Getting real

Improving global health care requires engaging with patients and health care providers on the ground. Last summer, students from the Johns Hopkins BME Center for Bioengineering Innovation and Design (CBID) traveled to India to gain an immersive knowledge of the challenges facing India’s rural and urban clinicians and community health workers.

Students in CBID develop and create solutions for major challenges to human health, with a focus on real-world impact. The program includes clinical immersion both at Johns Hopkins Medicine and in low-resource regions of the world.

What they learned, as engineers and as global citizens, is informing and inspiring their CBID research projects.

Tuberculosis in Urban and Rural Settings | August 2–21

Research Project Overview: Six CBID fellows traveled to India to gain a deeper understanding of how tuberculosis (TB) is screened, diagnosed, treated, and managed in rural and urban settings. Sponsored by the Gupta-Klinsky India Institute (GKII) at Johns Hopkins, the team attended research presentations and met with clinicians, researchers, government health care workers, and adult and pediatric TB survivors for in-person observations.

Reflections from Ishir Sharma

“India, the largest country in the world, with 1.4 billion people, has the highest burden of TB for any single country.

Our conversations with stakeholders revealed to us the power of community and family in delivering care at the grassroots of the Indian health care system. In rural Uttar Pradesh, we had a unique opportunity to interact with a TB survivor. His remarkable story exemplified the success of the Indian government’s National Tuberculosis Elimination Program. As a daily wage laborer from a different part of the country, he returned home for a six-month-long TB treatment paid for by the national program. However, he was the only family member who worked and could not earn for his family during treatment. We also spoke with rural health care providers responsible for treatment adherence.

“As engineers and engineering innovators, we often find ourselves interested in solving health care challenges that are most apparent to us.

This trip took us one level deeper. One of the most important lessons we learned was to engage stakeholders effectively and become better listeners [by focusing on] the soft skills needed for conducting effective informational and ethnographic interviews. I found myself leveraging my knowledge of the Hindi language to gain insights from local stakeholders in the most effective way possible for our team. In this way, the language barrier was not a major communication problem, even in remote or rural sites visited.

I took our team to the middle of one of the busiest markets in the city of Pune. The marketplaces were hustling and bustling with life: street vendors, food carts, fragrant flowers, colorful garments, bright jewelry, sweet delicacies, traffic honking, and masses of people! It was quite a push out of the comfort zones of our quiet hotel building, but there was still a calmness about where we were. We decided to embrace this new environment by engaging with the local people and cultures. We visited temples, ate local street food, and even rode auto rickshaw taxis. This day turned out to be one of the most meaningful cultural experiences we had together.”

NEXT STEPS: The team identified opportunities to improve India’s TB care pathway, focusing on technical solutions that address clinical- or systems-level challenges related to diagnostic and treatment workflow for India’s screening program, the GKII’s TB-Free Schools Initiative.

Streamlining AI/ Intelehealth | July 28–August 18

Research Project Overview: Five CBID students and a CBID fellow traveled across three states in India to observe telehealth consultations and workflow at health care centers across the Indian health care system. The goal: to create a more streamlined, culturally sensitive artificial intelligence/Intelehealth experience for patients and providers and to ensure patients have access to high-quality care.

Reflections from Lindsay Lamberti, Mitch Lipke, and Selena Shirkin

“We shadowed a community health worker in a tribal village.

She travels house to house collecting patient vitals, facilitating telemedicine consultations, and providing prescriptions to people unable to reach a pharmacy. During the consultation, the patient’s whole family and other patients from the village also observe. It was such a dichotomy to be in a crowded room with a tin roof, open doorways with curtain doors, and flickering lights and to be on a telehealth video call with one of the most prominent physicians in the state.” —Lindsay Lamberti

“The doctors care deeply about their patients and want to provide the best care possible, but they are constrained by the immense workload.

Each consultation lasts about two minutes, during which the doctor collects the patient’s history, provides a diagnosis, and prescribes a medication treatment plan, further testing, lifestyle modifications, or a referral to a specialist. In such a short period of time, it can be difficult to provide a complete and high-quality consultation, but unfortunately, the doctors do not have any additional time to spare. Due to the high patient demand and shortage of health care providers, consultations must be kept this short or else some patients will be left without treatment. When we asked one doctor why she cares so much, her response was, ‘The world is your family.’ She treats every patient with the same care that she would give to her own family. Many shared how grateful they were that we had come to learn from them and try to make an impact in their lives with our work.” —Lindsay Lamberti

“While conducting interviews with doctors at District Hospital in Cuttack, Odisha, I was taken aback by the number of people.

The entrance overflowed with patients waiting to receive their medication or be seen by a doctor. We were ushered past huge lines of patients into a cramped room with two doctors conducting telemedicine consultations. We split into two groups, one interviewing a doctor and another observing the other doctor’s telemedicine consultations. My interview was interrupted by a patient walking into the room and asking for his family member to be seen. This unexpected interruption and hospital crowding highlighted the intense demand for medical services and the challenges faced by health care providers working in these densely populated areas. Although I was outside my comfort zone, I politely paused the interview to allow this doctor to address her patient’s concerns. This taught me the importance of adaptability and composure in high-pressure environments. It also deepened my empathy for both health care providers and patients, reinforcing the need for health care innovations in resource-limited settings.” —Selena Shirkin

“India’s rural health and wellness centers staffed with a community health officer (CHO) serve as one of the first contact points for many.

The CHO’s role is critical to the Indian health care system, as the CHO determines where the patient goes next: Send them home or refer them to more advanced care. The CHO [we observed] knew these patients well and took the time to address each patient’s needs. The patients took to her advice much better than if she had been rushing. In developing new technologies in this space, it’s important that we don’t lose the human touch, but rather enable it. When we were in Nashik, we learned how resource-constrained India’s rural population is. This made us question bringing AI technology to some places. It seemed a little tone deaf, so focusing more on the needs and what technologies can service those needs will be our main goal this fall.” —Mitch Lipke

“India’s Ministry of Health and Family Welfare accredited social health activist workers—members of the villages who advocate for patient health and facilitate initiatives within the community, including vaccination camps and prenatal care—receive a fraction of their promised salaries.

They are overworked and undercompensated. It’s no wonder their numbers are declining. We learned that the corruption extends to the public sector of health care, which is supposed to be free and accessible to all patients. One village’s leader told us of a woman who had hepatitis and delayed treatment/ seeing a doctor because her husband was an alcoholic and would not allow her to go. She just kept working on her farm, and her condition got worse. She went to a rural hospital, but she was turned away until the tribe leader insisted she be treated. She was treated for one night and then sent away again. Next, she tried the ‘free’ public hospital and was told treatment would cost 40,000 rupees. (They live on 20,000 rupees per year.) She got no treatment, was sent home, and passed away that night. The village was still in the process of their grieving rituals when we were there. This was my ‘a-ha’ moment. It was raw and real. We were able to see the true impact of the injustices of the health care system and exactly where it falls short. From this point on, my project became about more than just improving access to quality health care in India. It became about the individual lives that can and will be changed because of the implementation of telemedicine services throughout India.” —Lindsay Lamberti

“Connectivity challenges affect how telemedicine is practiced in India.