A transcontinental collaboration for women’s health
Summer break for many faculty and students is a time for travel, getting away from campus to recharge and explore other parts of the world. One group from Virginia Tech traveled more than 8,000 miles to Malawi, Africa, in July.
This journey recharged their Ut Prosim (That I May Serve) mindset and desire to use technology and cost-saving creativity to improve women’s health care in a country where the average annual income is $640.
Virginia Tech TEAM Malawi — TEAM stands for Technology, Education, Advocacy, Medicine — is a transdisciplinary collaboration based on a community wellness model of health. It is designed to meet the challenges of resource-limited environments through community-based participatory research, design, and teaching. Faculty and students are collaborating with colleagues at the Malawi University School of Science and Technology (MUST) to develop new treatments for breast and cervical cancer using an innovative noninvasive technology. The team also is working to improve education and screening in remote areas to facilitate early detection of the disease.
MUST Vice Chancellor Address Malata, a renowned international speaker, author, and editor of various journals in the fields of health, nursing, midwifery, and health workforce, told the group from Virginia Tech she wanted her legacy to be improving health for all women in Malawi.
The collaboration of MUST faculty and students with TEAM Malawi may do just that.
Andre “Andy” Muelenaer, professor of practice in the Virginia Tech Department of Biomedical Engineering and Mechanics and the Virginia Tech Carilion School of Medicine, and Penelope “Penny” Muelenaer, who represents the medical school on Virginia Tech’s Commission for Outreach and International Affairs and mentors medical students, served as the principal leaders for the team. For nearly 20 years, the Muelenaers have cultivated relationships in Malawi through their involvement with various organizations, collaborating with stakeholders to support community wellness in the resource-limited environment by incorporating faculty expertise from many areas.
This was the first trip primarily focused on women’s health and oncology, and it included Eli Vlaisavljevich, associate professor in biomedical engineering and mechanics and director of the Therapeutic Ultrasound and Non-Invasive Therapies Laboratory; Martha Sullivan, chair of the industrial design program and associate professor of practice in the School of Design; and Adam Maxwell, a biomedical engineer and research associate professor in the department of urology with the University of Washington School of Medicine. Five students rounded out the group: Sarah Hall, Anne Leap, Nikki Keith, Danielle Mason, and Emily Galean-Maceda.
The team conducted research, presented technology and educational curriculum, and explored ways to address health care needs for the women of Malawi.
“Out of one week in Malawi, we generated three senior design projects, strengthened our ties with MUST, and found new collaborations with health care providers at Queen Elizabeth Central Hospital and Mercy James Center for Pediatric Surgery. The chief surgeon, Eric Borgstein, saw our tour and came over and started talking, and the next thing you know, he can’t wait to have focused ultrasound in his hands,” said Andy Muelenaer. “So it’s really all about this relationship building.”
According to Vlaisavljevich, no single discipline represented in TEAM Malawi could be as successful without the others.
“They all feed into each other,” said Vlaisavljevich. “We want to identify the patients, improve diagnostics, improve therapy, but we also want to improve the devices designed while thinking about cultural barriers, how we’re treating patients, how we’re engaging stakeholders, how the device is designed, how the workflow is designed. ... In order to be successful in our field, we have to have everybody from all these areas.”
In the future, Vlaisavljevich and Maxwell hope to work with MUST and Malawi physicians as well as partners at the University of Virginia (UVA), to create a clinical trial in Malawi using a cost efficient, noninvasive tool that can potentially treat breast cancer using focused ultrasound therapy. Vlaisavljevich said the major goals of this trip were to identify the key patient populations and clinical partners in order to initiate plans for pursuing the clinical trial.
“Focused ultrasound is currently being developed for treating breast cancer in the U.S., including multiple ongoing clinical trials being led by our colleagues at UVA, but there are limitations to our current clinical systems that prevent them from being utilized in places like Malawi. Our team is now working to develop the technology in order to make the devices more portable and affordable, as well as other advancements, so we can treat breast cancer patients in Malawi in the future. Long term, we want to expand this work to include additional projects focused on cervical cancer and multiple pediatric applications that were identified on this trip,” said Vlaisavljevich. “I think we left with a very clear plan of action that supports the long-term vision.”
Hall, a doctoral student in biomedical engineering, has worked with Vlaisavljevich on similar devices for breast cancer, and she is eager to collaborate on technology that fits the needs in Malawi.
“In Malawi, they really only have limited ultrasound imaging for diagnostics, and as much as we love ultrasound, it’s not used to diagnose or stage cancer. So we’re trying to think through what we could do to help them better diagnose as well as to treat their cancers,” said Hall.
The vision for the future is not simply to introduce new technology to Malawi, but to build an infrastructure for a sustainable focused ultrasound program. The team met with designers and entrepreneurs at MakerzSpace, and two MUST graduates, Ruth Mtuwa and Nathan Sambo, returned to the United States with the group. They will spend the next five years working with Vlaisavljevich and pursuing their doctoral degrees at Virginia Tech.
“If all goes well, Ruth and Nathan will complete their Ph.D.’s in our program here and then go back to Malawi to be the directors of the MUST Focused Ultrasound Program [FUS]. Our vision is to establish a sustainable FUS program where Ruth, Nathan, and other faculty at MUST are leading a center with education, research, and clinical focused ultrasound programs that can grow and become self-sustaining, similar to the Africa Data and Drone Academy that was previously established by Dr. [Kevin] Kochersberger,” said Vlaisavljevich.
The plan is ready to implement, but funding is the major barrier to moving forward.
“To actually build a program at MUST that includes a focused ultrasound educational lab and research-based program as well as a clinical program it is going to take a large influx of funding,” said Vlaisavljevich. “All the key strategic partners are in place, and we have a great team, but the next step really is funding this initiative.”
“We’re all feeling motivated, and we’re ready to put in a few grants to try to get these clinical trials and other research projects started,” said Hall.
Sullivan and Mason, an industrial design student, examined the focused ultrasound devices and intervention program ideas, weighing in human factors to make sure that the design fits the needs of the people.
“A specialty in industrial design is considering human factors and our relationships as humans to the built environment, including the impact of design on both the natural world and society,” said Sullivan, “so we were really interested in the public health part of it and using our communication skills in relationship to the focused ultrasound group to make sure that they have a really robust education program to disseminate this technology outside of the United States.”
Mason served on the focused ultrasound sub-team. She joined the engineering team to meet with MUST students and health care professionals to gauge the educational needs surrounding focused ultrasound technology. Prior to traveling, Mason assisted in creating an educational curriculum that she presented to MUST students at the end of the Malawi visit.
“When everyone finished their presentations, and we were setting up for the demonstrations of the technology, a few students came up and asked me how I came up with the curriculum and when it would be available. I was happy and excited that the presentation resonated with them,” said Mason.
With a focus in both biomedical engineering and public health, Sullivan said the group identified several design opportunities that could have a larger impact on women’s health in underserved communities. The focused ultrasound techniques and improved medical devices will help with diagnosis and treatment in Malawi, while a public health campaign could help with prevention and screening, therefore reducing the number of women affected by cancer in the future.
“We will partner with MUST to generate a multimedia campaign including health care publications, public art in communities, murals in health care facilities, and educational programs that could really move the needle on improving women’s health in relation to the prevention and increased screening for cervical and breast cancer,” said Sullivan.
To assess what women in Malawi understand about cervical cancer and to identify barriers to care, public health students from Virginia Tech collaborated with faculty from MUST to create a survey that appropriately asked questions about sensitive topics such as gynecological issues with women in rural communities. For example, rather than saying "cervical cancer," students were advised to refer to the “disease of the door to the womb.”
Students from MUST accompanied Virginia Tech students to the district hospital to conduct the survey, acting not only as translators, but as a means of “entering society culturally” so the foreign members of the team would be accepted and trusted by the Malawian women.
The team also met with Linnah Matanya, founder and head of Women for Fair Development, a nonprofit organization that works with women affected by HIV and AIDS. Matanya originally connected with the Muelenaers and Virginia Tech during a U.S. Department of State-funded exchange program focused on leaders of nonprofit organizations in Zambia and Malawi that took place many years ago. At a village community health center, Matanya supported the team’s current efforts to conduct surveys with a mother’s group that is working to improve vaccination rates for children throughout their community.
“She [Linnah Matanya] gets up, tells them why we’re here, that they should feel comfortable with us, and they should feel free to talk about anything they want to say,” Penny Muelenaer said. “It’s all about relationships. You can’t do anything without them, and that’s how we’ve managed to make things happen.”
The students divided the participants into two groups of 15 to conduct the survey and discuss health issues. This experience helped students improve their understanding of the community needs, which will inform the educational programs they create for future use in Malawi.
“We were out there asking questions about transportation, about the service, the quality of service, and they’re more than willing to answer that. But then as soon as our questions were done, they ask, ‘If I have HIV breastfeeding, could I give it to my child? If I have a suspicion of having something, could I give it to my child? What is the best way to protect my child?’ There’s this very big ‘protect my child’ mentality that to me stuck out because I think having a good quality of service for mothers is kind of the foundation and backbone of any thriving society,” said Galean-Maceda, an undergraduate studying public health.
“The most impactful moment was when I was interviewing one of the women and she said it was hard to decide when to go to the hospital because it is so far [to travel] just to find nothing is wrong. She knew people in her village with the same thought process, and once they decided they were sick, they died on the way walking,” said Leap, a master’s student in public health.
The impact of TEAM Malawi continues to reverberate from nearly two decades of relationship building, and the recent focus on women’s health connects new generations of professionals from Virginia Tech to others across the globe who embody Ut Prosim.
“It’s one of the benefits of working at Virginia Tech, an institution that supports international work,” said Sullivan. “Talking to people all over the world, you learn so much and you learn how the world can be better, and it’s so interesting. I feel lucky that we got to do such valuable, contextual research. That is something that we ask our students to do, so it’s exciting to have the opportunity to do that on such a meaningful project like women’s health.”
Mason would like to see more students with a desire to serve involved in TEAM Malawi to strengthen the mission and to benefit from the interdisciplinary experience.
“It was a really good experience for me to learn how to design with public health and engineering students and professionals next to me,” said Mason. “Every major and learning discipline has different sets of problem-solving skills that could contribute to the team and as long as you have a passion to serve, you have a place on the team.”
Keith, an undergraduate in neuroscience and biology and Beckman Scholar, spent 15 months in a mentored research fellowship with Vlaisavlievich prior to this trip. That work coupled with an interest in rural health care led to Keith’s involvement in TEAM Malawi. She described her involvement as one of the best learning experiences of her life.
“I aspire to channel the people I met in Malawi when confronted with obstacles, to be resilient, to maintain optimism, and to seek creative solutions,” said Keith. “The eagerness of clinicians to improve health care delivery has also inspired my curiosity to further explore solutions that will create sustainable changes in healthcare in both underserved and rural communities.”
For more information about TEAM Malawi, contact Andy Muelenaer at email@example.com or 540-520-9091. Students who would like to get involved can also reach out to Penny Muelenaer at firstname.lastname@example.org or 540-798-6527.
Funding for this trip was provided in part by:
- Virginia Tech Outreach and International Affairs
- Virginia Tech Undergraduate Research
- The Pratt Fund in the Virginia Tech College of Engineering
- The Beckman Foundation
- Vlaisavljevich Laboratory at Virginia Tech
- University of Washington Medicine Department of Urology