David Chandler, MIT News Office
February 6, 2008
In The World is a new column that explores the ways people from MIT
are using technology--from the appropriately simple to the cutting
edge--to help meet the needs of local people in places around the
planet. If you know of a good example and would like the News Office
to write about it, please e-mail email@example.com
Tuberculosis has long been eradicated from the world's industrialized
nations but continues to take a terrible toll in a few poor, rural
regions of Asia and Africa. Every year, 10 million new cases are
diagnosed and two million people die of the disease.
It's not that new treatments are needed--medical science long ago
figured out how to cure tuberculosis using a cocktail of antibiotics.
The problem is getting the medicine to the people who need it and,
most difficult, making sure they follow the six-month regimen of daily
Failure to follow the regimen not only leads to likely death of that
patient, but fosters the development of antibiotic-resistant strains
of the disease. "The problem is, how do you get people to take this
complex regimen," says Manish Bhardwaj, a doctoral student in the
Department of Electrical Engineering and Computer Science who works in
the Microsystems Technology Laboratories.
After a year of hard work and about eight revisions, Bhardwaj and a
team of collaborators think they may have found the answer. It's a
high-tech solution in a simple, inexpensive and easy-to-use -package.
The first part of the two-component system is a kind of "smart"
pillbox, called the uBox. It has 14 chambers that can each be loaded
with several pills, which it dispenses from one chamber per day. To
alert the patient that it's time to take the medicine, the box flashes
its lights and sounds a buzzer. When the compartment is opened, the
uBox records the exact time and prevents double-dosing by refusing to
open again until the next treatment is due.
After two weeks, a health care worker reloads the box and digitally
records and transmits the information stored in it. Doctors and public
health services can then get complete data on compliance, patient by
patient, in almost real time, instead of having to wait until the end
of the six-month treatment.
"How do you know if pills are getting to the patients or if patients
are taking them? Today, there's no good way of doing this," Bhardwaj
says. If people fail to take all their pills, "it is possible to do
harm by treatment that doesn't have good adherence." Even missing a
few pills can lead to the development of resistant strains, which can
then be spread by that noncompliant patient. "The people they infect
have no chance." Typical treatment trials have compliance rates as low
as 50 percent, according to World Health Organization statistics.
"We want to make sure the worker is motivated," Bhardwaj says, and at
present there's no way to tell which workers are diligent about making
the calls and which ones may skip some of their appointed -visits.
Accordingly, the uBox has an additional feature: a receptacle for a
tiny key, like a headphone plug, which is carried by the visiting
health care worker. At each visit the worker inserts the key, thus
recording the fact that the patient really has been visited--another
important gauge of compliance.
The second part of the group's new system is a cell phone, called the
uPhone. By using special software, health care workers can record a
patient's temperature, weight, and answers to a list of questions
related to symptoms, which adds to the set of detailed patient data
analyzed by doctors monitoring the study.
By looking at patterns of effects, the doctors can tell which field
workers are achieving the best adherence rates with their patients and
find out just what it is that those people are doing right. They can
then be recruited to train additional workers.
Bhardwaj has been working with MIT alumni Goutam Reddy and Sara
Cinnamon on the engineering and electronics of the pillbox, doctoral
student Bill Thies and alumnus Pallavi Kaushik on the uPhone software,
and MIT seniors Oliver Venn and Jessica Leon on fundraising and
Bhardwaj and Thiess went to Bihar province this January to begin their
first field test of the product, conducting a training session for 22
workers who will, in turn, train the field workers to distribute the
pillboxes in the field. In March, they will return to India to begin
the first actual field test with 100 of the boxes and 10 cell phones.
If all goes well, a second round of testing, using 1,000 uBoxes, is
set to begin. After that, it all depends on the results--and on the
ability to raise funds for future deployment. Health officials in
India are already keenly interested in this test, and Bhardwaj
recently met with a representative of the Bill & Melinda Gates
Foundation to discuss possible support.
The Ven. Tenzin Priyadarshi, MIT's Buddhist chaplain, helped to get
the project started and says, "I am hopeful that the uBox-uPhone
project will revolutionize the way we understand and provide health
care in rural areas of the world."
While Bhardwaj is proud of the product his team developed, he is not
proprietary about it. "We hope to make the uBox and the uPhone the
standard of treatment in Bihar. We worked very hard to make something
very simple and elegant," he says. "But we'd be delighted if someone
beats us to it and builds a uBox cheaper. We hope other people will
And to make a donation: http://www.firstgiving.com/ubox