Ghana Trip to Study Tuberculosis: Day 22

by Kaila Helm, Biological Basis of Behavior ’20;  Kathleen Givan, Bioengineering and Political Science ’20; Katharine Cocherl, Bioengineering ’20; Hope McMahon, Chemical and Biomolecular Engineering ’18; and Dave Pontoriero, Biotechnology MS ’18

Ghana 2.1
The APOC team following our presentations to KCCR researchers and clinicians (left to right: Dr. Miriam Wattenbarger, Jason Grosz, Katharine Cocherl, Hope McMahon, Danielle Tsougarakis, Kaila Helm, Kathleen Givan, Kate Panzer, Ethan Zhao, David Pontoriero, Dr. Yar)

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Today was the day we had been anticipating since the start of our trip: Presentation Day! We presented our final projects to a room full of people from KCCR. Scientists and research assistants attended to hear more about the designs we had been working on all semester.

Our presentations were in the afternoon, so we used the morning to work out any last-minute details. Each group presented on its pediatric tuberculosis diagnostic, with each trying to come up with innovative devices that could be implemented in the future. Even more exciting, we had an opportunity to present our more short-term ideas for problems that undergraduate students could address themselves. Our prompt was to create a project idea that could be completed in one year by one to five undergraduates with low funding requirements. The question-and-answer session that followed our presentations provided a wonderful opportunity to be critical of our ideas and contemplate the limitations of our designs, while still posing new questions regarding what could or could not work in our proposed plans for implementation.

Ghana 22.2
Students pose on the KCCR balcony after giving presentations to KCCR staff (left to right: Benjamin, Kate Panzer, David Pontoriero, Ethan Zhao, Danielle Tsougarakis, Salim, Kaila Helm, Hope McMahon, Kathleen Givan, Katharine Cocherl, Jason Grosz)

After a busy start to our day, we were eager to spend some time relaxing and reflecting on our academic experiences. We were amazed by the progress we made in the construction of our proposals. As engineers and individuals pursuing the STEM field we planned to create technology that could positively impact Ghana. Yet our presentations and the feedback we received were another source of evidence that we must continue to work on the ways in which our devices can be integrated into the Ghana’s current medical system. Nevertheless, we were proud to present all that we learned to such an insightful audience.

After a successful afternoon of presentations, we headed out to dinner to celebrate. We went to the same restaurant we went to two weeks previously. There was live music, dancing, and our new team favorite: grilled tilapia.

Ghana Trip to Study Tuberculosis: Day 21

by Danielle Tsougarakis, Bioengineering ’20; and Kate Panzer, Bioengineering ’18

Ghana 21.1
Medical records are currently being kept in paper form at the Suntreso Government Hospital and at all of the clinics that we have visited thus far.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Ghana 21.2
Student Kaila Helm (left) and KCCR Ph.D. candidate Tina (right) discuss their observations at the Suntreso Government Hospital.

Today, we had our last clinic visit of the trip to Suntreso Government Hospital. We first heard from Nurse Cynthia all about the hospital roles of diagnosing tuberculosis and providing patients with the necessary medication. It was a really great discussion; whenever we had a question, Nurse Cynthia had an answer based on her forty years of experience with TB patients. We visited the Voluntary Counseling and Testing (VCT) Centre of the hospital, where patients can pick up their medication every month and receive more education about their respective conditions. Nurse Cynthia discussed issues surrounding tuberculosis, including stigma about the disease, as well as educating the public on the symptoms and concerns surrounding the disease.

Ghana 21.3
Dr. Thomas Agyarko-Poku invited our group into his office to discuss his past publications involving HIV research. (Left to right: Dr. Thomas Agyarko-Poku, Tina (KCCR Ph.D. candidate), Kathleen Givan, Dr. Miriam Wattenbarger, Benjamin, Kaila Helm)

Afterwards, Dr. Thomas came and talked to us about HIV and other sexually transmitted diseases in Ghana. He described the prevalence, as well as prominent issues encompassing the diseases. Interestingly, the clinic only provides free condoms for people infected with HIV and not other sexually transmitted diseases (STDs). Dr. Thomas informed us, however, that despite the availability of condoms, they are often neglected for their intended use. Evidently, it is quite common for Ghanaians to repurpose condoms as fire starters, parasite protectors, and even jewelry. After our engaging discussion, we briefly viewed the STD clinic on site. Then, we headed back to KCCR, enlightened by the creativity of the innovative mind. We spent the rest of the afternoon refining our final presentations and projects. Then, we headed to bed for a good night’s rest before the big day.

Ghana 21.4
Throughout many of the clinics we have visited, one can find a poster of Nurse Cynthia representing all of Ghana in the effort to cure Tuberculosis.

Ghana Trip to Study Tuberculosis: Day 20

by Kaila Helm, Biological Basis of Behavior ’20;  Kathleen Givan, Bioengineering and Political Science ’20; Katharine Cocherl, Bioengineering ’20; Hope McMahon, Chemical and Biomolecular Engineering ’18; and Dave Pontoriero, Biotechnology MS ’18

Ghana 20.1
Our scavenger hunt took place in the busy Adum Market of Kumasi, where you can find any item imaginable.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Ghana 20.2
At the Adum Market, we bought a drink called fura, which is made by mixing milled millet, spices, condensed milk, and sugar, and is traditionally from Northern Ghana.

We started off today by visiting a disease control center at Manhyia District Hospital. It was interesting to hear how they distribute monthly doses of their TB drugs. Unlike some of the other clinics we have visited, they had not received any pediatric TB as of this year and felt that TB was confined to highly populated communities within their district of 300,000 people. Although HIV is still an urgen issue, it was nice to hear a little bit of good news. We visited their lab, where they process their smear microscopy samples. For any multidrug-resistant (MDR) TB cases, they must refer their patients to KATH, which has better facilities to treat these patients. We then got to talk to the hospital’s only pediatrician in the newly built children’s ward. However, the hospital still experiences space issues that prevent mothers from staying in the same rooms as their newborns and that cause some children to be placed in the adult ward.

Ghana 20.3a
Ghana 20.3bStudents Kate Panzer (top) and Hope McMahon (bottom) try out a kayayei’s large metal bowl as part of the scavenger hunt in the Adum Market.

After our visit at the hospital, we began an exciting afternoon of activities. The program coordinator Nana Yaa planned a scavenger hunt of 10 items that we had to find in Kumasi’s large market before coming back to campus by tro-tro. We split into four groups and set off into the crowded streets in search of items such as bananas, something black, a picture with a kayayei, an ingredient for dinner, and a few other things We met several people along our journey. The vendors throughout the street were very friendly, wanting to help us find the goods we were looking for. We got to practice our Twi and we made several people laugh as we asked them for bankye kakro, a small fried ball made of cassava.

The team then went back to the guesthouse and shared everything that we purchased. The guys got live crabs for their dinner contribution, so everyone had a good time helping with the preparation. The competition resulted in a four-way tie (we’re all winners!!!) , and we went out to an outdoor barbeque restaurant for our celebration.  Everyone got tilapia and banku, making it one of the best meals of the trip thus far. We then took a scenic tour around Kumasi for a bit and finally met back up at the guesthouse for ice cream and stories.

Ghana Trip to Study Tuberculosis: Day 19

by Ethan Zhao, Bioengineering ’19; and Jason Grosz, Bioengineering ’19

Ghana 19.1
A flow chart at the Afrancho Health Centre presenting the current steps for diagnosing pediatric tuberculosis.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Ghana 19.4
Students Kathleen Givan (left) and Hope McMahon (right) enjoy fresh coconuts by the roadside.

Over the course this trip so far, we have been learning about how doctors assess and diagnose patients with tuberculosis in different settings.  Today, we took a look at the system in place to ensure that patients adhere to their medications once the diagnosis occurs.  We visited one of the 11 directly observed treatment, short-course (DOTS) center at Afrancho Health Center in urban Kumasi.  The facility had about 50 employees and relatively limited resources for treatment other than a maternity ward and a small lab for diagnosing malaria.  Instead, as the name suggests, it directly observes patients taking pills for the first week of treatment.  Afterward, a trusted relative is brought in and educated about the dangers of breaking the regimen, to aid the patient in adherence.  The DOTS center employee then follows up with each of the patients in their own homes at least twice a month to ensure they are adhering to their medication.  We were surprised to learn that the social workers didn’t even consider tuberculosis one of the Top 10 most threatening diseases in the area, which included diseases such as malaria and HIV.  However, this may be a testament to the effectiveness of tuberculosis education and treatment in this area of Kumasi, rather than evidence that tuberculosis isn’t threatening.

A laboratory technician at Afrancho Health Centre observes a smear microscopy slide to analyze a sputum sample and determine if the sample contains Mycobacterium tuberculosis bacilli.

After returning from the DOTS center, we spoke to employees of the Kumasi Center for Collaborative Research (KCCR) about concerns we have about our projects. One person we spoke to is a data analyst who collects and analyzes data about the burden, distribution, demographics, etc., of TB across Ghana. We discussed how our idea of a phone application to process cough sound-bytes could contribute to data analysis and collection in the fight against TB. We also spoke to employees familiar with biological sample collection and preparation to help us assess the feasibility of our proposed devices.

Ghana 19.3
At the Afrancho Health Centre, a laboratory technician describes the laboratory equipment and procedures.

Ghana Trip to Study Tuberculosis: Day 18

by Kaila Helm, Biological Basis of Behavior ’20; Kathleen Givan, Bioengineering and Political Science ’20; Katharine Cocherl, Bioengineering ’20; and Hope McMahon, Chemical and Biomolecular Engineering ’18

Ghana 18.1
Students Kathleen Givan (left) and Danielle Tsougarakis (right) browsing the goods, including a large mound of freshly made peanut butter, at the large Adum Market in Kumasi.Students Kathleen Givan (left) and Danielle Tsougarakis (right) browsing the goods, including a large mound of freshly made peanut butter, at the large Adum Market in Kumasi.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Although we were supposed to visit a government hospital today, there was a bit of a mix-up. The person we were supposed to meet with had been sent out on another assignment. But no fear — we rescheduled that part of the saga for Thursday.

Ghana 18.2
After an adventure in the Adum Market, students pose at a popular taxi stop known as Tech Junction, which is the main entrance of Kwame Nkrumah University of Science and Technology (KNUST) (left to right: Dave Pontoriero, Kate Panzer, Danielle Tsougarakis, Katharine Cocherl, Ethan Zhao, Kathleen Givan).

Instead of going straight back to KCCR, we headed back to the major market. On the car ride, a few of us wanted what we thought were fried coconut balls. After Nana Yaa flagged down a street vendor from the bus, she demonstrated her cardio fitness as Uncle Ebo kept up with traffic, and she was left behind with the vendor. It turns out our snack was raw coconut served with a side of fried cassava dough balls. We decided they tasted like coconut hash browns and were definitely worth the whirlwind experience. Thanks again, Nana Yaa!

Ghana 18.3
Student Jason Grosz strikes a pose in his newly made, personalized Ghanaian outfit.

Once at the market we split into two groups. Most of us hadn’t ever been in a more crowded place, between the goods and the people. We took a tro-tro for the first time and the highlight was buying all of the roadside snacks along the way. We got tiger nuts, plantain chips, meat pie (which tasted like pop-tart crust), fish pie, spring rolls with beans, and peanut butter cake (which was actually brittle). The rest of the day was spent working on our academic presentations.

Ghana 18.4
Scrumptious peanut butter cake, with a consistency closer to peanut brittle, sold at Tech Junction.

We ended the day by working on a component of our final project: selecting small side projects appropriate to be tackled by Penn undergraduates. The overarching aim is to give back to KCCR and Ghana, as both have given us so much during our stay here. Our professor structured the activity like an elimination tournament, giving us “money” to fund projects. The four projects with the most money at the end of the night survived to the next round, while others were eliminated. Stay tuned to see what we have come up with!

Ghana 18.5
Student David Pontoriero enjoying the breeze and the view on his first tro-tro ride.

Ghana Trip to Study Tuberculosis: Day 17

by Danielle Tsougarakis, Bioengineering ’20; and Kate Panzer, Bioengineering ’18

Ghana 17.1
The view from the balcony of the newly built Kumasi Center Mall.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Without any planned activities for the day, the entire group decided to attend church to gain a better understanding of a Ghanaian Christian service. We ended up going with Uncle Ebo (the driver for KNUST’s School of Public Health, loved by all) to the Church of Christ–Oforikrom. Through joyous singing and colorful garb, we were all able to appreciate the experience regardless of individual religious beliefs.

Ghana 17.2
Students Ethan Zhao (left) and Kaila Helm (right) test a virtual reality game at the Kumasi Center Mall.

Once we returned back to KCCR, we cooked breakfast for ourselves, making “toad in a hole” (an egg cooked in the center of a piece of bread) and raving about the delicious local sugar bread, peanut butter, bananas, and pineapple. What a satisfying meal!

After a few hours of enjoying our relaxing Sunday morning, we headed via taxis to the Kumasi City Mall! Here we people-watched and enjoyed the modern ambiance of the bustling stores around us. We even got ice cream from a popular ice cream shop — “Yah!” We made a much-needed run to the grocery store to stock up on our new Ghanaian favorite, Golden Tree chocolate. Afterward, a few students tried a Virtual Reality stand and enjoyed the thrill of a roller coaster from the comfort of their seats in the mall. Later in the evening, the group spent some time working on their academic journals among other projects. After a full day, we finished up the night with a tasty dinner of a popular local noodle dish called indomie.

Dan Huh Receives $1M CRI Grant to Study Cancer

CRI huh
Dan Huh, Ph.D.

Dan Huh, Wilf Family Term Assistant Professor in the Penn Department of Bioengineering, has received the Cancer Research Institute (CRI) Technology Impact Award. Dr. Huh, whose research attempts to model cancer-immune cell interactions in microphysiological systems, will receive $1 million over the next three years for direct costs of his research.

“This award will provide us with an exciting opportunity to explore the potential of our organ-on-a-chip technology for the study of cancer immunotherapy, which is one of the most promising yet poorly understood clinical strategies for cancer treatment,” Dr. Huh said. “I am honored to receive this major award and excited with the prospect of contributing to this rapidly emerging area of medicine using innovative bioengineering technologies.”

Join us in congratulating Dr. Huh!

Ghana Trip to Study Tuberculosis: Day 16

by Kaila Helm, Biological Basis of Behavior ’20;  Kathleen Givan, Bioengineering and Political Science ’20; Katharine Cocherl, Bioengineering ’20; Hope McMahon, Chemical and Biomolecular Engineering ’18; and Dave Pontoriero, Biotechnology MS ’18

Ghana 16.1
Students gather around the fetish priestess (left) as she describes her practice of spiritual healing.

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Our day started out early with a trip back to the fetish priestess’s house. Just as we were arriving at her compound, the rainy-season storm drops began to fall. Over breakfast (and for a few more hours after that), we chatted and watched both the rain and a group of small children running in, out, and around the area we were sitting.

Ghana 16.2
Penn student Danielle Tsougarakis snaps of a picture of palm, used for treatment of multiple diseases and often reserved for kings due to its resiliency.

After exhausting our entire repertoire of team-bonding games and revisiting the implementation of our medical diagnostic tools with the Ghanaian program coordinator Nana Yaa, we began the serious portion of the day with a jungle tour that focused on the plants used by the priestess. She eased us in, warming us up to her knowledge by taking a strange fruit, banging it authoritatively on the wall, and offering the white flesh inside to us. Suck on the beans, she instructed. Don’t chew them. Later we learned that it was in fact the fruit of the cacao plant — yum. We give it an APOC 2017 official 5-star recommendation.

The rest of the plant tour led us into her enchanted forest of sorts. We loved hearing about how one plant could be used in so many ways. The uses ranged from curing an upset stomach to helping witches fly. She explained to us how she acquired her spiritual powers from a local river deity and how her spiritual “sight” helped her treat her patients. She even elaborated on which leaves to look for if you have a low red blood cell count. After we worked up an appetite hiking through her garden, we took a break for lunch, which consisted of yams and garden egg (eggplant) stew that the priestess herself made. She cooked all of the meals for us, and she was very welcoming to our group, greeting us hospitably.

Ghana 16.3
The fetish priestess (left) leads the APOC group through her forest to point out medicinal herbs and describe their respective healing potentials.

When we arrived back at KCCR, we spent some time chatting in groups and meeting the newest resident of the guest house, a rising second-year Pitt medical school student. Others tested out the handmade slingshots gifted to them in the village we visited. After visiting one of the Ghanaian students’ dorm room, in what they call their hostels, we arrived back at KCCR to watch an episode of Black Mirror and to make some homemade chocolate-chip cookies — a perfect way to end our most jam-packed day of the trip.

How Cells Spread in Fibrous Environments

New research by faculty in the University of Pennsylvania Department of Bioengineering is examining the interplay between cells and their environment and how they impact the cells’ ability to grow and spread, showing that stiffness is not the only factor researchers should consider when studying this process.

The relationship between cellular adhesion and spread is a key factor in cancer metastasis. Better understanding of this dynamic would improve diagnosis of the disease and provide a potential target in combating it; reducing the ability of cells to grip their environment could keep them contained.

 

fibrous environemnts
Vivek Shenoy (left) and Jason Burdick

The study, published in the Proceedings of the National Academy of Sciences, was led by Vivek Shenoy, professor in the Department of Materials Science and Engineering, co-director of Penn’s Center for Engineering Mechanobiology, and a secondary faculty member in the Department of Bioengineering, along with Xuan Cao and Ehsan Ban, members of his lab. They collaborated with Jason Burdick, professor in the Department of Bioengineering, Boston University’s Christopher Chen, the University of Michigan’s Brendon Baker and the University of Hong Kong’s Yuan Lin.

This collaboration reflects work of The Center for Engineering Mechanobiology, a National Science Foundation-funded Science and Technology Center that supports interdisciplinary research on the way cells exert and are influenced by the physical forces in their environment.

​​​​​​​Previous work from Shenoy’s group has shown that the relationship between cancer cells and the extracellular matrix is dynamic, containing feedback mechanisms that can change the ECM’s properties, including overall stiffness. One earlier study investigated how cancer cells attempt to strike a balance in the density of the fibrous netting surrounding them. If there are too few fibers to grip, the cells can’t get enough traction to move. If there are too many, the holes in the net become too small for the cells to pass through.

Read more at the Penn Engineering blog.

Ghana Trip to Study Tuberculosis: Day 15

by Ethan Zhao, Bioengineering ’19; and Jason Grosz, Bioengineering ’19

Ghana 15.1
The APOC group awaits the arrival of the Ghanaian herbalist with the hope of learning more about an alternative method of healing relative to Orthodox medicine (left to right: Nana Yaa, David Pontoriero, Hope McMahon, Danielle Tsougarakis, Katharine Cocherl, Salim, Kaila Helm, Ethan Zhao, Dr. Miriam Wattenbarger, Benjamin, Jason Grosz).

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

One of the main objectives of this trip has been to observe the impact of limited resources on the ability of hospitals to treat diseases.  However, today, we left the Western perspective on medicine to take a look at alternative methods of treating disease, visiting an herbalist and a fetish priestess.  Upon entering the herbalist’s compound, we were struck by the size and upkeep of his residence, giving off the impression of wealth.  Interestingly, he claimed that he does not charge for treatment but instead only asks that people pay if the treatment works.

Ghana 15.2
Our group posing with herbalist Dr. Boadi after a tour of his site and a demonstration of herbal methods of healing (left to right: Nana Yaa, Salim, Katharine Cocherl, Kate Panzer, David Pontoriero, Danielle Tsougarakis, Kathleen Givan, Jason Grosz, Hope McMahon, herbalist Dr. Boadi, Kaila Helm, Ethan Zhao, Dr. Miriam Wattenbarger).

He often quoted the Bible and claimed that he got the gift of “sight” from God— sight that allows him to see the diseases that different plants could be capable of healing.  For example, he explained that, even though grapes are not indigenous to the region, he could see that they would be good for healing cardiac problems, from hypertension to cardiac disease to even cardiac arrest.  Coconuts represented the human head; therefore, the skin of the coconut could heal problems associated with the skin, the shell could heal problems associated with bone, the coconut meat could help to heal the brain, and the water inside could heal problems associated with the blood.  He also claimed that he can cure HIV/AIDS and cancer regardless of how serious the patient’s condition is.

Ghana 15.3
Penn students (left to right) Kaila Helm, Hope McMahon, and Danielle Tsougarakis enjoying a filling meal of banku and chicken with light soup, cooked by the fetish priestess herself.

After visiting the herbalist, we visited a fetish priestess. Similar to the herbalist, she had appeared to be extremely wealthy. She had a large house on a large plot of land next to a river and was in the process of developing a hotel/resort for her patients across the road. The priestess treated us extremely nicely, fed us lunch, and let us relax at her resort. We didn’t have time, however, to speak to her about her spiritual beliefs and practices, so we returned to KNUST. We planned to visit her again the next day to discuss her beliefs.

Ghana 15.4
With the fetish priestess (left) and Nana Yaa (right) in the background, we tasted the sweet fruit of the cacao tree, which surrounds the bitter, raw cocoa bean.