that the design and implementation of our solution are meaningful and guided by the communities' input, we have adopted a participatory approach. We actively engage the target population through focus group discussions, interviews, and surveys to gather their perspectives, ideas, and concerns regarding dengue fever and healthcare access. Community leaders and representatives from indigenous communities play a crucial role in providing guidance and feedback during the solution development process.

Our team recognizes the importance of local knowledge and expertise. We collaborate closely with community health workers, who possess invaluable insights into the local context, cultural beliefs, and healthcare practices. Their involvement ensures that our solution is culturally sensitive, contextually relevant, and aligned with the communities' agendas.

Throughout the development of the solution, we will continue to conduct regular feedback sessions and workshops with the target population. We will present our findings, share prototypes, and gather their feedback to refine and improve the solution. This iterative and inclusive process ensures that the solution addresses the specific needs, preferences, and aspirations of the communities we are serving.

We are applying to the Prize because it presents a unique opportunity to overcome several barriers that we currently face in implementing our solution.

1. Financial Barriers: The Prize offers financial support that can help us overcome funding limitations. It will provide the necessary resources to scale up our solution, expand our reach, and ensure sustainability in the long term. The financial support can help cover the costs of training healthcare providers, procuring portable ultrasound devices, conducting research, and engaging with the target communities.

2. Market Barriers: Being selected as a Prize recipient will give us a platform to showcase our innovation, attract potential partners, investors, and collaborators, and create opportunities for scaling up and expanding our reach beyond the Loreto region. The recognition and validation from the Prize can also open doors for collaborations with governmental and non-governmental organizations, further strengthening our ability to address dengue fever, and other viral infections.
   
   

Dr. Andrea Dreyfuss is a Peruvian expert in Point-of-Care Ultrasound, with family from the Loreto region of Peru. She is the American College of Emergency Physicians ambassador to Peru and has started the first ultrasound fellowship in Lima. 

Caroline Tresise is the CEO of Bridge to Health USA and the Executive Director of Bridge to Health Canada and is currently working in the Nature, Climate and Energy team at the United Nations Development Programme. She has extensive experience in climate and social policy and sustainable development in low-and-middle income countries and has led research with the Lancet Countdown on Health and Climate Change on health vulnerabilities linked to climate change in Peru.

Dr Shelby Kemper is the CEO of Comunidades Unidas (CU) Peru, with over a decade of experience educating rural community health workers in the Peruvian Amazon to triage patients and employ preventative public health practices to empower their communities. 

Carlos Sandi is the previous leader of the Peruvian indigenous group, FECONACOR, and is the current regional counselor in Loreto. He has developed projects health related and linked to climate change and environment preservation.

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. 

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.

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)

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.

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.

15 volunteers
3 part time staff

5 years 

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.

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.

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.

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